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Abstract

Case Presentation: A 58-year-old woman presented with a 6-month history of a chronic discoid ulcer on the right shin following a minor trauma. It had not healed despite conservative treatment with regular dressings, oral antibiotics, and strong advice against smoking that was ignored. Her history was significant for osteoarthritis, obesity, heavy smoking, and Graves disease that had been in remission for several years. On further questioning, she complained of recent weight loss of ~8 kg, upper limb tremors, excessive sweating, and palpitation. Examination revealed an obese lady with body mass index of 36 kg/m2, normotensive with blood pressure of 120/70 mm Hg, tachycardia at 104 beats per minute, peripheral stigmata of thyrotoxicosis, and nicotine-stained fingers. There was exophthalmos with lid retraction and lid lag, a diffuse goiter, but no acropachy. A pretibial ulcer measuring 2.5 cm in diameter and ~2 mm deep with associated erythematous plaque and nonpitting edema was observed (Fig. 1). What is the diagnosis?