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Elephantiasis nostras verrucosa

Authors:
Halis Kaan Akturk
Halis Kaan Akturk
Halis Kaan Akturk
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Maryam Gbadamosi-Akindele
Maryam Gbadamosi-Akindele
Maryam Gbadamosi-Akindele
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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Elephantiasis nostras verrucosa
Halis Kaan Akturk, Maryam Gbadamosi-Akindele
Department of Internal
Medicine, Creighton University
Medical Center, Omaha,
Nebraska, USA
Correspondence to
Dr Halis Kaan Akturk,
kaanakturk@yahoo.com
Accepted 9 March 2014
To cite: Akturk HK,
Gbadamosi-Akindele M.
BMJ Case Rep Published
online: [please include Day
Month Year] doi:10.1136/
bcr-2013-200363
DESCRIPTION
A 63-year-old obese man presented with worsening
lower leg oedema, fever and chills. Physical exam-
ination revealed non-pitting oedema and hyperker-
atotic papulonodules with a verrucose appearance
in lower extremities, especially at posterior tibial
side (figure 1). Oedema sites were warm and red.
He had a history of colon cancer treated 8 years
ago with surgery and radiotherapy to the lower
abdomen. Chronic lymphoedema developed after
radiotherapy in both lower extremities (figure 2).
He had multiple hospital admissions due to cellu-
litis related to lower leg oedema. He was treated
with intravenous antibiotics and discharged with
recommendations of elevation of the limbs and
wound care.
Elephantiasis nostras verrucosa is a rare, disfigur-
ing complication of longstanding chronic lymphoe-
dema.
1
It is characterised by marked oedema of the
affected extremity, generalised thickening and liche-
nification of the skin.
2
Disruption of the lymphatic
system after trauma, surgery or radiation is the most
common cause of chronic lymphoedema. Recurrent
soft tissue infections also induce fibrosis and worsen
the condition.
3
Congenital, traumatic or surgical
disruption of lymphatic vessels, venous stasis, radi-
ation, neoplastic obstruction, portal hypertension,
obesity and congestive heart failure are the precipi-
tating factors of this disease.
23
The diagnosis is
based on the history and the peculiar skin changes.
Treatment options include use of elastic bandages,
pneumatic stockings, mechanical massage, oral
retinoids and surgery. The goal of the therapy is
to re-establish function and to reduce physical
disability. Oral retinoids were used successfully in
some case series. For refractory cases, microsurgical
lymphovenous anastomosis can be used.
Amputation should be the last option.
Learning points
▸Elephantiasis nostras verrucosa is a serious
complication of longstanding chronic
lymphoedema.
▸Soft hyperkeratotic verrucose appearance
distinguishes this lesion from the oedematous
site.
▸Prompt diagnosis is needed to prevent
disability and recurrent infections.
Contributors Both the authors were actively involved in patient
care and the preparation of the manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer
reviewed.
REFERENCES
1 Sisto K, Khachemoune A. Elephantiasis nostras verrucosa: a review.
Am J Clin Dermatol 2008;9:141–6.
2 Vaccaro M, Borgia F, Guarneri F, et al. Elephantiasis nostras
verrucosa. Int J Dermatol 2000;39:764–6.
3 Yoho RM, Budny AM, Pea AS. Elephantiasis nostras verrucosa.
J Am Podiatr Med Assoc 2006;96:442–4.
Figure 1 Left ankle and posterior tibial area.
Figure 2 Chronic lymphoedema in lower extremities.
Akturk HK, et al.BMJ Case Rep 2014. doi:10.1136/bcr-2013-200363 1
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2 Akturk HK, et al.BMJ Case Rep 2014. doi:10.1136/bcr-2013-200363
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... A elefantiase nostra verrucosa (ENV) é uma consequência rara e desfigurante do linfedema crónico de longa duração. [1][2][3][4] Caracteriza-se pelo espessamento e liquenificação da pele em associação a edema exuberante, observando-se frequentemente lesões hiperqueratósicas, verrucosas e papilomatosas na área afetada. 1,2,5,6 A ENV pode ocorrer em qualquer localização anatómica, sendo, no entanto, mais habitual nas extremidades dos membros inferiores. ...
... [1][2][3][4] Caracteriza-se pelo espessamento e liquenificação da pele em associação a edema exuberante, observando-se frequentemente lesões hiperqueratósicas, verrucosas e papilomatosas na área afetada. 1,2,5,6 A ENV pode ocorrer em qualquer localização anatómica, sendo, no entanto, mais habitual nas extremidades dos membros inferiores. 2,3,6 Numa fase inicial ocorre linfangite recorrente com aumento do volume da área afetada. ...
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... Diethylcarbamazine citrate (DEC) is the effectively used drug for treatment which is capable of disintegrating the adult W. bancrofti, B. malayi, and B. timori [9,25,29,30,33,35,39,40]. It rapidly disintegrates the microfilariae but disintegrates the adult worms slowly and incompletely. ...
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Elephantiasis nostras verrucosa
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