Elephantiasis nostras verrucosa secondary to congestive cardiac failure

Description

A 70-year-old woman with ischaemic cardiomyopathy was admitted and treated for de-compensated congestive cardiac failure (CCF). She had previously received treatment for recurrent episodes of lower limb cellulitis and reported progressively worsening swelling interfering with her daily activities. She had no history of filariasis or Milroy's disease.

Cutaneous examination showed grossly oedematous lower limbs with a woody, indurated feel on palpation (figure 1). There were multiple, tiny verrucous papules interspersed with postinflammatory hyperpigmentation, macerated web spaces and a positive Kaposi-Stemmer sign (figure 2). The patient was treated for CCF and lower limb cellulitis.

Figure 1

Grossly oedematous, erythematous lower limbs with verrucous papules, plaques and a woody indurated feel on palpation.

Figure 2

Positive Kaposi-Stemmer sign (inability to pinch the skin at the dorsal aspect of the base of the second toe).

First...

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