Case Report A Case of Tinea Saginata (tape worm) Infestation of the uterus presenting with abnormal vaginal bleeding Sadiah Ahsan 1 , Samiah Ahsan Zia 2 , Jameel Ahmed 3 Departments of Obstetrics and Gynaecology 1 and Medicine 3, Baqai Medical University, and Department of Histo and Cytopathology 2 , OMI Hospital, Karachi. Abstract There are many reported causes of abnormal uterine bleeding. We report an unusual case of uterine bleeding caused by tapeworm infestation, mimicking retained prod- ucts of conception in a 35 year old multipara. Introduction Tapeworms, or cestodes, are large worms (T. Saginata may be 25 mm long), which mainly infest the intestines after ingestion of viable cysticercus (larvae) of the parasite in undercooked cooked muscle of beef (T. Saginata) or pork (T.Solium). They have a worldwide dis- tribution. In muslim countries like Pakistan, Taenia Saginata is predominant, as pork is hardly consumed. Man is the definitive host. Adult tapeworms reproduce by pro- ducing proglottids in the intestines, which mature and become gravid with 80,000 to 100,000 eggs. These detach and migrate via the anus or are passed in stools. These eggs may survive for months to years, may be ingested by graz- ing cattle, whence it releases the oncosphere in the intestin- al wall, which migrates to its muscles and forms the cys- ticercus, a cyst like structure. These cysticerci can survive for several years in the animal. Once this undercooked meat is consumed by man, the cysticerci develop into adult tape- worms over 2 months, and may survive for 30 years or more. Clinical symptoms may be only mild abdominal cramps or the passage of proglottids via the anus. 1,2 Case Report Mrs. M.Z, 35 years old Baluch woman hailing from Zhob, presently residing in Orangi Town, presented with continuous fresh (bright red) bleeding per vaginum since 3 months. The bleeding was not profuse (no clots), but inter- mittent for 2 to 3 days, stopping for a few days and then restarting and as some days soaking nearly two to three san- itary pads. This was preceded by a Dilatation and Curettage which was performed at a local Orangi Town Clinic for an incomplete abortion of a 16 weeks duration pregnancy, 3 months back. She had also received a course of Ciprofloxacin and Metronidazole. There were no other complaints except for backache and intermittent, griping pain in the left iliac fossa, aggravated by movements and relieved by some unknown medication prescribed by her local general practitioner. She had been married for 20 years, para 7 (all children alive and healthy from home deliveries) with another prior miscarriage, apart from the one preceding her current problem. The last normal deliv- ery was 4 years back. Prior to her current problem, she had had normal regular periods with mild dysmenorrhea. General examination revealed normal blood pres- sure, pulse and temperature with mild anaemia (Hb 9 g). Vaginal examination showed small amount of fresh blood in the vagina. The external cervical os was multiparous while the internal was closed. The uterus was retroverted and bulky. Urine DR was normal and her random blood sugar was 69 mg/dl. Pelvic Ultasound showed a retroverted uterus measur- ing 8.5 cms x 5.6 cms. An echogenic bulge measuring 2 cms x 1.6 cms was seen in the posterior wall of the uterus, resem- bling retained products of conception. Adjacent to this in the uterine cavity was a hypoechoeic area measuring 1.2 cms x 0.6 cms, and what appeared to look similar to a collapsed ges- tation sac. Both ovaries were normal. A diagnosis of incomplete abortion was made and she underwent another dilatation and curettage. During this procedure a small amount of endometrial curettings were obtained, but no retained products, instead 2 segments of live tape worms measuring approximately 0.5 cms and 1 cm were retrieved. These were submitted for histopathology in formalin and one without any preservative in a container, and were confirmed to be gravid segments (proglottids) of Tinea Saginata. The endometrial curettings showed no retained products of conception, but instead showed inflammed endometrium, with a few isolated Tinea Saginata eggs (Figure 1). Vol. 56, No. 8, August 2006 377