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Etienne Crickx, Pierre Buffet, Éric Caumes, Stéphane Jauréguiberry, A Mauritanian Woman With a Swollen Knee, Clinical Infectious Diseases, Volume 57, Issue 9, 1 November 2013, Page 1362, https://doi.org/10.1093/cid/cit515
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(See page 1308 for the Photo Quiz.)
Diagnosis: Calcified adult Dracunculus medinensis worms.
This presumptive diagnosis was made given the typical linear calcifications of soft tissues on the knee radiograph (Figure 1). This typical linear and pluricentimetric aspect ruled out other causes of periarticular calcifications such as other parasites and vascular or tendinous calcifications. Foreign bodies such as wood or metal were unlikely. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) improved the patient's symptoms.
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After ingestion, D. medinensis worms spend a year maturing, reproducing, and migrating in their human hosts. Ultimately, the fertilized females normally complete their migration through the subcutaneous tissues toward the skin. However, migration near the articular capsule may trigger an aseptic articular effusion, sometimes several years after the worm's death [1].
In past decades, neglected populations were massively exposed to D. medinensis infection (number of cases in 1986 estimated at >3 million [2]). Consequently, although guinea worm disease is nearly eradicated [3], clinicians should nonetheless keep in mind the atypical presentation of painful articular effusion caused by D. medinensis even several years after infestation. There is no specific treatment, but NSAIDs may be used to relieve symptoms.
