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Subcutaneous Dirofilariasis

A previously healthy 26-year-old woman presented to the ophthalmology emergency department with a 1-day history of a mobile lesion in her left eyelid. She owned a dog. Physical examination was notable for a serpiginous structure within the left upper eyelid that was surrounded by mild erythema and edema (Panel A). Surgical excision of the lesion was subsequently performed and revealed an 11-cm roundworm (Panel B). The filiform parasite was identified as Dirofilaria repens on histopathological analysis, and microfilariae were seen in two uteri (Panel C). D. repens is a nematode whose definitive hosts are dogs, foxes, wolves, and raccoons. The species that causes heartworm in dogs is D. immitis. Human infection — which can result in pulmonary, subcutaneous, or ocular syndromes, depending on the infecting species — occurs when a mosquito vector transmits a larva during a blood meal. A small nodule develops at the site of inoculation and then grows into a worm over a period of months. On further history taking, the patient recalled the appearance of a nodule on her right temple 1 month before presentation that had disappeared 1 day before the lesion had appeared in her left eyelid. After extraction of the worm, the patient’s symptoms abated.Ruxandra Moroti Constantinescu, Ph.D., and Gabriela Andreea Dumitru, M.D.
Published November 22, 2025
N Engl J Med 2025;393: e37
DOI: 10.1056/NEJMicm2509643
VOL. 393 NO. 21

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