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Conjunctival dirofilariasis presenting as a painless, cystic nodule

An unusual manifestation

Bidaye Sule, Shivani; Nair, Akshay Gopinathan1; Sule, Satish; Pande, Abhay2

Author Information
Indian Journal of Ophthalmology: November 2020 - Volume 68 - Issue 11 - p 2523
doi: 10.4103/ijo.IJO_712_20
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Infection caused by the filarial parasite of the genus Dirofilaria, clinically known as Dirofilariasis, is a zoonotic helminthic infection that is largely endemic in Mediterranean countries and commonly affects animals, mostly dogs, raccoons, wolves and foxes.[1] Human infection is uncommon.[1] Mosquitoes are the vectors in the disease cycle and humans are the final host of this parasite.[1] Ocular dirofilariasis, although uncommon, has been reported from various parts of the world with reports of periorbital, subconjunctival, orbital and intraocular involvement.[234567] Previously published reports of conjunctival dirofilariasis have described patients presenting with ocular discomfort, intense pain, and redness.[67] In our case, conjunctival dirofilariasis was found to manifest as a painless, cystic, nodular mass [Fig. 1a]. Surgical removal of the lesion with histopathological confirmation is the preferred treatment with anti-helminthic therapy having no role in the management [Fig. 1b and c]. Dirofilariasis should be considered a differential diagnosis when evaluating a patient who presents with a painless cystic conjunctival mass, even in a traditionally non-endemic area.

Figure 1
Figure 1:
(a) External photograph showing a cystic, nodular, conjunctival mass seen temporally, measuring approximately 8 mm in diameter; with overlying tortuous vessels. (b) Histopathological examination showing multiple cross sections of what appeared to be a parasitic nematode in a background of intense inflammatory reaction. (c) High power microscopy allowed identification of a multi-layered cuticle, inner longitudinal muscles (black arrows), lateral chords (yellow arrows), uterine cavity (yellow asterisk) and the intestinal lumen (black asterisk)

2.1 Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

2.2 Financial support and sponsorship

Nil.

2.3 Conflicts of interest

There are no conflicts of interest.

References

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