Iatrogenic necrolytic migratory erythema: a case report and review of nonglucagonoma-associated necrolytic migratory erythema.

Abstract

Necrolytic migratory erythema is characterized by waves of irregular erythema in which a central bulla develops, and subsequently erodes and becomes crusted. It usually occurs in patients with an alpha-islet cell tumor of the pancreas. However, necrolytic migratory erythema has also been observed in patients without an associated glucagonoma. We describe a woman with iatrogenic necrolytic migratory erythema. She received intravenous glucagon for hypoglycemia associated with an insulin-like growth factor II-secreting hemangiopericytoma. After chemotherapy, she developed necrolytic migratory erythema. The characteristics of the previously reported patients with nonglucagonoma-associated necrolytic migratory erythema are reviewed. In patients with nonglucagonoma-associated necrolytic migratory erythema, the dermatosis-related conditions most commonly observed were celiac disease or malabsorption, cirrhosis, malignancy, and pancreatitis; less common conditions included hepatitis, inflammatory bowel disease, heroin abuse, and odontogenic abscess. Although the pathogenesis of necrolytic migratory erythema remains unknown, hyperglucagonemia appears to have had a causative role in the development of this dermatosis in our patient. Patients who develop necrolytic migratory erythema should be evaluated for the presence of a glucagonoma; if a glucagonoma is ruled out, evaluation for other conditions known to occur with necrolytic migratory erythema, such as liver disease, malabsorptive disorders, and nonislet-cell tumors is warranted.

• Authors: E A Mullans, P R Cohen
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 38 Issue 5 Pt 2 Pg. 866-73 (May 1998) ISSN: 0190-9622 [Print] United States
• PMID: 9591806 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Gastrointestinal Agents
• Insulin-Like Growth Factor II
• Glucagon

Topics

• Adult
• Diagnosis, Differential
• Erythema (chemically induced, diagnosis, etiology)
• Female
• Gastrointestinal Agents (adverse effects)
• Glucagon (adverse effects)
• Glucagonoma (complications, diagnosis)
• Hemangiopericytoma (metabolism, secondary)
• Humans
• Hypoglycemia (drug therapy, etiology)
• Iatrogenic Disease
• Insulin-Like Growth Factor II (metabolism)
• Kidney Neoplasms (secondary)
• Liver Neoplasms (secondary)
• Necrosis
• Pancreatic Neoplasms (complications, diagnosis)
• Paraneoplastic Syndromes (diagnosis, etiology)
• Skin Diseases, Vesiculobullous (chemically induced, diagnosis, etiology)