A 32-year-old female African patient presented to the emergency department for abdominal pain. She had been diagnosed with HIV infection 3 years earlier. She was ART-naïve with a CD4-T cell count of 456/μl and a viral load of 626 cp/ml. Her C-reactive protein level was elevated at 84.3 mg/l, and no other laboratory abnormality was noted.

Surgery for suspected appendicitis was performed. Histopathological work-up revealed phlegmonous appendicitis with localized eosinophilic infiltration and necrotic epitheloid granulomas (Fig. 1a, b). Differential diagnoses included eosinophilic gastroenteritis, hematologic malignancy, and mycobacterial infection. Finally, three species of intestinal worms, Schistosoma mansoni (Fig. 1c), Strongyloides stercoralis (Fig. 1d), and Dicrocoelium dendriticum (Fig. 1e) were detected in a stool sample. Antihelminthic treatment with praziquantel (1,800 mg on days 1 and 8) and albendazole (800 mg qd on days 1–3 and 8–10) was administered. Further stool samples were negative, and the patient remained asymptomatic. The CD4-T-cell counts measured 1 and 4 months later were somewhat higher at 675 and 633/μl, respectively.

Fig. 1
figure 1

a Phlegmonous appendicitis with eosinophilic infiltration and b necrotic granuloma. c Schistosoma mansoni egg with lateral spine (arrow). d Strongyloides stercoralis larva. e Dicrocoelium dendriticum egg

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More than two billion individuals are estimated to be infected with one or more helminth species [1, 2] and over 22 million are HIV-coinfected [3, 4], especially in sub-Saharan Africa. Typical clinical signs and symptoms or laboratory abnormalities are often absent, despite the frequency of typical histopathologic alterations such as eosinophilic granulomas in chronic schistosomiasis [5]. Helminthic infections are not considered to be opportunistic infections. However, helminth-induced immunomodulation may affect the CD4 count [3–6]. The benefit of deworming in helminth/HIV-coinfection is suggested by several studies, but its effect may vary by individual helminth species [4]. Routine screening for tropical parasites according to travel or origin is recommended by current HIV treatment guidelines [7], reflecting the travel- and migration-related increasing overlap of tropical medicine and HIV care also in developed countries [8].