Dracunculus medinensis:A ‘Dying’ Worm Masquerading as Tumoral Calcinosis

Abstract

Guinea worm transmission is targeted to be the first among the parasites to be eliminated globally. Chronic manifestations of the infection, however, are still likely to be seen over the next decade or two. When such patients present, especially in non-endemic countries, diagnosis may be problematical. We report a patient who presented with pain and swelling in the left lumbar region. On fine needle aspiration cytology, a provisional diagnosis of tumoral calcinosis was considered. However, on biopsy of the superficial lesion, a degenerated female Dracunculus medinensis was identified on the basis of the morphology of the adult worm and the larvae present in the body cavity. Although D. medinensis is likely to be a medical relic in the near future, attention is drawn to this case as the disease manifestations caused by the parasite are likely to still be encountered. Because of the bizarre presentations that may occur, a definitive diagnosis is essential for the prognosis of the patient as the infection caused by the worm may masquerade as a number of other clinical conditions.