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. 2021 Jul 30;61(2):273–274. doi: 10.2169/internalmedicine.7106-21

Musculoskeletal Ultrasound Manifestation of Osteoarthropathy in EMO Syndrome

Shin-ya Kawashiri 1,2, Remi Sumiyoshi 2, Atsushi Kawakami 2
PMCID: PMC8851171  PMID: 34334562

EMO syndrome is a rare condition seen in <1% of patients with Graves' disease. It is defined as a triad of exophthalmos, pretibial myxedema, and osteoarthropathy (1,2). We herein report a case of EMO syndrome in which musculoskeletal ultrasound (MSUS) was useful for the diagnosis of osteoarthropathy. A 54-year-old woman had a 1-year history of hand stiffness. She had been diagnosed with ophthalmopathy associated with Graves' disease 6 years earlier (TSAb 3,674% TRAb 32.9 IU/L). A physical examination revealed clubbed fingers and pretibial non-pitting edema. X-ray showed brushed periosteal hypertrophy on the metacarpal and metatarsal bones (Picture 1, 2). MSUS showed irregular bone prominence (Picture 3, 4) and local subcutaneous hypertrophy of the left lower leg, which was proven to be myxedema by a histopathologic examination. It is not easy to detect periosteal hypertrophy on X-ray. Since MSUS has a high spatial resolution and little direction dependence, periosteal hypertrophy can be easily detected using this modality.

Picture 1.

Picture 1.

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Picture 2.

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Picture 3.

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Picture 4.

The authors state that they have no Conflict of Interest (COI).

References

  • 1.Anderson CK, Miller OF 3rd. Triad of exophthalmos, pretibial myxedema, and acropachy in a patient with Graves' disease. J Am Acad Dermatol 48: 970-972, 2003. [DOI] [PubMed] [Google Scholar]
  • 2.Senel E, Güleç AT. Euthyroid pretibial myxedema and EMO syndrome. Acta Dermatovenerol Alp Pannonica Adriat 18: 21-23, 2009. [PubMed] [Google Scholar]

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