Bag of worms

A Pacific Island male with previously diagnosed but untreated filariasis with episodic chyluria presented to us with spiking temperatures. A CT scan of his abdomen revealed innumerable serpiginous non-enhancing structures within the posterior mediastinum from the carina, throughout the retroperitoneum and pelvis and into the upper inguinal regions. This abnormality involved the hilar regions of both kidneys. The temperatures eventually settled after treatment with doxycycline for filiriasis.