Unilateral Lower Extremity Elephantiasis

A 72-year-old man presented with elephantiasis and multiple large plaques covered with white scales over his right lower extremity that have been present for the past 30 years. The lesion started as a small papule on the right thigh; it has steadily grown in size to involve the entire limb and developed into elephantiasis (Figure 1). The lesion was asymptomatic except for mild itching. There were no systemic symptoms, no history of trauma prior to lesion onset, and no family history of similar lesions. Chest X-ray, skin fungal smear, and skin tissue fungal culture were negative (Figures 2 and 3). What is your diagnosis? Diagnosis: Giant lupus vulgaris with elephantiasis A skin biopsy revealed tuberculoid granulomas containing central caseous necrosis, epithelioid cells, lymphocytes, and Langerhans-type giant cells in dermis (Figure 4). Although acid-fast staining was negative, polymerase chain reaction from the tissue specimen for Mycobacterium tuberculosis, antituberculosis antibody test, and tuberculin skin test was positive. In addition, the chest X-ray, skin fungal smear, and culture were normal (Figures 2 and 3).