Calcification of the breasts due to loiasis.

A 53-year-old HIV-positive female from Cameroon was diagnosed with loiasis in 2013 due to symptoms of polyarthritis and laboratory confirmed eosinophilia. Because of high microfilaremia primary treatment was given with two courses of albendazol and ivermectin and completed with a course of diethylcarbamazine. Therapy was successful as symptoms, eosinophilia and microfilaremia disappeared. In 2015, she had a gynecology check-up where a screening mammography showed several round and linear, meandering calcifications in both breasts, the latter are typically seen in filariasis.

A 53-year-old HIV-positive female from Cameroon was diagnosed with loiasis in 2013 due to symptoms of polyarthritis and laboratory-confirmed eosinophilia. Because of high microfilaremia primary treatment was given two courses of albendazol and ivermectin and completed with a course of diethylcarbamazine. Therapy was successful as symptoms, eosinophilia and microfilaremia disappeared. In 2015, she had a gynecology check-up where a screening mammography showed several round and linear, meandering calcifications in both breasts, the latter are typically seen in filariasis (Fig. 1).

Fig. 1

(a and b) Two views of the left breast mammogram with typical calcifications.

Loiasis is a filariasis endemic in West Africa that is transmitted by bites of flies of the Chrysops genus. The larvae spread through the lymphatic system, causing first inflammation and tissue necrosis that lead to calcification [1]. Even though a predilection to attack eyes and skin is seen, most organs can be affected [1]. Adeniji-Sofoluwe et al. found parasitic breast calcification in 7.4% of screening mammographies in Nigeria [2]. Exact numbers of breast calcifications from loiasis are lacking, but case reports have been published [3], [4]. Not only in industrial, but also in endemic countries mammographies are performed more often and filarious calcification can potentially be misdiagnosed as malignant lesions despite specific signs [2]. Unnecessary invasive work-ups can be the consequence. Filarial breast calcifications appear to represent the chronic sequela of infection; in an acute phase an erythematous lump and progress to lymphedema and fibrosis can appear. The calcifications have a characteristic serpiginous, wormlike appearance and remain stable on follow-up mammograms. The characteristic morphology and appropriate clinical history are the most helpful factors in diagnosing filarial calcifications [5].

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Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.