Dirofilariasis of Perineal Soft Tissue: a Clinical Case Study

The article presents the results of examination and treatment of the patient who addressed the urologist with complaints on local lesions in the perineum to the left in the immediate proximity to the wicket. Dirofilariasis is a disease caused by the parasitism of the nematode of the genus Dirofilaria, the Filariidae family in the human body. It parasitizes the nematode (Dirofilaria repens) in subcutaneous fatty tissue, the mucous and conjunctiva of the eye, the genital organs (gastritis, testicle), the mammary glands, rarely in the tissues and organs of the abdominal cavity. This helminthis is characterized by slow development and prolonged chronic course. The purpose of the article is to share the experience of diagnosis and successful treatment of dirofilariosis, taking into account the incidence of this disease in regions with continental climate. Watch changes for 2 months. Within the process of treatment we revealed the signs of urological pathology. The patient was referred to a surgeon with a diagnosis – «fibroma of perineal soft tissue». To exclude the association of the disease with changes in the organs of the scrotum and regional lymph nodes we performed an ultrasound examination. According to the ultrasound data, no changes were observed from the organs of the gut, in the region of the perineum to the left, in the thickness of the subcutaneous fatty tissue, the hypoechoic formation of round form was visualized, delimited by the hypoechoic inflammatory rim with moderate blood flow at the doppler and the presence of actively moving tubular structures in the center, anechoic fine dispersion suspension. The conclusion was echo-signs of parasitic cyst of soft tissues of the perineum to the left, most likely – dirofilariasis. The general tests of blood, urine and biochemical parameters did not reveal pathological changes. There was also an immunological study performed – IgG antibody to Toxocara canis. During the operation the tumor-like formation of whitish color was selected and removed without disturbing the integrity of the capsule. At the intersection of the capsule of formation we detected a parasite. Thus, the final diagnosis was parasite cyst of soft tissues of the perineum with inflammation phenomena. A parasite was studied in a parasitologic laboratory. The conclusions of parasitological and pathologist research are presented in the article. Pathology is quite rare for our region, but its diagnosis is complicated at the pre-surgical stage. Conclusions. There is a great interest in the above-mentioned case because the clinical symptoms of dirofilariosis are nonspecific, and the diagnosis is based on a morphological study of surgically removed helminthis. Parasitologic diagnosis is difficult, since there is no microfilaria in the patient's blood, and eosinophilia is not characteristic. Immunological studies are not always available and informative. All this creates serious difficulties in the process of diagnosis, which until the operation can be assumed only by ultrasound examination, which allows you to detect alive helminthis. The described case of dirofilariasis of perineal soft tissue will be of interest to urologists, surgeons and general practitioners.