Elephantiasis Nostras Verrucosa: A Great Mimicker of True Elephantiasis – A Rare Case Report

Abstract

Elephantiasis nostras verrucosa (ENV) is an uncommon, progressive complication of chronic non-filarial lymphedema characterized by dermal fibrosis, papillomatosis, and hyperkeratotic verrucous plaques. We report a 56-year-old woman with diabetes and chronic lower limb ulcer who developed cobblestone-like plaques over the right leg. Laboratory findings showed inflammatory markers elevation, while filarial, fungal, and tubercular aetiologies were excluded. Histopathology revealed marked hyperkeratosis, pseudoepitheliomatous hyperplasia, dilated lymphatics, dermal fibrosis, and inflammatory infiltrate. D2-40 immunostaining confirmed lymphatic endothelial proliferation. Clinicopathological correlation established the diagnosis of ENV. Early recognition is essential to differentiate ENV from filarial elephantiasis and other mimickers to ensure appropriate multidisciplinary management.