Intended for healthcare professionals

Endgames Case Review

Pruritus ani in a school age boy

BMJ 2022; 376 doi: (Published 09 February 2022) Cite this as: BMJ 2022;376:e067817
  1. Nicholas Beng Hui Ng, associate consultant,
  2. Jeremy Bingyuan Lin, senior consultant
  1. Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, Singapore
  1. Correspondence to: N B H Ng nicholas_bh_ng{at}

A school age boy presented to the emergency department with a five day history of worsening pruritis ani. Itching was the only symptom, but it was severe enough to affect his quality of life and disrupt sleep. He had no diarrhoea, faecal soiling, perianal discharge, perirectal bleeding, or abdominal discomfort. He had a normal appetite and his weight was within range for his age. He had experienced perianal itch three months previously, which had resolved spontaneously after two days. His family members, including one other sibling of school age, were not affected.

On examination, the boy was fidgety and appeared to be in discomfort. He showed good hygiene. Systemic examination was unremarkable, including the absence of eczema and candidiasis. Figure 1 shows the perianal region.

Fig 1

Multiple white worm-like organisms, similar in appearance to cotton threads, are visible at …

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