Department of Plastic Surgery, Ibn Sina teaching hospital, Mohamed V University, Rabat, Morocco

A extremely uncommon illness called vulvar elephantiasis is frequently brought on by filariasis infection. This syndrome may potentially have additional causes, such as general inflammatory disease, cancer therapy, traumatic events, or other infections. It sometimes results from unidentified causes. The clinical case of a young Moroccan female patient with no notable past is given in this study. She had vulvar elephantiasis linked with scabies and showed no signs of filariasis infection, generalised inflammation, cancer, or other infection. The high volume of lymphedema, the atypical localization, the combination with generalised scabies, and the lack of a clear aetiology, which may explain its occurrence, make this clinical case exceptional.

KEYWORDS Lymphedema, vulvar, scabies, and elephantiasis.

A significant growth of a limb or the external genitalia caused by persistent lymphedema is known as elephantiasis [1]. In impoverished countries, filariasis is a common cause of the rare illness elephantiasis of the vulva [3]. In this paper, we present the clinical case of a 27-year-old woman who presented with elephantiasis of the vulva evolved one year earlier, linked with scabies. The patient had no notable medical history. No signs of filariasis infection or any other known cause that could account for the emergence of this illness were present in the patient.

A female patient, 27, who had no prior medical history, was hospitalised to our department with vulvar elephantiasis that had been present for a year and was accompanied by generalised itching skin sores. The general clinical examination revealed that the patient's BMI was 26 and that their body temperature was normal.

Lesions from scratches and erythematous papules. A substantial pendulous swelling mass with mild skin inflammation was discovered during the vulvar examination, and there was considerable lymphedema in the right labia majora (figure 1, 2). Lower leg varices and bilateral inguinal adenopathy were also discovered during the clinical examination. However, neither an abdominal tumour nor a gynaecological mass were found during the clinical or radiological investigations. According to the biological analysis, there are more circulating eosinophilic granulocytes. Regular biochemistry, glucose, and serological tests for sexually transmitted infections (hepatitis B, HIV, and syphilis) did not reveal anything unusual, although C-reactive protein (CRP) was elevated (84 mg/L). A Midnight peripheral blood smear for filarial worms was also conducted, but the results were unfavourable.Simple cutaneous sutures were developed to stop the loss of the remaining material.

The fragments were sent for an anatomicopathological analysis, which found vulvar lymphedema but no evidence of cancer. The surgical aftercare was straightforward, but after two months the patient returned with a second recurrence of lymphedema in the left labia majora, without any concomitant general skin abnormalities.The patient underwent a total excision of her vulvar tumours, removing a mass of 2 kg from the left labia majora and a mass of 500 g from the right labia majora. The patient also received antiscabies treatment for her skin lesions.

Lymphedema is known as the swelling of soft tissues brought on by the buildup of interstitial fluids high in protein due to a limited lymphatic output [3].Primary lymphedema is a congenital abnormality of vascular formation that can affect lymphatic drainage, and infections, trauma, surgery, and ageing all damage lymphatic vessels diation, diligent irritation, obstacle because of metastases or then again parasite pervasion (auxiliary lymphedema)

[1].Lymphedema is as often as possible experienced in the appendages, less generally in the face and the genital organs [3]. In its earliest stages, lymphedema is delicate and pitting; in any case, with constancy, lymphedema has a strong, non-pitting appearance compared to peau d'orange as a result of complement of skin folds also, follicular ostia. The majority of the expanding happens in the subcutaneous tissue, yet the skin shows the most changes, which,when serious, is named elephantiasis [1]. Elephantiasis depicted a gross growth of the piece of the body that has been involved. Audit of the world's writing uncovers that persistent vulvar elephantiasis is an extremely interesting condition [3].

Most of instances of vulvar elephantiasis found in the writing are because of filariasis [3] [4]. Different causes incorporate bacterial physically communicated contaminations (Sti's), particularly lymphogranulomavenereum (LGV) and donovanosis; tuberculosis, hematological malignancies, and dermatological illnesses and in some cases from obscure reason [4, 1, 2].Lu et al. [1] introduced a clinical series of 24 instances of limited lymphedema; he made a correlation between those patients what's more, the patients with diffuse lymphedema. Lu viewed that as the most regular localisation in these patients is anogenital, and generally speaking, ladies were all the more oftentimes impacted by lymphedema, especially in the anogenital area and trunk, than men.The patients in Lu et al. series had no type of malignant growth treatment, they were altogether bound to have history of injury to the site (vaginal conveyance), and less inclined to have a

existing together, persistent incendiary cycle (rosacea and Crohn's sickness), No etiology or related illness was viewed as in about 33% of all cases. Lu and al. Additionally, show in his review that 85% of patients were large or overweight which can advance lymphedema by check of the lymphatic waterways by fat cells.Antonio et al. [2] introduced two clinical instances of unilabial vulvar lymphedema like the Lu and Al series, yet entirely dissimilar to the Lu et al. series, they found no elements that might make sense of the beginning of Lymphedema with the exception of stoutness in one patient.In our review the patient had no past clinical history or a clear reason that can make sense of the vulvar elephantiasis, the exploration of filariasis was negative and furthermore no

indication of physically sent contamination, neither an indication of harm or incendiary illness. Histological assessment of the extracted mass showed Acanthosis papillomatous epidermis conquered by hyperkeratosis and orthokeratosis without cytonuclear atypia; in the dermis, we viewed as many widened lymphatic vessels of variable size. Significant interstitial oedema without any indication of threat. The main anomaly she introduced alongside the vulvar elephantiasis was the skin injuries which were

settled after antiscabies treatment and, the marginally raised level of circling granulocyte and the CRP which might correspond with the past scabies pervasion.

Our patient introduced a repeat of lymphedema after extraction. In Lu and al series most of lymphedematous growths were relieved with extraction, and those that repeated or advanced were related with factors known to disturb lymphedema: stoutness, cellulitis, indications of industrious irritation. In our patient, we accept that diligent of aggravation can make sense of repeat. Anyway we intended to acknowledge more examination to make sense of the repeat, however the patient decline to go under beneficial assessment.

Due to the huge amount of lymphedema, the odd location, the relationship with generalised scabies, and the lack of a clear explanation, which may explain its development, this clinical case is uncommon.

Sabur Reporting on the case was Sarah. The case management and content of this publication were equally contributed by all authors, who also approved of the final draught after reading it.

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Bounajma Saoussane. Scabies-related vulvar non-filarial elephantiasis. Insights of Clinical and Medical Images 2022.