How Imported Pathology Becomes Overlooked as Resources Increase: An Example of a Neglected Tropical Disease (NTD)

This case report highlights how neglected tropical diseases (NTDs) may remain underdiagnosed in high-resource settings despite advanced healthcare systems. We describe an 18-year-old woman from Equatorial Guinea living in Spain who presented with chronic pruritus and episodic ocular symptoms and was ultimately diagnosed with ocular loiasis after the incidental extraction of a conjunctival filaria. Diagnostic evaluation included microscopy, serology, and molecular techniques, confirming Loa loa and Mansonella perstans co-infection alongside evidence of exposure to other parasitic infections. Management involved staged antiparasitic therapy with albendazole, ivermectin, praziquantel, and diethylcarbamazine, combined with corticosteroids to mitigate treatment-related reactions. The patient showed clinical improvement, although follow-up was irregular and microfilaremia persisted. This case illustrates key challenges in non-endemic settings, including low clinical suspicion, fragmented care pathways, and barriers to healthcare access among migrant populations. Despite the availability of sensitive diagnostic tools, delayed recognition remains common when tropical diseases are not considered in the differential diagnosis. Comprehensive, multidisciplinary approaches are essential, particularly in patients from endemic regions who may harbor multiple co-infections. Strengthening clinical awareness, referral pathways, and appropriate screening for NTDs may help reduce diagnostic delays and improve patient outcomes in increasingly globalized healthcare settings.