Case of delayed diagnosis of necrolytic migratory erythema

Abstract

Necrolytic migratory erythema (NME) is a rare cutaneous paraneoplastic manifestation of glucagonoma. Estimated incidence of glucagonoma is 1/20,000,000/year. 1 Elevated glucagon level can cause a variety of clinical manifestations including weight loss, diabetes, and NME. This skin rash has a cyclic nature, and lesions exist simultaneously at different stages. 2 Misdiagnosis of paraneoplastic cutaneous manifestation could delay the diagnosis of glucagonoma. We report an interesting case of a female patient with a 6-year history of delayed diagnosis of glucagonoma. | CASE REPORTA 36-year-old Tunisian woman had been followed in our dermatology department for 6 years. She was referred to us for chronic prurigo. Laboratory testing revealed hypochromic microcytic anemia. Serum glucose, HBA1C, and liver plasma tests were normal. She had normal serum zinc, albumin, and lipid levels. Abdominal ultrasound was normal. She was treated with topical steroid intermittently with variable response. Since this episode, she had returned several times with polymorphous skin lesions such as papules, erythematosquamous and crusty plaques, vesicles, pustules, and erosions accompanied by severe pruritus. At that time, we thought she had prurigo (Figure 1A), eczema (Figure 1B), insect bites (Figure 1C), or even drug eruption (Figure 1D).The eruption was episodic with spontaneous exacerbations and remissions. The patient had no abdominal pain, gastrointestinal symptoms, or weight loss. Multiple skin biopsies were performed. They concluded to drug eruption, eczema, prurigo, and erythema multiforme. During the course of the outbreaks, the patient developed angular cheilitis and gingivitis, a deep vein thrombosis in the leg, and psychological problems which affected her social and professional life. Six years later, she presented with acute abdominal and pelvic pain. Abdominal computed tomography (CT) was performed, and hyperdense mass was confirmed on body-tail pancreatic of 15 cm in maximum diameter with mild degree of contrast enhancement. Removal of the tumor was indicated and the cutaneous lesions vanished 1 week after surgery. Pathology report indicated a tumor in the pancreatic alfa

Mechanism of Lethal Skin Toxicities Induced by Epidermal Growth Factor Receptor Inhibitors and Related Treatment Strategies

“…These skin toxicities may result in fatal complications if they are ignored ( 11 ). Doctors, pharmacists, and nurses must consider how to avoid severe skin toxicity in their patients and determine which patients would be prone to fatal skin toxicity.…”