Marusić Zlatko, Stastny Tomislav, Kirac Iva, Stojcević Dagny, Kruslin Bozo, Tomas Davor
Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital, Vinogradska cesta 29 HR-10000 Zagreb, Croatia.
Acta Dermatovenerol Croat. 2008;16(4):222-5.
A 31-year-old man with a history of intravenous drug abuse presented with an inflamed subcutaneous nodule in his left thigh. The nodule measured up to 1.2 cm in largest diameter. Under the clinical impression of an inflamed epidermal cyst or a subcutaneous abscess, surgical excision was performed. Histopathologic examination of the nodule and subsequent polymerase chain reaction (PCR) analysis revealed the presence of the helminth Dirofilaria (D.) repens, a member of the family Filarioidea. Dirofilariasis is a parasitosis caused by D. repens and D. immitis that most frequently affects canines. It can rarely be found in humans, usually in the form of a subcutaneous nodule. In Europe, most cases of human dirofilariasis have been detected in the Mediterranean countries, Ukraine and Russia, but sporadic cases have also been reported in central and north European countries. Dirofilariasis must be distinguished from other forms of filarial disease such as onchocercosis and Wuchereria bancrofti filariasis. Diagnosing dirofilariasis purely by histopathology has its pitfalls, especially when the morphology of the nematode is altered due to inflammatory response or surgical artifacts. PCR analysis offers an opportunity to confirm dirofilariasis and identify the dirofilarial species as well. Briefly, we conclude that a diagnosis of subcutaneous dirofilariasis should be considered in cases of subcutaneous mass in an endemic area of animal dirofilariasis.
一名有静脉注射吸毒史的31岁男子，其左大腿出现一个发炎的皮下结节。该结节最大直径达1.2厘米。在临床诊断为发炎的表皮囊肿或皮下脓肿的情况下，进行了手术切除。对该结节进行组织病理学检查及随后的聚合酶链反应（PCR）分析显示存在蟠尾丝虫科成员——蟠尾丝虫。蟠尾丝虫病是一种由匐行恶丝虫和犬恶丝虫引起的寄生虫病，最常影响犬类。它在人类中很少见，通常表现为皮下结节。在欧洲，大多数人类蟠尾丝虫病病例在地中海国家、乌克兰和俄罗斯被发现，但在中欧和北欧国家也有散发病例报告。蟠尾丝虫病必须与其他形式的丝虫病如盘尾丝虫病和班氏吴策线虫丝虫病相区分。单纯通过组织病理学诊断蟠尾丝虫病存在缺陷，尤其是当线虫形态因炎症反应或手术假象而改变时。PCR分析为确诊蟠尾丝虫病并鉴定恶丝虫种类提供了机会。简而言之，我们得出结论，在动物蟠尾丝虫病流行地区出现皮下肿物的病例中，应考虑皮下蟠尾丝虫病的诊断。
