Case of Migrating Dirofilaria repens- moving blemishes around face

Dr.Vladimir Kartashev professor in the Department of Infectious Diseases at Rostov State Medical University in Rostov-na-Donu, Russia and associates have reported a case of Migrating Dirofilaria repens that has appeared in NEJM.

Dirofilaria repens is a long parasitic roundworm that is spread by mosquitoes, according to the Centers for Disease Control and Prevention. Dirofilaria is usually found in dogs or other carnivores, according to the CDC, but have been known to infest humans, too, especially in Europe and with certain species — D. repens, D. tenuis and D. immitis (better known as heartworm in dogs).

The patient, in this case, started showing symptoms after travelling to a rural area not far from Moscow, where she “recalled being frequently bitten by mosquitoes.

According to case history, 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).

Images Courtesy Images in clinical Practice-NEJM

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.

For further reference log on to: DOI: 10.1056/NEJMicm1716138