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[Erythema necroticans migrans without glucagonoma]
M Tanner1, J Brasch, E Christophers
1Hautklinik, Christian-Albrechts-Universität zu Kiel.
Summary
Necrolytic migratory erythema, a skin paraneoplastic syndrome, is often linked to pancreatic tumors. This case highlights necrolytic migratory erythema associated with chronic hepatitis, not cancer, suggesting alternative causes for this skin condition.
Area of Science:
- Dermatology
- Oncology
- Hepatology
Background:
- Necrolytic migratory erythema (NME) is a rare skin condition often associated with pancreatic alpha-cell tumors (glucagonomas).
- While commonly considered a paraneoplastic syndrome, recent literature suggests NME can occur without evidence of malignancy.
- This challenges the established understanding of NME's etiology.
Observation:
- A 59-year-old woman presented with clinical and histological features characteristic of NME.
- Extensive investigations, including staging and laboratory tests, ruled out any neoplastic disease.
- A liver biopsy confirmed chronic persistent hepatitis.
Findings:
- The patient's NME was not associated with a glucagonoma or any other neoplasia.
- Hepatocellular dysfunction was identified, correlating with the skin manifestations.
- This case adds to a growing body of evidence linking NME to non-neoplastic conditions.
Implications:
- The findings suggest that hepatocellular dysfunction, particularly in the context of chronic liver disease, may be an alternative cause of NME.
- This broadens the differential diagnosis for NME beyond paraneoplastic syndromes.
- Further research is warranted to elucidate the mechanisms connecting liver dysfunction and NME.