[Necrolytic migrating erythema without glucagonoma].

Abstract

INTRODUCTION:

The glucagonoma syndrome is an uncommon but well-known entity associating erythema necroticans migrans (ENM) with glucagonoma.

CASE REPORT:

A 43-year-old man with a past history of alcoholic cirrhosis and ascitis was hospitalized for skin disorders which had developed over the past 4 months. Centrifugal erythematous skin lesions were observed, some with non-turgid bullae and marginal desquamation, others with an erosive center. Lesions first appeared on the hands then diffused widely without involving the periorifical areas, folds and lower limbs. Laboratory results revealed an anemia, hypovitaminosis K, cholestatic liver failure, a beta-gamma block and low zinc levels. Histology study of the skin biopsy demonstrated a << Neapolitan trench >> image suggestive of ENM. A paraneoplasic syndrome and pancreas tumor were not found. Despite supplementation with zinc, amino acids and vitamins, the patient died from his liver disease.

DISCUSSION:

There have been 4 cases of ENM reported in the literature, all in cirrhosis patients, two of which had low zinc levels. Our case is thus the third with cirrhosis and low zinc. Bazex's syndrome, acrodermatitis enteropathica, annular chronic lupus erythematosis and annular superficial pemphigus were eliminated as possible diagnoses. The failure of zinc and amino acid supplementation would favor the secondary nature of the zinc deficiency and the predominant role of cirrhosis in this skin disease. The possible role of essential fatty acids in ENM is raised.

• Authors: H Maillard, P Celerier, C Maisonneuve, J L Forest, A Blanchi, C Pasquiou
• Journal: Annales de dermatologie et de venereologie (Ann Dermatol Venereol) Vol. 122 Issue 11-12 Pg. 786-8 ( 1995) ISSN: 0151-9638 [Print] France
• Vernacular Title: Erytheme necrolytique migrateur sans glucagonome.
• PMID: 8729827 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Zinc

Topics

• Adult
• Diagnosis, Differential
• Erythema (etiology, pathology)
• Fatal Outcome
• Glucagonoma (diagnosis)
• Humans
• Liver Cirrhosis (complications)
• Male
• Necrosis
• Pancreatic Neoplasms (diagnosis)
• Skin (pathology)
• Zinc (blood)