We described a case of a 49-year-old obese Chinese man with no known medical illness who had been under close observation for the bilateral lower limbs swelling and disfigurement for 2 years. The lesions started 30 years ago, initially described as skin thickening, worsening into nodules and thick plaque formation, but he did not seek treatment.
Clinical examination revealed that his bilateral lower limbs were severely disfigured, swollen with a cobblestone appearance up to the distal third of the tibia, non-pitting in nature, with ulceration and crusting over the exposed skin surface (figure 1). There was lost of sensation over the hyperkeratotic skin of bilateral lower limbs.
The lower limbs had worsened recently and were complicated with a foul-smelling serous discharge (figure 2). A skin biopsy showed a benign fibroepithelial polyp with some reactive changes with no features of malignancy. His blood parameters and septic workups were normal, and a skin culture showed a mixed growth.
His functional status was severely impaired with a loss of ankle function, and required walking frames for ambulation. The lower limbs disfigurements had restricted his daily activities and he became unemployed and remained single. Limited activities had in turn worsened his lymphoedema.
1Department of Internal Medicine, Sibu Hospital, Sibu, Sarawak, Malaysia
2Faculty of Medicine, SEGI University3Department of Dermatology, Sarawak General Hospital, Kuching, Sarawak, Malaysia
Correspondence to Dr Neoh Kar Keong, firstname.lastname@example.org
Copyright © BMJ Publishing Group Ltd