Elephantiasis Nostras Verrucosa (ENV): A Complication of Congestive Heart Failure and Obesity

The Journal of the American Board of Family Medicine

David Bode¹  Zachariah DeYoung¹  Troy Akers¹  Drew Baird¹ 

[1] From the Department of Family and Community Medicine, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA

关键词: Elephantiasis;    Congestive Heart Failure;    Obesity;    Lymphedema;    Case Report;   

DOI  :  10.3122/jabfm.2010.03.090139

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Congestive heart failure (CHF) and obesity are common medical conditions that have many complications and an increasing incidence in the United States. Presented here is a case of a disfiguring skin condition that visually highlights the dermatologic consequences of poorly controlled CHF and obesity. This condition will probably become more common as CHF and obesity increase in the US.

• Elephantiasis
• Congestive Heart Failure
• Obesity
• Lymphedema
• Case Report

A 48-year-old man presented to our clinic complaining of 7 months of worsening, bilateral leg swelling with painful, oozing “water sores.” He also described worsening dyspnea on exertion and 3-pillow orthopnea. His medical history was significant for poorly controlled congestive heart failure (CHF); obesity (body mass index, 43 kg/m²); atrial fibrillation; and diabetes mellitus. He had no significant travel history or family history.

During physical examination vital signs showed mild hypoxia, tachypnea, and a fever of 101.6°F. Jugular venous distension, bibasilar crackles, and an irregular heart rhythm were present. The lower legs revealed significant pitting edema with woody, indurated skin that had a circumferential confluence of weeping plaques with a pebbled, verrucous appearance (see Figures 1, 2, and 3).

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Figure 1.

Below both knees the patient had tense, woody edema with a circumferential confluence of white- to pink-colored plaques.

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Figure 2.

The patient's edema was seen especially from the mid-tibia to the ankle.

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Figure 3.

The confluence of plaques had a verrucous, “cobblestoned” appearance with tightly packed, tense papules. Some papules had weeping ulcerations.

Laboratory evaluation revealed normal complete blood count, cardiac enzymes, metabolic panel, and thyroid studies. Abnormal laboratory values included a C-reactive protein level of 4.1 mg/dL (normal, 0 to 1.0) and brain naturetic peptide level of 342 pg/mL (normal, 0 to 100). Chest radiography showed diffuse pulmonary infiltrates and electrocardiogram showed atrial fibrillation. The patient was admitted for an acute CHF exacerbation and presumed cellulitis. A wound culture grew multiple organisms (Staphylococcus aureus, Serratia marcescens, Citrobacter koseri, Acinetobacter lwoffii) but blood and fungal cultures were negative. A skin punch biopsy was consistent with stasis dermatitis and, based on clinical examination, the patient was diagnosed with elephantiasis nostras verrucosa (ENV) with overlying acute lymphangitis. A conservative therapy was adopted to control his ENV, specifically antibiotics to treat the acute infection and leg elevation and compression stockings to manage the chronic ENV. Although discharged in stable condition, the patient died 3 months later from CHF-related complications.

【 授权许可】

Unknown   

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