title: An unusual presentation of filariasis in a nonendemic country.
abstract: BACKGROUND
  Filariasis is an endemic disease with worldwide distribution in tropical and subtropical regions. It is uncommon in Qatar. The conventional diagnostic procedure is the demonstration of microfilaria in blood smears. Even with its high incidence, it is unusual to detect microfilaria in fine needle aspiration cytology (FNAC) smears. Although the 'filarial dance sign' is rarely documented, it remains a classical ultrasonographic sign in lymphatic filariasis.
  
  
  METHODS
  We present a case of a 38-year-old male patient with fever, chills, shortness of breath and a tender warm swelling on his right thigh. Ultrasound of the thigh lesion showed the classical filarial dance sign. Subsequently FNAC from the lesion documented microfilaria in spite of absent peripheral blood eosinophilia and microfilaria. The patient underwent an incision and drainage of the thigh lesion and was treated with ivermectin and diethylcarbamazine. He was subsequently admitted to the medical ward and discharged home after two weeks in a stable condition.
  
  
  CONCLUSIONS
  This case report illustrates the importance of diagnostic tools like ultrasound and FNAC along with a high index of clinical suspicion while evaluating patients presenting with unusual signs and symptoms. We would like to highlight the rarity of filarial presentation in a nonendemic country like Qatar. This case is unique since microfilaria was demonstrated in the pus aspirated from the thigh abscess and showed the filarial dance sign by ultrasound along with involvement of the pleura and pericardium.
authors: Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Parampil Thulasidharan Shibu
authors: PT
authors: Kandalam
authors: Department of Radiology, Emergency Radiology Section, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Arif Nelliyulla
authors: AN
authors: Parampath
authors: Department of Laboratory Medicine, Pathology Section, Hamad General Hospital, Doha, Qatar.
authors: Hanan Ibrahim
authors: HI
authors: Farghaly
authors: Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Salem Abo
authors: SA
authors: Salah
authors: Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Muhammed Kunhi
authors: MK
authors: Kayakkool
authors: Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Joe Varghese
authors: JV
authors: Mathew
authors: Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Pradeep
authors: P
authors: Radhakrishnan
authors: Emergency Department Short Stay Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Ibrahim
authors: I
authors: Al Badawi
authors: Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors: Saleena
authors: S
authors: Farook
keywords: Diff-Quick stain; FNAC; Wuchereria bancrofti; filarial dance sign; microfilariae