Clinical Experience with Rituximab and Intravenous Immunoglobulin for Pretibial Myxedema: A Case Series

Kotwal, Anupam; Turcu, Adina F.; Sonawane, Vikram; Bahn, Rebecca S.; Pittelkow, Mark R.; Bridges, Alina G.; Stan, Marius N.

doi:10.1089/thy.2018.0706

Cited by 13 publications

(6 citation statements)

References 24 publications

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“…Rituximab (RTX) and IVIg have recently been reported to achieve improvement or stability of PTM. RTX depletes both B lymphocytes in the intermediate stages of maturation and short-lived plasma cells, whereas IVIg depletes T lymphocytes [37]. This indicates that TSHR autoimmunity of PTM is involved with B and T lymphocytes.…”

Section: Diagnosis and Treatmentmentioning

confidence: 93%

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Lan

Liao

et al. 2020

J Clin Med Res

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Background: Pretibial myxedema (PTM) is a local mucinous dermopathy associated with thyroid diseases. Since the etiology of PTM is unclear, the aim of this study is to identify the risk factors for PTM and their etiological roles in PTM occurrence. Methods: A large-scale case-control study (n = 1,200) was performed to identify risk factors for PTM by calculating odds ratio (OR) values and 95% confidential intervals. The PTM group entered a glucocorticoid treatment trial. Patients with complete response were followed up to the first relapse in a cohort study. The relative risk (RR) values of the main risk factors were calculated for PTM relapse to test their etiological roles. Results: Among the 19 factors, six risk factors were identified: thyroid-stimulating hormone (TSH) receptor antibody (TRAb) (OR 42.93), autoimmune thyroid disease (AITD) or AITD history (OR 10.30), local trauma (OR 6.55), venous stasis posture (OR 6.16), cigarette smoking (OR 4.48), and age (OR 1.05). Serum TRAb levels were positively correlated with the severity of PTM. Of note, 371/400 patients received glucocorticoid treatment, and 330 achieved complete response. The serum TRAb levels after treatment decreased dramatically compared with those before treatment. After stopping glucocorticoid treatment, serum TRAb levels increased significantly when PTM relapsed (P < 0.001). In 165 relapse cases, an increase in serum TRAb levels occurred first, followed by persistent venous stasis posture or local trauma and finally PTM. The RR of elevated serum TRAb levels was 6.73 in PTM relapse cases. In the elevated serum TRAb level group, the RRs of local trauma, venous stasis posture, and local trauma plus venous stasis posture were 8.81, 6.5, and 8.84, respectively, for PTM relapse cases. Conclusions: TSHR autoimmunity and local factors in the six identified risk factors are the main causes of PTM occurrence.

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Section: Diagnosis and Treatmentmentioning

confidence: 93%

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Lan

Liao

et al. 2020

J Clin Med Res

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“…2 The patient presented here had no adverse effects to rituximab; however, transient hypertension and injection-site thrombophlebitis has been reported in a patient receiving RTX specifically for PTM. 6 Consideration should also be given to the risks of repeated RTX infusions such as hepatitis B infection/reactivation and cytopenias. 7 Hypogammaglobinemia and susceptibility to infectious agents, such as the JC virus, is rarely reported for RTX used for other autoimmune conditions.…”

Section: Discussionmentioning

confidence: 99%

Rituximab therapy for a severe case of pretibial myxedema

2021

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“…The treatment of choice is topical application of a mid- or high-strength glucocorticoid under occlusion to improve absorption [ 7 , 8 , 9 ]. Pentoxifylline [ 10 , 11 ], intralesional injections of hyaluronidase with [ 12 ] or without [ 13 , 14 ] intralesional injections of glucocorticoid, rituximab [ 15 ], IVIG [ 16 ] and UVA-1 phototherapy [ 17 ] have all been reported with varying degrees of success.…”

Section: Discussionmentioning

confidence: 99%

Insidious-Onset Indurated Plaques on the Shins

2021

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A 64-year old male presented with a several-year history of an insidious-onset tender, itchy and xerotic rash on his lower legs. Past medical history was significant for Graves’ disease and Graves’ ophthalmopathy. The examination revealed peau d’orange-appearing plaques on his shins clinically consistent with pretibial myxedema. A punch biopsy showed separation of collagen bundles with extensive dermal mucin deposition, confirming the diagnosis of pretibial myxedema. After initially failing treatment with a topical clobetasol 0.05% ointment, the patient switched to regular pentoxifylline and triamcinolone 0.1% ointment under occlusion. He remains under follow-up.

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Clinical Experience with Rituximab and Intravenous Immunoglobulin for Pretibial Myxedema: A Case Series

Cited by 13 publications

References 24 publications

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Rituximab therapy for a severe case of pretibial myxedema

Insidious-Onset Indurated Plaques on the Shins

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