Elephantiasis Nostras Verrucosa secondary to recurrent trauma and insect bites: A case report

Background: Elephantiasis, the most advanced stage of lymphedema, is classically linked to filarial infections in tropical regions. However, non-parasitic etiologies such as trauma, obesity, and recurrent infections are increasingly recognized, particularly in non-endemic areas.Case Presentation: A 54-year-old male farm worker from Florida, USA, with no history of international travel, presented with progressive, severe bilateral lower extremity swelling over four years. The condition began after a significant blunt force injury and was exacerbated by recurrent minor trauma and frequent insect bites sustained during his work. Physical examination confirmed International Society of Lymphology (ISL) Stage III lymphedema, consistent with Elephantiasis Nostras Verrucosa (ENV). Due to financial constraints, confirmatory tests like circulating filarial antigen or PCR were not performed; however, the epidemiological context made parasitic infection highly improbable. Initial management involved conservative therapy with diuretics, compression, and skin care.Discussion: This case highlights that in non-endemic regions like the United States, a high index of suspicion for non-filarial elephantiasis is paramount. It demonstrates how environmental and occupational factors (recurrent trauma, insect bites) can initiate and perpetuate a vicious cycle of lymphatic injury, inflammation, and fibrosis. Furthermore, the case underscores the profound impact of socioeconomic barriers, which can delay definitive diagnosis and access to specialized care. Early, multidisciplinary intervention focusing on compression, skin hygiene, and management of comorbidities is essential to halt disease progression and improve quality of life.