Lymphatic filariasis continues to be endemic in several regions of India, with Wuchereria bancrofti accounting for the majority of infections and contributing substantially to chronic morbidity despite ongoing elimination efforts.1 The disease typically presents with limb lymphoedema, hydrocele or epididymo-orchitis; however, localised scrotal involvement without accompanying systemic features is distinctly uncommon and easily overlooked.2 In such situations, the clinical picture may closely resemble more familiar surgical entities, including varicocele or inguinal hernia, often delaying appropriate diagnosis.3 A 32-year-old man from a filariasis-endemic district of Uttar Pradesh, currently employed in an industrial unit in Gujarat, presented with gradually progressive scrotal swelling for 3 months. Initially asymptomatic, the swelling later caused discomfort during walking. He consistently noted minimal swelling in the morning with a gradual increase over the course of the day. There was no history of fever, trauma, urethral discharge, limb oedema or similar prior complaints. On examination, bilateral scrotal enlargement was observed, more marked on the left side. The overlying skin appeared normal, without penile oedema or visible venous prominence. Palpation revealed soft, tortuous tubular structures clearly separate from both testes. The swelling was non-fluctuant, transillumination was negative and no cough impulse was elicited. Systemic examination was otherwise unremarkable. Routine laboratory investigations were largely within normal limits except for peripheral eosinophilia. A diethylcarbamazine provocation test demonstrated microfilariae on peripheral smear, supporting the diagnosis.4 Scrotal ultrasonography showed multiple dilated, anechoic tubular channels extending towards the inguinal region, without internal vascularity or solid components, consistent with lymphatic dilatation Figure 1. The filarial dance sign was not visualised, a finding that may be absent in localised or chronic disease.3 Circulating filarial antigen testing was positive, confirming active infection. Semen analysis revealed no abnormalities.Figure 1: Ultrasound of the scrotum suggestive of dilated, anechoic lymphatic channels (lymphangiectasia) around the testis with scrotal wall thickening and minimal hydrocele – findings corresponding to lymphangiectasia secondary to scrotal filariasisThe patient was treated with oral diethylcarbamazine at a dose of 6 mg/kg/day for 12 days, along with antihistamines and scrotal support, in line with established treatment recommendations.5 At 1-month follow-up, there was a marked reduction in scrotal swelling with significant symptomatic improvement. Repeat ultrasonography demonstrated regression of the dilated lymphatic channels, and nocturnal peripheral smear was negative for microfilariae. By 2 months, near-complete clinical resolution had occurred, with no residual functional limitation. This case underscores the need for clinical vigilance when evaluating isolated scrotal swellings in individuals from endemic regions. Awareness of such atypical presentations allows timely medical management and may prevent progression to chronic, irreversible disease.1,5 Authors’ contributions BP: Responsible for data collection, patient care and initial case management. Contributed to the interpretation of clinical findings and drafted the manuscript. MS: Supervised the study, critically reviewed the manuscript for intellectual content, and ensured clinical accuracy of patient management. PA: Supervised the study, reviewed and revised the manuscript and contributed to patient care and clinical decision-making. DP: Drafted the manuscript, participated in patient care and coordinated communication with co-authors, assisted in literature review and manuscript structuring. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Parmar et al. (Thu,) studied this question.