

A case of a 43 year old man with obesity, diabetes and Graves' disease.

This man was injured in a car accident and since he was forced not to leave his bed for months, his legs got smelly skin lesions. The fact that he was obese didn't seem important at the time, but he developed an autoimmune disease which led to diabetes. This caused the changes to his leg, which lead to complete immobility. The changes could not be treated with much success and his leg stayed like that to the rest of his life.

Here are doctor's findings. Non pitting edema of lower legs with typical cobblestone like findings 2 ) and Graves' disease; it reported a trauma to the lower limbs whereas was negative for filariasis, surgery, radiation, neoplasia and familial Milroy's disease. In order to defeat the development of the disease, our patient was also started on treatment for obesity and hyperthyroidism. After 2 months a moderate improvement was shown. The treatment continued without much success. An obese 43-year-old male presented to our dermatology department with a bilateral non-pitting edema of both legs. His legs had "woody" appearance and were covered with profoundly malodorous, fungating, verrucous skin lesions. There was an ulcerative infected lesion on the lateral malleolus of the left extremity that was causing him severe pain . He noticed that the swelling of the legs began 9 years ago, since he was forced to a wheelchair due to a spinal cord injury. The lymphedema has started with swelling of the dorsum of his feet, and then with a progressive involvement of the front and the back of legs. It is to be noted that the leg ulcer has developed and grown constantly in size during the last year. His toenails showed a marked pachyonychia and onycogryphosis. On examination digital clubbing, tachycardia and eyeballs' protrusion were noted. His medical history revealed obesity (BMI 48 kg/m) and Graves' disease; it reported a trauma to the lower limbs whereas was negative for filariasis, surgery, radiation, neoplasia and familial Milroy's disease.















Diabetes changes your body's ability to fight infections. Damage to blood vessels because of diabetes results in less blood and oxygen getting to your feet. Because of this, small sores or breaks in the skin may become deeper skin ulcers. The affected limb may need to be amputated if these skin ulcers do not improve, get larger, or go deeper into the skin.

If you have diabetes, you should: Improve control of your blood sugar Stop smoking Get a foot exam by your health care provider at least twice a year and learn whether you have nerve damage. Check and care for your feet every day, especially if you already have known nerve or blood vessel damage or current foot problems. . If you have diabetes you are more likely to have foot problems. Diabetes can damage your nerves (See: Diabetic neuropathy). This, in turn, may make you less able to feel an injury or pressure on the skin of your foot. You may not notice a foot injury until severe damage or infection develops.Diabetes changes your body's ability to fight infections. Damage to blood vessels because of diabetes results in less blood and oxygen getting to your feet. Because of this, small sores or breaks in the skin may become deeper skin ulcers. The affected limb may need to be amputated if these skin ulcers do not improve, get larger, or go deeper into the skin.If you have diabetes, you should: