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   Introduction
   Case Report
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CASE REPORT
Year : 1992  |  Volume : 58  |  Issue : 5  |  Page : 343-344

Vitiligo occurring after thyroidectomy at sites of leprosy lesions




Correspondence Address:
E Anuja George


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Source of Support: None, Conflict of Interest: None


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  Abstract 

A 51-year-old female patient developed vitiligo at the previous sites of treated leprosy immediately after thyroidectomy. A neurological factor in association with thyroid dysfunction is considered as the possible aetiology of vitiligo in this case.


Keywords: Vitiligo, Thyroidectomy, Leprosy


How to cite this article:
George E A, Sarojini P A. Vitiligo occurring after thyroidectomy at sites of leprosy lesions. Indian J Dermatol Venereol Leprol 1992;58:343-4

How to cite this URL:
George E A, Sarojini P A. Vitiligo occurring after thyroidectomy at sites of leprosy lesions. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Feb 29];58:343-4. Available from: http://www.ijdvl.com/text.asp?1992/58/5/343/3844



  Introduction Top


The exact aetiology of vitiligo is not known. Autoimmune hypothesis has its origin in coexistence of vitiligo with other autoimmune disorders like autoimmune thyroid disorders, diabetes mellitus, hypoparathyroidism, pernicious anaemia, alopecia areata etc. [1] According to the neurohumoral hypothesis, certain compounds released at the peripheral nerve endings inhibit melanogenesis and have toxic effect on melanocytes. [2] There may also be a disturbance in autonomous nervous system [3] at the sites of leprosy lesions after thyroidectomy.


  Case Report Top


A 51-year-old woman presented with multiple hypopigmented and depigmented macules and patches varying from a few millimetres to 20cm in diameter, over both shoulders extending to scapular areas, lumbosacral areas and buttocks, back of trunk, forearms, knuckles and legs. of 6 months duration. They had started as hypopigmented lesions and progressed to depigmentation. Some had white hairs over them. Linear depigmented lesions suggestive of Koebner phenomenon were also present.

She gave a history of hypopigmented patches with sensory impairment over both shoulder, chest, and forearms, which was diagnosed as paucibacillary leprosy and treated with multi drug therapy. All lesions had disappeared and she stopped treatment 2 years ago. During a subsequent review, she was detected to have thyroid swelling with 2 soft nodules. Clinically she was euthyroid and diagnosis of multinodular goiter was made.

Her urinalysis, haemogram, chest x-ray, and ECG were normal. Ultrasound of the thyroid showed enlarged lobes with solid nodular architecture and a 30xl5mm solid nodule with irregular hypoechoic texture on the right lobe. FNAC showed blood and benign thyroid cells. Thyroid function tests were normal.

A subtotal thyroidectomy was done in February 1992. The histopathology report was multinodular goiter and she was later put on Eltroxin 0.1gm daily.

One week after surgery, she developed hoarseness of voice and 2 months later, developed the hypopigmented macules and patches. Some of the patches arose at the original sites of leprosy and sensations were impaired over these patches.

A possibility of relapse of leprosy versus vitiligo was considered. Her urinalysis and haemogram were normal. No acid fast bacilli were demonstrated from the skin smears. A biopsy from a hypopigmented patch at the old site of leprosy showed no evidence of activity. In the course of to 2 months, the hypopigmented patches became depigmented.


  Comments Top


This patients presented with hypopigmented patches at the site of previous leprosy and also at new sites, following thyroidectomy. Since the patches at the sites of leprosy were anaesthetic, the possibility of relapse was considered. But no acid fast bacilli were demonstrable and biopsy from these patches showed no activity which ruled out relapse of leprosy. The sensory impairment was perhaps the persistence of previous nerve damage. The depigmented patches, with white hairs over some of them and the Koebner phenomenon, favoured the diagnosis of vitiligo. In this case, the vitiligo followed immediately afte r thyroidectomy suggesting a thyroid dysfunction as an etiology.

Association of vitiligo with autoimmune thyroid disorder, both hypothyroidism and hyperthyroidism is seen with greater tendency towards the hypothyroid state. Subclinical thyroid dysfunction in clinically euthyroid patients with vitiligo appears to be an adaptive change. [4] A 7% incidence of vitiligo developing after varying years of treatment for lepromatous leprosy has been reported. [5] A number of autoantibodies are found in lepromatous leprosy, lending further support to the autoimmune basis for vitiligo. But in this case, vitiligo occurred in the anaesthetic areas of old paucibacillary leprosy which suggests a neurological factor in association with thyroid dysfunction as an aetiology of vitiligo.

 
  References Top

1.Kenney JA Jr. Vitiligo. Dermatol Clin 1988; 6 425-34.  Back to cited text no. 1    
2.Bleehen SS, Ebling FJG. Disorders of skin colour. In: Text book of Dermatology (Rook AJ, Wilkinson DS, Ebling FJG, et al, eds), 4th edn. London : Blackwell Scientific Publications, 1987; 1591.  Back to cited text no. 2    
3.Arnol HL, Odom RB, James WD. Disturbances of Pigmentation. In : Andrew's Diseases of the Skin, 8th edn. Philadelphia : WB Saunders Company, 1990; 1002.  Back to cited text no. 3    
4.Kumar V, Shankar V, Chaudhary S, et al. Radioactive iodine uptake in Vitiligo. J Dermatol 1990; 17 : 41-3.  Back to cited text no. 4  [PUBMED]  
5.Jopling VUH. Vitiligo and leprosy. Lepr Rev 1978; 49 : 88.  Back to cited text no. 5    




 

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