Elephantiasis nostras verrucosa secondary to recurrent erysipelas

Description

A 79-year-old man presented with worsening lower leg oedema, nausea, prostration, fever and chills. He had history of several episodes of erysipelas during 10 years, chronic venous insufficiency and type 2 diabetes mellitus. Physical examination revealed lesions of a mossy and verrucose appearance, with exophytic and agglomerated lesions on the left lower limb (figure 1). The dermatological findings of epidermal thickening, lymphoedema and fibrosis of the dermis and subcutaneous tissue were consistent with the final stage of erysipelas in the rare form of elephantiasis nostras verrucosa (ENV). The patient received intravenous furosemide and heparin to control oedema and to prevent deep vein thrombosis and antibiotic therapy.

Figure 1

Detailed view of verrucose and exophytic lesions on the left lower limb of the patient.

ENV is a serious complication of chronic lymphoedema that causes progressive cutaneous hypertrophy.1 Lymphoedema, if left untreated,...

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