Department of dermatology, henry ford health system, detroit, michigan 2. However, histopathologic examination of biopsy speci mens and imaging. Protein, water and waste products are released into tissue in the normal way but a damaged lymphatic system prevents the drainage away and swelling of the affected area results lymphostasis. Elephantiasis nostras verrucosa env is uncommon, arising in the. To our knowledge, this is one of the few cases reported in literature, in which on the background of a graves disease a precipitant factor, as immobility and obesity, determine the impairment of lymphatic flow leading to elephantiasis. Elephantiasis nostras verrucosa, journal of hospital medicine. Elephantiasis nostras verrucosa env is a rare clinical condition associated with. Elephantiasis, also known as lymphatic filariasis, is a very rare condition thats spread by mosquitoes the common name is often used because if you have it, your arms and legs can swell and. Treatment of env remains poorly elucidated but has historically involved conservative management aimed at relieving the underlying lymphedema, with a few cases managed by surgical intervention. The doppler ultrasound was negative, and the biopsy ruled out malignancy and infection. Study of a rare case of elephantiasis nostra in verrucous form on the dorsum of the foot of an 80. Elephantiasis nostras verrucosa secondary to recurrent erysipelas. Elephantiasis nostras verrucosa is used to describe lymphedema of the lower limbs caused by a nonfilarial etiology. Elephantiasis nostras verrucosa env is the progressive disfiguring enlargement of a body part caused by recurrent soft tissue bacterial infections in the setting of chronic secondary lymphedema.
Elephantiasis nostras verrucosa env is a rare clinical condition associated. Elephantiasis nostras verrucosa on the legs with morbid. Various factors can cause obstruction of the lymphatic system and result in env. We describe a case who remained hypothyroid for a long period of time, eventually developed elephantiasic ptm. It is important that physicians recognise this unusual pathology in its initial stage to prevent debilitating deformities and impairment of the involved limb. Elephantiasis nostras is a cutaneous condition, a final hypertrophic fibrosis following longstanding chronic lymphangitis. That rings true whether you are an internist or an orthopaedic surgeon. It is characterised by oedema, hypertrophy, and fibrosis of skin and subcutaneous tissues, due to obstruction of lymphatic vessels. Elephantiasis nostras verrucosa associated with psoriasis in a chinese patient. Characteristic cutaneous signs include profound hyperkeratosis, dermal fibrosis, and lichenification, and a verrucous and papillomatous eruption with a cobblestonelike appearance fig 1. Elephantiasis definition of elephantiasis by medical dictionary. Lymphoedema is the name given to the swelling that occurs because of a damaged or blocked lymphatic system. The idea is not necessarily to know everything every time, but to know how to find what you need know efficiently and with accuracy.
Elephantiasis nostras verrucosa presents as a grossly enlarged and disfigured appendage, most commonly of the lower extremities and feet, with a cobblestone or mossy appearance. Oct 12, 2012 a biopsy is important because of the risk of associated malignancy. Elephantiasis form of ptm which is known as elephantiasis nostra verrucosa env is extreme rare form which is found late in the course of graves disease. Elephantiasis nostras verrucosa usually presents as diffuse nonpitting edema and a hyperkeratotic papulonodule with a verrucous appearance on the lower extremity. Elephantiasis nostras verrucosa represents longstanding obstruction of the lymphatic drainage, leading eventually to grotesque enlargement of the chronically dependent elephantiasis nostras verrucosa on the legs with morbid obesity 3 of 5 picture.
Sep 01, 2009 elephantiasis nostras verrucosa is a rare disorder secondary to chronic noninfectious or recurrent cellulitic lymphedema that results in hyperplastic fibrotic dermal changes. Sep 29, 2017 elephantiasis is also known as lymphatic filariasis. Elephantiasis is also known as lymphatic filariasis. Elephantiasis nostras verrucosa env is a rare, chronic, deforming disorder characterized by hyperkeratosis and papillomatosis of the epidermis with underlying woody fibrosis of the dermis and subcutaneous tissue resulting from chronic nonfilarial lymphoedema. Pdf a case of elephantiasis nostras verrucosa researchgate. A complication of congestive heart failure and obesity drew baird, md, david bode, md, troy akers, do, and zachariah deyoung, md congestive heart failure chf and obesity are common medical conditions that have many complications and an increasing incidence in the united states.
Elephantiasis nostras verrucosas and wound maggots youtube. Excision of elephantiasis nostras verrucosa lesions in a. If you have any concerns with your skin or its treatment, see a dermatologist for advice. The condition is characterized by papules, verrucous lesions, enlargement, and woody fibrosis of the affected area. The disease is caused by the filarial worm, which is transmitted form human to human via the female. Elephantiasis nostras verrucosa of the pannus springerlink. The dermatological findings are consistent with elephantiasis nostras verrucosaa dermatologic disorder secondary to chronic nonfilarial lymphedema caused by bacterial or noninfectious lymphatic obstruction. Elephantiasis is caused by infection with the filarial worm, which is transmitted to humans by the mosquito and lives in the human lymphatic system. True elephantiasis is the result of a parasitic infection caused by three specific kinds of round worms. An institutional analysis of 21 cases article in journal of the american academy of dermatology 646. Its caused by parasitic worms, and can spread from person to person through mosquitoes. A pink or brown hard papules and nodules on both toes and toe webs. Elephantiasis nostras verrucosa radiology reference article. Verrucous lesions arising in lymphedema and diabetic.
The long, threadlike worms block the bodys lymphatic systema network of channels, lymph nodes, and organs that helps maintain proper fluid levels in the body by draining lymph from tissues into the bloodstream. Elephantiasis nostras verrucosa env is the progressive disfiguring. Elephantiasis nostras verrucosa env is a rare cutaneous sequela of chronic lymphedema. Elephantiasis nostra definition of elephantiasis nostra by. Pdf elephantiasis nostras verrucosa env is a rare clinical condition associated. Elephantiasis nostras verrucosa on the legs with morbid obesity 4 of 5. Elephantiasis causes swelling of the scrotum, legs. However, histopathologic examination of biopsy speci. Elephantiasis nostras verrucosa env is a rare form of chronic lymphedema that causes progressive cutaneous hypertrophy. Elephantiasis nostras verrucosa env picture and case. The condition is characterized by papules, verrucous lesions, enlargement, and woody. Apr 29, 2015 the resulting chronic lymphoedema manifests in the skin with discoloration, verrucous deformity, hyperplasia, hyperkeratosis, papillomatosis, and eventually elephantiasis, which is known as elephantiasis nostras verrucosa. The most effective therapeutic drugs are diethylcarbamazine and sodium caparsolate, which kill the adult worms and microfilariae.
The disease usually affects the lower legs or scrotum. Elephantiasis nostras verrucosa, a rare complication of longstanding chronic lymphedema,8 must also be considered as the diagnosis in this case. Infective etiologies include bacterial and fungal infections along with chronic. Dermnet nz does not provide an online consultation service. Elephantiasis nostras verrucosa on the legs and abdomen with. Full text pretibial myxedema mimicking elephantiasis. Elephantiasis nostras article about elephantiasis nostras.
It can lead to severe disfiguration of body parts with gravitydependent blood flow, especially the lower extremities. Elephantiasis refers to a parasitic infection that causes extreme swelling in the arms and legs. Elephantiasis nostras verrucosa env is an uncommon and singular array of dermatologic manifestations that can complicate chronic lymphedema. Additionally, wound maggots were discovered during the evaluation. Elephantiasis nostras verrucosa radiology reference. We present a case of elephantiasis nostras verrucosa in a patient of leprosy with. The pannus completely encircled the patients genitals and left a fibrotic tract from which he urinated. The swelling is accompanied by rough nodules or wartlike plaques on the skin. Successful surgical treatment in a gross deformity.
The skin feels woody, the edema is nonpitting, and does not resolve upon elevation of the extremity. Oct 12, 2012 elephantiasis nostras verrucosa presents as a grossly enlarged and disfigured appendage, most commonly of the lower extremities and feet, with a cobblestone or mossy appearance. If the disease is not treated, it eventually results in pain and immobility. May 11, 2015 the patients medical history and physical examination did not differ from patients presenting with elephantiasis nostra verrucosa living in a nonbancroftian filariasis endemic areas sanders et. Elephantiasis nostras verrucosa american board of family medicine. Elephantiasis nostras verrucosa represents an infrequent clinical entity with cutaneous changes characterized by dermal fibrosis, hyperkeratotic verrucous and papillamotous lesions resulting from. This is the first reported case of elephantiasis nostras verrucosa associated with psoriasis in a chinese. Elephantiasis nostras verrucosa on the legs and abdomen with morbid obesity in an indian lady podila s sarma md 1, ashok ghorpade md mnams 2 dermatology online journal 14 12.
Pdf on oct 12, 2012, rafi fredman and others published elephantiasis nostras verrucosa find, read and cite all the research you need on researchgate. Elephantiasis nostras verrucosa on the buttocks and sacrum of two immobile men hedy g setyadi 1 md, megan reif iacco 2 ba, tor a shwayder 1 md, adrian ormsby 3 md dermatology online journal 17 2. Elephantiasis nostras verrucosa env is a rare and dramatic sequela of chronic nonfilarial lymphedema. The patients medical history and physical examination did not differ from patients presenting with elephantiasis nostra verrucosa living in a non. Elephantiasis nostras verrucosa associated with psoriasis in. Env is a progressive condition, and, without intervention, ongoing deformity and disability will result.
A 49yearold woman with morbid obesity and hypertension presented with extensive areas of redness and weeping sores on her legs. Elephantiasis nostras verrucosa pubmed central pmc. I believe ive made the diagnosis of elephantiasis nostras verrucosa using my medical skill set and the power of observation. The term elephantiasis is often used in reference to symptoms caused by parasitic worm. Sep 10, 2012 elephantiasis nostras verrucosa env is a rare and dramatic sequela of chronic nonfilarial lymphedema. Elephantiasis nostras verrucosa associated with psoriasis. Elephantiasis nostras verrucosa is a rare cause of chronic lymphedema, arising in the setting of chronic nonfilarial lymphedema caused by bacterial or noninfectious obstruction of the lymphatics. This video demonstrates the condition, elephantiasis nostras verrucosas. Purificacion gactosanchez 1, p fernandezortega 1, jj pereyra rodriguez 2 1 department of plastic and reconstructive surgery, virgen del rocio university hospitals, sevilla, spain 2 department of dermatology, virgen del rocio university hospitals, sevilla.