Kandalam Parampil Thulasidharan Shibu, Parampath Arif Nelliyulla, Farghaly Hanan Ibrahim, Salah Salem Abo, Kayakkool Muhammed Kunhi, Mathew Joe Varghese, Radhakrishnan Pradeep, Al Badawi Ibrahim, Farook Saleena
Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Department of Radiology, Emergency Radiology Section, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2016 Feb 3;2015(2):17. doi: 10.5339/qmj.2015.17. eCollection 2015.
Filariasis is an endemic disease with worldwide distribution in tropical and subtropical regions. It is uncommon in Qatar. The conventional diagnostic procedure is the demonstration of microfilaria in blood smears. Even with its high incidence, it is unusual to detect microfilaria in fine needle aspiration cytology (FNAC) smears. Although the 'filarial dance sign' is rarely documented, it remains a classical ultrasonographic sign in lymphatic filariasis.
We present a case of a 38-year-old male patient with fever, chills, shortness of breath and a tender warm swelling on his right thigh. Ultrasound of the thigh lesion showed the classical filarial dance sign. Subsequently FNAC from the lesion documented microfilaria in spite of absent peripheral blood eosinophilia and microfilaria. The patient underwent an incision and drainage of the thigh lesion and was treated with ivermectin and diethylcarbamazine. He was subsequently admitted to the medical ward and discharged home after two weeks in a stable condition.
This case report illustrates the importance of diagnostic tools like ultrasound and FNAC along with a high index of clinical suspicion while evaluating patients presenting with unusual signs and symptoms. We would like to highlight the rarity of filarial presentation in a nonendemic country like Qatar. This case is unique since microfilaria was demonstrated in the pus aspirated from the thigh abscess and showed the filarial dance sign by ultrasound along with involvement of the pleura and pericardium.
丝虫病是一种在热带和亚热带地区呈全球分布的地方病。在卡塔尔并不常见。传统的诊断方法是在血涂片中发现微丝蚴。即使其发病率很高，但在细针穿刺细胞学检查（FNAC）涂片中检测到微丝蚴也并不常见。尽管“丝虫舞动征”鲜有记录，但它仍是淋巴丝虫病的经典超声征象。
我们报告一例38岁男性患者，有发热、寒战、呼吸急促以及右大腿压痛性温热肿胀。大腿病变的超声检查显示出典型的丝虫舞动征。随后，尽管外周血嗜酸性粒细胞增多症和微丝蚴均未出现，但病变部位的FNAC检查发现了微丝蚴。该患者接受了大腿病变的切开引流，并接受了伊维菌素和乙胺嗪治疗。随后他被收入内科病房，两周后病情稳定出院。
本病例报告说明了在评估出现不寻常体征和症状的患者时，超声和FNAC等诊断工具以及高度的临床怀疑指数的重要性。我们想强调在卡塔尔这样的非流行国家丝虫病表现的罕见性。该病例很独特，因为从大腿脓肿抽出的脓液中发现了微丝蚴，超声显示出丝虫舞动征，同时胸膜和心包也有受累。
