Pulmonary Dirofilaria immitis Infection and Concurrent Pleural Lymphangiomatosis in a Young Woman from Costa Rica: A Diagnostic Challenge after 20 Years of Silence.
Daniel Cascante-Serrano, Manuel Villalobos-Zúñiga, Daniela Salazar-Porras et al.
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Case in brief
A woman from Costa Rica presented with respiratory distress, marked eosinophilia (47%), and severe chylothorax. Pleural biopsies showed a lymphoplasmacytic reaction with eosinophils; molecular analysis of bronchoalveolar fluid identified sequences consistent with Dirofilaria immitis and its Wolbachia endosymbiont. An extensive workup excluded other infectious, autoimmune, and malignant causes. Chylothorax recurred after treatment with methylprednisolone and albendazole, followed by albendazole plus doxycycline. Left upper-lobe biopsy confirmed pleural lymphangiomatosis. She was discharged on continued treatment and was clinically stable.
What made this case unusual
Pulmonary D. immitis infection coexisted with pleural lymphangiomatosis, complicating the interpretation of severe, recurrent chylothorax.
Diagnostic / clinical pearl
In suspected pulmonary dirofilariasis, molecular findings in bronchoalveolar fluid can support identification, while tissue biopsy may reveal a concurrent lymphatic disorder contributing to the presentation.
Why it matters
The case illustrates the diagnostic complexity of filariasis and coexisting lymphadenopathies in an endemic setting, and the value of integrating clinical, molecular, and histopathological findings.