• Rev Med Interne · Dec 2023

    Case Reports

    [Pretibial myxedema after Graves' disease: A differential diagnosis of lymphedema].

    • O Lebreton, R Seddiki, S Abba, and S Vignes.
    • Unité de lymphologie, site constitutif du centre national de référence des lymphœdèmes primaires, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
    • Rev Med Interne. 2023 Dec 1; 44 (12): 641645641-645.

    IntroductionPretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema.ObservationsWe reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves' disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema.ConclusionPretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves' disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema.Copyright © 2023 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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