Elephantiasic Pretibial Myxedema: A Rare Manifestation in Graves’ Disease: Elephantiasic pretibial myxedema

Apichat Kaewdech; Kumpol Aiempanakit; Siripan Sangmala; Kanokphorn Chiratikarnwong; Sauvarat Auepemkiate; Josef Symon S. Concha

doi:10.31584/jhsmr.201942

Authors

Apichat Kaewdech Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
Kumpol Aiempanakit Division of Dermatology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. https://orcid.org/0000-0001-5256-827X
Siripan Sangmala Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Kanokphorn Chiratikarnwong Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Sauvarat Auepemkiate Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Josef Symon S. Concha Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States.

DOI:

https://doi.org/10.31584/jhsmr.201942

Keywords:

dermatopathology, elephantiasis, Graves’ disease, pretibial myxedema, thyroid dermopathy

Abstract

Elephantiasic pretibial myxedema is an extremely rare condition, affecting patients with thyroid disease. The
clinical manifestation is difficult to diagnosis, and the treatment is challenging. Herein, the authors report on a case of a patient with Graves’ disease, who had a long-standing enlargement of bilateral legs, and histopathologic studies confirmed the diagnosis as; pretibial myxedema. The patient was treated with an antithyroid drug, iodine-131 (131I) irradiation, a potent topical corticosteroid, with occlusion, and compression therapy, however, the patient’s skin condition remained unchanged. This report aims to demonstrate a rare form of pretibial myxedema, to review the clinical presentations, differential diagnosis as well as therapeutic options.

Author Biography

Kumpol Aiempanakit, Division of Dermatology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

Assistant Professor

Division of Dermatology,
Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University,

References

1. Fatourechi V, Pajouhi M, Fransway AF. Dermopathy of Graves disease (pretibial myxedema). Review of 150 cases.
Medicine (Baltimore) 1994;73:1-7.

2. Schwartz KM, Fatourechi V, Ahmed DD, Pond GR. Dermopathy of Graves’ disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab 2002;87:438-46.

3. Fatourechi V. Pretibial myxedema: pathophysiology and treatment options. Am J Clin Dermatol 2005;6:295-309.

4. Rapoport B, Alsabeh R, Aftergood D, McLachlan SM. Elephantiasic pretibial myxedema: insight into and a hypothesis regarding the pathogenesis of the extrathyroidal manifestations of Graves’ disease. Thyroid 2000;10:685-92.

5. Susser WS, Heermans AG, Chapman MS, Baughman RD. Elephantiasic pretibial myxedema: a novel treatment for an uncommon disorder. J Am Acad Dermatol 2002;46:723-6.

6. Terheyden P, Kahaly GJ, Zillikens D, Brocker EB. Lack of response of elephantiasic pretibial myxoedema to treatment with high-dose intravenous immunoglobulins. Clin Exp Dermatol 2003;28:224-6.

7. Dhaille F, Dadban A, Meziane L, Fessier C, Coltal L, Lok C, et al. Elephantiasic pretibial myxoedema with upper-limb
involvement, treated with low-dose intravenous immunoglobulins. Clin Exp Dermatol 2012;37:307-8.

8. Heyes C, Nolan R, Leahy M, Gebauer K. Treatment-resistant elephantiasic thyroid dermopathy responding to rituximab and plasmapheresis. Australas J Dermatol 2012;53:e1-4.

9. Shirai K, Ito T, Mitsuhashi Y, Tsuboi R. Dramatic effect of lowdose oral steroid on elephantiasic pretibial myxedema. J Dermatol 2014;41:941-2.

10. Yu H, Jiang X, Pan M, Huang R. Elephantiasic pretibial myxedema in a patient with Graves disease that resolved after 131I treatment. Clin Nucl Med 2014;39:758-9.

Elephantiasic Pretibial Myxedema: A Rare Manifestation in Graves’ Disease