Alex is a 32-year-old male who presents with 18 months of indurated plaques and lower-limb oedema.

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<p>Alex is a 32-year-old male who presents with 18 months of indurated plaques and lower-limb oedema.</p><p>The plaques are not painful or itchy, and the shin oedema is non-pitting.</p><p>Alex has previously been diagnosed with idiopathic lymphoedema but had no investigations or further management.</p><p>He reports 8kg unintentional weight loss, with associated increased appetite, tremor, palpitations, anxiety and sweating. Bowel habits are unchanged.</p><p>Alex’s past history is significant for hypertension, for which he takes irbesartan 150mg daily. There is no family history of note.</p><p>On examination, his heart rate is 110bpm and regular; his vital signs are otherwise normal.</p><p>A fine intention hand tremor is noted. Thyroid is non-tender and slightly enlarged.</p><p>Abdominal and lower-limb neurovascular examinations are normal.</p><p>There are indurated waxy plaques and nodules and diffuse non-pitting oedema on the shins (pictured).</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.