# Integrated imaging in rare eyelid lesions: a case report of palpebral dirofilariosis

## TL;DR

A rare eyelid infection caused by Dirofilaria repens was diagnosed using combined clinical, imaging, and histological methods in a 64-year-old man.

## Contribution

The paper highlights the diagnostic value of integrating clinical, radiologic, and histologic data in diagnosing rare zoonotic infections like Dirofilaria repens.

## Key findings

- Integrated imaging and histology confirmed Dirofilaria repens infestation in a subcutaneous eyelid nodule.
- Digitalized imaging access improves diagnostic accuracy and reduces delays in ophthalmic care.
- Dirofilaria repens is an emerging zoonosis with increasing incidence in Mediterranean regions.

## Abstract

Integrated evaluation of clinical records, radiologic imaging, and histologic slides was key in the diagnosis of a rare ophthalmic infection such as Dirofilaria repens, an emerging zoonosis in many Mediterranean regions, where it is endemic in cats and dogs and can spread to humans through mosquitos of the genera Anopheles, Aedex and Culex.

We present the case of a 64-year-old male with a subcutaneous nodule at the right medial canthus. Surgical excision was performed under the clinical suspicion of a sebaceous cyst, and the specimen was submitted for pathological examination. Histological analysis revealed a partially necrotic abscess with numerous eosinophils and multiple cross-sections of the body of a parasite. The integrated evaluation of CT, MRI and histologic sections were consistent with the diagnosis of infestation by a female Dirofilaria repens.

In this report we discussed an illustrative case of Dirofilaria infestation, an uncommon condition, and illustrate the benefits of an integrated approach to the care of ophthalmic lesions. Indeed, direct access to digitalized images of different modalities is beneficial in reducing delays, increasing accuracy, and is beneficial for prompt medical care and accurate diagnosis. The rising incidence and the possibility of serious complications, especially for the less frequent localizations more typical of species other than Dirofilaria repens, translates the need for a more widespread knowledge of these zoonoses.