PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：我们提出了在胸膜腔中极为罕见的丝虫病表现。这是立陶宛首次报道的人类肺野丝虫病；据我们所知，世界上只有另外两名患者有这种病理记录.
方法：一名72岁妇女因呼吸困难入院，左侧胸痛,干咳.她是一个退休人员，独自生活在农村，没有家养宠物（有时会出现流浪狗）或旅行史。全血细胞计数在正常范围内,CRP水平为16.8mg/l，D-二聚体浓度为900µg/l，怀疑是肺栓塞.在胸部计算机断层扫描血管造影中，肺栓塞被排除,仅确诊为左胸腔积液，无异常病变。进行了左侧胸腔穿刺术,胸膜液被评估为嗜酸性粒细胞占优势的渗出物（59％），还有寄生虫的存在.这些寄生虫表现出白丝虫的形态。口服多西环素（100毫克，每天两次）和阿苯达唑（400毫克，每天两次）的处方为14天的课程。一个月后,胸部X光片没有病理学发现,患者不再有呼吸道症状。然而,病人出现了一个，疼痛触及右乳房肿块，之前观察到皮疹。超声成像显示一个1.5×2厘米的结节，手术切除了.怀疑与Dirofilariarepens相符的寄生虫，但未明确确定。没有进一步规定对丝虫病的药物治疗。
结论：这种情况鼓励医生更加警惕，因为患者，既不旅行也不养宠物，感染了丝虫病.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产生了积极的结果，提示异丝虫性胸膜炎的潜在疗效。
方法：一名72岁妇女因呼吸困难入院，左侧胸痛,干咳.她是一个退休人员，独自生活在农村，没有家养宠物（有时会出现流浪狗）或旅行史。全血细胞计数在正常范围内,CRP水平为16.8mg/l，D-二聚体浓度为900µg/l，怀疑是肺栓塞.在胸部计算机断层扫描血管造影中，肺栓塞被排除,仅确诊为左胸腔积液，无异常病变。进行了左侧胸腔穿刺术,胸膜液被评估为嗜酸性粒细胞占优势的渗出物（59％），还有寄生虫的存在.这些寄生虫表现出白丝虫的形态。口服多西环素（100毫克，每天两次）和阿苯达唑（400毫克，每天两次）的处方为14天的课程。一个月后,胸部X光片没有病理学发现,患者不再有呼吸道症状。然而,病人出现了一个，疼痛触及右乳房肿块，之前观察到皮疹。超声成像显示一个1.5×2厘米的结节，手术切除了.怀疑与Dirofilariarepens相符的寄生虫，但未明确确定。没有进一步规定对丝虫病的药物治疗。
结论：这种情况鼓励医生更加警惕，因为患者，既不旅行也不养宠物，感染了丝虫病.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产生了积极的结果，提示异丝虫性胸膜炎的潜在疗效。
