ABSTRACT
Lymphedema of filarial origin affecting the vulva is extremely rare. It is a dilemma if seen in a pregnant woman as there are no guidelines regarding excision and the mode of delivery. With the World Health Organization-driven global program to eradicate filaria, it is unfortunate to see such cases. We report of a woman who had massive lymphedema of both the labia majora following filarial infection with a small secondary ulcer. She presented to our outpatient department in early pregnancy. After detailed counseling with the couple, a decision was taken for excision. The same was carried out. The wound healed well but the lymphedema recurred after 6 weeks. She was thereafter managed symptomatically. Pregnancy advanced without any complication. Her intrapartum management for a successful vaginal delivery is outlined in the report.
Subject(s)
Filariasis/surgery , Lymphedema/surgery , Pregnancy Complications, Parasitic/surgery , Vulvar Diseases/surgery , Adult , Female , Humans , PregnancyABSTRACT
Wilson's disease is an autosomal recessive genetic disorder affecting copper transport leading to hepatic and/or neuropsychiatric manifestations. Changes in pregnancy can mimic certain clinical features of chronic liver disease such as spider naevi, and constraints for the use of various investigation for diagnosis pose a challenge to physicians. A high index of suspicion, multi-disciplinary team approach, use of correct non-invasive testing including viral serology, autoantibodies and copper studies and ultrasonography help to diagnose most of the pre-existing, de novo or pregnancy-specific hepatological conditions. We report a case of Wilson's disease diagnosed during pregnancy and discuss the challenges in diagnosis and treatment in pregnancy.
