Bartholin gland abscesses are typically caused by bacterial agents. Abscesses induced by Enterobius vermicularis are exceptional. We report, here, the case of a 27-year-old woman, whose histopathological examination of the Bartholin gland cyst confirmed the presence of E. vermicularis eggs in the lumen of the cyst

Lobna BOUZIDI

Manel MELLOULI

Marwa BOUHAMED

Mouna ZGHAL

Saadia MAKNI

Slim CHARFI

Tahya Sellami BOUDAWARA

Turkish Journal of Pathology

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Case Report136Correspondence: Saadia MAKNI   Department of Pathology, Habib Bourguiba University Hospital, SFAX, TUNISIAE-mail: olfa_saadia@yahoo.Fr    Phone: +216 20 330 432 doi: 10.5146/tjpath.2024.13381Copyright © 2025 The Author(s). This is an open-access article published by the Federation of Turkish Pathology Societies under the terms of the Creative Commons Attribution License that permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited. No use, distribution, or reproduction is permitted that does not comply with these terms.Enterobius Vermicularis Induced Bartholin Gland AbscessSaadia MAKNI , Manel MELLOULI , Mouna ZGHAL , Lobna BOUZIDI , Slim CHARFI , Tahya Sellami BOUDAWARA , Marwa BOUHAMED Department of Pathology, Habib Bourguiba University Hospital, SFAX, TUNISIAABSTRACTBartholin gland abscesses are typically caused by bacterial agents. Abscesses induced by Enterobius vermicularis are exceptional. We report, here, the case of a 27-year-old woman, whose histopathological examination of the Bartholin gland cyst confirmed the presence of E. vermicularis eggs in the lumen of the cyst. Keywords: Bartholin gland, Abscess, Enterobius vermicularis, Pinworm, OxyuriasisINTRODUCTIONEnterobiasis is a common parasitic condition in the world, especially in temperate climate countries. It is caused by Enterobius vermicularis (pinworm), which is a helminth belonging to the nematode family. The parasites affect mainly children and most infections are asymptomatic. Man will be contaminated by ingesting E. vermicularis eggs that colonize the intestinal lumen. Extraintestinal locations by ectopic migration of the parasite are rare and the female genital tract is the most common site (1). Enterobiasis has been reported in the vaginal wall, cervix, endometrium, ovary, and fallopian tube (2,3). Bartholin gland affection is extremely rare (4,5). We report here a case of Bartholin gland abscess caused by E. vermicularis eggs to clarify the etiopathogenic particularities and to describe the clinical and pathological criteria of this rare pathology.CASE REPORTA 27-year-old woman, with no past medical or surgical his-tory, presented with a vulvar mass. According to the pa-tient, this mass had been present for more than six months. On gynecological examination, it was a cystic mass, pain-less on palpation, primarily suggestive of a Bartholin gland cyst. A surgical excision was done and the patient received antibiotherapy based on Levofloxacin and Clindamycin. The histopathological analysis found a cystic wall contain-ing mucous Bartholin gland (Figure 1, asterisks) bordered by inflammatory infiltrate consisting of macrophages, lym-phocytes, neutrophils, and eosinophils. The lumen con-tained necrotic material with oval-shaped, asymmetrical parasite eggs, which were approximately 52 µm. This size and appearance were typical for Enterobius Vermicularis eggs (Figure 1,2, arrows). Upon retrospective questioning, the patient revealed recurrent episodes of anal and vulval itching exacerbated at night as well as a personal and family history of intestinal pinworm disease. The Scotch tape test was performed after obtaining the histopathology report and the stool examination was positive for the eggs and adult worm of E. vermicularis. Treatment with Mebenda-zole 100mg was initiated for the patient and all household members. The patient was well with no recurrence at five months of follow-up.DISCUSSIONBartholin gland abscesses are typically caused by obstruc-tion of the Bartholin gland duct, leading to an accumula-tion of fluid and subsequent infection. The most common pathogens associated with Bartholin’s gland abscesses are bacteria, particularly those from the gastrointestinal tract such as Escherichia coli, and sexually transmitted patho-gens like Chlamydia and Neisseria (1). However, in rare instances, various other organisms can be implicated. In the English literature, only one case report of a 45-year-old woman has been documented, in which E. vermicularis eggs were detected in the aspirate of the Bartholin gland abscess (4). Regarding etiopathogenesis, there is no well-established di-rect link between oxyuriasis and Bartholin gland abscesses. However, it is conceivable that if oxyuriasis leads to severe perineal itching, excessive scratching could potentially in-Received: 05.03.2024   Accepted: 11.07.2024   Published Online: 26.07.2024Turk Patoloji Derg 2025, 41:136-138137Turkish Journal of PathologyMAKNI S et al: Enterobiasis and Bartholin Gland Abscess   Vol. 41, No. 3, 2025; Page 136-138troduce bacteria from the perianal region into the Bartho-lin’s gland duct, increasing the risk of infection (4,5).On clinical examination, at this site, the parasite often caus-es an inflammatory mass or a pseudo-tumoral granuloma (1-4)The differential diagnosis includes various parasitic infec-tions, namely Entamoeba histolytica, Microfilaria, Stron-gyloides stercoralis, Schistosoma haematobium, Trichuris trichiura, Ascaris, and Taenia (6). To establish a diagnosis, it is crucial to integrate clinical findings with laboratory in-vestigations like stool examination and culture. Under the microscope, these parasites and their eggs can be differenti-ated based on distinct morphological features.Adult female worms found in tissue sections have a maxi-mum diameter of 500 μm while males reach up to 200 μm. Both sexes show a muscular wall and exhibit prominent lateral alae.Enterobius vermicularis eggs measure approximately 50 to 60 μm in length and 20 to 30 μm in width. These eggs typi-cally possess a thick shell, flattened on one side, and con-tain a larva within.Treatment consists of the abscess drainage and administra-tion of antiparasitic medications such as mebendazole or albendazole to eradicate the E. vermicularis infection. Ad-ditionally, antibiotics may be used to treat any associated bacterial infection (2-5). In conclusion, E. vermicularis or pinworm is an excep-tional cause of Bartholin gland abscesses. This article high-lights the importance of considering parasitic infections as a possible etiology in patients presenting with gynecologi-cal symptoms. Further research and awareness are needed to better understand the pathogenesis, diagnosis, and man-agement of such cases.AcknowledgmentWe thank Dr. Mohamed Hedi Saguem and Dr. Ines Saguem (private laboratory of pathology) for their contribution to the diagnosis of this original case.Ethical Approval The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for her clinical information to be reported in the journal.Conflict of InterestNo financial or personal interests.Funding No funding received.Authorship ContributionsConcept: SM, Design: MM, Supervision: SC, Data collection and/or processing: LB, Analysis and/or interpretation: MZ, Literature search: MB, Writing: SM, Approval: TSB.  REFERENCES1. Procop GW, Pritt B. Pathology of Infectious Diseases: A Vol-ume in the Series: Foundations in Diagnostic Pathology. Elsevier Health Sciences; 2014.2. Khabir A, Makni S, Khmiri H, Gheriani M, Rekik S, Boudawara T S. Enterobiasis of the female pelvi-genital tract: a report of three cases. J Gynecol Obstet Biol Reprod (Paris) 2005;34(2):162-5.Figure 1: A cystic wall containing mucous Bartholin gland (asterisks) bordered by inflammatory infiltrate. The lumen contained necrotic material with oval-shaped, asymmetrical parasite eggs (arrow) (H&E×25)Figure 2: The egg of Enterobius vermicularis at high magnification (arrows) (H&E×400).138Turkish Journal of Pathology MAKNI S et al: Enterobiasis and Bartholin Gland Abscess   Vol. 41, No. 3, 2025; Page 136-1383. Smolyakov R, Talalay B, Yanai-Inbar I, Pak I, Alkan M. Enterobi-us vermicularis infection of female genital tract: a report of three cases and review of literature. Eur J Obstet Gynecol Reprod Biol 2003 Apr 25;107(2):220-2.4. Dönmez M E, Özlü T, Yılmaz F, Ayaz E. Enterobius vermicularis: Can it be a possible pathogen in Bartholin gland abscess forma-tion? J Obstet Gynaecol Res 2014 Jan;40(1):268-70.5. Hussien S M M, Taha M A A, Omran E Kh. Relationship be-tween enterobius vermicularis infection and pelvic inflammatory diseases in children at Sohag governorate, Egypte. J Egypt Soc Parasitol 2015 Dec;45(3):633-8.6. C-Yi, Junod R, Jacot-Guillarmod M, Beniere C, Ziadi S, Bongio-vanni M. Vaginal Enterobius vermicularis diagnosed on liquid-based cytology during Papanicolaou test cervical cancer screen-ing: A report of two cases and a review of the literature. Diagn Cytopathol 2018 Feb;46(2):179-186.

Enterobius Vermicularis Induced Bartholin Gland Abscess

Enterobius Vermicularis Induced Bartholin Gland Abscess

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