Infective etiologies include bacterial and fungal infections along with chronic. It can lead to severe disfiguration of body parts with gravitydependent blood flow, especially the lower extremities. True elephantiasis is the result of a parasitic infection caused by three specific kinds of round worms. 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. Characteristic cutaneous signs include profound hyperkeratosis, dermal fibrosis, and lichenification, and a verrucous and papillomatous eruption with a cobblestonelike appearance fig 1. 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, journal of hospital medicine. 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.
The term elephantiasis is often used in reference to symptoms caused by parasitic worm. That rings true whether you are an internist or an orthopaedic surgeon. Sep 29, 2017 elephantiasis is also known as lymphatic filariasis. Various factors can cause obstruction of the lymphatic system and result in env. An institutional analysis of 21 cases article in journal of the american academy of dermatology 646.
Elephantiasis nostras verrucosa is used to describe lymphedema of the lower limbs caused by a nonfilarial etiology. Elephantiasis nostras verrucosa represents an infrequent clinical entity with cutaneous changes characterized by dermal fibrosis, hyperkeratotic verrucous and papillamotous lesions resulting from. Elephantiasis nostras verrucosa associated with psoriasis in a chinese patient. Elephantiasis nostras verrucosa radiology reference. However, histopathologic examination of biopsy speci.
Elephantiasis nostras verrucosa env is a rare cutaneous sequela of chronic lymphedema. Elephantiasis nostras verrucosa env is a rare clinical condition associated with. 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. 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. The doppler ultrasound was negative, and the biopsy ruled out malignancy and infection.
Elephantiasis nostras verrucosa env is an uncommon and singular array of dermatologic manifestations that can complicate chronic lymphedema. Env is a progressive condition, and, without intervention, ongoing deformity and disability will result. Elephantiasis nostras verrucosa on the legs with morbid. Elephantiasis is also known as lymphatic filariasis. Elephantiasis nostras verrucosa env is a rare and dramatic sequela of chronic nonfilarial lymphedema. I believe ive made the diagnosis of elephantiasis nostras verrucosa using my medical skill set and the power of observation. The pannus completely encircled the patients genitals and left a fibrotic tract from which he urinated. 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 verrucosa presents as a grossly enlarged and disfigured appendage, most commonly of the lower extremities and feet, with a cobblestone or mossy appearance.
The idea is not necessarily to know everything every time, but to know how to find what you need know efficiently and with accuracy. Full text pretibial myxedema mimicking elephantiasis. Oct 12, 2012 a biopsy is important because of the risk of associated malignancy. If you have any concerns with your skin or its treatment, see a dermatologist for advice.
The patients medical history and physical examination did not differ from patients presenting with elephantiasis nostra verrucosa living in a non. The dermatological findings are consistent with elephantiasis nostras verrucosaa dermatologic disorder secondary to chronic nonfilarial lymphedema caused by bacterial or noninfectious lymphatic obstruction. The disease usually affects the lower legs or scrotum. Elephantiasis nostras verrucosa american board of family medicine. The swelling is accompanied by rough nodules or wartlike plaques on the skin. Elephantiasis nostras verrucosa, a rare complication of longstanding chronic lymphedema,8 must also be considered as the diagnosis in this case. We describe a case who remained hypothyroid for a long period of time, eventually developed elephantiasic ptm.
Elephantiasis nostras article about elephantiasis nostras. Elephantiasis nostras is a cutaneous condition, a final hypertrophic fibrosis following longstanding chronic lymphangitis. Excision of elephantiasis nostras verrucosa lesions in a. Elephantiasis nostras verrucosa associated with psoriasis in.
Elephantiasis causes swelling of the scrotum, legs. 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. Elephantiasis nostras verrucosa secondary to recurrent erysipelas. 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. Elephantiasis refers to a parasitic infection that causes extreme swelling in the arms and legs. This is the first reported case of elephantiasis nostras verrucosa associated with psoriasis in a chinese. Elephantiasis nostras verrucosa associated with psoriasis. 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. 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. 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. 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.
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 on the legs with morbid obesity 4 of 5. It is characterised by oedema, hypertrophy, and fibrosis of skin and subcutaneous tissues, due to obstruction of lymphatic vessels. Lymphoedema is the name given to the swelling that occurs because of a damaged or blocked lymphatic system. Elephantiasis nostras verrucosa usually presents as diffuse nonpitting edema and a hyperkeratotic papulonodule with a verrucous appearance on the lower 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. 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. Elephantiasis nostras verrucosa of the pannus springerlink. Elephantiasis nostras verrucosa on the legs and abdomen with. 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 verrucosa env is the progressive disfiguring. Successful surgical treatment in a gross deformity.
Additionally, wound maggots were discovered during the evaluation. We present a case of elephantiasis nostras verrucosa in a patient of leprosy with. Elephantiasis is caused by infection with the filarial worm, which is transmitted to humans by the mosquito and lives in the human lymphatic system. Study of a rare case of elephantiasis nostra in verrucous form on the dorsum of the foot of an 80. Elephantiasis is the enlargement and hardening of limbs or body parts due to tissue swelling. The condition is characterized by papules, verrucous lesions, enlargement, and woody. The condition is characterized by papules, verrucous lesions, enlargement, and woody fibrosis of the affected area. 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 verrucosas and wound maggots youtube. Elephantiasis nostras verrucosa is a poorly understood disease leading to debilitating deformities. 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.
Dermnet nz does not provide an online consultation service. 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. Pdf elephantiasis nostras verrucosa env is a rare clinical condition associated. 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. If the disease is not treated, it eventually results in pain and immobility. Its caused by parasitic worms, and can spread from person to person through mosquitoes. Elephantiasis nostras verrucosa pubmed central pmc. However, histopathologic examination of biopsy speci mens and imaging.
Elephantiasis nostras verrucosa radiology reference article. The skin feels woody, the edema is nonpitting, and does not resolve upon elevation of the extremity. Department of dermatology, henry ford health system, detroit, michigan 2. Sep 10, 2012 elephantiasis nostras verrucosa env is a rare and dramatic sequela of chronic nonfilarial lymphedema.
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