Eruptive xanthomas in a child with the nephrotic syndrome

The Role of Atorvastatin in Management of Eruptive Xanthoma on a Boy: A Case Report

Background: Eruptive xanthoma is a benign skin lesion caused by the accumulation of cholesterol and triglycerides in the skin's dermis. Xanthoma can be an early clinical manifestation of systemic diseases such as dyslipidemia, cardiovascular disease, diabetes mellitus. Clinical presentation varies from asymptomatic skin lesions to intense pruritus and tenderness. Aim: This study aims that oral atorvastatin is effective in treating a child with eruptive xanthoma. Case report: A three-year-old boy with an 8.4 kg body weight and 82.5 cm height came to the hospital with the chief complaint of small yellowish-white papules and nodes, discrete, 2-5 mm in size, painless on pressing, itchy, scattered, mainly in the lower extremity around the buttocks. On laboratory examination, Hb 11.5 g/dL, leukocyte 9,900/ul, platelet 413,000/uL, blood glucose 66 mg/dL. Further evaluation revealed total cholesterol 814 mg/dL, LDL 970 mg/dL, HDL 341 mg/dl, triglycerides 621 mg/dL; there is no evidence of familial hypercholesterolemia. The diagnosis is eruptive xanthoma.  After starting treatment with atorvastatin 0.2 mg/kg body weight/day in one dose for six months, his cutaneous lesions gradually subsided and significantly decreased cholesterol, LDL, HDL, and triglyceride levels. Conclusion: Early therapy with atorvastatin will reduce the morbidity and mortality of eruptive xanthoma.

Eruptive xanthomas masquerading as molluscum contagiosum

Eruptive xanthomas are cutaneous manifestations of hyperlipidemias in which lipids accumulate in large foam cells within the skin. They classically present as crops of 1- to 4-mm yellow-orange papules and are often associated with extreme hypertriglyceridemia. We describe a 12-year-old boy with autism who was thought to have widespread molluscum contagiosum for a year before dermatologic consultation was obtained. Recognition of eruptive xanthomas led to the discovery of massive hypertriglyceridemia (serum triglycerides 6853 mg/dL) and diabetes mellitus. Through medical intervention, including insulin and fenofibrate therapy, and dietary modification with weight loss, the xanthomas cleared during the subsequent months, and his serum triglyceride levels nearly normalized.

Mixed Hypercholesterolemia and Hypertriglyceridemic Xanthomatosis: Four classic types of Xanthomas in one patient at the same time

Xanthomas are localized infiltrates oftipid-containing cells found within the dermis. Cutaneous xanthomas are mostly cosmetic disorders but xanthomas can indicate the presence of an underlying generalized disturbance in lipid metabolism possibly associated with coronary artery disease. Because hyperlipidemia may present as xanthomatosis, a dermatologist might be the first to diagnose these associated lipid abnormalities, We report a 36-year-old male who presented with four classic types of xanthomas (Xanthelasma, Tuberous, Eruptive and Plane xanthomas) at the same time. Laboratory tests confirmed hypercholesterolemia and hypertriglyceridemia of dysbetalipoprotein Type III of the Fredrickson classification. The occurrence of four clinical types of xanthomas simultaneously in the same patient is rarely reported in the literature. The clinical, histopathology, laboratory investigation and management of hyperlipidemia and cutaneous lesions is fully discussed together with a review of the literature.

Potential of essential fatty acid deficiency with extremely low fat diet in lipoprotein lipase deficiency during pregnancy: A case report

BACKGROUND: Pregnancy in patients with lipoprotein lipase deficiency is associated with high risk of maternal pancreatitis and fetal death. A very low fat diet (< 10% of calories) is the primary treatment modality for the prevention of acute pancreatitis, a rare but potentially serious complication of severe hypertriglyceridemia. Since pregnancy can exacerbate hypertriglyceridemia in the genetic absence of lipoprotein lipase, a further reduction of dietary fat intake to < 1-2% of total caloric intake may be required during the pregnancy, along with the administration of a fibrate. It is uncertain if essential fatty acid deficiency will develop in the mother and fetus with this extremely low fat diet, or whether fibrates will cross the placenta and concentrate in the fetus. CASE PRESENTATION: A 23 year-old gravida 1 woman with primary lipoprotein lipase deficiency was seen at 7 weeks of gestation in the Lipid Clinic for management of severe hypertriglyceridemia that had worsened with pregnancy. While on her habitual fat intake of 10% of total calories, her pregnancy resulted in an exacerbation of the hypertriglyceridemia, which prompted further restriction of fat intake to < 2% of total calories, as well as administration of gemfibrozil at a lower than average dose. The level of gemfibrozil, as the active metabolite, in the venous and arterial fetal cord blood was within the expected therapeutic range for adults. The clinical signs and a biomarker of essential fatty acid deficiency, namely the ratio of 20:3 [n-9] to 20:4 [n-6] fatty acids, were closely monitored throughout her pregnancy. Despite her extremely low fat diet, the levels of essential fatty acids measured in the mother and in the fetal blood immediately postpartum were normal. Normal essential fatty acid levels may have been achieved by the topical application of sunflower oil. CONCLUSIONS: An extremely low fat diet in combination with topical sunflower oil and gemfibrozil administration was safely implemented in pregnancy associated with the severe hypertriglyceridemia of lipoprotein lipase deficiency.