Monday, October 15, 2007


You decide to do some international work in India and at one of the clinics, you see this man. He is about 40. He says that he has had this for a while. The tissue is hard to the touch. He says that he came in today because his urine was milky white. Blood tests show eosinophilia.

Challenge: What is the diagnosis? What is the causative agent?

Image is in the public domain.


Alex said...

elephantiasis... do you get all your images from wiki?

Craig said...


Lymphatic filariasis can be caused by the nematodes Wuchereria bancrofti, Brugia malayi, or Brugia timori. Both W. bancrofti and B. malayi exist in India, but the former is most common. Several mosquito species act as vectors for transmitting infective larvae via bite which then travel to the lymphatics. The adult parasite cannot replicate within the human host, but can produce microfilariae which can be taken up by mosquito bite to become infective larvae. To diagnose, blood should be drawn at night due to nocturnal periodicity of the microbes; a Wright or Giemsa stain will show microfilariae. Lymphedema occurs due to chronic inflammation of the lymphatic vessels; if the inguinal nodes are involved, then swelling occurs in the lower limbs and if axillary nodes are involved, swelling occurs in the upper limbs. Severe lymphadenopathy is called elephantiasis. If renal lymphatics are involved, lymph fluid may be passed in the urine, called chyluria.

Proteus syndrome (the title of this case) is an extremely rare congenital disorder involving skin overgrowth, atypical bone development, and tumor formation. The “elephant man” Joseph Merrick had Proteus syndrome, hence its connection to this case of elephantiasis.

Sources: Wikipedia, UpToDate.