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What is the reason for huge solid pouches on the lower legs and thighs in a patient with multiple sclerosis?

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General & Family Physician
Practicing since : 2003
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Question sister has MS and has experienced huge pouches on her lower legs and thighs....her ankles and feet look normal but the rest of her leg is similar to someone with one is helping her...doplars were normal. She's 71 and has limited mobility.
Mon, 7 May 2012 in General Health
Answered by Dr. Deepak Anvekar 32 minutes later

From the history it is difficult to make a proper diagnosis.

The condition could be associated with degenerative connective tissue disease.

Please provide additional details regarding any prior examination findings, diagnostic investigations if they have been done.

Please mention Any family history of any other conditions if present as well.

Once additional details are provided it can help us to give you steps to manage the situation accordingly.

Above answer was peer-reviewed by
Follow-up: What is the reason for huge solid pouches on the lower legs and thighs in a patient with multiple sclerosis? 22 minutes later
Thank you....She swims/ walks in the pool in the summer but there is no abatement of the size of the pouches.....they are solid, and no edema per an exam at the time she had the doppler....her blood pressure is great 120/70 with no meds, and her heart is good also. She is very distressed by this. What more would you need to know?
Follow-up: What is the reason for huge solid pouches on the lower legs and thighs in a patient with multiple sclerosis? 19 minutes later
The etiology is unknown. The disease may be caused by an autoimmune reaction; deposits of IgM, IgG, and the 3rd component....she had weeks of IVIg infusions for her MS....could that have caused this??
Answered by Dr. Deepak Anvekar 1 hour later

Solid pouches or nodules on the skin could be associated with conditions like
1. Neurofibromatosis,
2. tuberous sclerosis,
3. Acrochordons (Flesh-coloured pedunculated lesions - 'skin tags') ,
4. dermatofibrosis,
5. Chondrodermatitis nodularis, etc.

Investigations :
Some investigations that might be helpful for diagnosis include:-
1. FBC and erythrocyte sedimentation rate (ESR) are basic investigations.
2. Uric acid should be measured if nodules may be gout.
3. The appearance of xanthomata is fairly typical. Fasting lipid profile is required.
4. Urinalysis is required if inflammatory or vasculitic skin lumps are suspected:
There may be proteinuria if the lumps are associated with systemic and renal disorders.
5. Excision biopsy is the definitive investigation.

In case the biopsy of the tissue was done, and gave the probability of a autoimmune disease, (with deposits of IgM , IgG and C3), then the condition might be treatable with immunosuppression or radiotherapy.

IVIG therapy for MS is not associated with the skin condition that you might be having.

You might benefit by consulting a Rheumatologist for proper evaluation and specific treatment.

I hope this helps.

Above answer was peer-reviewed by
Follow-up: What is the reason for huge solid pouches on the lower legs and thighs in a patient with multiple sclerosis? 5 hours later
Doctor please excuse my cont'd pursuit of an answer but these are NOT minor skin lesions. These are sacs, large sacs not unlike seen with someone with elephantiasis. They go all the way around her whole leg, not discolored, no lesions, very pronounced.....just these huge sac-like appendages. They are gross to look at and must be very heavy for her to lug around. Her foot and ankle are normal size then her legs balloon out just about 4 inches above her ankle. There is a marked deliniation between her normal ankle/foot and these sacs. Would a osteoarthritis, two ruptured discs, and spinal stenosis. There is no family history of anything like this. This is like a very exaggerated cellulite. I've seen one grossly obese patients with this type of sac and they were surgically removed.
Answered by Dr. Deepak Anvekar 33 minutes later
Hello Bette,

I have already understood the situation from the history given before.

The diagnosis that i have given so far are NOT simple medical conditions and are associated with skin lesions similar to the one described by you.

Before a condition can be treated surgically, it has to be diagnosed properly. Since you have mentioned about the presence of deposits of IgM , IgG and C3 in the lesions, I can assume that this is a autoimmune disorder and needs further work up under a rheumatologist.

I might be of more help, if i could have a look at the pictures of the concerned lesions. Please forward the pictures if possible to YYYY@YYYY and mention the subject: ATTN Dr. ANVEKAR .

Once i review the pictures i will revert back to you and give my final opinion.

I hope this will be helpful.

Above answer was peer-reviewed by
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