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A healthy 54-year-old man previously presented to vascular surgeons with a 4-year history of swelling of the penis and scrotum was scheduled for ultrasound evaluation in the angiology office in our department. At presentation, there was a giant enlargement of the penis and scrotum, without swelling of the legs. Ultrasound evaluation was negative for vascular abnormalities. A diagnosis of chronic lymphatic disease was suspected; thus, a lymphoscintigraphy was performed. This test was normal showing, a good visualization of major lymphatics. The patients had a history of psoriasis with a documented previous event of flexural psoriasis involving his genitals with secondary infection 4 years before. Since that infection, his genitals progressively increased in size, and despite medical treatment and different surgical evaluations, the patient’s symptoms have not resolved, with marked disability associated with walking and sexual activity.

Estrone conjugate (E1C) and pregnanediol glucuronide (PdG) were predominant steroid metabolites of estrogen and progesterone in feces of most primates and could be used to evaluate ovarian function. These metabolites were determined along with records of genital swelling throughout 3-4 months period from three female Javan Gibbons (Hylobates moloch) maintained in pairing-typed cage at Schmutzer Primate Center, Jakarta (Ullah) and at Taman Margasatwa Taman Sari, Bandung (Donna and Citah). Following methanolic extraction of lyophilized fecal powder, samples were analyzed using enzyme linked immunosorbent assay (ELISA) for E1C and PdG. In all of the three females observed, both hormone profiles did not indicate any regular cycle of ovarian function even though genital swellings were sometimes observed. In one female (Donna) the hormone patterns showed clear signs of cycle irregularities with extended luteal phase of 40 days and erratic pattern of follicular phase. Of the other two females, no ovarian cycle was found. The data indicate that the fecal steroids analysis is a practical and valuable diagnostic tool for providing reliable information on ovarian function in Javan Gibbon. Factors affected reproductive hormonal profile should be taken in consideration in trying to achieve success in captive breeding program for this species.

Estrone conjugate (E1C) and pregnanediol glucuronide (PdG) were predominant steroid metabolites of estrogen and progesterone in feces of most primates and could be used to evaluate ovarian function. These metabolites were determined along with records of genital swelling throughout 3-4 months period from three female Javan Gibbons (Hylobates moloch) maintained in pairing-typed cage at Schmutzer Primate Center, Jakarta (Ullah) and at Taman Margasatwa Taman Sari, Bandung (Donna and Citah). Following methanolic extraction of lyophilized fecal powder, samples were analyzed using enzyme linked immunosorbent assay (ELISA) for E1C and PdG. In all of the three females observed, both hormone profiles did not indicate any regular cycle of ovarian function even though genital swellings were sometimes observed. In one female (Donna) the hormone patterns showed clear signs of cycle irregularities with extended luteal phase of 40 days and erratic pattern of follicular phase. Of the other two females, no ovarian cycle was found. The data indicate that the fecal steroids analysis is a practical and valuable diagnostic tool for providing reliable information on ovarian function in Javan Gibbon. Factors affected reproductive hormonal profile should be taken in consideration in trying to achieve success in captive breeding program for this species.

We present a case of intense genital swelling because of a hereditary angioedema. This rare disease should be included in the differential diagnosis of acute and asymptomatic genital edema, because it may prevent future potentially life-threatening episodes of visceral angioedema.