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Paper text:
filariasis is an endemic disease in the asian and african subcontinent and has emerged as a major health concern .
it is caused by transmission of larvae of nematode wuchereria bancrofti and brugia malayi and it commonly affects lower limbs , spermatic cord , epididymis and retroperitoneum . here a rare case of breast filariasis has been reported .
a 50-year - old lady hailing from bihar ( india ) presented to surgical outpatient department with the history of intermittent fever with chills for 6 months and gradually increasing right breast lump for 1 month .
breast examination revealed a large 8  8 cm breast lump involving all quadrants with well - defined margins , firm in consistency , bosselated surface , mobile ( no fixity to pectoral muscle ) , the overlying skin was indurated , hyperpigmented with few dilated veins .
nipple was retracted on ipsilateral side and peau de orange was absent ( fig .  1 ) .
in the right axilla few pectoral group of lymph nodes was enlarged ( 2  3 cm ) .
fine needle aspiration cytology ( fnac ) of the breast lump and the axillary lymph node was reported as a hemorrhagic aspirate showing many eosinophils , neutrophils and histiocytes along with microfilaria of w. bancrofti ( fig . 
2 ) , no malignant cells were seen and an impression of filarial mastitis was made .
differential leucocyte count was p69 l19 m04 e08 and the absolute eosinophil count was 1200 cells / mm ( 0450 cells / mm ) corroborating with the cytology report . 

ultrasound of the breast showed multiple cystic lesions in 3 , 7 and 11 o'clock positions .
a final diagnosis of breast filariasis was made and the patient was started on diethyl carbamazine 6 mg / kg / day for 21 days . following which the patient showed dramatic response with the resolution of the overlying pigmentation and a gradual decrease in lump size .
filariasis is an endemic disease in india particularly bihar ( 17% ) , kerela ( 15.7% ) and uttar pradesh ( 14.6% ) .
culex mosquitoes serve as an intermediate vector when they feed from an infected person they ingest the microfilaria .
these larvae develop into active motile forms penetrating the stomach wall and finally reaching the proboscis ( 1012 days ) ready for further transmission to a new host .
some of the unusual sites of presentation of filariasis are breast , thyroid , body fluids [ 6 , 7 ] and skin .
walter et al .   suggested that microfilaria appear in tissue fluids and exfoliated surface material due to lymphatic or vascular obstruction and subsequent extravasation .
our patient is one of the few rare cases which have been reported till date from india .
the absence of microfilariae in the peripheral blood in this case corroborates with the observation that in endemic areas filariasis can exist without microfilaremia .
this is an unusual case of breast flariasis which is clinically mimicking inflammatory breast carcinoma , thereby creating a diagnostic confusion .
therefore , if any patient residing in an area endemic for filariasis presenting with initial history of fever followed by breast lump with overlying skin induration and pigmentation , one should always keep in mind the rare possibility of breast filariasis .
filarial involvement of breast is a rare entity . here is an unusual case of an old lady with right breast lump with axillary lymphadenopathy mimicking breast carcinoma , cytologically diagnosed as filarial mastitis . 
 the patient subsequently received antihelmenthic therapy and showed marked clinical response within few weeks .