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Wednesday, October 23, 2013

Giant scrotal elephantiasis in a Haitian man


Lymphatic filariasis is a nasty parasitic disease caused by the nematode worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. These worms occupy the lymphatic system, including the lymph nodes. In chronic cases, blockage of lymphatic vessels by the parasites leads to elephantiasis - various body parts swell up to gigantic proportions, with thickening of the skin and of underlying tissues. The effects of chronic lymphatic filariasis were documented many centuries ago: ancient Greek and Roman writers noted the similarity of the enlarged limbs and cracked skin of infected individuals to that of elephants.

Wuchereria bancrofti is responsible for 90% cases of lymphatic filariasis. It is estimated that over 120 million people are infected with this parasite, primarily in Africa, South America, and other tropical and subtropical countries. Elephantiasis caused by this species of worm can affect the legs, arms, vulva, breasts, and scrotum. The parasite is transmitted by the bite of infected mosquitoes.

The deformations associated with elephantiasis can be truly grotesque, as in the following case of a young Haitian man, reported in bjui.org. The patient, aged 20 years, living in the south east part of Haiti,  was diagnosed with filariasis in 2003 at St Croix hospital of Leogane, 20 miles from Port-au-Prince. The city of Leogane is officially known as an endemic area for Wuchereria bancrofti infestation. Despite standard medical management, good skin care and compression bandaging, the disease slowly progressed, and over a five year period, the unfortunate young man became almost completely incapacitated by a huge swelling of the external genital organs and his right leg. The scrotal swelling alone weighed around 55 kilos. This particular case of scrotal elephantiasis ranks among the biggest ever recorded in medical literature.   



Giant scrotal elephantiasis in a Haitian man.


Note that the penis is completely embedded in the edematous tissue. Frankly, I'm surprised that the patient is able to stand with that huge weight dangling down. And here is another photo showing the scrotal mass:






This particular story has a happy ending: it seems that a team of surgeons at the Christian Martinez Medical Center of Jacmel in Haiti managed to successfully dissect the mass and perform plastic reconstruction of the scrotum and penis, using skin flaps.

All images from: bjui.org



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