Subcutaneous dirofilariasis: single inoculum, multiple worms

The present report describes an unusual case of subcutaneous dirofilariasis attributed to Dirofilaria repens. The patient, a 42-year-old caucasian male, who acquired the infection in Africa, presented on two different occasions, 10 months apart, with a sudden onset of symptoms and a living worm moving about in the periorbital tissues. Both worms were mature nongravid females. Based on the maturation of the respective reproductive systems and the volume and distribution of eggs in the reproductive tracts, it was concluded that both worms were in the same infecting inoculum. The first worm was at least two years old and the second was therefore 10 months older than the first. These observations indicate that the worms developed and resided in the tissues without eliciting any host response for two and three years.