Dirofilaria from the index finger of a man in Costa Rica.

A 4.5-cm male Dirofilaria indistinguishable from D. immitis was removed from the tip of the index finger of an 18-year-old farmer in Costa Rica. The case is reminiscent of a report of a larger (9-cm) but otherwise similar Dirofilaria, identified as D. spectans, a heartworm of otters, causing Raynaud's syndrome by occluding an artery of the fifth finger of a farm woman in Brazil. As in the present case, the worm was removed from a painful papule on the volar surface at the extreme tip of the affected finger.