Chief Complaint: “I have a painful swelling on my leg, and a white worm is coming out.”

History of Present Illness:
A 42-year-old man presents to the clinic with a painful,s burning lesion on his right lower leg. He reports that the area started as a swollen, red bump about a week ago, but over the past two days, the pain has worsened, and a thin, white worm has started emerging from the skin. The patient also recalls experiencing intermittent fever and joint pain over the last few weeks.

Upon further questioning, he mentions that he recently traveled to a rural area where he drank untreated water from a local pond. He denies any history of similar symptoms or chronic illnesses.

Physical Examination:

• A large, inflamed ulcer on the right lower leg with a white, thread-like worm partially protruding
• Surrounding erythema, mild swelling, and tenderness
• No signs of systemic infection, no lymphadenopathy

Diagnosis:
The patient’s history of drinking untreated water and the presence of a worm emerging from an ulcerated lesion strongly suggest dracunculiasis (Guinea worm disease), caused by Dracunculus medinensis. The infection occurs when larvae are ingested through contaminated water, and after a year, the adult female worm migrates to the skin to emerge.

Management Plan:

• Gradual worm extraction: Carefully wrapping the worm around a sterile stick and pulling it out slowly over several days to prevent breakage
• Symptomatic treatment: Pain relief with NSAIDs, wound care to prevent secondary infection
• Prevention:
  • Educating the patient on drinking only filtered or boiled water
  • Encouraging the use of community-based water filtration programs
  • Reporting cases to health authorities for eradication efforts

The patient is advised to return for daily wound care and monitoring until the worm is completely removed.