Profound Swelling Due to Chronic Lymphadema

Four years ago, this patient had necrotizing cellulitis of the right calf that required surgical debridement. He did well for the next 2 years, but then his lower leg became increasingly swollen. When he sought medical care, the leg appeared as seen here.

At 225 kg (500 lb), the 30-year-old patient was morbidly obese. The affected leg was not erythematous, warm, or tender. The skin was woody, with brawny, slightly pitting edema that extended from his foot to his knee. He had full strength and range of motion in the knee, ankle, and foot.

A venous and arterial Doppler ultrasonographic study ruled out deep venous thrombosis and showed good arterial flow. Results of complete blood cell count, erythrocyte sedimentation rate, and blood chemistry profile were normal, as were those of x-ray studies and antifilarial antibody titers.

The diagnosis was chronic lymphedema secondary to lymphatic insufficiency, a result of the past surgery, reports Dr Robert R. Meacham III of Hernando, Miss. The patient was placed on a rigorous weight-loss program and was instructed to wrap his leg daily with an elastic bandage and keep it elevated as much as possible. Now, 12 months after beginning treatment, this man has lost 67.5 kg (150 lb), and his right calf has dramatically decreased in size.