Elephantiasis nostras verrucosa (ENV) is a rare form of chronic lymphedema, most commonly affecting the lower limbs. It has primary and secondary etiologies; primary lymphedema results from an intrinsic abnormality of the lymph-conducting pathway, while secondary lymphedema—which is more common—results from an acquired obstruction or obliteration of the lymph-conducting pathway. We report a 49-year-old female presenting with a slowly progressive verrucous swelling over the dorsum of the right lower leg for one year, clinically mimicking ENV. Histopathology revealed epithelioid granulomas with Langhans giant cells and caseous necrosis. Cartridge-based nucleic acid amplification testing (CBNAAT) confirmed Mycobacterium tuberculosis without rifampicin resistance, while the interferon-gamma release assay (IGRA) was positive. The patient was started on standard anti-tubercular therapy with early clinical improvement. This report describes a rare case of elephantiasis of the lower limb where the underlying etiology was cutaneous tuberculosis.