The Author Respond

Abstract

Dear Sir: Upon reading the comments on our report of first human case of hepatic dirofilariasis (1), we thank Dr. S. Pampiglione and Dr. A. Gustinelli for providing us a lesson and a chance to correct the inappropriate diagnosis. The case we reported presented degenerated nematode sections in a limited area of the patient's liver. In the process of identifying the nematode sections morphologically, Capillaria hepatica was ruled out from the initial stage because egg sections were lacking (1). As shown in Table 1 of the paper by Choe et al. (2), all of previously reported cases of hepatic capillariasis revealed sections of the pathognomonic eggs on histopathologic samples. In this regard, the case was unique and exceptional. The infection with degenerated adult C. hepatica without eggs may explain the rarity of human capillariasis. Retrospectively, the absence of egg sections led us to the wrong morphologic identification: while identifying the sections as Dirofilaria immitis based on the width, internal structures and estimated length, the coagulated bacillary bands in hypodermis were interpreted as degenerated muscle cells. Correct identification of helminth sections is not always easy because, in many occasions, the parasites are in the process of different degrees of degeneration, especially in the granulomatous lesions. We regret that we made a wrong diagnosis, and hope this correspondence be a lesson also to other nematodology specialists.