An 18-year old man presented with increasing pigmentation in multiple nevi
as well as so-called "eruptive nevi" over a 24 month period. The first exci
sonal biopsy was from a plantar nevus which showed melanocytic hyperplasia.
Following excisions of both hyperpigmented and newly appearing nevi showed
only increased pigmentation. Two years after the first examination Addison
-like hyperpigmentation was noticed in typical locations. Both Addison dise
ase and Hashimoto thyroiditis were then confirmed by elevated serum levels
of ACTH,TSH, and decreased levels of cortisol and L-thyroxine. This confirm
ed the diagnosis of Schmidt syndrome as part of polyglandular autoimmune di
sease (PGAS) type II. After another 18 months of treatment with hormone sub
stitution of L-thyroxine and hydrocortisone, the hyperpigmentation resolved
and the hyperpigmented nevi decreased in number.