Lee Jae-Hoon, Park Sang-Myung, Lew Bark-Lynn, Sim Woo-Young
Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea.
Ann Dermatol. 2018 Oct;30(5):592-596. doi: 10.5021/ad.2018.30.5.592. Epub 2018 Aug 28.
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.
象皮肿是一种以腿部皮肤及皮下组织增厚为特征的症状。胫前黏液性水肿（PTM）是自身免疫性甲状腺炎，尤其是格雷夫斯病的一种不常见表现。黏液性水肿病变最常发生于胫前表面，也可出现在既往损伤或瘢痕部位及其他区域。一名49岁男性双侧胫前区、足背、脚踝及脚趾出现严重象皮肿。20年前，他因甲状腺毒症接受了放射性碘治疗。实验室检查显示患者甲状腺功能正常，但促甲状腺激素（TSH）受体抗体水平非常高（>40 IU/L）。活检证实为PTM。有趣的是，深层真皮中的结缔组织被TSH受体抗体染色。象皮肿样PTM是黏液性水肿的一种严重形式，报道病例很少。我们报告一例罕见的PTM病例，表现为严重象皮肿。
