Jacobs Journal of Clinical Case Reports

Non-Filarial Elephantiasis, a Case Report with Review of the Literature

*Manuel Lora Gonzalez
Department Of Case Reports, The University Of Kansas, United States

*Corresponding Author:
Manuel Lora Gonzalez
Department Of Case Reports, The University Of Kansas, United States
Email:douglas.mcgregor@va.org

Published on: 2018-06-25

Abstract

A 67 year old male presented to the wound clinic for evaluation of non-healing ulcers and massive edema of the lower extremities. He was an obese male with a history of quadriplegia secondary to septic embolus to the spinal cord. His course had been complicated by recurrent episodes of sepsis, including urosepsis. He routinely followed up at wound clinic for his lower extremity edema and recalcitrant ulcers over a period of years. Five years after his initial spinal cord injury, verrucous plaques began to develop on his inner thighs. The lesions demonstrated a fine scale and were darker than the surrounding tissue. They began as plaques bilaterally and spread slowly over time with formation of satellite lesions followed by coalescence. These lesions appeared to favor areas with prolonged exposure to moisture - remaining on the inner thighs bilaterally and extending to the groin. The primary treatment strategy was moisture reduction with wicking pads changed daily. The lesions did not respond to therapy, and recalcitrant ulcers and osteomyelitis of the left lower leg eventually led to a left above the knee amputation. This did lead to improvement in the verrucous lesions with a moderate reduction in the size of the lesions - presumably related to improved dryness of the area.

Keywords

Non-Filarial Lymphedema; Elephantiasis Nostras Verrucosa; Verrucous

Introduction

A 67 year old male presented to the wound clinic for evaluation of non-healing ulcers and massive edema of the lower extremities. He was an obese male with a history of quadriplegia secondary to septic embolus to the spinal cord. His course had been complicated by recurrent episodes of sepsis, including urosepsis. He routinely followed up at wound clinic for his lower extremity edema and recalcitrant ulcers over a period of years. Five years after his initial spinal cord injury, verrucous plaques began to develop on his inner thighs. The lesions demonstrated a fine scale and were darker than the surrounding tissue. They began as plaques bilaterally and spread slowly over time with formation of satellite lesions followed by coalescence. These lesions appeared to favor areas with prolonged exposure to moisture - remaining on the inner thighs bilaterally and extending to the groin. The primary treatment strategy was moisture reduction with wicking pads changed daily. The lesions did not respond to therapy, and recalcitrant ulcers and osteomyelitis of the left lower leg eventually led to a left above the knee amputation. This did lead to improvement in the verrucous lesions with a moderate reduction in the size of the lesions - presumably related to improved dryness of the area. Biopsy of the plaque demonstrated two pedunculated lesions, confluent at their base, with dermal expansion by fibrocystic cells. There were increased and widened vascular and lymphatic vessels throughout the dermis, but particularly in the superficial dermis. The stroma was variably collagenized and edematous with many stromal cells staining positively for factor XIIIa and CD163. Inflammation was sparse with a mild infiltrate of perivascular lymphocytes. The epidermis was hyperplastic with focal verrucous changes bordering on pseudoepitheliomatous hyperplasia. The changes were considered consistent with verrucous lymphedema.