Congestive heart failure (CHF) and obesity are common medical conditions that have many complications and an increasing incidence in the United States. Presented here is a case of a disfiguring skin condition that visually highlights the dermatologic consequences of poorly controlled CHF and obesity. This condition will probably become more common as CHF and obesity increase in the US. A 48-year-old man presented to our clinic complaining of 7 months of worsening, bilateral leg swelling with painful, oozing "water sores." He also described worsening dyspnea on exertion and 3-pillow orthopnea. His medical history was significant for poorly controlled congestive heart failure (CHF); obesity (body mass index, 43 kg/m 2 ); atrial fibrillation; and diabetes mellitus. He had no significant travel history or family history.During physical examination vital signs showed mild hypoxia, tachypnea, and a fever of 101.6°F. Jugular venous distension, bibasilar crackles, and an irregular heart rhythm were present. The lower legs revealed significant pitting edema with woody, indurated skin that had a circumferential confluence of weeping plaques with a pebbled, verrucous appearance (see Figures 1, 2, and 3).Laboratory evaluation revealed normal complete blood count, cardiac enzymes, metabolic panel, and thyroid studies. Abnormal laboratory values included a C-reactive protein level of 4.1 mg/dL (normal, 0 to 1.0) and brain naturetic peptide level of 342 pg/mL (normal, 0 to 100). Chest radiography showed diffuse pulmonary infiltrates and electrocardiogram showed atrial fibrillation. The patient was admitted for an acute CHF exacerbation and presumed cellulitis. A wound culture grew multiple organisms (Staphylococcus aureus, Serratia marcescens, Citrobacter koseri, Acinetobacter lwoffii) but blood and fungal cultures were negative. A skin punch biopsy was consistent with stasis dermatitis and, based on clinical examination, the patient was diagnosed with elephantiasis nostras verrucosa (ENV) with overlying acute lymphangitis. A conservative therapy was adopted to control his ENV, specifically antibiotics to treat the acute in-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2025 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.