Filarial abscess in the submandibular region
A 25-year-old lady presented to dental out-patient services with swelling and pain in the right side of the face. Local examination showed a fluctuant swelling measuring 5 mm × 3 cm over the right side of the angle of mandible []. The swelling was warm and tender on palpation with signs of impending rupture. Clinical examination of the orofacial region did not reveal any odontogenic or non-odontogenic foci of infection. Patient's vitals were in the normal limits. All the hematological parameters were normal except for borderline leukocytosis and a low hemoglobin level. Incision and drainage (I and D) of the abscess was carried out under local anesthesia. As the patient was in her 12th week of gestation, antibiotics were prescribed in consultation with the gynecologist.\nOn a follow-up visit after 2 weeks, a painless indurated swelling at the same site was noted [, inset]. Pus culture carried out during the incision and drainage had not revealed any bacterial growth. As the condition was not resolving, a fine needle aspiration cytology (FNAC) was advised in consultation with the pathologist, to rule out tubercular infection.\nAspirate from the swelling yielded purulent material. The smears were moderately cellular and showed abundant necrotic debris within which were seen polymorphs and histiocytes. One of the smears revealed the presence of a single microfilaria of W. bancrofti, which was rounded anteriorly and tapered posteriorly []. The caudal end of the microfilariae had a clear space free of nuclei. After the aspiration, the patient was admitted and a midnight blood sample was taken. The wet mount preparation showed motile microfilariae, which confirmed the diagnosis of filariasis.\nSince, the patient was in the first trimester of pregnancy, decision was taken to start the anti-filarial drugs after delivery.