SHM Converge Scientific Abstract ePoster Gallery-Elephantiasis Nostras Verrucosa Complicated by Severe Retention Hyperkeratosis

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This case describes a 56-year-old man with elephantiasis nostras verrucosa (ENV), a chronic lymphedema-related condition causing thickened, verrucous lower-extremity skin, who was hospitalized for sepsis from cellulitis. He was bedbound, had poor assistance with bathing and toileting, and was nonadherent to skin care and lymphedema management.<br /><br />On exam, he had malodorous, indurated brown plaques on both legs and feet with embedded gray/yellow debris and a positive Kaposi-Stemmer sign. Labs showed leukocytosis, elevated CRP, and acute kidney injury. Imaging supported diffuse plaque-like nodularity and cellulitis without abscess or osteomyelitis.<br /><br />Based on the exam, social history, and comparison with prior photographs, clinicians diagnosed severe retention hyperkeratosis superimposed on ENV. Retention hyperkeratosis, also called dermatosis neglecta, occurs when the stratum corneum is not shed properly and accumulates with sebum, sweat, and debris. The team avoided skin biopsy because the diagnosis was made clinically and the appearance fit the patient’s inability to maintain hygiene.<br /><br />The differential diagnosis included epidermodysplasia verruciformis, ichthyosis vulgaris, acanthosis nigricans, and terra firma-forme dermatosis; the latter was less likely because topical isopropyl alcohol was ineffective. He was treated with leg elevation, diuresis, ammonium lactate lotion, and IV ampicillin-sulbactam, with slow skin improvement. His hospitalization was later complicated by pulmonary embolism requiring MICU care.<br /><br />The report emphasizes that retention hyperkeratosis can signal severe barriers to self-care, can worsen underlying lymphedema/ENV, and may increase risk for infection and thromboembolic complications. Thorough social history and clinical photography were key to diagnosis and helped avoid unnecessary biopsy.

Asset Subtitle

Cindy L. Tsui

Meta Tag

Author List Cindy L. Tsui, Edward Troncoso, Surinder Singh

Category Clinical Vignettes

Concept Hyperkeratotic Plaque

Concept Retention Hyperkeratosis

Concept Differential Diagnosis

Concept Elephantiasis Nostras Verrucosa

Concept Lymphatic Impairment

Distinguished Non-Finalist

Presenter Organization NYU Grossman School of Medicine

Presenting Author Cindy L. Tsui

Track Adult

Keywords

elephantiasis nostras verrucosa

retention hyperkeratosis

dermatosis neglecta

cellulitis

sepsis

lymphedema

Kaposi-Stemmer sign

lower extremity plaques

skin hygiene

pulmonary embolism

Hyperkeratotic Plaque

Retention Hyperkeratosis

Differential Diagnosis

Elephantiasis Nostras Verrucosa

Lymphatic Impairment