VULVAL FILARIASIS--A RARE CASE REPORT.

India has 40% of world's lymphatic filariasis (LF) cases. Thread like adult parasites reside in afferent lymphatics and may remain viable for more than two decades. Males have a substantial 13.67% greater rate of LF-related disease overall than females. Cases have been reported from 20 states and union territories (UT) of India. A 55-year-old postmenopausal female, presented with complaints of swelling over the vulval region with itching since 25 years. She had history of elephantiasis of lower limbs and inguinal swellings for which she was operated and medically treated 30 years back. On local examination, swelling was present on labia majora bilaterally affecting left more than right. The swelling was Arm in consistency, nonreducible, noncompressible, no impulse present on coughing, nonfluctuant and no nodularity was felt inside the swellings. The overlying skin was excoriated, thickened, nontender and pigmented. Provisional diagnosis of vulval fllariasis was made. Midnight peripheral smear for microfilaria (MF) was negative. Excisional biopsy of bilateral vulval swelling with primary repair was done. Postoperative period was uneventful and histopathology report of mass was consistent with vulval fllariasis. Filarial Antigen and PCR based assay for DNA are other tests for LF. High frequency ultrasound and Doppler identifies motile adult worm within dilated lymphatics known as Filarial Dance Sign. Aims of management of vulval fllariasis is reduction of vulval swelling by cosmetic surgery, prevention of secondary infections and restoration of normal genital and sexual functions. Vulval elephantiasis is very rare especially in a nonendemic district resident and it is always a clinical diagnosis of exclusion. [ABSTRACT FROM AUTHOR]