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Elephantiasis Nostras Verrucosa or "Mossy Foot Lesions" in Lymphedema Praecox

Report of a Case

Amy L. Duckworth, DPM ^*, Jugnoo Husain, MD  and Patrick DeHeer, DPM 

^* St. John North Shores Hospital, Harrison Township, MI. Dr. Duckworth is now with Northern California Orthopedic Centers, Carmichael, CA.
Department of Pathology, AmeriPath, Indianapolis, IN.
Private practice, Richmond, IN.

Corresponding author: Amy L. Duckworth, DPM, 6403 Coyle Ave, Ste 170, Carmichael, CA 95608.

Abstract

Elephantiasis nostras verrucosa is a rare disorder that results from chronic obstructive lymphedema. It is characterized clinically by deforming, nonpitting edema; malodorous hyperkeratosis with generalized lichenification; cobblestoned papules; and verrucous changes, that often result in extreme enlargement of the involved body part. Although elephantiasis nostras verrucosa is striking in clinical appearance, biopsy reveals only moderately abnormal findings: pseudoepitheliomatous hyperplasia with dilated lymphatic spaces in the dermis, accompanied by chronic inflammation and fibroblast proliferation. The term elephantiasis nostras (nostras means "from our region") has traditionally been used to differentiate temperate zone disease from the classic disease process, elephantiasis tropica, which is defined by chronic filarial lymphatic obstruction caused by Wuchereria bancrofti, Wuchereria malayi, or Wuchereria pacifica. We present a case report of elephantiasis nostras verrucosa arising as a result of lymphedema praecox. (J Am Podiatr Med Assoc 98(1): 66–69, 2008)