XIX 
JUXTA-ARTICULAR NODULES 
Tue relationship of certain onchocercal tumors to the lesions classed as Juxta- 
articular nodules is of interest. Blacklock ! says he would have diagnosed several 
of his cases as juxta-articular nodules but for the fact that they occurred in a 
region where Onchocerca volvulus was present. In one of his cases there were 
nodules about each trochanter, each elbow, and the left knee. Nine punctures 
of the nodules were made and amber-colored fluid was usually obtained, but no 
larvae or ova of filaria. He would have concluded the lesions were not due to 
O. volvulus but for the fact that he later found the embryos of this parasite in 
sections of skin from the scapula, loin and thigh regions. He notes another 
similar case, anatomically, with similar findings regarding the parasites. Van 
Hoof ? says that Onchocerca tumors simulate very well juxta-articular nodules 
and points out that the filarial nodes affect the same regions. He adds that it is 
impossible to distinguish clinically one from the other and says in order to do 
this it is necessary to resort to puncture and microscopical examination of the 
fluid removed. However, as Blacklock has shown, and we have also had similar 
experience, this does not always lead to the determination of the etiology. 
Dubois * points out that onchocercal tumors may cause confusion with other 
juxta-articular tumors. As we shall illustrate, however, the histological picture 
of the nodules due to Onchocerca is quite different from that of juxta-articular 
nodules. 
Sharp * points out that onchocercal tumors may simulate juxta-articular 
nodules, which latter condition he declines to believe forms a clinical entity and 
regards as a sequela of a fibrous tumor caused by Onchocerca, spirochaetes or 
other organisms as the result of slight but prolonged irritation to the subcutane- 
ous fascia. 
We also encountered in Liberia and the Belgian Congo, a number of cases 
answering to the clinical description of juxta-articular nodules. In all, ten cases 
were studied. In a number of these we were likewise unable to demonstrate 
the embryos of Onchocerca volvulus by aspiration or sections of the skin. In one, 
however, we found this parasite (Case 498, Illustration No. 182). Of course 
it is quite possible in some instances after the nodule is in process of formation 
that the adult filaria might die within the nodule and disintegrate or even perhaps 
withdraw from it. In Photograph No. 194 one of the typical cases of juxta- 
articular nodules observed in Liberia (Case 75), is illustrated. The patient was 
1 Blacklock: Loe. cit. 
? Van Hoof: Ann. Soc. Belge de Méd. Trop. (1926), VI, 53. 
8 Dubois: Bruxelles Méd. (1925), V, 1453. 
4 Sharp: Proc. Royal Soc. Med. (1927), XX, 927. 
258 
