Francisco Miled Pherez, MD

A 60-year-old man was hospitalized with fever and hypotension secondary to recurrent cellulitis of the left leg. He had a history of polysubstance abuse and hepatitis C. Elephantiasis nostras verrucosa was diagnosed based on bilateral nonpitting edema and hyperkeratotic verrucous lesions in the pretibial area. The patient's erythrocyte sedimentation rate and white blood cell count showed evidence of infection; osteomyelitis of the left fifth metatarsal head was suspected.