Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania.
Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania.
BMC Pulm Med. 2024 Jul 15;24(1):340. doi: 10.1186/s12890-024-03154-y.
We present an extremely rare manifestation of dirofilariasis in the pleural cavity. This is the first human pulmonary dirofilariasis reported in Lithuania; according to our knowledge, only two other patients were documented with this pathology in the world.
A 72-year-old woman was admitted to the hospital complaining of dyspnea, left-side chest pain, and a dry cough. She was a retiree living alone in the countryside without domestic pets (sometimes stray dogs appear) or a travel history. A complete blood count was within normal limits, with a CRP level of 16.8 mg/l and D-dimer concentration of 900 µg/l, which raised suspicion of pulmonary embolism. In chest computed tomography angiography, pulmonary embolism was excluded, and only left pleural effusion without abnormal lesions was confirmed. Left thoracocentesis was performed, and the pleural fluid was evaluated as an exudate with a predominance of eosinophils (59%), along with the presence of parasites. These parasites exhibited the morphology of Dirofilaria repens. Oral doxycycline (100 mg, twice daily) and albendazole (400 mg, twice daily) were prescribed for a 14-day course. A month later, there were no pathological findings on the chest X-ray, and the patient no longer had respiratory symptoms. However, the patient presented with an emerged, painful palpable right breastmass, where the rash was previously observed. Ultrasound imaging revealed a 1.5 × 2 cm nodule, which was surgically removed. Parasites consistent with Dirofilaria repens were suspected but not definitively identified. Pharmacological treatment for dirofilariasis was not further prescribed.
This case encourages doctors to be more vigilant because the patient, who neither travelled nor kept any pets, contracted dirofilariasis. Diagnostic and treatment guidelines are lacking, necessitating further research. Treatment with doxycycline and albendazole yielded positive outcomes, suggesting potential efficacy for dirofilarial pleuritis.
我们呈现了一种极为罕见的胸腔内血丝虫病表现。这是在立陶宛首次报告的人类肺部血丝虫病病例；据我们所知，全世界仅有另外两例患者被记录患有该病理学疾病。
一名 72 岁女性因呼吸困难、左侧胸痛和干咳而入院。她是一名退休人员，独自居住在农村，没有家养宠物（有时会出现流浪狗）或旅行史。全血细胞计数正常，C 反应蛋白水平为 16.8mg/L，D-二聚体浓度为 900µg/L，这提示存在肺栓塞的可能。胸部计算机断层血管造影排除了肺栓塞的可能性，仅确认存在左侧胸腔积液且无异常病变。进行左侧胸腔穿刺，胸腔积液被评估为渗出液，以嗜酸性粒细胞为主（59%），同时存在寄生虫。这些寄生虫表现出旋毛虫的形态。给予口服多西环素（100mg，每日两次）和阿苯达唑（400mg，每日两次）治疗 14 天疗程。一个月后，胸部 X 射线检查无病理发现，患者不再有呼吸道症状。然而，患者出现了一个新出现的、疼痛可触及的右侧乳房肿块，之前在该部位观察到皮疹。超声成像显示一个 1.5×2cm 的结节，该结节被手术切除。怀疑寄生虫与旋毛虫有关，但无法明确诊断。未进一步开处方用于治疗血丝虫病的药物。
本病例鼓励医生更加警惕，因为这名既未旅行也未饲养宠物的患者感染了血丝虫病。缺乏诊断和治疗指南，需要进一步研究。多西环素和阿苯达唑治疗取得了积极的结果，表明其对血丝虫性胸膜炎可能具有疗效。
