A 32-year-old woman in Russia had a live worm removed from her face after going to the doctor about a lump that had migrated from her eye area to her lip.
Imagine waking up with a lump on your face. Now imagine that the lump starts moving to another part of your face and you go to the doctor and find out that it's actually a live worm with absolutely zero chill, crawling around under your skin. Sounds like a complete nightmare, right?
This actually happened to a woman in Russia, according to a case study published this week in the New England Journal of Medicine (NEJM). At first, the lump appeared below her left eye. After five days, the lump moved to the eyelid; ten days after that, it moved to her upper lip and caused visible swelling. She captured the migrating face lump in a series of horrific selfies.
Other than some localized itching and burning, she had no symptoms. After two weeks, she went to an ophthalmologist to get things checked out. There, she received some less-than-ideal news: The lump on her face was definitely moving, and it had to be surgically removed. Take a deep breath because it gets worse.
During the surgery, the doctor held the nodule in place with a pair of forceps, opened up her skin, and pulled out a long, white worm from the woman's face. The case study did not discuss the size of the worm (pictured above, bottom right), but it looks bad enough. Testing revealed that it was Dirofilaria repens — a parasitic infection. Fortunately, they got the whole worm out and she made a full recovery.
So what on earth is this skin invader, and how does it get into the body?
Dirofilaria repens is a parasite that typically infects dogs and cats. Occasionally, it is transmitted to humans from the bite of an infected mosquito.
D. repens is a "filarial nematode" — aka a parasitic roundworm — that typically infects dogs, cats, and other carnivores, according to the US Centers for Disease Control and Prevention (CDC). The larvae spread to humans through the bite of an infected mosquito.
Once the worm takes up residence under the skin, which looks like a nodule or bump, it can wander around to various parts of the body: to the eyes, lips, knees, groin. It may sound gross, but the worm usually doesn't do too much harm other than causing localized swelling and irritation.
Humans are aberrant hosts for D. repens, meaning they do not normally host the parasite and the conditions are not ideal for the worm to mature. Essentially, humans are dead-end hosts for D. repens and the worms will die eventually, but this could take a few years. The typical treatment is surgical removal of the worm, but anti-parasitic medications may also be used, according to the CDC.
There are actually two other species of dirofilaria that can infect humans, D. immitis and D. tenuis. These are usually carried by dogs, foxes, wolves, and raccoons, and they can cause more serious symptoms like coughing, chest pain, and fevers if left untreated.
D. repens is the species that is most likely to infect humans, and it isn't as rare as you'd like to think. There were over 3,500 cases reported in Europe between 1977 and 2016. The woman in this case study had recently traveled to a rural area outside Moscow, where she ended up getting a lot of mosquito bites.
You can prevent infection with D. repens by avoiding mosquitos — but only in Europe, Asia, or Africa. This specific parasite is not found in the US.
Now that you know about this horrifying parasite, you'll probably want to do everything you can to make sure it doesn't get into your body. The best way to do that is to prevent mosquito bites.
The CDC recommends wearing insect repellent (preferably containing DEET) and wearing long sleeves and pants when you are outside and using screens or nets in the home.
So keep these in mind when you are in an area with a lot of mosquitos. Fortunately, D. repens is not found in the US, but the other species of dirofilaria — D. tenuis and D. immitis — are found in North America.
If you have any questions or you think you have a parasitic infection, talk to a health care provider.