Vulval Elephantiasis Secondary to Tubercular Lymphadenitis

Abstract

Abstract

Background: Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs, or genitalia, and occurs because of the presence of various obstructive diseases of the lymphatic system. Commonly, genital elephantiasis follows filariasis and lymphogranuloma venereum. Genital elephantiasis may also follow granuloma inguinale, carcinomas, lymph-node dissection or irradiation, and tuberculosis, but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph-node destruction by tuberculosis is very rare. This article presents a very unusual case of vulval elephantiasis caused by tuberculous destruction of the inguinal lymph nodes. Case: A 30-year-old Indian woman had progressively increasing vulval swelling for 5 years' duration. This patient had a history that was significant because she had undergone a complete course of antitubercular treatment for inguinal lymphadenopathy. Her vulval swellings were extremely large—20×15 cm on the left side and 15×10 cm on the right side. This case was managed by surgical excision with reconstruction. Results: While the patient experienced oozing of lymph fluid during and after surgery, her outcome was positive. Conclusions: Elephantiasis of the female genitalia is unusual, and it has rarely been reported following tuberculosis. This case of vulval elephantiasis as a consequence of extensive lymph-node destruction by tuberculosis is reported here to highlight this rare clinical scenario. (J GYNECOL SURG 30:322)