Elephantiasis-like appearance of upper and lower extremities in Graves' dermopathy

Graves' dermopathy, affecting upper as well as lower extremities, is reported in a 50-year-old male patient addicted to multiple narcotic drugs. The narcotic drug administration routes include subcutaneous and intravenous injection in all limbs over a period of 29 years. The combination of drug injection trauma and Graves' dermopathy produced elephantiasis-like appearance of upper and lower limbs with impairment of their function; the left hand required amputation. Other features of Graves' disease, ie, hyperthyroidism and ophthalmopathy were severe and required multiple modes of therapy. Although the pathogenesis of Graves' dermopathy is unclear, it is surmised that trauma to skin might exacerbate it and preventive measures for trauma might be helpful in the management of dermopathy.