Erythema Gyratum Repens: A Rare Paraneoplastic Rash

Abstract

Erythema gyratum repens (EGR) is a rare and characteristic, paraneoplastic rash associated with a variety of malignancies, most notably lung, esophageal, and breast cancers. This case report details the appearance, epidemiology, diagnosis, and treatment of EGR. Prompt identification of EGR is essential, as the rash often precedes the diagnosis of malignancy by several months. Urgent patient referral to evaluate for malignancy is crucial, as this may lead to decreased morbidity and mortality.

Self-assembled multi-ring formations of glutamine and a possible link to erythema gyratum repens

“…There are a few viewpoints to the origin of EGR, including cross-react antibody theory [4]. The purpose of this paper is to suggest glutamine as the reason for the unusual skin patterns and to prompt those with medical facilities to carry out a more direct experimental set-up using the actual skin or cutaneous cells to investigate the issue, for which the key molecules that forms ring structures in EGR remain unknown.…”

“…The healthy structure of the skin can also become disorganised with illness [2]. In the case of EGR the whole body can become covered, with an advance of about 1 cm/day, that persists with advancing serpiginous trails [3,4] and nonspecific histopathologic features [4]. Here we hypothesise a link between L-glutamine and EGR, for those with access to facilities to carry out mass spectrometric analyses of biopsied specimens from each ring and normal skin between rings from EGR.…”

Appearances in clinical dermatology

“…The appearance may resemble a wood-grain pattern. [121] It typically affects the trunk and proximal extremities, generally sparing the hands, feet, and face. Bands can migrate up to 1 cm per day and often are pruritic.…”

Erythema gyratum repens as a manifestation of drug reaction with eosinophilia and systemic symptoms

“…[16] Erythema annulare centrifugum and urticarial vasculitis were unlikely in our patient owing to the larger and rapidly migrating nature of lesions and the absence of neutrophilic vasculitis (histologically), respectively. [78] Malignancy-associated erythema gyratum repens with DRESS was considered since fever and edema manifested by our patient could not be explained by erythema gyratum repens alone. A transudate pleural effusion which responded to systemic steroids and the complete resolution of erythema gyratum repens noted in our case were against a malignancy-associated process.…”

“…A transudate pleural effusion which responded to systemic steroids and the complete resolution of erythema gyratum repens noted in our case were against a malignancy-associated process. [7] Erythema gyratum repens has been reported following drugs such as azathioprine and in the resolving stage of pityriasis rubra pilaris. [910] Despite extensive literature search, we did not come across any previous reports of erythema gyratum repens occurring during the treatment of DRESS.…”