Graves' disease presenting as localized myxoedematous infiltration in a smallpox vaccination scar

Abstract

We describe a 54-year-old woman with diffuse myxoedematous infiltration at the site of a smallpox vaccination scar as the presenting symptom of Graves' disease. Associated features included acute ocular symptoms (vascular congestion of the sclera, epiphora and blurred vision) and transient erythema on both shins. However, there were no signs of pretibial myxoedema. A number of neoplastic, inflammatory and systemic diseases may localize to scar tissue in skin, including at smallpox vaccination sites, but this case demonstrates the unusual occurrence of myxoedematous infiltration at such a site and illustrates a most atypical cutaneous presentation of Graves'disease.

Dermatological Lesions near the Smallpox Vaccination Site after Scab Detachment

“…There are reports of melanoma, basal cell carcinoma, and squamous cell carcinoma in smallpox vaccination sites. The development of postscab lesions during the interval after scab detachment but before the appearance of skin cancer is not described [7,8,10,11,13,14,18,21]. These reports would fit our definition of a "postscab lesion" that occurred many years after vaccination, although our study is limited to a much shorter time interval.…”

“…During the era of routine smallpox vaccination in the 1960s, this phenomenon was not routinely monitored. However, published reports from that era describe the appearance of a new skin lesion after scab detachment or scar formation [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Atypical presentation of infiltrative thyroid dermopathy

“…The arm was affected in only 2 of 178 cases 3 . There are reports of thyroid dermopathy occurring in skin grafts and areas of trauma 4,5 …”

Smallpox vaccination site complications

“…Pujol et al . reported a patient who presented with localized myxedematous infiltration of her smallpox vaccination scar, prompting subsequent thyroid testing 53 . Graves’ disease was diagnosed.…”