Rare Form of Chronic Lymphedema: Elephantiasis Nostras Verrucosa

Clinical Image

Volume 4, Issue 1 (January Issue)

Rare Form of Chronic Lymphedema: Elephantiasis Nostras Verrucosa

Eyad Cheikh¹ and Sumanth Kumar Bandaru^2,3,4*

¹Medstar Harbor Hospital, Infectious Disease, USA

²Medstar Harbor Hospital, Internal Medicine, Baltimore, USA

³Medstar Union Memorial Hospital, Baltimore, USA

⁴Medstar Franklin Square Hospital, Baltimore, USA

^*Corresponding author: Sumanth Kumar Bandaru, Department of Internal Medicine, Medstar Harbor Hospital, Medstar Union Memorial Hospital, Medstar Franklin Square Hospital, Baltimore, USA. E-mail: sumanthkumar.bandaru@medstar.net

Received: February 04, 2022; Accepted: February 12, 2022; Published: February 27, 2022

Citation: Cheikh E, Bandaru SK, et al. Rare Form of Chronic Lymphedema: Elephantiasis Nostras Verrucosa. Clin Image Case Rep J. 2022; 4(1): 213.

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Abstract

64-year-old obese man (BMI-34.2) with past medical history chronic kidney disease stage II presented to the emergency department with left lower extremity pain and redness. Patient has been having chronic worsening lymphedema and skin changes of the left lower extremity since 10 years.

On examination patient was found to have chronic lymphedema with erythema and thickened verrucous skin of the left lower extremity. Left leg also had open ulceration with drainage of serosanguineous fluid.

Labs showed increased CRP 95.87, leukocytosis 24.1 and elevated lactic acid of 4.5 which improved with fluid resuscitation. Lower extremity duplex didn’t show any evidence of deep vein thrombosis. Patient was managed with antibiotics and was discharged home to follow-up with lymphedema and wound clinic.

Elephantiasis nostra verrucosa is a rare sequela of chronic lymphedema. Diagnosis usually made clinically based on the history of chronic lymphedema and chronic skin changes. It is characterized by hyperkeratotic popular nodules with cobblestone-like appearance.