Vulval Elephantiasis: A Case Report

Introduction. Elephantiasis is a chronic manifestation of filariasis; it commonly affects limbs, scrotum, and trunk. Females have lower incidence of filarial infection. Vulval elephantiasis due to filariasis is still rarer. It is difficult to make the diagnosis on histopathology alone, more so in view of the fact that the parasite is usually not identified in tissue sections. Identification of microfilariae in night samples of peripheral blood or seropositivity for filarial antigen is requisite for the correct diagnosis. Case Presentation. A young female presented with progressively increasing vulval swelling over a period of two years. The swelling was soft and measured ？cm. Other possible differential diagnoses were excluded, and ancillary tests were performed to reach a conclusive diagnosis of vulval elephantiasis on histopathology. Conclusion. Vulval elephantiasis due to filariasis is rare. Its diagnosis on histopathology is more often by exclusion. High index of suspicion on microscopic findings and corelation with relevant diagnostic tests are required to reach the correct diagnosis. 1. Introduction Elephantiasis is a rare disorder involving lymphatic channels of the affected part of the body. It is characterised by gross enlargement of the particular body part. Most commonly, it is caused due to filarial parasites. The prototype of this disease was depicted by involvement of lower limbs. Other areas like trunk, breasts, upper limbs, and external genitalia can also be involved. Genital elephantiasis, also known as esthiomene, is a rare, dramatic end result of lymphatic obstruction. Although mainly associated with filariasis and sexually transmitted diseases such as lymphogranuloma venereum and donovanosis, it could also be an uncommon complication of tubercular lymphadenitis [1, 2]. Filarial elephantiasis of the female genitalia is extremely uncommon and is reported infrequently as isolated case reports [3]. 2. Case Presentation An 18-year-old, unmarried female presented with the complaint of low grade fever on and off and a perineal swelling. The swelling had been present for 2 years, slowly increasing to its present size. The patient was a migrant from Azamgarh, Uttar Pradesh, India. On general physical examination, the patient was afebrile and there was no lymphadenopathy. Local examination revealed a polypoidal growth measuring 5 × 6？cm, arising from the left labium minus. The growth was soft, and the overlying skin showed rugosities. A clinical diagnosis of fibrolipoma was suggested. Fine needle aspiration of the growth was performed.