Elephantiasis nostras verrucosa: Swelling with verrucose appearance of lower limbs

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Figure 1
Elephantiasis nostras verrucosa: A) Verrucose, cobblestone-like papulonodules and plaques bilaterally over the lower legs. B) Detailed view of papulonodules and plaques on the right lower limb of the patient.
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Figure 2
Kaposi-stemmer sign
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Figure 3
Magnetic resonance imaging of lower limb lymphedema: Note the thickening of the skin and honeycomb appearance of the subcutaneous tissue (box).

Table 1

Differential diagnosis of elephantiasis nostras verrucosa

DIAGNOSIS	CLINICAL FEATURES
Venous stasis dermatitis	Pitting edema, erythematous to brownish pruritic patches with dilated superficial veins over the medial lower leg^1–3
Lipedema	Early age of onset; positive family history; typically affects overweight women; abnormal accumulation of subcutaneous fat in lower limbs and buttocks; always symmetric and bilateral; feet not affected^1,4,5
Lipodermatosclerosis	Related to venous stasis, hyperpigmentation, and nonpitting edema with subcutaneous fibrosis. Characteristic “inverted wine bottle” appearance: swelling of proximal parts and fibrosis of the distal parts of the lower limbs^1,4
Pretibial myxedema	Caused by hyperthyroidism. Mucin accumulation of the dermis resulting in nonpitting edematous papulonodules or plaques over anterior surface of the legs and dorsal aspect of the feet^1,4
Filariasis	Infection by the parasite Wuchereria bancrofti. History of travel to an endemic tropical area. Obstruction of lymphatic ducts causes secondary bacterial infection. Localized lymphedema in the lower legs and genitals^1,4
Chromoblastomycosis	Chronic fungal infection; fungus is commonly found in soil. Infection through minor trauma of skin. Verrucose papulonodules and plaques. Cultures are positive for fungus⁴