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Dermatology
Necrolytic migratory erythema: a fortuitous diagnosis
  1. Amuthavalli Kanagarajan,
  2. Daya Babu and
  3. Shanmugasekar Chandrasekaran
  1. Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  1. Correspondence to Dr Amuthavalli Kanagarajan; dr.amutha.k{at}gmail.com

Abstract

A woman in her late 60s presented with widespread, itchy, dark lesions over her trunk and legs for 1 month. Initially, she was managed as nutritional dermatitis and experienced partial improvement. However, her condition worsened over 2 months, characterised by aggravated skin lesions, new-onset diabetes and a 12 kg weight loss. On suspicion of necrolytic migratory erythema (NME) secondary to glucagonoma, the contrast-enhanced CT (CECT) abdomen revealed a primary pancreatic lesion with multiple liver metastases. The diagnosis of neuroendocrine tumour was confirmed by liver biopsy with immunohistochemistry, and stage 4 status was revealed by fluorodeoxyglucose-positron emission tomography CT. Following 6-monthly octreotide injections and nutritional and supportive care, her skin lesions completely resolved. This case emphasises the significance of recognising NME, a rare and often misdiagnosed dermatological condition, as it may signify an underlying occult neuroendocrine pancreatic malignancy. Early recognition is crucial for the timely initiation of appropriate management.

  • Dermatology
  • Diabetes Mellitus, Type 1
  • Pancreas and biliary tract
  • Neuroendocrinology
  • Nutrition and metabolism

https://doi.org/10.1136/bcr-2024-260893

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: AK, DB, SS. AK is the guarantor. The following author gave final approval of the manuscript: SS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.