Potash alum-induced chemical vaginitis masquerading as vulvovaginal malignancy: a case report on the perils of digital health misinformation

Abstract

Abstract Background Vaginal discharge is a common gynecological complaint among women of reproductive age in low- and middle-income countries, including Nepal. However, formal healthcare utilization remains low due to stigma and access barriers. This creates conditions favorable to self-medication based on unverified social media content. Case presentation A 33-year-old multiparous woman presented with severe lower abdominal pain and progressive vulval swelling for three days, with chronic whitish vaginal discharge for several months, but had not sought medical care due to shame. Directed history-taking revealed self-insertion of solid potash alum fragments into the vaginal canal after watching a social media video recommending it as a home remedy. On examination, the vaginal introitus was narrowed with wart-like lesional changes, diffuse mucosal exfoliation, blackish flaky discharge, and a hard, irregular intravaginal mass, raising initial suspicion for vulvovaginal malignancy, condyloma acuminata, or retained foreign body. Investigations showed leukocytosis with neutrophilia; abdomen and pelvis ultrasonography was normal. A 2 × 2 cm alum fragment was retrieved under aseptic precautions. The vaginal canal was irrigated with normal saline; empirical broad-spectrum antibiotics and intravenous analgesia were administered. The patient was discharged on day four. At one-week follow-up, mucosal healing was complete, and discharge had resolved. Pap smear was negative for intraepithelial lesion or malignancy. Histopathological examination showed degenerated tissue with foreign particles and no evidence of granuloma, dysplasia, or malignancy, confirming chemical injury from the self-inserted alum. Conclusions Self-insertion of solid potash alum caused severe chemical vaginitis closely mimicking vulvovaginal malignancy. Digital health misinformation poses direct patient safety risks, and non-judgmental elicitation of self-treatment history is essential in atypical gynecological emergencies.