Scrotal elephantiasis secondary to hidradenitis suppurativa: a rare case report

Background Genital elephantiasis is a rare but debilitating condition characterized by progressive enlargement due to chronic lymphatic dysfunction. While most commonly associated with filarial infection, secondary causes include malignancy, trauma, surgery, and chronic inflammatory conditions. Scrotal involvement secondary to hidradenitis suppurativa is exceedingly rare. Case presentation We report a 34-year-old male with long-standing, treatment-refractory hidradenitis suppurativa involving the groin, axilla, and chest, presenting with progressive massive scrotal enlargement over several years. Physical examination revealed a firm, non-tender scrotal mass measuring 20 × 16 × 6 cm. Laboratory investigations were within normal limits. The patient underwent complete surgical excision of the scrotal mass via en bloc resection with preservation of both testes and spermatic cords, followed by reconstruction with split-thickness skin grafting of the penile shaft. The resected specimen weighed approximately 6 kg. Histopathology demonstrated reactive fibromyxoid changes without evidence of malignancy. Conclusion Scrotal elephantiasis secondary to hidradenitis suppurativa is an exceptionally rare complication reflecting advanced lymphatic destruction. Early recognition and timely surgical intervention are essential to restore function and quality of life. This case highlights that even biologic therapy may not prevent progression to end-stage lymphatic disease in refractory HS.