Bilateral vulval filarial elephantiasis

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 blood collected at midnight examined by concentration technique using Leishman stain was negative for microfilaria. However, immunochromatographic test for microfilarial antigen was …