Twenty two-year-old house wife from Sharkeya, Egypt presented to the outpatient clinic of Tropical Medicine Department with fatigue and bilateral heaviness and swelling in her lower limbs as well as her left upper limb that started at the dorsum of her feet and progressed gradually to affect both limbs asymmetrically (the left lower limb was swollen more than the right) up to the knee and then appeared in the left upper limb starting from the hand and gradually progressing to reach level of the elbow. The patient had normal general examination.

Examination of the affected limbs revealed normal color, temperature and hair distribution. No visible or dilated veins were noted. The examination revealed no ulceration or any skin lesions in the affected limbs. The oedema was partially pitting with spongy sensation (stage 2). The circumferences of the affected limbs were measured to observe the response to therapy. The oedema level was up to knee in both lower limbs and up to elbow in the upper limb (grade 1). The pulsation of dorsalis pedis, posterior tibial, popliteal, and femoral arteries in both lower limbs were intact as well as radial, ulnar, brachial and axillary arteries pulsations in the affected upper limb. There were no palpable inguinal or axillary lymph nodes. The patient was admitted to Tropical Medicine Department, Zagazig University Hospitals for evaluation of her condition. The patient received broad spectrum antibiotic and diuretic therapy and was advised to elevate her lower limbs and wear an elastic band over the affected upper limb. The previous measures gave minimal improvement of the swelling. The patient's routine laboratory investigations were normal. The patient performed Doppler evaluation for the venous systems in the affected limbs which was normal. The nocturnal peripheral blood film was negative for W. bancrofti microfilaria. The lymphiscintigraphy for lower limbs revealed patent lymphatics.