Images in Clinical Medicine

Lymphedema Tarda

Jose A. Melendez Burgos, M.D., and Adam Luginbuhl, M.D.

N Engl J Med 2009; 360:1015March 5, 2009

• Slide

Article

A 42-year-old woman was admitted with hypotension. Sepsis was diagnosed, which was probably caused by cellulitis related to chronic severe edema, skin breakdown, and lichenification of both legs (Panels A and B). Blood cultures were negative. The patient had a history of lymphedema tarda in the legs and had been admitted several times before with recurrent cellulitis. Her mother and sister both had the same condition. Lymphedema is characterized by a regional accumulation of excessive amounts of interstitial protein-rich fluid. Lymphedema tarda is a congenital disease, although the clinical manifestations may not become evident for several decades. The disease was diagnosed in the patient, her mother, and her sister when they were all in their 30s. The patient was treated with broad-spectrum antibiotics for the sepsis and had a full recovery.

Jose A. Melendez Burgos, M.D.
Adam Luginbuhl, M.D.
University of Connecticut Health Center, Farmington, CT 06030