Bilateral vulval filarial elephantiasis

Description

A 25-year-old unmarried woman, resident of a filarial endemic region, presented with progressive swelling of the vulva along with recent onset redness, dragging pain and consequent difficulty in walking. She had noticed the vulval swelling about 2 years before her presentation and had been suffering from recurrent episodes of low-grade fever for the preceding 2 years. The swelling had been reducible initially and became non-reducible after about 6 months. She denied any pelvic surgery, radiation or trauma. Her medical and family histories were unremarkable. A thorough systemic examination did not document any abnormality. Genital examination revealed non-ulcerative bilateral vulval swelling with bosselated surface, hard in consistency with raised local temperature and palpable bilateral superficial inguinal lymph nodes (figure 1). Baseline work-up was as follows: haemoglobin 11 g/dL, total leucocytes count 7000 cells/mm³, neutrophil 60%, lymphocytes 20%, eosinophil 12% and erythrocyte sedimentation rate (ESR) 60 mm in first hour. Peripheral...

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