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Shrestha A, Bam PK, Pandit A, Shrestha H, Koirala M. Eruptive xanthoma as a warning sign of uncontrolled hypertriglyceridemia presenting with acute pancreatitis and uncontrolled type II diabetes mellitus: A case report. Clin Case Rep 2024; 12:e8926. [PMID: 38799544 PMCID: PMC11111605 DOI: 10.1002/ccr3.8926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical Message Managing diabetic ketoacidosis (DKA) in individuals with severe dyslipidemia necessitates a comprehensive approach. While rehydration and continuous insulin infusion are fundamental components of DKA management due to the underlying insulin deficiency, the presence of severe hyperlipidemia with eruptive xanthomas warrants additional consideration. Early initiation of lipid-lowering agents can expedite the resolution of cutaneous lesions and substantially mitigate the risk of severe complications such as pancreatitis, along with attenuating long-term cardiovascular risks. Abstract Xanthomas are the benign lesions which are generated by localized lipid deposits in the skin, tendons, and subcutaneous tissue. They appear clinically as yellowish papules, nodules, or plaques. Acute pancreatitis and eruptive xanthomas can occur as complications of hyperlipidemia. Uncontrolled diabetes mellitus in one of the risk factors for hypertriglyceridemia. Early recognition and treatment of the eruptive xanthomatosis as a warning sign of hypertriglyceridemia can decrease the morbidity and mortality due to acute pancreatitis. Here, we discuss a case of 37-years old female patient with uncontrolled type II diabetes mellitus presented with acute pancreatitis and eruptive xanthomas as result of raised triglycerides and uncontrolled diabetes.
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Affiliation(s)
- Ankit Shrestha
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Prabin Kumar Bam
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Aakash Pandit
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Hari Shrestha
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Melisha Koirala
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
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2
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Saoji V, Madke B, Shembalkar J, Rambhia K. Eruptive xanthomas. BMJ Case Rep 2024; 17:e260230. [PMID: 38627045 PMCID: PMC11029258 DOI: 10.1136/bcr-2024-260230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Affiliation(s)
- Vikrant Saoji
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Jayashri Shembalkar
- Department of Endocrinology, GetWell Hospital, Dhantoli, Nagpur, Maharashtra, India
| | - Kinjal Rambhia
- Department of Dermatology, HBT Medical College and Dr. RN Cooper Hospital, Mumbai, Maharashtra, India
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3
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Ohtaki S, Ashida K, Matsuo Y, Moritaka K, Iwata S, Nagayama A, Kawaguchi A, Koga H, Yoshinobu S, Hasuzawa N, Motomura S, Akiba J, Nakama T, Nomura M. Eruptive xanthomas as a marker for metabolic disorders: A specific form of xanthoma that reflects hypertriglyceridemia. Clin Case Rep 2022; 10:e05671. [PMID: 35474985 PMCID: PMC9021930 DOI: 10.1002/ccr3.5671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Eruptive xanthomas are skin manifestations associated with hypertriglyceridemia. Accordingly, the improvement of hypertriglyceridemia can ameliorate this condition. We report a case of a patient with type 2 diabetes mellitus who was diagnosed with this skin lesion. Clinicians should be aware that eruptive xanthomas could indicate metabolic disorders associated with atherosclerosis.
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Affiliation(s)
- Sohichiroh Ohtaki
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Yuko Matsuo
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Kanoko Moritaka
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Aya Kawaguchi
- Department of Diagnostic Pathology Kurume University Hospital Fukuoka Japan
- Department of Dermatology Kurume University School of Medicine Fukuoka Japan
| | - Hiroshi Koga
- Department of Dermatology Kurume University School of Medicine Fukuoka Japan
| | - Satoko Yoshinobu
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Nao Hasuzawa
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Seiichi Motomura
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Jun Akiba
- Department of Diagnostic Pathology Kurume University Hospital Fukuoka Japan
| | - Takekuni Nakama
- Department of Dermatology Kurume University School of Medicine Fukuoka Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
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Marogi EP, Ohiomoba RO, Stone NJ. Eruptive Xanthomas: Importance of Recognition to Reduce Delay of Effective Triglyceride Reduction. Am J Med 2022; 135:444-447. [PMID: 34732347 DOI: 10.1016/j.amjmed.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
Eruptive xanthomas are localized lipid deposits in the dermis and an important early clue to severe hypertriglyceridemia. These small erythematous or yellow papules that localize to the extensor surfaces of extremities, buttocks, and the back are often overlooked during routine visits secondary to poor familiarity and limited skin examinations. We present 3 cases of patients with eruptive xanthomas and severe hypertriglyceridemia who underwent skin biopsy and waited weeks to years before receiving effective treatment. We suggest the following to minimize the delay between presentation and effective management. First, perform a comprehensive skin examination. Second, be mindful of the association between metabolic syndrome or diabetes with severe hypertriglyceridemia. Third, evaluate the Four D's of secondary hypertriglyceridemia: Diet/Lifestyle, Drugs/Medications, and Diseases/Disorders of metabolism. Finally, initiate effective treatment promptly after recognition. This includes beginning with a minimal fat diet and appropriate pharmacological intervention to control triglycerides as outlined in recent guidelines.
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Affiliation(s)
- Emily P Marogi
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | - Neil J Stone
- Departments of Medicine (Cardiology) and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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Lipid Metabolic Disorder with Varied Clinical Manifestations. Am J Med 2022; 135:e42-e43. [PMID: 34655537 DOI: 10.1016/j.amjmed.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022]
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6
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Misra S, Singh A, Aggarwal N. Giant sacral xanthoma in familial hypercholesterolemia. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_215_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lim PN, Chopra M, Murphy A, Digby S, Aldworth G, Panarelli M, Christie A, Torley D. An acute papular eruption in an adolescent boy. Clin Exp Dermatol 2021; 47:480-483. [PMID: 34637555 DOI: 10.1111/ced.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- P N Lim
- Department of Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Chopra
- Department of Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - A Murphy
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - S Digby
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - G Aldworth
- Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Panarelli
- Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, UK
| | - A Christie
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | - D Torley
- Department of Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
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Ringoringo HP. The Role of Atorvastatin in Management of Eruptive Xanthoma on a Boy: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Parente C, Reis R, Toscano M, Botelho I, Ramos A. Abdominal Pain as the Manifestation of Chylomicronemia Syndrome During Pregnancy: A Challenging Diagnosis. Cureus 2021; 13:e14317. [PMID: 33968527 PMCID: PMC8101506 DOI: 10.7759/cureus.14317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypertriglyceridemia is a frequent cause of acute pancreatitis. Levels higher than 1000 mg/dL are often associated with a genetic predisposition that can be aggravated by other factors such as pregnancy and poorly controlled diabetes. The authors report a 19-year-old primigravida that presented with abdominal pain, emesis and a pruritic rash, along with severely increased plasma triglyceride levels. Therapeutic plasmapheresis was proposed in the setting of a presumed acute pancreatitis. Chylomicronemia syndrome is a rare and frequently misdiagnosed pathology that can evolve with abdominal pain, vomiting and a specific cutaneous rash designated as eruptive xanthomatosis. This case report illustrates the challenges of achieving a correct diagnosis for rare conditions and corroborates the safety of plasmapheresis during pregnancy.
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Affiliation(s)
- Catarina Parente
- Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Rúben Reis
- Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | | | - Isabel Botelho
- Internal Medicine: Critical Care, Hospital De Cascais, Cascais, PRT
| | - Armindo Ramos
- Internal Medicine: Critical Care, Hospital De Cascais, Cascais, PRT
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Yan Q, Wang X. Dermoscopic and reflectance confocal microscopy features of eruptive xanthoma. Skin Res Technol 2020; 27:639-640. [PMID: 33373069 DOI: 10.1111/srt.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Qiao Yan
- Department of Dermatology, School of Medicine, Zhong Da Hospital, Southeast University, Nanjing, China
| | - Xiaopo Wang
- Department of Pathology, Hospital for Skin Disease and Institute of Dermatology, Peking Union Medical College & Chinese Academy of Medical Sciences, Nanjing, China
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Tsuchiya S, Sawada S, Takeda K, Takahashi K, Nakajima T, Kohata M, Kurosawa S, Satake C, Imai J, Kikuchi K, Aiba S, Katagiri H. Eruptive xanthomas in a patient with soft-drink diabetic ketosis and apolipoprotein E4/2. Endocr J 2019; 66:107-114. [PMID: 30393272 DOI: 10.1507/endocrj.ej18-0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soft-drink diabetic ketosis, characterized by acute onset ketosis induced by excessive ingestion of sugar-containing drinks, is often seen in obese, young patients, even with undiagnosed type 2 diabetes. We herein report a 15-year-old obese patient with the apolipoprotein E4/2 phenotype, in whom eruptive xanthomas lead to a diagnosis of soft-drink diabetic ketosis. He developed multiple asymptomatic yellowish papules on the auricles, back, buttocks and the extensor surfaces of the elbows and knees. He initially visited a dermatology clinic and his blood triglyceride and HbA1c levels were found to be 6,490 mg/dL and 16.5%, respectively. He was referred to our hospital for treatment of hyperglycemia and hypertyriglyceridemia. On admission, he had ketonuria and increased blood levels of 3-hydroxybutylate and acetoacetate. He habitually drank 1-3 litters of sweet beverages daily to quench his thirst. Therefore, "soft-drink diabetic ketosis" was diagnosed. Severe hypertriglyceridemia was considered to have been a consequence of impaired insulin action and his apolipoprotein E4/2 phenotype. We treated the diabetic ketosis and hypertriglyceridemia with intensive insulin therapy and a fat-restricted diet. At discharge, he no longer required insulin therapy and his blood glucose levels were controlled with metformin and voglibose. Along with amelioration of the hyperglycemia, triglyceride levels decreased to 247 mg/dL without administration of anti-hyperlipidemia agents. The eruptive xanthoma lesions gradually diminished in size and number and eventually disappeared by 12 months. This case provides an instructive example of eruptive xanthomas serving as a sign of severe dysregulation, not only of lipid, but also glucose, metabolism.
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Affiliation(s)
- Satoko Tsuchiya
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Shojiro Sawada
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Kana Takeda
- Department of Dermatology, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Kenji Takahashi
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Takeko Nakajima
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Masato Kohata
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Satoko Kurosawa
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Chihiro Satake
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Junta Imai
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Katsuko Kikuchi
- Department of Dermatology, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Hideki Katagiri
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
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Anthony EP, Lichtblau BJ, McCormack C. Hyperlipidaemia presenting as palmoplantar pain. Australas J Dermatol 2017; 59:e213-e214. [PMID: 28924996 DOI: 10.1111/ajd.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eleni P Anthony
- Dermatology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | | | - Christopher McCormack
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
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