Dirofilaria repens in the Spermatic Cord of a 5-Year-Old Boy: A Rare Pediatric Case in Italy

Abstract

We report the case of a 5-year-old boy from a Sri Lankan migrant family in Catania, Italy, diagnosed with a Dirofilaria repens infection in the spermatic cord. The child presented with pain and swelling in the left inguinal area. Initial evaluation suggested orchiepididymitis, which was treated unsuccessfully with amoxicillin/clavulanate and NSAIDs. As symptoms worsened, torsion of the Morgagni hydatid was considered. An exploratory surgery revealed a firm mass in the left spermatic cord. Histopathological examination of the excised lesion showed fragments of a helminth within a granulomatous inflammatory reaction. Subsequent PCR analysis detected D. repens DNA. The patient fully recovered after surgical excision of the mass. Given the increasing incidence of human dirofilariasis, D. repens should be considered in the differential diagnosis of unexplained subcutaneous or inguinal nodules, especially in patients with a relevant travel history. This case highlights the importance of accurate diagnosis to avoid unnecessary invasive procedures or prolonged antimicrobial therapies. It represents one of the youngest pediatric cases with genital involvement reported in Italy, a country that accounts for half of the cases in Europe.

Keywords: dirofilariosis; pediatric helminthiasis; pediatric zoonotic diseases; vector-borne diseases; zoonotic diseases.

Figure 1

Initial ultrasound showing a thickened left spermatic cord with increased vascular signals.

Figure 2

Follow-up ultrasound demonstrating a hypoechoic nodule containing linear hyperechogenic lines.

Figure 3

Surgical sample of the excised nodule in the left spermatic cord.

Figure 4

Histological section of a whitish centimetric nodule: Pseudocyst with chronic granulomatous inflammation; in the lumen, fragments of helminth (black arrows) and fibrino-purulent exudate.