Unexpected Death in Elephantiasis Due to an Abnormal Life‐Style

Abstract

A 22-year-old man was found dead after he had continued to sit on a reclining chair for 2 years. He had consumed an unbalanced diet, kept wearing the same pair of socks and never washed himself for the term. His skin of bilateral crura developed into elephantiasis with severely festered ulcers on its surface. At autopsy, subcutaneous edema was significant in his lower limbs, and chronic circulatory disturbance of lymphoducts and veins was observed histologically. There were no crucial findings to account for chronic edema in the lower limbs. It has been reported that maintaining a seated posture obstructs both lymphoducts and veins because of bending the groin, decreases their return flow by inducing muscular atrophy, and causes subcutaneous edema in the lower limbs. Oligotrophia and dirt on his limbs might have exacerbated the chronic edema in elephantiasis. We concluded that a long-term abnormal life-style had caused fatal elephantiasis.

Noncontrast MR Lymphography in Secondary Lower Limb Lymphedema:

“…A possible explanation could be that patients with higher LE stages usually report limited motion, resulting in muscle wasting 25 . This correlation could also be explained by an excess volume of fat identified in the subfascial compartment, as described in a recent study on 13 patients with LE using water–fat MR 26 …”

Elephantiasis Nostra Verrucosa at Autopsy

“…It was felt to be of bacterial origin, with skin changes as a consequence of recurrent infections. Occasional cases have been reported in the literature, but descriptions of pathological changes and autopsy reports are limited (4)(5)(6).…”

“…A number of reports have described ENV (1)(2)(3)(4)(5)(6). It is a skin condition secondary to chronic lymphedema and is associated with obesity and chronic heart failure.…”

“…Sato and colleagues reported a case of a 22-year-old man who developed ENV after spending 2 years in a reclining chair (6). The features were similar to this case, where there was also a period of immobility.…”