The Cheeky Parasite: a Rare Case of a Dirofilaria-Associated Granulomatous Swelling in the Cheek

Dirofilaria is a filarial nematode that infests domestic and wild animals, especially dogs; humans are accidental dead-end hosts. Dirofilaria can cause granulomatous inflammation and swelling in the subcutaneous region; intramuscular involvement is rare. There are very few reported cases of intra-muscular dirofilariasis in Literature. This makes the diagnosis of the same very challenging, and maybe the reason for recurrences of such lesions. The mode of infection and spread is not very well known as this is an uncommon infestation in an unintended host. However, such parasitic infections must be considered in unusual intra-muscular swellings. Here, we present a case of a left cheek swelling in a 34-year-old female. Intra-operatively, we were able to isolate the entire parasite enclosed within the granulomatous mass involving the left masseter muscle. Histopathology confirmed the diagnosis of intramuscular dirofilariasis in this case. Following the excision, patient received anti-helminthic treatment and has not reported any episode of recurrence.