Protein-losing enteropathy--vomiting the diagnosis.

Protein-losing enteropathy is uncommonly due to intestinal worm infestations. The 20-year-old lady reported here presented with bilateral progressive pedal edema for 2 months without abdominal distension, facial puffiness, or other symptoms. Physical examination was unremarkable except for pedal edema. Her body mass index was 17.1 kg/m. Laboratory evaluation revealed microcytic anemia (hemoglobin 10.8 g/dL) and low levels of total protein (4.2 g/dL) and albumin (1.8 g/dL). Cardiac, thyroid, and renal functions were normal and there was no eosinophilia. Ultrasound abdomen revealed mild ascites. Before the malabsorption work up was done, while hospitalized, she vomited pink worms that gave us the diagnosis! Upper gastrointestinal endoscopy revealed multiple motile worms in the duodenum, which range from 1 to 5 cm