Ocular Sparganosis in an Urban Patient: A Case Report With Histopathological Confirmation

Sparganosis is a rare zoonosis caused by the larval stage of cestodes of the genus Spirometra spp., which can affect different tissues, including the ocular region, and is uncommon in urban areas. Its clinical presentation is variable and may lead to delayed diagnosis due to low clinical suspicion. We report the case of a 56-year-old male patient, a construction worker, living in an urban area, with no history of travel, no contact with wild animals, no consumption of game meat, and no bathing in rivers or lakes. For approximately four years, he presented recurrent left ocular symptoms characterized by burning sensation, eyelid edema, and episodes of conjunctival hemorrhage, frequently treated symptomatically but without definitive resolution. Orbital magnetic resonance imaging revealed thickening and hyperintense T2/FLAIR signal with infiltrative appearance in the soft tissues of the left upper eyelid region. A biopsy was performed, and the obtained material was submitted to anatomopathological analysis, which revealed fragments of connective and muscle tissue with chronic lymphoplasmacytic inflammation associated with numerous eosinophils, in addition to an elongated structure covered by thin tegument, containing longitudinal muscle fibers and translucent or calcified rounded formations. These findings were compatible with the larval stage of a cestode, strongly suggesting the diagnosis of sparganosis. The larva was surgically removed at the time of biopsy. Imaging studies of other possible sites did not reveal additional foci of infestation or infection. The patient evolved favorably after excision, with complete resolution of symptoms and no signs of recurrence. This report emphasizes the importance of including sparganosis in the differential diagnosis of chronic ophthalmologic manifestations, even in patients without evident epidemiological risk factors and residing in urban areas. It also reinforces the fundamental role of anatomopathological examination in diagnostic confirmation, which is crucial to guide appropriate management in rare and long-evolving cases.