Elephantiasis and verrucous lesions in an Ethiopian man living in Italy

Elephantiasis refers to chronic, severe lymphedema caused by the abnormal accumulation of interstitial fluid due to reduced lymph transport and lymph stasis. This condition is observed secondary to injury, infection, cancer or cancer-related treatment, or congenital abnormalities of the lymphatic system. One of the several forms of elephantiasis is Elephantiasis Nostras Verrucosas (ENV), where “nostras" refers to a non-filarial form of lymphedema that occurs primarily in non-tropical areas. We describe a case of ENV in an Ethiopian man living in Italy, presenting with fever, hypotension, woody edema, hyperemic skin, and diffuse verrucous lesions. The case poses a differential diagnosis challenge, considering the epidemiological and clinical characteristics of patients coming from countries where several different skin neglected conditions, including filariasis, podoconiosis, chromoblastomycosis and mycetoma, are endemic. Understanding this challenge is crucial for improving diagnostic accuracy and tailoring appropriate treatment strategies.