INTRODUCTION Filariasis is an infectious parasitic disease and is regarded as a major public health problem in the tropical countries of 1 Africa, Southern America, and Asia . In India it is endemic in Orissa, Uttar Pradesh, Bihar, Andhra Pradesh, Tamil Nadu and Gujarat. The nematode Wuchereria bancrofti accounts for 90 % of cases worldover followed by Brugia malayi and 2 Brugia timori . Infected mosquitoes serve as vectors and humans are the denitive host. The commonest presentation is lymphatic lariasis which usually involves lower extremities, scrotum, retroperitoneal tissue and axilla causing lymphoedema, elephantiasis, hydrocele, Ram horn penis and rarely in breast. Usually it presents as a generalized lymphoedema of affected parts. CASE REPORT A 51 year old male, resident of Kanyakumari district, presented with swelling in the penile shaft since 2 weeks, associated with itching. There was no history of fever with chills or trauma. No signicant treatment or drug history, no other similar swellings in the body. On examination 2cm x 1.5cm size, non tender, rm, mobile swelling in the penile shaft. There was no inguinal lumphadenopathy, provisionally diagnosis of Fibroma was made and posted for excision biopsy. Post excision the lesion was bisected and found to have live worm (gure: 1 and 2) provisionally diagnosis made as? Cysticercosis and sent for HPE. Oral albendazole and ivermectin, tablets were given. Biopsy report came as larial worms within the cyst and cyst contains heavy lymphoplasma cells and eosinophils inltration. Patient came for rst follow up; wound is clean and healthy, no edema noted. Fig 1: worm with in cyst Fig 2: live worm Fig 3: biopsy report DISCUSSION Filariasis is a parasitic infection caused by a round worm of Filarioideae super family. Humans are denitive hosts in larial nematodes. The disease manifests as two distinct clinical types- 1) Lymphatic lariasis caused by parasite in lymphatic system and, 2) occult lariasis caused by immune hyper responsiveness of the human host as tropical pulmonary eosinophilia. The global burden of is not well dened, lymphatic lariasis but it is known to be endemic in over 80 countries, placing 1 billion persons at risk. The World Health Organization (WHO) most recently estimated 120 million people to be currently infected—2% of the world's population. Of these, 44 million have clinical manifestations such as lymphoedema, elephantiasis, hydrocele, lymphangitis, chyluria and renal disease. Lymphatic lariasis is a major health problem in India with most infections caused by Wuchereria Bancrofti (90%), Brugia malai and Brugia timori. Heavily infected areas are Tamil Nadu, Uttar Pradesh, Bihar, Jharkhand, Andhra 3 Pradesh, Orissa, Kerala and Gujarat . AN UNCOMMON PRESENTATION OF THE FILARIAL WORM AS A PENILE NODULE- A RARE CASE REPORT Original Research Paper Dr. Devaprasath Jeyasekharan M.S (GEN),F.A.MS, Urology X 41GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS General Surgery Filariasis is a tropical infectious disease and a major global health problem with high incidence in Indian subcontinent. Presenting with lymphatic dysfunction in the form of hydrocele, lymphocele, chyluria and groin lymphadenovarix. We report a rare presentation of lariasis as penile nodule. ABSTRACT KEYWORDS : VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Sabu Jeyasekharan* M.S General Surgery *Corresponding Author Dr. Bala V Sagar M.S General Surgery Dr. Deepak David M.S Mch, Urology Dr. Nithila Dnb Gen Surgery Dr. Scott M.S General Surgery Dr. Rangaswami DNB Resident, General Surgery 42 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Adult worms usually stay in the lymphatic tissue and release early larval forms in blood stream known as microlaria into the host bloodstream. Circulating microlaria are picked up along with a blood meal by the arthropod vector and 4 transmitted to a new host . Depending on whether microlaria can be detected in the peripheral blood, patients are described as microlaraemic or amicrolareamic. Man is a natural host. All ages are susceptible. In endemic areas, the microlaria rate is higher in men. Culex , Anopheles and Aedes species of mosquito are vectors for Wuchereria Bancrofti. The disease may be asymptomatic or there can be acute episodes of local inammation involving skin, lymph nodes and lymphatic vessels. Chronic disease in endemic communities can manifest in men in the form of genital damage, especially hydrocele, funiculitis, epididymitis and elephantiasis of the penis and scrotum. In women, the vulva or breast may be 4 involved. An entire arm or leg maybe affected in both sexes . Microlaria of W.bancrofti circulates in the peripheral blood with regular nocturnal periodicity and maximum density had 5 been reported between 10 pm and 2 am . Tests used for diagnosis include demonstration of microlaria in the peripheral blood or skin and detection of larial antigens and antibody. For detection of microlaria, thick and thin blood smears are made and stained with haematoxylin or giemsa stains. Ultrasound is a valuable tool in the diagnosis of cases of 7 lymphatic lariasis. Amaral et al had rst reported the use of ultrasound to visualize adult worms of Wuchereria Bancrofti in the scrotal area of infected men. They described a continuous, distinctive and specic pattern of worm movement called the 6 "Filarial dance" sign . There is continual development of new control strategies and treatment programs for lariasis. Four drugs are now used s i n g l y o r i n v a r i o u s c o m b i n a t i o n s a n d d o s e s - diethylcarbamazine,(DEC), ivermectin, albendazole, and doxycycline. The DEC recommended dose is 6mg/kg body weight per day in divided doses given orally for 12 days. It may be combined with either Albendazole or Ivermectin (a single dose of 200 to 400 µg/kg) for mass therapy in endemic areas. Vectors can be controlled by anti-larval measures and minor environmental measures. CONCLUSION The uniqueness of this case is its presentation as isolated penile shaft nontender mobile lesion with atypical morphology, without concomitant involvement of scrotum. Though the larial cyst was completely removed this patient will be followed up periodically. REFERENCES 1. Chakrabarti I, Das V, Halder B, Giri A. Adult larial worm in the aspirate from a breast lump mimicking broadenosis. Trop Parasitol 2011;1:129-31. 2. Bhattacharjee PK, Ray RP, Halder S. Filariasis of breast: An unusual presentation. Ann Trop Med Public Health 2012;5:376-8 3. Park K. Park’s Textbook of Preventive and Social Medicine. 23rd edition. Jabalpur: Bhanot;2015. 4. Upadhyaya V, Upadhyaya DN, Sarkar S. An interesting case of breast lariasis. Indian J Radiol Imaging 2006;16:915-7. 5. Paniker Jayaram CK, Ghosh Sougata. Paniker’s Textbook of Medical Parasitology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2013. 6. Upadhyaya V, Upadhyaya DN, Sarkar S. An interesting case of breast lariasis. Indian J Radiol Imaging 2006;16:915-7. 7. Amaral F, Dreyer G, Figueredo-Silva J, et al. Adult worms detected by ultrasonography in human bancroftian lariasis. Am J Trop Med Hyg 1994; 50: 753. VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra