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Endoscopic removal of an intraorbital "tumor": a vital surprise
H Braun1, W Koele, H Stammberger
1University Ear, Nose, and Throat Hospital, Department of General ENT, Graz, Austria.
Abstract:
We present the first case report of an endoscopic removal of a living worm, species Dirofilaria repens, from the orbital cavity. As of today, over 410 cases of Dirofilaria repens infections in man are recorded in world literature, six of which were localized in the orbital cavity. In Austria we know of four cases of an infection with this parasite, but none in the orbit. Dirofilaria repens is widespread only in the Old World, particularly in Southern and Eastern Europe, in Asia Minor, and in Central and Southern Asia. The highest prevalence of the disease is recorded in Italy (181 cases). In clinical practice, the infections have mostly been misdiagnosed as a neoplasia, usually benign but sometimes malignant. Under the assumption of an intraorbital tumor, the endoscopic transnasal revision of the orbital cavity was performed, as this approach promised to be least traumatic and best suited for the lesion, resulting in complete removal of the live worm. In unclear lesions in the head and neck, and infection with Dirofilaria repens should be considered as a differential diagnosis.
Insights
This case report details the endoscopic removal of a Dirofilaria repens worm from the orbital cavity. This rare parasitic infection highlights the importance of considering Dirofilaria repens in orbital lesions.
Area of Science:
- Ophthalmology
- Parasitology
- Infectious Diseases
Background:
- Dirofilaria repens infections in humans are rare, with over 410 cases reported globally.
- Orbital cavity involvement is exceptionally uncommon, with only six prior documented cases worldwide.
- The parasite is endemic to the Old World, prevalent in Southern/Eastern Europe and parts of Asia.
Observation:
- A case of a living Dirofilaria repens worm was successfully removed from the orbital cavity via endoscopic transnasal surgery.
- The patient presented with an intraorbital lesion, initially suspected to be a neoplasm.
- This marks the first reported instance of endoscopic orbital cavity worm removal in Austria.
Findings:
- Endoscopic transnasal revision provided a minimally invasive approach for complete removal of the live Dirofilaria repens.
- The procedure was effective in resolving the orbital lesion.
- Accurate diagnosis is crucial, as Dirofilaria repens infections are often misdiagnosed as orbital tumors.
Implications:
- Clinicians should consider Dirofilaria repens infection in the differential diagnosis of unclear head and neck lesions, particularly those in the orbital region.
- This case underscores the utility of endoscopic techniques in managing rare parasitic infections.
- Increased awareness may improve diagnostic accuracy and patient outcomes for Dirofilaria repens infections.