Chief Complaint: "My legs have been swelling up over the past few months, and I feel really tired all the time."

History of Present Illness:
A 40-year-old male presents with complaints of progressively worsening swelling in both of his legs, particularly after long periods of standing or walking. He describes the swelling as more prominent at the end of the day and gradually worsening over the last six months. He also reports feeling more fatigued than usual, with episodes of feeling weak and sluggish.

The patient mentions having lived in a rural area near a river for several years, where he frequently encountered mosquito bites while working outdoors. He recalls experiencing occasional itching and mild pain in his legs during the past few months but did not seek treatment until the swelling became more pronounced. He has no history of fever, joint pain, or recent weight loss.

Physical Examination:

• Bilateral, non-pitting edema in both legs, extending from the feet to the knees
• Palpable, firm lymph nodes in the inguinal region
• No skin ulcers or signs of infection
• No fever or other systemic symptoms

Diagnosis:
Based on the clinical findings of lymphedema (leg swelling) and the patient's history of mosquito bites in an endemic area, lymphatic filariasis is suspected. This disease is caused by Wuchereria bancrofti, Brugia malayi, or Brugia timori, and is transmitted through mosquito bites. The filarial worms block lymphatic vessels, leading to chronic lymphedema and elephantiasis in the affected limbs.

Management Plan:

• Antiparasitic treatment: Diethylcarbamazine (DEC) to kill microfilariae and adult worms
• Symptomatic treatment: Compression stockings, leg elevation, and pain relief with NSAIDs
• Lymphedema management: Regular cleaning and moisturizing of the affected legs to prevent secondary infections
• Patient education:
  • Use of insect repellent and bed nets to prevent mosquito bites
  • Emphasizing the importance of completing the full course of DEC treatment

The patient is scheduled for follow-up to monitor his condition and ensure the effectiveness of the treatment plan.