Thursday, June 21, 2018

A migrating subcutaneous worm

Selfies from Russian woman documented a worm moving around her face below the skin, as reported in the New England Journal of Medicine. The parasite turned out to be Dirofilaria repens and had probably been transmitted by a mosquito bite.

Kartashev V, Simon F. Migrating Dirofilaria repens. N Engl J Med. 2018 Jun 21;378(25):e35.

A 32-year-old woman presented to an ophthalmologist with a 2-week history of nodules that moved around her face. She had first noted a nodule below her left eye (Panel A). Five days later, it had moved to above her left eye (Panel B), and 10 days after that to the upper lip (Panel C). She documented these changes by taking photographs of her face (i.e., “selfies”). The nodules occasionally caused a localized itching and burning sensation, but otherwise she had no symptoms. She had recently traveled to a rural area outside Moscow and recalled being frequently bitten by mosquitoes. A physical examination showed a superficial moving oblong nodule at the left upper eyelid. A parasite was fixed with forceps and removed surgically (Panel D). The parasite was identified by means of a polymerase-chain-reaction assay as Dirofilaria repens, which is a zoonotic filarial nematode. Dogs and other carnivores are the definitive hosts, and mosquitoes serve as vectors. Humans can become aberrant hosts. Surgical excision of the worm is curative. After removal of the worm, the patient had a full recovery.

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