Treatment of pretibial myxoedema with pentoxifylline

Abstract

Pretibial myxoedema is a rare symptom of Graves' disease. Histological studies detected mucopolysaccharide and glycosaminoglycan accumulation, and the role of anti-TSH receptor antibodies has been suggested. In this paper the authors present the case of a 34-year-old male patient with pretibial myxoedema treated successfully with pentoxifylline. In his case history multiple autoimmune diseases (type 1 diabetes mellitus, Graves' disease with severe ophthalmopathy) concomitantly occurred. His severe pretibial myxoedema was undiagnosed and untreated at the time of admission. Because of his diabetes, steroid was contraindicated, which made the choice of the treatment more difficult. He received first intradermal, then intravenous and, finally, oral pentoxifylline, which resulted in a regression of the dermatological symptoms. The beneficial effect of pentoxifylline might be explained by its inhibitory effect of proinflammatory cytokines and proliferation of fibroblasts, and the production of glycosaminoglycan. It was concluded that pentoxifylline can be an effective and safe treatment of pretibial myxoedema.