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Case Reports
. 2012 Dec;7(6):487-9.
doi: 10.1159/000345471.

Filariasis of the axilla in a patient returning from travel abroad: a case report

Maria Roethlisberger  1 , Rachel Wuerstlein  2 , Michael Majores  3 , Irene Müller-Stöver  4 , Hanns M Seitz  5 , Kerstin Rhiem  1 , Stefan Kraemer  1 , Peter Mallmann  1 , Reinhard Büttner  6 , Nadia Harbeck  2
Affiliations
Case Reports

Filariasis of the axilla in a patient returning from travel abroad: a case report

Maria Roethlisberger et al. Breast Care (Basel). 2012 Dec.

Abstract
in English, German

Background: The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites.

Patients and methods: A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy.

Results: On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae.

Conclusion: Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine.

Hintergrund: Der Begriff Filariose umfasst eine Gruppe von parasitären Infektionen, die von Helminthen verschiedener Gattungen der Überfamilie der Filaroidea verursacht werden. Die Humanparasiten kommen hauptsächlich in tropischen und subtropischen Regionen vor. Filarien werden jedoch auch in gemäßigten Klimazonen gefunden, wo sie sowohl Wild- als auch Haustiere infizieren. Menschen werden selten von diesen zoonotischen Parasiten befallen.

Patientin und methoden: Eine 55-jährige Patientin stellte sich mit dem Verdacht einer neu aufgetretenen axillären Lymphknotenschwellung rechts vor. Die Sonographie der rechten Axilla zeigte einen singulären, 1,3 cm großen, soliden Befund. Sonographie der Mamma beidseits, Axilla und Lymphabflusswege links sowie Lymphabflusswege rechts und Mammographie beidseits waren unauffällig. Der Knoten wurde exzidiert, da die Patientin eine Jet-Biopsie ablehnte.

Ergebnisse: In der Histologie fand sich das Hinterende eines Parasiten aus der Gruppe der Filarien. Die Patientin gab an, beruflich in Afrika und Malaysia gewesen zu sein. Außerdem hatte sie 6 Monate zuvor nach einer Auslandsreise an Fieber und reduziertem Allgemeinzustand gelitten. Die Patientin wurde zur weiteren Behandlung an die Tropenmedizin der Universität Düsseldorf überwiesen, wo aufgrund des positiven Befundes mit Antikörpern gegen Filarien eine Therapie mit Ivermectin durchgeführt wurde.

Schlussfolgerung: Dieser Fall zeigt, wie wichtig die interdisziplinäre Zusammenarbeit zwischen Brustzentrum, Pathologie und weiteren Spezialgebieten wie Mikrobiologie und Tropenmedizin ist.

Keywords: Axilla; Breast; Filariasis.

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Figures

Fig. 1
Fig. 1
Macroscopic view prior to excision.
Fig. 2
Fig. 2
Ultrasonography of the right axilla at first presentation, pre-surgical.
Fig. 3
Fig. 3
Histology of the removed tissue. An oblique cross-cut of the worm, showing a cuticula with at least 2 layers and disintegrated musculature. The surrounding granuloma is packed with degranulated leukocytes.
Fig. 4
Fig. 4
Histology of the inflammation at some distance from the parasite: pronounced eosinophilic infiltration.
See this image and copyright information in PMC

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