Extra-Lymphatic Filariasis: A Study of Three Interesting Cases

Abstract

Filariasis is a chronic disabling parasitic disease that causes a major public health problem in tropical countries like India. Wuchereria bancrofti is associated with almost 99.4% of cases. Filariasis not only affects the structure and function of lymphatic vessels but is also associated with extra-lymphatic pathology and diseases. Lymphatic filariasis is commonly found throughout the tropics and subtropics. While lymph nodes are the common sites, unusual sites include the breast, spleen, subcutaneous tissue, thyroid, bone marrow, urinary tract, sputum, bronchial washing, pleural and pericardial fluid. Patients from endemic areas presenting with swelling should be evaluated for filariasis. Here in present case series, the authors discussed three cases: filariasis of the breast with fibroadenoma, soft-tissue nodule, and splenic lesions, due to their extreme rarity and unusual sites. In the first case, 20 years old female patient presented with a lump in the left breast. The complete blood cell (CBC) revealed eosinophilia, but peripheral smears did not show the presence of microfilariae. On Fine Needle Aspiration Cytology (FNAC), smears showed Wuchereria bancrofti microfilaria in the background of fibroadenoma. The patient was treated with Diethylcarbamazine (DEC) for 21 days. Repeat CBC revealed a decrease in the absolute eosinophil count. Lumpectomy for fibroadenoma was performed, which showed fragments (dead) of the microfilarial parasite. The association of filariasis with fibroadenoma is possibly due to pre-existing subclinical filariasis when the neoplasm developed, as the patient hails from an endemic area. Filariasis presenting as a soft-tissue nodule is an uncommon incidence. In the second case discussed here, 30 years old female patient had soft-tissue swelling over the left elbow. Peripheral smear only revealed eosinophilia without any parasites. On FNAC, smears showed Wuchereria bancrofti microfilaria, along with lymphoid cells and a few eosinophils. The swelling subsided with DEC treatment, and repeat CBC showed a decrease in the absolute eosinophil count. The third case discussed here, involved an unknown 35 years old male, who was brought dead to the hospital. No clinical details were available. On autopsy, the spleen showed multiple white patches, ranging in size from 0.2 to 0.5 cm in diameter. All other organs were unremarkable. Microscopy showed many granulomas and numerous dead fragmented microfilariae. It was a case of isolated splenic filariasis, which is a rarely diagnosed entity. These unique cases will raise awareness of diagnosing and instituting proper therapy.