Homoeopathic intervention in chronic elephantiasis-case report

Dr Karthik KS

Abstract
Lymphatic filariasis is a chronic parasitic disease caused by filarial nematodes, primarily Wuchereria bancrofti, and less commonly Brugia malayi and Brugia timori. The infection is transmitted to humans through the bite of infected mosquitoes, predominantly of the genera Culex, Anopheles, and Aedes. Adult worms reside in the lymphatic vessels and lymph nodes, where they induce inflammatory reactions, lymphatic obstruction, and progressive impairment of lymphatic drainage.

The clinical manifestations of lymphatic filariasis range from asymptomatic microfilaremia to acute adenolymphangitis and chronic sequelae such as lymphedema, hydrocele, and elephantiasis involving the limbs, genitalia, or breasts. Chronic disease is marked by irreversible lymphatic damage, fibrosis, skin thickening, and recurrent secondary bacterial infections, leading to substantial physical disability, psychological distress, and social stigma.

Lymphatic filariasis remains a major public health concern in tropical and subtropical regions, particularly in South-East Asia, including India. It is recognized by the World Health Organization as one of the leading causes of permanent disability worldwide. Despite ongoing global elimination programs, advanced and chronic cases continue to pose therapeutic challenges, emphasizing the need for effective long-term morbidity management strategies.

This case report describes a 70-year-old female presenting with chronic swelling and pain of the right lower limb. Individualized homoeopathic management was initiated, with Hydrocotyle asiatica prescribed based on pathological indications, followed by Arsenicum album according to the totality of symptoms. The patient demonstrated significant reduction in pain, itching, and skin thickening, suggesting a potential role for homoeopathy in the supportive management of advanced lymphatic disorders.

Key words: Elephantiasis, homoeopathy, hydrocotyle, case report, arsenicum album

Introduction

• Filariasis is a major global health concern, with over 1.3 billion people at risk in 72 countries.
• Approximately 65% of infected individuals reside in the WHO South-East Asia region, with a higher prevalence observed in women.
• The condition progresses from initial pitting edema to permanent, non-pitting subcutaneous fibrosis and hyperkeratosis.
• Elephantiasis is a chronic, progressive condition characterized by massive enlargement, thickening, and fibrosis of skin and subcutaneous tissues, most commonly affecting the lower limbs, genitalia, breasts, or upper limbs.
• It results from long-standing lymphatic obstruction leading to chronic lymphedema.¹

Etiology^2,3

Elephantiasis may be parasitic or non-parasitic in origin.

1. Filarial Elephantiasis (Most common)

Caused by lymphatic filarial worms:

• Wuchereria bancrofti (most common worldwide)
• Brugia malayi
• Brugia timori

Transmission occurs through mosquito vectors (Culex, Anopheles, Aedes).

2. Non-filarial Causes

• Congenital lymphatic dysplasia (primary lymphedema)
• Recurrent bacterial lymphangitis
• Tuberculosis of lymph nodes
• Malignancy causing lymphatic obstruction
• Post-surgical or post-radiation lymphatic damage
• Podoconiosis (non-filarial elephantiasis due to chronic barefoot exposure to irritant soils)

Pathogenesis^4,5

• Adult filarial worms reside in lymphatic vessels, causing inflammation and obstruction
• Repeated episodes of acute adenolymphangitis
• Progressive lymphatic damage → chronic lymphedema
• Secondary bacterial infection leads to fibrosis, skin thickening, hyperkeratosis
• Final stage results in elephant-like appearance

Clinical Features

Early Stage

• Asymptomatic microfilaremia
• Recurrent fever with lymphangitis
• Pitting edema

Chronic Stage (Elephantiasis)

• Non-pitting edema
• Marked enlargement of affected part
• Thickened, rough skin with hyperkeratosis
• Papillomatosis and fissures
• Common sites:
  • Legs (most common)
  • Scrotum (hydrocele)
  • Penis, vulva, breasts

Diagnosis

• Peripheral blood smear (microfilariae – nocturnal periodicity)
• Circulating filarial antigen tests
• Ultrasonography (filarial dance sign)
• Lymphoscintigraphy (lymphatic obstruction)
• Clinical diagnosis in advanced cases

Management^2,3

Medical Treatment

• Diethylcarbamazine (DEC) – drug of choice
• Albendazole ± ivermectin (mass drug administration)
• Antibiotics for secondary infection

Supportive Management

• Limb hygiene and skin care
• Compression therapy
• Limb elevation
• Physiotherapy

Surgical Management

• Indicated in advanced genital elephantiasis
• Hydrocelectomy or debulking procedures

Prevention

• Vector control
• Mass drug administration programs
• Early treatment of filariasis
• Proper limb hygiene to prevent secondary infection

CASE DETAILS

Patient named Mrs.Z, aged 70 years, presented to the OPD of Government Homoeopathic Medical College and hospital, Bangalore on 24 June 2025, with the complaints of pain, itching and swelling in the right lower limb for 13 years, with acute aggravation over the last 15 days.

​History of Present Illness: Symptoms began 13 years ago after the patient was drenched in rain while traveling. Previous allopathic treatments (including Ivermectin) provided temporary relief but the condition recurred.

​Comorbidities: History of hypertension, atrial fibrillation, and acute decompensated heart failure.

Negative History: No history of trauma, injury, insect bite, wound, systemic signs of infection, recent surgery, prolonged immobility, calf tenderness, visible tortuous vein

Past history: Vaccinated. Surgical History-Hysterectomy 15 years ago (? menorrhagia, fibroid uterus)

Family history:

Father – Dead, Alcoholic liver disease

Mother – Dead, old age

Maternal and paternal grandparents– Dead, Natural death

Siblings – 4 younger brother-2 Alive –apparently healthy,2dead unknown cause.2younger sister –Alive apparently healthy.

Personal history

• Diet: mixed
• Appetite: good
• Thirst: Thirsty,2-3 ltrs/day
• Desires: Tea
• Aversion: nothing specific
• Bowel habits: regular, once/day, no discomfort
• Bladder habit: 4-5 times/ day, once/night, non- offensive, no discomfort. Sleep: disturbed (because of pain, itching)
• Dreams: nothing specific
• Perspiration: on exertion, non-offensive
• Thermals: Chilly
• Addictions: nil

Life Space Investigation:

The patient is from Sira, Tumkur, and comes from a middle-class family. Family is very important to her, especially her children. She is very attached to her son and depends a lot on him emotionally. Her happiness and peace of mind are closely linked to his well-being, particularly his future and marriage.

She is emotionally sensitive and gets upset easily. When she experiences pain, sadness, or emotional stress, she starts crying, and after crying she feels some relief. She often worries about her health and keeps thinking that her illness may get worse.

She frequently thinks about past sad events, especially the death of her husband. When she remembers him, she starts crying and then becomes quiet and withdrawn. She also has a strong fear of dead people and death. Overall, she feels anxious about the future, remains fearful and insecure, and depends a lot on her loved ones for emotional support and reassurance

General Physical Examination:

• Orientation: well oriented with time, place and person
• Built and nourishment: moderately built and poorly nourished. Weight: 65kg, Height – 4’6, BMI – 20 Kg/m²
• No signs of pallor, cyanosis, Clubbing, icterus.
• Inguinal lymph nodes are enlarged, mild pain
• Mouth, Eyes, Nose, throat, nails: NAD

Systemic examination:

• Respiratory system: bilateral normal vesicular breath sounds heard.
• CVS: S1, S2 Heard, no murmurs
• GIT: bowel sounds heard, no tenderness in abdomen
• CNS: reflexes normal, gait normal

Local examination:

Inspection

• Site and extent of Swelling-Right lower limb, foot to knee
• Skin Changes-Hyperkeratosis

Fissuring, scaling

No ulceration

Reddish black discoloration

• Toe involvement
• Asymmetry compared to left
• No scars or discharging sinus

 Palpation

• Temperature-warmth compared to left limb
• Tenderness
• Consistency –hard
• Non pitting edema
• Skin thickness
• Inguinal lymph nodes –vertical and horizontal group enlarged

 Movements-Restricted

LAB INVESTIGATIONS DONE

CBC-WBC:11200cumm, Eosinophils:8%

PPBS-149mg/dl

Blood urea-22mg/dl

1. Creatine-0.81mg/dl

Ultrasound of abdomen and pelvis on 8/6/25- Nothing abnormality detected

Doppler study on 8/6/25-Screening for DVT: No evidence of DVT both lower limbs.

Diagnosis⁶:  ICD-10 Diagnosis: I89.0 – Elephantiasis of right lower limb

Analysis of symptoms:(Table 1)

Common Symptoms	Uncommon Symptoms
• Pain and swelling in right lower limb • Pain aggravation motion, morning, night • Pain amelioration by rest	• Pricking pain • Thirsty • Chilly

Table 2: Evaluation of symptoms

Mental generals	Physical generals	Characteristic particulars
Anxiety about health Thinks about past sad events Fear of dead bodies and death Restlessness	Thirsty Chilly	Pain amelioration by tight bandage

 Totality of Symptoms:

• Anxiety about health
• Thinks about past sad events
• Fear of dead bodies and death
• Restlessness
• Thirsty
• Chilly
• Pain and swelling in right lower limb
• Pain > Tight bandage

Non reportorial approach:

Selection of remedy: HYDROCOTYLE ASIATICA

 Indications:⁷

• Curative in disorders that exhibit interstitial inflammation
• Great thickening of epidermoid layer and exfoliation of scales
• It is supposed to influence on leprosy, elephantiasis

 Prescription: 24/06/25

Rx

1.HYDROCOTYLE ASIATICA 30 TID/4days

2.CF 6X TID/5DAYS

Selection of Repertory: Synthesis Repertory

Justification: Based on Totality

• Anxiety about health
• Weeping
• Fear of dead bodies and death
• Mental restlessness
• Chilly
• Thirsty
• Pain better by pressure
• Elephantiasis

Interpretation:
A Modified Naranjo (MONARCH) score of 8 suggests a probable causal relationship between the homoeopathic medicine Arsenicum album and the clinical improvement observed in this case of elephantiasis.

Discussion: Lymphatic filariasis in its chronic stage presents with irreversible pathological changes such as lymphatic obstruction, fibrosis, hyperkeratosis, and recurrent inflammatory episodes. In such advanced cases, the scope of conventional treatment is largely palliative, focusing on infection control and symptom suppression. Homoeopathy, through individualized remedy selection based on totality, offers a holistic approach addressing both local pathology and the patient’s constitutional state.

In the present case, the initial prescription of Hydrocotyle asiatica was based on its strong clinical and pathological indications. Hydrocotyle has a well-documented affinity for chronic lymphatic inflammation, thickening of the epidermoid layer, induration, and elephantiasis-like conditions. The patient’s marked skin hypertrophy, non-pitting edema, fissuring, and “tree-trunk” appearance of the limb strongly corresponded to the pathological sphere of this remedy. Administration of Hydrocotyle asiatica 200 resulted in rapid improvement in local symptoms such as pain, itching, and skin texture, indicating correct remedy selection at the pathological level.

However, after significant local improvement, the case evolved, revealing a clearer constitutional picture. Repertorisation at this stage emphasized prominent mental generals such as marked anxiety about the future, fear of dead persons, restlessness, and a weeping disposition, along with physical generals including chilly constitution, thirst, aggravation at night, and burning-pricking pains. These symptoms strongly pointed toward Arsenicum album as the constitutional remedy.

Arsenicum album is a deep-acting antipsoric remedy with a known action on chronic inflammatory states, induration, ulcerative tendencies, and systemic debility. Its sphere of action includes anxiety-driven mental states, fearfulness, and restlessness, particularly in elderly patients with long-standing disease. The administration of Arsenicum album 1M, after careful repertorisation, helped in stabilizing the improvement achieved by Hydrocotyle asiatica and contributed to overall well-being, improved sleep, and absence of new complaints.

This case clearly demonstrates the importance of stage-wise prescribing in homoeopathy—where an organ-specific or pathological remedy may be required initially to reduce gross pathological changes, followed by a constitutional remedy to address the deeper miasmatic and psychosomatic layers of disease. The sequence of remedies was not complementary in the classical sense but was clinically justified based on evolving symptomatology and therapeutic response.

The miasmatic background of the case appeared to be predominantly syco-syphilitic, evidenced by chronic lymphatic obstruction, tissue hypertrophy, induration, and skin changes, with an underlying psoric component expressed through anxiety and hypersensitivity. The combined approach helped in achieving sustained improvement in a condition otherwise considered irreversible.

Conclusion:
This case report demonstrates the potential role of individualized homoeopathic intervention in the management of chronic lymphatic filariasis. Initial prescription of Hydrocotyle asiatica, based on pathological indications, resulted in significant improvement in local symptoms such as pain, itching, skin thickening, and induration. Subsequent constitutional treatment with Arsenicum album, selected after repertorisation, helped sustain clinical improvement and enhanced the patient’s overall well-being.

Limitation: As this is a single case report, the findings cannot be generalized. Objective lymphatic imaging and long-term follow-up were limited.

In accordance with CARE guidelines, this report highlights a patient-centered, stage-wise homoeopathic approach and suggests the need for larger, systematic clinical studies to further evaluate the role of homoeopathy in chronic lymphatic filariasis.

Financial support and sponsorship: None

Conflicts of interest: None declared.

References:

1. World Health Organization. Lymphatic Filariasis [Internet]. WHO; 2023 [cited 2026 Jan 17]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/lymphatic-filariasis
2. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw-Hill Education; 2022. Chapter 230.
3. Park K. Park’s Textbook of Preventive and Social Medicine. 27th ed. Jabalpur: Banarsidas Bhanot Publishers; 2023. p. 289-294.
4. Centers for Disease Control and Prevention. Lymphatic Filariasis: Epidemiology & Risk Factors [Internet]. CDC; 2022 [cited 2026 Jan 17]. Available from: https://www.cdc.gov/parasites/lymphaticfilariasis/index.html
5. Babu S, Nutman TB. Immunopathogenesis of lymphatic filarial disease Immunopathology. 2012;34(6):847–861. doi:10.1007/s00281-012-0346-4 Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3498535/
6. World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems. 10th Rev. Geneva: WHO.
7. Homeopathic Materia Medica: Hydrocotyle Asiatica. Boericke W. Hydrocotyle Asiatica Homoeopathic Materia Medica. Available at MateriaMedica.info. [cited 2025 Sept 17].

8. Synthesis App [mobile application software]. Version 1. ZEUS SOFT. Based on Repertorium Homoeopathicum Syntheticum (Synthesis).
9. Lamba CD, Gupta VK, van Haselen R, Rutten L, Mahajan N, Molla AM, et al. Evaluation of the Modified Naranjo Criteria for assessing causal attribution of clinical outcome to homeopathic intervention as presented in case reports. Homeopathy. 2020;109(4):191-197

Dr. KARTHIK K S
PG Scholar, Department of Homoeopathic Materia Medica Government Homoeopathic Medical College & Hospital, Bengaluru – 560079
Under the Guidance of Dr. RENUKA S PATIL Head of the Department and PG Guide

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