Necrolytic migratory erythema: a fortuitous diagnosis

Area of Science:

• Oncology
• Dermatology
• Endocrinology

Background:

• Necrolytic migratory erythema (NME) is a rare dermatosis often associated with glucagonoma, a type of neuroendocrine tumor.
• Early diagnosis of NME is crucial as it can be an indicator of an underlying malignancy.

Observation:

• A woman in her late 60s presented with widespread, itchy, dark skin lesions, new-onset diabetes, and significant weight loss.
• Initial management for presumed nutritional dermatitis provided only partial improvement, with subsequent worsening of symptoms.

Findings:

• Contrast-enhanced CT (CECT) and fluorodeoxyglucose-positron emission tomography CT revealed a primary pancreatic lesion with liver metastases, consistent with stage 4 neuroendocrine tumor.
• Liver biopsy with immunohistochemistry confirmed the diagnosis of neuroendocrine tumor.

Implications:

• This case highlights the importance of recognizing NME as a potential paraneoplastic syndrome.
• Prompt diagnosis and management of NME can lead to the early detection of pancreatic neuroendocrine tumors, improving patient outcomes.