Lymphadenovarix in the axilla--an unusual presentation of filariasis

Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases

BACKGROUND

Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies.

AIMS AND OBJECTIVES

This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body.

MATERIALS AND METHODS

This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed.

RESULTS AND ANALYSIS

Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions.

CONCLUSION

Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies.

Fine-needle aspiration of axillary swelling: Cytodiagnosis of an unusual presentation of filariasis

Lymphatic filariasis is a major public health problem in tropical and subtropical countries. Fine-needle aspiration cytology (FNAC) is not routinely used for its identification. However, it has been detected incidentally, while doing FNAC for the evaluation of other lesions. We describe a presentation of occult filariasis with microfilariae (mf) in an isolated axillary swelling wherein FNAC was helpful in establishing the diagnosis.

Subcutaneous filariasis: An unusual presentation with an adult gravid worm on aspiration

Detection of adult gravid filarial worm in fine-needle aspiration cytology (FNAC) smears is unusual despite the high incidence of this parasite in endemic zones. Bancroftian filariasis presenting as subcutaneous nodules is very rare, and only a few cases are reported in literature. In spite of various reports stating the presence of microfilaria using aspiration cytology in various sites, the presence of an adult gravid filarial worm in subcutaneous nodules by FNAC is an extremely rare finding. We hereby report an unusual case of detection of adult gravid worm of Wuchereria bancrofti on FNAC of a subcutaneous nodule in the axilla. In differential diagnosis of subcutaneous nodular swellings, a possibility of filariasis must be kept in mind, and a careful search should be done for the adult worm or microfilaria in the aspiration smears done for an accurate diagnosis. The conventional method of diagnosis of filariasis is by demonstration of microfilaria in the peripheral blood smear which may be diurnal or nocturnal. Buffy coat can be helpful in detecting microfilaria in asymptomatic cases with peripheral blood eosinophilia.

An unusual presentation of filariasis in a nonendemic country

Introduction: 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. Case presentation: 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. Conclusion: 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.

An uncommon infectious cause of pleural effusion

Lymphatic filariasis is one of the major public health problems across the globe. Clinical manifestations usually depend on the site of lymphatic involvement. A 21-year-old female resident of a non-endemic filarial region presented with axillary lymphadenopathy, bilateral pleural effusion, ascites and pedal oedema. Fine-needle aspiration cytology (FNAC) of axillary lymph nodes revealed microfilariae. On the administration of diethyl carbamazine, lymph nodes gradually disappeared, the patient improved symptomatically and the filarial antigen test after treatment was negative. We report this case of bilateral axillary lymphadenopathy with pleural effusion and ascites as a rare manifestation of filariasis.