Elephantiasis Verrucosa Nostrum

A 62-year-old obese woman with adult-onset type 1 diabetes mellitus had a 6-year history of bilateral leg edema. During the last year, the edema worsened and the skin on her legs thickened. She also had multiple, bilateral, painful, superficial ulcers that drained copiously. Based on the history and presentation, LT Michael E. Herman, MD, of the Naval Hospital in Jacksonville, Fla, diagnosed elephantiasis verrucosa nostrum. Also called elephantiasis nostras, “mossy leg,” and lymphangitis recurrens elephantica, this condition results from obstructive disease of the lymphatic system that causes progressive enlargement, coarsening, corrugation, and fissuring of the skin and subcutaneous tissue. Diagnostic clues include a history of recurrent infection (as seen in this patient), surgery, trauma, or radiation therapy to the area. Characteristic features are an often grossly swollen affected site with marked, nonpitting edema from dermal fibrosis and thickened skin that has a cobblestone appearance and verrucous changes. When the clinical diagnosis is in doubt, lymphangiography and skin or lymph node biopsy may be helpful. To prevent recurrent lymphangitis, edema and infection need to be controlled. Manage recurrent infections with antibiotics. Counsel the patient to elevate the affected leg whenever possible, to use compression stockings, and to maintain good personal hygiene. Pneumatic pumps may provide relief as well.