EMO syndrome as a late explanation for pretibial swelling

Agminated Blue Naevi in a Patient with EMO Syndrome

“…Cross-reactive TSH receptor antibodies are supposed to bind to fibroblasts, inducing an autoimmune process. In this inflammatory environment, overproduction of glycosaminoglycans may result from non-specific fibroblast activation (6,7). Acral osteoarthropathy (acropachy) including digital clubbing has been described as a late manifestation of Graves' disease (3).…”

“…Acral osteoarthropathy (acropachy) including digital clubbing has been described as a late manifestation of Graves' disease (3). Acropachy may involve bones, tendons and muscles (7)(8)(9).…”

“…Further therapeutic approaches include gamma globulin, plasmapheresis and immunotherapy (3,7,10). The therapeutic intention aims at a reduction in the fibroblast-induced production of hyaluronic acid.…”