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A 45 year old woman presents with a swollen toe that is both non-tender, non-pitting and non-erythematous. Been increasing in size over the past 4-6 months. She has a history of Grave’s disease. On examination, she also has mildly indurated plaques on both of her shins.


What is your diagnosis?


Pretibial Myxedema


Pretibial Myxedema

 

Diagnosis:

Pretibial Myxedema (biopsy positive)

Pretibial myxedema is an infiltrative dermopathy that occurs as a rare complication of Grave’s disease. It is seen in about 3% of patients with Graves’ disease. The skin appears thickened having a so-called peau d'orange (orange peel) appearance— as clearly demonstrated in the photograph of her toe. It commonly affects the anterior lower extremities (shins) and dorsal feet (as in this case) and in rare extreme cases been reported on trunk, arms, neck, back, face and ears. Biopsy shows marked dermal mucin deposition. Treatment is notoriously difficult and the condition may persist even with good control of the Grave’s disease. (Note: the nail loss was coincidental from a podiatric procedure done in the past).



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