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Vulval elephantiasis as a result of tubercular lymphadenitis: two case reports and a review of the literature

Chintamani1*, JP Singh1, Megha Tandon1, Rohan Khandelwal1, Tushar Aeron1, Sidharth Jain1, Nikhil Narayan1, Rahul Bamal1, Yashwant Kumar1, S Srinivas1 and Sunita Saxena2

Author Affiliations

1 Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India

2 Institute of Pathology, Indian Council of Medical Research, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India

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Journal of Medical Case Reports 2010, 4:369  doi:10.1186/1752-1947-4-369

Published: 18 November 2010

Abstract

Introduction

Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma venereum. It may 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. We present two very unusual cases of vulval elephantiasis due to tuberculous destruction of the inguinal lymph nodes.

Case presentation

Two Indian women - one aged 40 years and the other aged 27 years, with progressively increasing vulval swellings over a period of five and four years respectively - presented to our hospital. In both cases, there was a significant history on presentation. Both women had previously taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval swellings were extremely large: in the first case report, measuring 35 × 25 cm on the right side and 45 × 30 cm on the left side, weighing 20 lb and 16 lb respectively. Both cases were managed by surgical excision with reconstruction and the outcome was positive. Satisfactory results have been maintained during a follow-up period of six years in both cases.

Conclusions

Elephantiasis of the female genitalia is unusual and it has rarely been reported following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario.