Elephantiasis Nostras Verrucosa of the Pannus

Abstract

A 54-year-old man with morbid obesity and congestive heart failure presented with paroxysmal nocturnal dyspnea, bilateral lower extremity edema and weight gain. Physical exam revealed a large abdominal pannus with lichenified skin containing cobblestone-like verrucous nodules and papules with hyperpigmentation (Figs. 1 and ​and2)2) . The pannus completely encircled the patient’s genitals and left a fibrotic tract from which he urinated. The dermatological findings are consistent with elephantiasis nostras verrucosa—a dermatologic disorder secondary to chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. Epidermal changes and fibrosis of the dermis and subcutaneous tissue are characteristic features1–3. Diagnosis is based on exam findings, but imaging and biopsy are used to exclude malignancy such as lymphoma and angiosarcoma5. Topical keratolytics, emollients, retinoids and surgical debridement are only minimally effective1,4. The patient was treated for decompensated heart failure and was discharged home with outpatient follow-up to be evaluated for an elective panniculectomy. Figure 1 Large abdominal pannus Figure 2 Large abdominal pannus