Eruptive Xanthomas Associated with Hypertriglyceridemia and New-Onset Diabetes Mellitus

Abstract

previously healthy, 38-year-old man with a family history of early cerebrovascular accidents presented with a sudden eruption of pink papules with creamy-colored centers on his arms and upper torso (Panels A and B). He was otherwise asymptomatic and had no abdominal pain. The results of laboratory tests performed while the patient was fasting included a total cholesterol level of 1268 mg per deciliter (32.8 mmol per liter), a total triglyceride level of 8869 mg per deciliter (100.1 mmol per liter), a glucose level of 241 mg per deciliter (13.4 mmol per liter), and a glycosylated hemoglobin value of 13.4 percent. Triglyceride-lowering therapy with gemfibrozil was initiated to enhance lipoprotein lipase activity, and insulin therapy was initiated to treat the hyperglycemia. Twenty-four hours later, his total triglyceride level was 6466 mg per deciliter (73.0 mmol per liter). At follow-up visits three and five months later, the patient's eruptive xanthomas had decreased in size and number. After eight months of treatment with gemfibrozil, glyburide, and glucophage, his total cholesterol level was 218 mg per deciliter (5.6 mmol per liter), his total triglyceride level was 302 mg per deciliter (3.4 mmol per liter), and his glycosylated hemoglobin value was 8.3 percent; the eruptive xanthomas had completely resolved. Review of his records revealed a preexisting, untreated dyslipidemia (total cholesterol level, 216 mg per deciliter [5.6 mmol per liter]; total triglyceride level, 422 mg per deciliter [4.8 mmol per liter]), which was consistent with the presence of Frederickson's type IV familial hypertriglyceridemia. This case, however, would be better classified as a type V phenotype, mixed hypertriglyceridemia, owing to the coincident new-onset diabetes mellitus.

Eruptive xanthomas in a patient with soft-drink diabetic ketosis and apolipoprotein E4/2

“…Ketosis-prone diabetes is on occasion accompanied by hypertriglyceridemia [12][13][14]. There are several case reports documenting eruptive xanthomas with severe hypertriglyceridemia (>2,000 mg/dL) as well as uncontrolled diabetes mellitus (HbA1c >10%) [3,[15][16][17][18][19]. Most of these patients were relatively young (<40-year-old) and were obese (BMI >25 kg/m 2 ).…”

Current Diagnosis and Management of Primary Chylomicronemia

“…• Eruptive xanthomas: Eruptive xanthomas affect 10-50% of the monogenic type 95,96) . They appear when plasma TG levels increase to more than 2,000 mg/dL as yellow papules on the skin of the trunk, buttocks, and extremities (extensor surfaces of the arms and knees) as a result of TG uptake by macrophages (see references by Nayak KR et al and Yuan G et al for photographs) 2,4,56,101) . Along with reduction in plasma TG levels, they gradually genes (APOC2, GPIHBP1, APOA5, and LMF1) 5,15,53) .…”

A young man with extensor eruptive skin lesions

“…Eruptive xanthomas are round yellowish waxy skin lesions usually appearing in the back and extensor surface of the extremities, and are caused by severe hypertriglyceridaemia 1. The latter may be due to uncontrolled diabetes mellitus, alcoholism, morbid obesity with significant insulin resistance and uncontrolled hypothyroidism.…”