CLINICAL A 20-year-old African male moved from the Ivory Coast to Texas approximately 10 years ago. Prior to leaving Africa the patient noticed a small asymptomatic nodule on his forehead. The nodule remained unchanged over the next 10 years. Recently it began enlarging and the patient saw a plastic surgeon. The nodule was thought to be a cyst and it was excised without complication. When subsequently seen in our dermatology clinic the patient had no complaints, specifically denying pruritus. Physical examination revealed a well-appearing male with a well-healed excision site without evidence of any residual nodule. No other nodules were appreciated. Mild scaling was present on his neck, trunk and legs. Subsequent biopsies of the leg and back failed to reveal microfilaria. An eye exam was normal.
HISTOLOGY Subcutaneous nodule with numerous parasitic organisms within the fibrosed subcutaneous tissue. The organisms have an eosinohilic cuticle and paired uteri most consistent with onchocerciasis.
IMPORTANT FEATURE: REASON FOR PRESENTATION This is a rare diagnosis in the United States that can be made by the diagnostic histologic features. Treatment of the adult worms which can live as long as 10-15 years requires excision. The microfilaria have a lifespan of 2-3 years and are treated with a single dose of ivermectin (9 mg/kg).

REFERENCES

1. Albert MR, Klion A, Turner M. Pruritus and eosinophilia in a 14-year-old girl from Liberia. J Am Acad Dermatol 2001; 45:435-437.

2. Coyne PE. Sumarin and therapy of onchocerciasis. Arch Dermatol 1992; 128:698.

3. Rozenman D, Kremer M, Zuckerman F. Onchocerciasis in Israel. Arch Dermatol 1984; 120:505-507.