Ascariasis with malaria is both endemic and prevalent in tropical settings settings and their co-infections should be expected. Asymptomatic ascariasis infection is often missed and untreated. We report a fatal case of cerebral malaria with ascaris co-infection in a 2 year old boy. The diagnosis of intestinal helminths would have been missed, but for the extrusion of several round adult worms out of the body through the anus. The implication of the extrusion of the helminths from the body through the anus is highlighted. Suggestions that may help improve case management of ascariasis in paediatric admissions are also proffered.