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Lymphatic System and Diseases / Lymphatic Disorders and Treatments / Skin Diseases and Diabetes · Journal article
Cureus · August 4, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case report describes a 77-year-old man with elephantiasis nostras verrucosa (ENV), a rare end-stage complication of chronic nonfilarial lymphedema characterized by severe hyperkeratosis, verrucous skin changes, and polymicrobial wound infection. Management with intravenous cefepime, multidisciplinary care, and structured wound protocols was employed, but no outcome efficacy data or follow-up results are provided.
Case report. A 77-year-old man with longstanding bilateral lower-extremity lymphedema, severe hyperkeratosis, malodorous drainage, and polymicrobial wound infection presenting with extensive verrucous lesions and chronic venous stasis wounds.. Intervention: Intravenous cefepime and multidisciplinary management using the TIME framework with involvement of infectious disease, wound care, and vascular surgery; structured wound care plan and ongoing antimicrobials at discharge..
Patient presented with longstanding bilateral lower-extremity lymphedema, severe hyperkeratosis, and polymicrobial wound infection Examination revealed extensive verrucous lesions with worsening edema and drainage consistent with ENV Management included intravenous cefepime and multidisciplinary TIME framework approach involving infectious disease, wound care, and vascular surgery
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This case illustrates the clinical recognition and multidisciplinary management of ENV, a severe dermatologic and infectious complication of advanced lymphedema. It underscores the need for early recognition, culture-guided antimicrobial therapy, edema control, and structured wound management, but does not provide comparative efficacy evidence or outcome data to guide treatment decisions.
A single-patient case report describing clinical presentation, diagnosis, and management of a rare complication; no comparative data, no efficacy metrics, and no generalizable evidence for clinical decision-making.
As stated by the source record.
Quoted from the source exactly as published.
This case illustrates the clinical recognition and multidisciplinary management of ENV, a severe dermatologic and infectious complication of advanced lymphedema. It underscores the need for early recognition, culture-guided antimicrobial therapy, edema control, and structured wound management, but does not provide comparative efficacy evidence or outcome data to guide treatment decisions.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Elephantiasis nostras verrucosa (ENV) is a rare, end-stage complication of chronic nonfilarial lymphedema, marked by progressive dermal fibrosis, hyperkeratosis, and verrucous skin changes, which increase susceptibility to recurrent infections and chronic wounds. We present a 77-year-old man with longstanding bilateral lower-extremity lymphedema, severe hyperkeratosis, malodorous drainage, and polymicrobial wound infection. Examination revealed extensive verrucous lesions with worsening edema and drainage from chronic venous stasis wounds, along with hyperkeratotic changes consistent with ENV. Management included intravenous cefepime and a multidisciplinary approach using the TIME framework, with involvement of infectious disease, wound care, and vascular surgery. He was discharged with a structured wound care plan, ongoing antimicrobials, and coordinated outpatient follow-up. This case underscores the dermatologic and infectious complications of advanced lymphedema and the microbiologic complexity of chronic wounds. Effective management requires early recognition, culture-guided therapy, edema control, structured wound management, and optimization of comorbidities to improve healing, reduce recurrence, and minimize healthcare burden.
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