Successful therapeutic approach in a patient with elephantiasic pretibial myxedema

Marina Ferreira,Luciana Helena Zacaron,Annair Freitas Do Valle,Aloisio Carlos Couri Gamonal

doi:10.1016/j.abd.2019.02.007

Marina Ferreira, Luciana Helena Zacaron + Show 2 more

Open Access

https://doi.org/10.1016/j.abd.2019.02.007

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Abstract

Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5–4% of patients with Graves’ disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.

Highlights

ଝ How to cite this article: Ferreira M, Zacaron LH, Valle AF, Gamonal ACC
The patient developed bilateral exophthalmos and severe retro-orbital impairment. She was subjected to orbital decompression and iodine therapy in 2012, developing hypothyroidism while maintaining clinical stability with levothyroxine use. She presented with nondepressible edema, associated with nodules and yellowishbrown plaques that formed an elephantiasiform pattern on the lower right limb, on the ankle and foot regions, in addition to hyperpigmentation and fissures with hypertrichosis on the dorsum of the foot and phalanges, and to a lesser extent, non-depressible edema in the lower left limb (LLL) (Figs. 1 and 2)
Exophthalmia is usually present in patients with myxedema, in approximately 15% of cases.3---5

Summary

Introduction

ଝ How to cite this article: Ferreira M, Zacaron LH, Valle AF, Gamonal ACC. Successful therapeutic approach in a patient with elephantiasic pretibial myxedema. Intravenous immunoglobulin, generating a mild to moderate response, with unpleasant results in severe cases.[1,4] The current article describes the authors’ experience with intralesional corticotherapy in patient who present with the elephantiasic form, noting a satisfactory and encouraging clinical response during the follow-up of over 11 months.

Results

Conclusion