A 62‐year‐old white man was referred to our department in May 1998 because of the progressive development of chronic lymphedema on the lower extremities; since the age of 58 years, he had noted recurrent swelling with bilateral edema involving, at first, the dorsum of the feet and, later, both the front and the back of the legs, leading to the advancing deformation of the entire extremities.His medical history was significant for congestive heart failure and severe obesity; anamnestic investigation was negative for filariasis and familial Milroy's disease.Physical examination revealed a man in poor health with diffuse thickening of both feet and legs, accompanied by profound, nonpitting edema, generalized lichenification, and cobblestone‐like skin surface. Severely malodorous verrucous plaques were present on the calves; ulcerative lesions were also noted on the medial malleolus of the left extremity( Fig. 1). The toes of both feet showed marked pachyonychia and signs of onycogryphosis.Physical examination shows nonpitting edema, generalized lichenification, and cobblestone‐like skin surface with ulcerative lesionsimagePosterior tibial and dorsal pedis pulses were not palpable bilaterally. Laboratory tests revealed slightly elevated serum levels of sugar, triglycerides, and cholesterol. Repeated cultures from lesional areas showed Trichophyton rubrum, Candida albicans, and β‐hemolytic Streptococcus group A.A surgical biopsy specimen obtained from the edge of the ulcer showed hyperkeratosis with parakeratosis and acanthosis of the epidermis; diffuse edema and multiple dilated lymphatic spaces throughout the papillary and reticular dermis were observed. There was no sign of neoplastic change ( Fig. 2).Histology shows hyperkeratosis with parakeratosis and acanthosis, and diffuse dermal edema with multiple dilated lymphatic spaces (hematoxylin and eosin stain; original magnification, × 40)imageThe patient was given oral itraconazole 200 mg/day and amoxicillin plus clavunalate 1 g twice daily, but treatment was stopped because of the increased cardiac decompensation and subsequent death.