Elephantiasis Nostras Verrucosa Presenting As Chronic Lymphedema In A Patient With Long Standing Rheumatoid Arthritis: A Case Report

Abstract

Elephantiasis nostras verrucosa (ENV) is a rare form of chronic lymphedema characterized by progressive cutaneous hypertrophy, papillomatosis, and hyperkeratosis, often affecting gravity-dependent regions such as the lower extremities. This condition can lead to severe deformities and is frequently difficult to manage. This case report details a 32-year-old female with a 10-year history of rheumatoid arthritis (RA) who developed massive swelling of both lower limbs accompanied by ulcerations. She was diagnosed with seropositive RA one year prior and had been undergoing treatment with methotrexate. Clinical examination revealed non-pitting edema, cobblestone-like papulonodules, and ulcerations on the left leg. Laboratory findings included low MCV anemia and elevated inflammatory markers, but venous thrombosis was ruled out. A biopsy showed pseudoepitheliomatous hyperplasia without signs of malignancy. Management included limb elevation, compression therapy, and Tofacitinib for RA. This case highlights the interplay between RA and lymphedema, emphasizing the need for comprehensive care to address both conditions and associated complications. A multidisciplinary approach is essential for optimal management and to ensure continuous improvement.