SHM Converge Scientific Abstract ePoster Gallery-A Rare Complication of Chronic Lymphedema

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A 54-year-old man with a history of intravenous drug use and morbid obesity presented with worsening bilateral lower-leg pain and swelling on a background of chronic edema since a car accident one year earlier. Over several months, he developed progressive skin changes and had previously been treated for presumed cellulitis with antibiotics. He reported no recent travel, animal bites, orthopnea, or shortness of breath. He had not sought medical care during the COVID-19 pandemic and had lost insurance coverage.<br /><br />Workup showed a normal white blood cell count, marked inflammation (CRP 291, ESR 100), severe hypoalbuminemia (albumin 1.7 g/dL), a normal echocardiogram, unremarkable ankle-brachial indices, and CT imaging without abscess or focal fluid collection. Physical examination revealed diffuse verrucous plaques, chronic edema of both lower legs, yellow serous discoloration of the dorsal feet, and malodorous maceration between the toes.<br /><br />Dermatology diagnosed Elephantiasis Nostras Verrucosa (ENV), a rare complication of chronic non-filarial lymphedema characterized by progressive cutaneous hypertrophy. The patient was treated for superimposed soft tissue infection with ceftriaxone and vancomycin, along with topical econazole, gentamicin cream, and acetic acid soaks. He was also provided a pneumatic lymphedema device before discharge and arranged for wound care and dermatology follow-up.<br /><br />This case highlights how chronic lymphedema can progress to severe skin changes and infection, and emphasizes the role of social barriers—such as lack of insurance, delayed care access, and poor health literacy—in worsening morbidity and quality of life.

Asset Subtitle

Ariadna C. Perez-Sanchez

Meta Tag

Author List Ariadna C. Perez-Sanchez, Kanapa Kornsawad, Mahmoud Kabbani

Category Clinical Vignettes

Concept Elephantiasis Nostras Verrucosa

Concept Lymphatic Impairment

Concept Non-filarial Lymphedema

Concept Verrucous Skin Change

Concept Morbid Obesity

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center at San Antonio

Presenting Author Ariadna C. Perez-Sanchez

Track Adult

Keywords

Elephantiasis Nostras Verrucosa

chronic lymphedema

bilateral leg swelling

verrucous plaques

soft tissue infection

intravenous drug use

morbid obesity

hypoalbuminemia

dermatology diagnosis

wound care

Elephantiasis Nostras Verrucosa

Lymphatic Impairment

Non-filarial Lymphedema

Verrucous Skin Change

Morbid Obesity