Abstract

Elephantiasis nostras verrucosa, also described as non-filarial elephantiasis, is a rare cutaneous manifestation of chronic lymphedema. This is a reactive condition that can arise in the setting of congestive heart failure, malignancy, infection, and others. Blockage of lymphatic channels, usually affecting the lower limbs, leads to progressive edema of the affected limb with an increase in limb diameter, woody induration, and a cobblestone appearance. Late lesions can also develop verrucoid papules which, when florid, can raise concern for malignancy such as squamous cell carcinoma. Here we describe the case of a 66-year-old male patient with chronic lower limb lymphedema secondary to congestive heart failure, obesity, and poor mobility. Following left knee arthroplasty, the patient developed multiple prominent nodular growths around the surgical scar, measuring up to 1.7 cm in the greatest dimension. The appearance was concerning for malignancy clinically and debridement was performed. The excision specimen showed epidermal papillomatosis and hyperkeratosis, dermal fibrosis, and prominent dilated vascular and lymphatic channels. The histologic appearance was consistent with a florid manifestation of chronic lymphedema, most compatible with elephantiasis nostras verrucosa. This case highlights the rare entity, elephantiasis nostras verrucosa, and describes an unusual presentation of proliferative nodules at the site of prior surgery.

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