The term elephantiasis describes a body part that becomes enlarged and disfigured due to edema and fibrosis of the skin.
Conditions that block lymphatic drainage can induce lymphedema, including neoplasms, trauma, radiation treatment, congestive heart failure, obesity, hypothyroidism, chronic venous stasis, and filarial infection.
It can lead to severe disfiguration of body parts with gravity-dependent blood flow, especially the lower extremities.
Clinically, it begins at the dorsal aspect of the foot and progresses to the proximal parts of the limbs. In the beginning, the lesion presents as mild and persistent pitting edema. Later, the affected area loses its elasticity and eventually has a hypertrophic, verrucose, cobblestone-like appearance.
The pathogenesis is still unclear. It is conceivable that first the lymphatic channels are damaged and blocked due to one or more of the above-mentioned conditions, and excessive protein-rich fluid accumulates in the dermis and subcutaneous tissues. Second, the protein-rich fluid decreases oxygen tension and might decrease the immunity of the skin. Third, poor immunity increases the skin’s susceptibility to infection by micro-organisms. Finally, there is swelling, fibrosis, and disfiguration of the affected areas. Hence, a vicious cycle begins, as the underlying conditions predispose the skin to microbial infections.
In this case, patient denied having traveled to a tropical area, and blood smear for microfilaria was negative. However, he presented with several medical conditions, including congestive heart failure, partial deep vein thrombosis, and morbid obesity. These conditions can cause poor venous and lymphatic circulation. In addition, the patient had several episodes of soft tissue infection bilaterally in his lower limbs. It induced fibrosis of the soft tissue and worsened the already deteriorating lymphatic drainage.
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