Rituximab therapy for a severe case of pretibial myxedema

Pretibial myxedema (PTM) (thyroid dermopathy) is a known manifestation of Graves disease (GD), commonly presenting as localized, circumscribed, or infiltrated plaques over the pretibial areas. PTM is present in up to 4.3% of GD patients and in 15% of patients with Graves ophthalmopathy.1 Rituximab (RTX) has shown potential to become a novel therapy for the treatment of severe cases of Graves ophthalmopathy in recent years; however, it is not well-documented for the treatment of PTM.2 We present a case of a patient with severe PTM refractory to systemic, intralesional, and topical corticosteroid therapy and compression, who showed a rapid and sustained response when treated with RTX in addition to topical corticosteroids under occlusion.