Elephantiasis in the Netherlands, a rare finding and a reason to perform an autopsy

Introduction
Elephantiasis is endemic around the equator. In Western countries the phenomenon is extremely rare.

Case description
A Dutch 41-year-old severely obese male was found dead in his home. During the external examination, an extensive skin infection was seen on both lower legs. The man was treated for erysipelas two years prior and did not visit the general practitioner again. Clinical autopsy showed there was a serious stasis dermatitis of both lower legs with a superimposed erysipelas which led to a sepsis and multiple organ failure. The erysipelas presented itself as elephantiasis.

Discussion
Elephantiasis is most often caused by filariasis. In our case, the deceased had not been abroad and had predisposing factors for elephantiasis nostras verrucosa (ENV), such as obesity and an objectified erysipelas infection two years prior. The chronic skin infection caused sepsis and multiple organ failure. The position in which the deceased was found may have contributed to the death.

Conclusion
Elephantiasis is a highly uncommon phenomenon in Western countries. A chronic erysipelas can cause non-filarial elephantiasis and if left untreated, can cause death.