Elephantiasis nostras verrucosa cutis (ENV) is a rare presentation of chronic lymphedema which affects gravity dependant body parts - especially lower limbs. It is clinically characterised by non-pitting edema and progressive cutaneous hypertrophy leading to hyperkeratotic papulonodules which causes a verrucose or cobblestone like appearance. Differential diagnoses include lymphatic filariasis, chromoblastomycosis as well as non-infectious conditions like lipodermatosclerosis, pretibial myedema, lipidema and venous stasis dermatitis. Although the exact pathogenesis is still not known, it is believed that as the lymphatic channels are damaged and blocked, excessive protein rich fluid accumulates in the dermis and subcutaneous tissues. This leads to decreased oxygen tension leading to decreased local skin immunity. As a result, there is increased susceptibility to infections. All these ultimately leads to swelling, fibrosis and disfiguration of the area. And a vicious cycle ensues. Our case was of a 42 years normotensive, non-diabetic male diagnosed as lymphatic filariasis 10 years ago. He presented with progressive swelling of bilateral lower limbs, left more than right with multiple clustered small nodules each of few millimetres in size affecting left lower limb. He had no other comorbidities.