Chief Complaint: “My legs have become swollen and painful over the past few months.”

History of Present Illness:
A 45-year-old man presents to the clinic with complaints of progressively worsening swelling in both of his lower legs. The swelling started insidiously about three months ago and has gradually increased, making it difficult for him to walk. He describes the swelling as particularly noticeable in the evenings, with a sensation of heaviness and tightness in his legs.

The patient also mentions that, on some nights, he experiences itching and a dull ache in his groin. He recalls several mosquito bites during a recent visit to a rural area where he stayed for an extended period. He has no history of similar symptoms and denies fever, but he has noticed the swollen areas becoming increasingly hard and lumpy over the past few weeks.

Physical Examination:

• Bilateral, non-pitting edema on the lower legs, extending from the feet to the knees
• Palpable, firm, and slightly tender lymph nodes in the groin area
• No signs of systemic infection or fever
• No skin ulcerations or signs of secondary infection

Diagnosis:
Based on the clinical findings of lymphedema, elephantiasis, and the patient's recent travel history, filariasis is suspected. The condition is caused by Wuchereria bancrofti, Brugia malayi, or Brugia timori, transmitted through mosquito bites. The worms block lymphatic vessels, leading to chronic lymphedema and other complications.

Management Plan:

• Antiparasitic treatment: Diethylcarbamazine (DEC) to kill microfilariae and adult worms
• Symptomatic relief: Elevation of the legs, compression stockings to reduce swelling, and anti-inflammatory medications for pain
• Lymphedema management: Regular cleaning and moisturizing of the affected area to prevent infection
• Patient education:
  • Preventing further mosquito bites by using insect repellent and sleeping under bed nets
  • Importance of completing the full course of antiparasitic treatment

The patient is referred for further workup to confirm the diagnosis through blood tests and is scheduled for a follow-up to monitor response to treatment.