Elephantiasis nostras verrucosa
Repetitive streptococcal infections are thought to be a factor in the pathogenesis of elephantiasis nostras verrucosa. A more significant cause is obesity. Lymphedema of obesity is simply due to poor lymphatic return. The massive increase of tissue in obese people acts as an impediment to lymphatic drainage, which is already compromised due to decreased muscular activity and peripheral vascular disease. These effects are further compounded by bacterial lymphangitis.
Elephantiasis nostras verrucosa is a progressive condition that, left untreated, results in ongoing deformity and disability. Complications include swelling, lymphorrhea, infection, and poor wound healing.
This condition should not be confused with elephantiasis secondary to parasitic infection with filarial worms (filariasis), Wucheria bancrofti, Brugia malayi, and Brugia timori, all of which are transmitted by a mosquito bite. A history of travel to Southeast Asia or Sub-Saharan Africa should indicate lymphatic filariasis.
I89.0 – Lymphedema, not elsewhere classified
61624008 – Elephantiasis nostras
- Venous stasis dermatitis – Dilated superficial leg veins, skin induration (classic inverted champagne bottle).
- Pretibial myxedema – Bilateral nodules or plaques are present on the pretibial area bilaterally.
- Filariasis – Lymphedema is present in lower limbs and possibly genitals and is accompanied by history of foreign travel.
- Lymphangioma circumscriptum
- Acquired lymphangiectasia
- Tuberculous lymphangitis (see tuberculosis)
- Deep venous thrombosis