Photo Quiz: Migrating Worm Naturally Exited through the Palate

A 21-year-old female patient presented to the ophthalmological emergency department for a worm wandering around her upper left eyelid (Fig. 1A). More precisely, she described a nodule that had been migrating between the eye and the temporal region 5 days earlier. This was followed 2 days later by visualization of the worm, with no clinical symptoms, which occasioned the presentation. On physical examination during the presentation, no intraocular or intrapalpebral worm was noted. The patient described trips to Morocco (1 year previously), Croatia, Sicily, European capitals, and the United States. She had no noteworthy medical history and was not undergoing any treatment. It was decided that peripheral white blood cell counts would be performed to evaluate for eosinophilia and to examine for microfilariae. These tests were negative, as was filarial serology (IgG4). Toxocariasis was then suspected, and it was decided that the patient would be treated with diethylcarbamazine for 21 days even though the antitoxocariasis antibody search in serum and cerebrospinal fluid was negative. Five days after the presentation, the patient returned because she had extracted a white 14-cm-long worm from her palate (Fig. 1B).

FIG 1.

(A) Intrapalpebral worm location. (B) Observation of entire worm after extraction (14-cm length).

What is your diagnosis?