Puffy erythemic eyelids caused by amiodaron-induced hypothyroidism mimicking dermatomyositis

We report a 62-year-old man with puffy eyelids caused by amiodarone-induced hypothyroidism and elevated levels of serum muscle enzymes. He had been diagnosed as having spontaneous dilated cardiomyopathy in July 1990 and had received amiodarone hydrochloride (Ancaron®) since May 10, 2001. In January 2002, erythematous puffy edema appeared in the periocular regions without subjective symptoms and gradually expanded around the eyelids. Tentative clinical diagnoses included dermatomyositis or photosensitivity due to amiodarone hydrochloride. Despite the elevated levels of serum myoglobin and aldolase, histopathologic features showed no liquefactive degeneration suggestive of dermatomyositis. The eyelid lesion was weakly positive for mucin. Neither muscle weakness nor abnormal findings of electromyogram were observed. Phototests using UVA and UVB were normal. Hypothyroidism due to amiodarone hydrochloride was diagnosed because of increased levels of TSH with decreased freeT₄ levels. Administration of levothyroxine sodium (Tyradin S®) improved the hypothyroidism and skin lesions.