In 1970, a 40-year-old farmer from the highlands of Ethiopia visits the All Africa Leprosy Education Rehabilitation and Training Center (ALERT) in Addis Ababa because of a progressive swelling of the legs existing for about 15 years. Physical examination revealed edema of both legs with mossy warts on the feet, left more than right.
Differential diagnostic considerations were leprosy, filariasis or ‘non-filarial elephanthiasis’. However, there is no evidence of leprosy and filariasis does not occur in the Ethiopian highlands. A lymph node removed from the groin shows silica particles in the macrophages and extensive fibrosis.
