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   Abstract
   Introduction
   Case Reports
   Discussion
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CASE REPORT
Year : 1995  |  Volume : 61  |  Issue : 5  |  Page : 308-309

Vulval elephantiasis : A sequel to tubercular lymphadenitis




Correspondence Address:
R C Sharma


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Source of Support: None, Conflict of Interest: None


PMID: 20953000

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  Abstract 

Two cases of vulval elephantiasis arising as a sequel to complete destruction of regional lymph nodes of tubercular aetiology are described for its rarity


Keywords: Vulval elephantiasis, Tuberculosis


How to cite this article:
Sharma R C, Thami P G, Sharma N L, Sharma A s. Vulval elephantiasis : A sequel to tubercular lymphadenitis. Indian J Dermatol Venereol Leprol 1995;61:308-9

How to cite this URL:
Sharma R C, Thami P G, Sharma N L, Sharma A s. Vulval elephantiasis : A sequel to tubercular lymphadenitis. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Jul 21];61:308-9. Available from: http://www.ijdvl.com/text.asp?1995/61/5/308/4251



  Introduction Top


Elephantiasis is dramatic end result of a variety of obstructive diseases of lymphatic system commonly affecting arms, legs and genitalia. Genital elephantiasis is a common sequel of filariasis, lymphogranuloma venereum and rarely it follows Donovanosis, carcinomas, lymph node irradiation and tuberculosis.[1] We report two unusual cases in whom vulval elephantiasis was ascertained to be the consequence of extensive lymph node destruction by tubercular infection.


  Case Reports Top


Case 1: A 28-year-old female presented with asymptomatic diffuse swelling of vulva of 5 years duration. It started twenty years back when she developed small multiple asymptomatic swellings in both inguinal regions one after the other followed by ulceration and discharge of cheesy material lasting about 8-10 months. It took about another 6-12 months to heal with indigenous oral medication. She developed similar swellings with similar course of events in both cervical regions over a period of another 4-5 years. Presently the patient had diffuse lymphoedema of both labia majora and minora attaining double the normal size, with multiple yellowish papular lesions over cutaneous parts of labia majora [Figure - 1]. Both inguinal and cervical regions on either sides showed linear puckered scars overlying the lymph nodes. A single 1.5 cm big, firm, mobile lymph node was present in left cervical region. No lymph node mass was palpable beneath the scars in cervical and inguinal regions. Axillary lymph nodes were not enlarged. There was no hepatosplenomegaly. General health of the patient was preserved. She had not received any anti-tubercular treatment till now.

Skin biopsy from vulva showed features suggestive of lymphoedema. The lymph node from left cervical region on histopathology showed loss of lymph node architecture, replaced by granulomatous tissue consisting of epilthelioid cells with occasional Langhans type giant cells and foci of caseation. Stain for acid fast bacilli was negative. X-ray chest did not reveal any active or healed focus suggestive of tuberculosis. Mantoux test was positive.

Case 2: This 40 years old female had almost similar history and findings except that the elephantiasis was gross, reaching about 10-12 times the size of normal vulva [Figure - 2]. No lymph node mass was available for biopsy in both cervical and inguinal regions. Mantoux test was positive. Biopsy from vulva showed changes of lymphoedema with gross fibrosis and no malignant changes. Tissue smears were negative for acid fast bacilli and Donovan bodies. No active focus of tuberculosis was found.


  Discussion Top


Though pseudoelephantiasis of vulva has been reported previously;[2],[3] elephantiasis of vulva due to extensive destruction of lymph nodes in inguinal region by tubercular process is hitherto unreported to the best of our knbowledge. In our cases, absence of tubercular histology from vulva rules out direct infiltration i.e., pseudoelephantiasis. Clinical events point towards almost complete destruction of lymph nodes in inguinal region.

In case I, the only remaining cervical lymph node showed typical tuberculous granuloma corraborating well with the clinicaldiagnosis. However in case II, the diagnosis was presumptive and retrospective based on typical history and clinical features. Although antitubercular treatment has been started in case I it is unlikely to reverse the elephantiasis in this patient. In case II, long standing lymphoedema of vulva has probably contributed to extensive fibrosis.

 
  References Top

1.Routh HB. Elephantiasis (Review). Int J Dermatol 1992;31:845-52.  Back to cited text no. 1  [PUBMED]  
2.Rao CM, Patniak R. Lupus vulgaris of thigh and vulva. Ind J Dermatol Venereol 1965;31:131-2.  Back to cited text no. 2    
3.Shah BH, Shah DM. Pseudoelephantiasis of vulva of tuberculosis aetiology. Ind J Dermatol Venereol 1968;34:245-7.  Back to cited text no. 3    


    Figures

[Figure - 1], [Figure - 2]

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