Elephantiasic Pretibial Myxoedema in a Patient with Graves’ Disease

Ruzhi Zhang^1*, Yuhua Yang¹, Wenyuan Zhu²

¹Department of Dermatology, The Third Affiliated Hospital of Suzhou University, Changzhou, China.
²Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

DOI: 10.4236/jcdsa.2015.54036                

Abstract

Pretibial myxoedema (PM) is a late and rare manifestation of autoimmune thyroiditis, particularly in patients with Graves’ disease. It occurs in 0.5% to 4.3% of patients [1], and is usually associated with high levels of thyroid hormones. The classification of PM includes four forms: non-pitting edema; plaque; nodular; or elephantiasis [1]. Mild PM often regresses spontaneously, but the severe, elephantiasic variant is typically progressive and refractory to treatment. Elephantiasic pretibial myxoedema (EPM) is characterized by massive edema, skin fibrosis and verrucous nodule formation, and it clinically resembles lymphedema. Herein, we describe a man with Graves’ disease presenting with EPM for nearly 2 years. Although advanced cases have been described in the literature, to our knowledge, none have reached this level of severity.

Keywords

Pretibial Myxoedema (PM), Graves’ Disease

Conflicts of Interest

The authors declare no conflicts of interest.

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