OBJECTIVE: To discuss a case of unilateral lower extremity swelling caused by an uncommon condition, lymphedema praecox. An emphasis is placed on diagnostic imaging.

CLINICAL FEATURES: A 48-yr-old man suffered from low back and left leg pain. The left leg was swollen with evidence of cellulitis. Orthopedic evaluation separated the low back pain from the leg pain, and a diagnosis of sacroiliac syndrome concurrent with lymphedema was made. Further evaluation led to a diagnosis of congenital lymphedema, specifically lymphedema praecox, because of the age of onset.

INTERVENTION AND OUTCOME: Because of active cellulitis, direct treatment of the lymphedema was contraindicated. The patient was advised in techniques to keep the leg clean and to help decrease pooling of lymph by placing the limb in an elevated position. The patient was also referred to a medical facility for antibiotics. The low back pain was addressed using chiropractic.

CONCLUSION: Congenital lymphedema is an uncommon condition that causes unilateral limb swelling. The differential diagnosis includes other uncommon entities that should be ruled out so that proper treatment may be administered. Congenital lymphedema is best treated conservatively and only after any cellulitis has been controlled.

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