Hoffmann's syndrome: delayed onset and progression in the elderly - a case report

Abstract

Hoffmann's syndrome (HS) is typically characterized by myopathy and linked to hypothyroidism. It is distinguished by hypothyroidism, muscle weakness, and pseudohypertrophy of particular muscles. In the present case report, a 70-year-old man was brought to the hospital with major complaints of hematuria and swelling in both legs, and a small wound on his right leg. He had a known history of type 2 diabetes mellitus with irregular medication. The hematological investigation reveals abnormalities, including an irregular Q-wave, an inverted T-wave, and low voltage in the limb leads, as identified by electrocardiography (ECG). Troponin I was negative, cardiac indicators were aberrant, and the creatine kinase myocardial band (CK-MB) level was 132 U/l. To manage the symptoms and stabilize the patient’s condition, he was treated initially with antibiotics, metformin, metoprolol, furosemide, aspirin, and clopidogrel. Contrarily, the leg swelling did not improve. Later, the hematological investigation revealed that abnormal thyroxine levels (T3-0.26 ng/ml, T4-0.5 ng/ml, and TSH-60.0 mIU/l) and prominent right leg swelling were associated with chronic kidney disease (CKD) and Hypothyroidism.  The swelling and cellulitis gradually reduced after intravenous meropenem and oral thyroxine treatment. He was continuously monitored, and signs and symptoms steadily improved. In this instance, it is crucial to stress that, particularly in the absence of obvious signs of hypothyroidism, a differential diagnosis of musculoskeletal problems should be taken into consideration when a patient presents with leg swelling, and early detection of Hoffman’s disorder leads to a more effective treatment outcome.