Vulval lymphangiomata secondary to tubercular inguinal lymphadenitis with HIV

P Madavamurthy; Nadiga Rajashekhar; Chatura; Sugareddy; Prashanth Kumar Desai

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Year : 2008 \| Volume : 29 \| Issue : 1 \| Page : 37-39

Vulval lymphangiomata secondary to tubercular inguinal lymphadenitis with HIV

P Madavamurthy, Nadiga Rajashekhar, Chatura, Sugareddy, Prashanth Kumar Desai
Department of Dermatology, Venereology and Leprosy, J. J. M. Medical College, Davangere, Karnataka, India

Correspondence Address:
P Madavamurthy
Department of Dermatology, Venereology and Leprosy, J. J. M. Medical College, Davangere-577 004, Karnataka
India

Source of Support: None, Conflict of Interest: None

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Abstract

Acquisition of vulval lymphangiomata is a rare occurrence; clinically characterized by the presence of circumscribed eruptions of thin walled, translucent vesicles. Here, we report a case of 18-year-old HIV-positive female with multiple smooth to warty, flesh colored papules and nodules covering labia and mons pubis with bilateral inguinal linear puckered scars with enlarged right cervical group of lymph nodes. Our case is unique because of its association with HIV.

Keywords: HIV positive, tubercular inguinal lymphadenopathy, vulval lymphangiomata

How to cite this article:
Madavamurthy P, Rajashekhar N, Chatura, Sugareddy, Desai PK. Vulval lymphangiomata secondary to tubercular inguinal lymphadenitis with HIV. Indian J Sex Transm Dis 2008;29:37-9

How to cite this URL:
Madavamurthy P, Rajashekhar N, Chatura, Sugareddy, Desai PK. Vulval lymphangiomata secondary to tubercular inguinal lymphadenitis with HIV. Indian J Sex Transm Dis [serial online] 2008 [cited 2023 Dec 10];29:37-9. Available from: https://ijstd.org/text.asp?2008/29/1/37/42715

Lymphangioma circumscriptum is a rare congenital malformation of the lymphatic system, characterized by persistent multiple clusters of translucent vesicles containing clear lymph fluid. Acquisition of vulval lymphangiomata is a rare occurrence; clinically characterized by the presence of circumscribed eruptions of thin walled, translucent vesicles.^[1] However, epithelial changes and tissue organization may occasionally give rise to firmer nodules or even warty lesions, seen in association with scarring process due to recurrent infections,^[2] radiotherapy, or surgeries.^[3] We report such a case of vulval lymphangiomata due to tubercular inguinal lymphadenopathy in a HIV-positive patient.

Case Report

An 18-year-old female patient presented to our OPD with complaints of genital lesions since one year. The patient had a history of fever and cough along with multiple swellings and ulcerations over both the inguinal regions. On examination, smooth to warty, flesh colored papules, vesicles, and nodules covering labia majora and mons pubis were present [Figure 1]. Bilateral inguinal puckered scars were present. Right cervical group of lymph nodes were enlarged, tender, and matted. Laboratory investigations showed routine blood and urine examinations within normal limits. HIV was reactive (by capillus, tridot, and Coombs methods), and Venereal Disease and Research Laboratory test as well as HbsAg were nonreactive. Chest X-ray showed resolving TB, FNAC of right cervical lymph nodes showed TB lymphadenitis, Mantoux showed strong positivity [Figure 2]. CD4 cell count was 515 cells/cumm. Histopathology showed acanthosis, papillomatosis, and hyperkeratosis of epidermis, dilated thin walled lymphatic channels in the superficial papillary dermis [Figure 3], dense infiltrate of lymphocytes and neutrophils in the dermis, and scattered neutrophils, plasma cells, and pigmented macrophages. The patient was initially treated with isoniazid 300 mg, rifampicin 450 mg, pyrazinamide 1500 mg, and ethambutol 800 mg for two months and subsequently with two drugs, isoniazid 300 mg and rifampicin 450 mg. The lesions regressed initially with one month treatment and thereafter remained static [Figure 4]. The patient was followed up for four months.

Discussion

Acquired or secondary lymphangioma arise following damage to previously normal deep lymphatic vessels.^[4] In lymphangioma circumscriptum, dilated superficial lymphatics occur due to a congenital anomaly of the deep dermal and subcutaneous lymphatics. The pathogenesis of lymphangioma circumscriptum was studied by Whimster, who concluded that large lymphatic vessels running mainly vertically through the dermis transmit pressure from underlying abnormal cisterns that do not communicate with the deeper dermal lymphatics, and therefore form a closed system.^[5] Lymphangiomas can be congenital or can be acquired from local factors, such as surgery, neoplasms (including lymphoma), radiotherapy,^[3] erysipelas, lymphogranuloma venereum, tuberculosis, or filariasis.^[6] They are most often observed in the areas of neck, upper trunk, tongue, and proximal extremities.^[7] Lymphangioma of the vulva are also described following cancer treatment, tuberculous inguinal lymphadenopathy,^[8] and genital involvement with Crohn's disease.^[9] Our case is following tubercular inguinal lymphadenopathy in association with HIV. Histopathologically also, it satisfies required findings consistent with acquired lymphangioma. Other treatment modalities include radical surgery, intralesional administration of sclerosant, for example, doxycycline^[10] or picibanil^[11] (OK-432), simple electricautery, and vaporization with CO₂ laser.^[12] Recognition and appropriate treatment of vulval lymphangioma is important, primarily because the lesions may act as portals of entry for infections and secondarily to prevent complications. In addition, persistent leakage of lymphatic fluid, the cosmetic appearance, and the social repercussions of misdiagnosis as a STD may all pose significant problems.

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