A Rare finding of Microfilaria in Pus sample of an ulcer over Elephantiasis Leg
Abstract:
Skin ulcerations are a significant cause of morbidity and can be challenging to manage. Among the various causes of chronic non-healing ulcers, lymphedema is also considered a possible diagnosis in countries such as Nepal. Lymphatic filariasis has been a significant public health issue in endemic areas. Wuchereria bancrofti is a common nematode parasite that causes lymphatic filariasis. Excessive retention of lymphatic fluid in the interstitial compartment can cause localized tissue swelling, known as lymphedema, which is caused by impaired lymphatic drainage. Microfilariae can be detected in peripheral blood, body fluids, and needle aspirates. Microfilaria is not commonly found in ulcers on elephantiasis legs. We discuss here a case of 73 year old women with elephantiasis legs with pus discharging ulcers in the thighs. Microscopic examination of pus discharge revealed microfilaria which highlights the importance of pus examination as diagnostic modality in endemic countries.     
Introduction:
 Chronic non-healing ulcers pose a significant challenge for healthcare     professionals in the Departments of Dermatology and Surgery.  While venous disorders account for the majority of cases, approximately 30% of chronic ulcers result from various vascular disorders, including diabetes, malignant ulcers, traumatic      ulcers, and chronic lymphedema (2). Lymphatic filariasis remains a public health concern in several regions of South-East Asia.  While a decline in prevalence is notable, isolated cases of lymphedema and elephantiasis persist (3).  Nearly 63% of 1.34 billion people worldwide are at risk of LF, and about 50% of the 120 million infected people live in the South-East Asia Region. This region bears approximately 57% of the total global burden of an estimated 5.1 million disability-adjusted life years (DALYs) lost due to LF. (4)    Lymphatic filariasis is a progressive condition that significantly impacts both the physical and psychological well-being of affected patients, resulting in a considerable reduction in their quality of life (5). It remains a debilitating parasitic disease (6).
Apart from the blood and lymph node aspirate, microfilaria can also be isolated in fine needle aspirates from various samples, as well as from chyluria, chylous ascites, and hydrocele fluid (6).
Case report:
A 73-year-old female patient was admitted with complaints of bilateral leg swelling persisting for the past 53 years. (Figure 1)