Ann Dermatol.  2018 Oct;30(5):592-596. 10.5021/ad.2018.30.5.592.

Pretibial Myxedema Presenting as Severe Elephantiasis

• Lee JH
• Park SM
• Lew BL
• Sim WY

• KMID: 2419751
• DOI: http://doi.org/10.5021/ad.2018.30.5.592

Abstract

Elephantiasis is a symptom characterized by the thickening of the skin and underlying tissues in the legs. Pretibial myxedema (PTM) is a non-frequent manifestation of autoimmune thyroiditis, particularly Graves' disease. Lesions of myxedema occur most commonly on the pretibial surfaces, also develop at sites of previous injury or scars and other areas. A 49-year-old male presented with severe elephantiasis on the both pretibial areas, dorsum of the feet, ankles and toes. Twenty years previously, he had received radioactive iodine treatment for thyrotoxicosis. Laboratory tests showed that the patient's thyroid function was normal, but the level of thyroid stimulating hormone (TSH) receptor antibodies was very high (>40 IU/L). The biopsy confirmed PTM. Interestingly, the connective tissue was stained with the TSH receptor antibodies in the deep dermis. Elephantiasic PTM is a severe form of the myxedema and there is few reported case. We report a rare case of PTM with appearance of severe elephantiasis.

Keyword

Elephantiasis; Myxedema

MeSH Terms

Ankle
Antibodies
Biopsy
Cicatrix
Connective Tissue
Dermis
Elephantiasis*
Foot
Graves Disease
Humans
Iodine
Leg
Male
Middle Aged
Myxedema*
Receptors, Thyrotropin
Skin
Thyroid Gland
Thyroiditis, Autoimmune
Thyrotoxicosis
Thyrotropin
Toes
Antibodies
Iodine
Receptors, Thyrotropin
Thyrotropin

Figure

• 

  Fig. 1 Multiple violaceous polypoid, verrucous nodules, cerebriform hypertrophic plaques and orange peel appearance on the both pretibial areas, dorsum of the feet, toes and ankles.

• 

  Fig. 2 (A) Fragmentation and fraying of collagen fibers and large depositions of mucin in the dermis. (B) Abundant deposition of mucin in the dermis. (C) In the deep dermis, the connective tissue was stained with the thyroid stimulating hormone (TSH) receptor-antibodies, probably in dermal fibroblasts (A: H&E, ×40; B: Alcian blue, ×40; C: TSH receptor antibody, ×100).

• 

  Fig. 3 At 9 months of follow-up, erythema with dark brownish colored pigmentation and plaques on the shins and dorsa of the feet, but note significantly decreased edema, nodularity.

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