Figure.3 Gram staining of pus showing microfilaria
The patient underwent incision and drainage (I&D) for a right inguinal abscess located under the ulcer. In addition, medical management was provided using steroids (Prednisolone) and Diethylcarbamazine (6mg/kg) (7). There was dramatic improvement in ulcer healing within 3 weeks with minimal  scar. Patient was followed up in 4 months without recurrance and  healed ulcers.
Discussion:
Filariasis is the most common cause of lymphedema worldwide. Around 120 million people are infected, and approximately 40 million have lymphatic problems. The disease is seen in Africa, Southeast Asia, the Western Pacific, the Americas, and the Middle East (8). Transmission and morbidity rates are highest in Southeast Asia and Sub-Saharan Africa. It is caused by Wuchereria bancrofti, Brugia Malayi, and Brugia Timori, and is transmitted by female mosquitoes (Culex, Anopheles, and Aedes). Nearly 90% of microfilariae are of W. bancrofti (6,9). Usually, people residing in endemic zones and being exposed to repeated mosquito bites over several months are required in order to acquire lymphatic filariasis. The majority of infected patients are asymptomatic, while others present with acute symptoms such as fever, headache, malaise, inguinal and axillary lymphadenitis, lymphangitis, cellulitis, abscess formation, and funiculoepididymo-orchitis. In the chronic form, it can lead to the formation of elephantiasis in the legs, arms, scrotum, vulva, penis, and breasts. Chyluria and lymphovarix are rare conditions. Eosinophilia and microfilaremia are common during the acute phase.
Peripheral blood smears stained with   Gram stain, Ziemsa stain, or H&E are crucial for diagnosing microfilaria, as they enable detection in the blood. Differential diagnosis of filariasis should be considered for any lymphedema in an endemic zone, even in the absence of circulating antigens or parasites on laboratory examination.
Conclusion
This case report highlights rare finding of the presence of microfilaria in the pus sample of an ulcer over an elephantiasis leg. Lymphatic filariasis, caused by Wuchereria bancrofti, is a common public health issue in endemic areas. The patient presented with chronic leg swelling, recurrent ulceration, and lymphadenopathy. Microscopic examination of the pus sample revealed the presence of microfilariae. The patient was managed with incision and drainage for abscess, along with medical treatment involving steroids and diethylcarbamazine. This case emphasizes the importance of considering filariasis as a differential diagnosis in chronic non-healing ulcers, particularly in endemic regions, even in the absence of circulating antigens or parasites on laboratory examination. Early detection and appropriate management can be crucial in reducing the morbidity associated with lymphatic filariasis.
Acknowledgements:
Author wants to thank all teaching staff of Department of Dermatology and staffs of Department of Microbiology, Bakulahar Ratnanagar Hospital for their suggestions and constant support to make this work successful.
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Declaration of Conflicting Interests:  The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding:  The author(s) received no financial support for the research, authorship, and/or publication of this article.
Patient consent: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy