Home About us Editorial board Ahead of print Current issue Archives Submit article Instructions Advertise Search Subscribe Contacts Login 
  • Users Online: 79
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
IMAGES/VIDEO IN CLINICAL PRACTICE
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 26-27

Elephantiasis tropica


Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication13-Jun-2014

Correspondence Address:
Dr. Nidhi Singh
Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-4220.134447

Get Permissions


How to cite this article:
Singh N, Kumari R, Thappa DM. Elephantiasis tropica. Int J Adv Med Health Res 2014;1:26-7

How to cite this URL:
Singh N, Kumari R, Thappa DM. Elephantiasis tropica. Int J Adv Med Health Res [serial online] 2014 [cited 2019 Dec 12];1:26-7. Available from: http://www.ijamhrjournal.org/text.asp?2014/1/1/26/134447

A 40-year-old lady presented with swelling of her right foot and leg, for a duration of two years, as also thickening of the skin over her right foot with multiple tiny projections, for the past 18 months. Physical examination revealed non-pitting edema of the right foot and leg. The dorsum of the toes and the distal right foot was studded with cobblestone-like papules, which gave a verrucous appearance [Figure 1] and had a woody feel. The closely studded, cobblestone-like papules were also seen along the sides of the heel and few linear arrays of papules extended along the skin markings at the anterior aspect of the ankle [Figure 2]. The skin over the dorsum of the second toe was not pinchable (Kaposi-Stemmer sign was present). The skin was thickened and indurated in the area surrounding these cobblestone-like papules. Serology for filariasis by an indirect hemagglutination test was found to be positive, with a titer of 1 in 64. Thus, it was diagnosed as elephantiasis tropica.
Figure 1: Cobblestone-like papules over the dorsum of the toes of the right foot. Note normal left foot

Click here to view
Figure 2: Closely studded, cobblestone-like papules along the sides of the heel and few linear arrays of papules extending along the skin markings at the anterior aspect of right ankle

Click here to view


Elephantiasis has been classified by Castellani into four subtypes: Elephantiasis tropica (caused by filariasis), elephantiasis nostras (secondary to recurrent bacterial cellulitis or lymphangitis), elephantiasis symptomatica (secondary to tuberculosis, neoplasm, surgery, fungi, syphilis, etc), and elephantiasis congenita. However, recent literature includes a simplified approach to all these cases, with skin changes resulting from chronic, non-filarial, lymphedema being termed as "elephantiasis nostras verrucosa" (ENV). Chronic lymphedema can be complicated with verrucous and papillomatous eruptions, with a cobblestone-like appearance, which usually occur in the presence of severe fibrotic edema, which resists pitting. In lymphatic filariasis, the parasite burden traumatizes the lymphatic vessels and secondary bacterial lymphangitis may supervene. Many such episodes lead to increased lymphatic stasis, and thus, progressive accumulation of lymphocytes, proteins, and other metabolites. Fibroblasts proliferate and collagen is deposited, resulting in cutaneous thickening. Consequently, progressively limb swelling occurs. Repeated lymphangitis finally results in fibrosis. Recurrent cellulitis or lymphangitis is probably due to the nidus of infection, which could be due to interdigital maceration or disruption of a skin barrier from cutaneous fissures, erosions, and ulcerations. Elephantiasis tropica is usually unilateral, unlike ENV, which is usually bilateral. Disability due to lymphatic filariasis is primarily caused by chronic manifestations like lymphedema, elephantiasis of limbs, and hydrocele. Prevention of new cases of chronic disease is the final objective of any lymphatic filariasis elimination or control program. There is also a continuous search for an anti-Wolbachia therapy, which has macrofilaricidal activity, which could be used in mass drug administration, as Wolbachia is an endosymbiont. At present, doxycycline is used as an anti-Wolbachia therapy, but has the disadvantage of requiring a long course of - four to six weeks of treatment, and is contraindicated in pregnant ladies and children below eight years of age. Despite mass drug administration of single dose diethylcarbamazine citrate (DEC) with albendazole to eliminate lymphatic filariasis in south India, we still continue to see cases of elephatiasis tropica. This emphasizes the importance of early diagnosis and treatment of lymphatic filariasis. In addition, skin care to prevent interdigital maceration, prompt treatment of fissures, and antibiotic prophylaxis, should be considered in these cases.


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Article Figures

 Article Access Statistics
    Viewed3074    
    Printed134    
    Emailed0    
    PDF Downloaded200    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]