Breast filariasis
A 50-year-old lady hailing from Bihar (India) presented to surgical outpatient department with the history of intermittent fever with chills for 6 months and gradually increasing right breast lump for 1 month. There was no history of nipple discharge. General physical examination was unremarkable. Breast examination revealed a large 8 × 8 cm breast lump involving all quadrants with well-defined margins, firm in consistency, bosselated surface, mobile (no fixity to pectoral muscle), the overlying skin was indurated, hyperpigmented with few dilated veins. Nipple was retracted on ipsilateral side and peau de orange was absent (Fig. ). In the right axilla few pectoral group of lymph nodes was enlarged (2 × 3 cm). Rest of the systemic examination was normal. A provisional clinical diagnosis of inflammatory breast carcinoma was made.\nFine needle aspiration cytology (FNAC) of the breast lump and the axillary lymph node was reported as a hemorrhagic aspirate showing many eosinophils, neutrophils and histiocytes along with microfilaria of W. bancrofti (Fig. ), no malignant cells were seen and an impression of filarial mastitis was made. Differential leucocyte count was P69 L19 M04 E08 and the absolute eosinophil count was 1200 cells/mm3 (0–450 cells/mm3) corroborating with the cytology report.\nMidnight peripheral blood smear showed—normocytic normochromic red blood cells, no microfilaria were seen. Ultrasound of the breast showed multiple cystic lesions in 3, 7 and 11 o'clock positions. There was no evidence of adult filarial worms. A final diagnosis of breast filariasis was made and the patient was started on diethyl carbamazine 6 mg/kg/day for 21 days. Following which the patient showed dramatic response with the resolution of the overlying pigmentation and a gradual decrease in lump size.