Elephantiasis nostras: an eight-year observation of progressive nonfilarial elephantiasis of the lower extremity.

An eight-year follow-up of a progressive case of nonfilarial elephantiasis affecting the lower extremity and a review of the literature is presented. The natural history and management of this disorder are discussed, together with recommendations to assist the clinician in early identification an treatment. Elephantiasis nostras is characterized by chronic enlargement of a limb, resulting from lymphatic blockage secondary to recurrent attacks of streptococcal lymphangitis. Each subsequent attack results in greater edema of the limb. Without appropriate intervention the cycle continues until the deformity is greatly exaggerated. Control of edema an infection is important in preventing the recurrent lymphangitis that will eventually result in grotesque enlargement of the limb. Photographic documentation and serial circumferential limb measurements are recommended to document progression of the disease and effectiveness of treatment.