Case Number : Case 557 - 27 July Posted By: Guest

[b]Necrolytic migratory erythema (glucagonoma syndrome) is my first consideration. Other diseases with similar histological findings include Pellagra and zinc deficiency.[/b]

Necrolytic erythema.

The histopatological findings suggest any of the nutritional deficiencies (necrolytic migratory erythema or zinc deficiency -acrodermatitis enteropathica), however, the clinical information does not support the diagnosis.

Completely agree with Marcela.

I agree with Marcela too. Maybe could be a Glucagonoma syndrome with psoriasiform hyperplasia

necrolytic migratory erythema secondary to either glucagonoma or pseudoglucagonoma syndrome. (Histology is that of nutritional deficiency)

[font=arial,helvetica,sans-serif][size=4][color=black][b]Vacuolated keratinocytes with scattered dyskeratotic cells in the upper epidermis[/b],[b] necrotic keratinocytes [/b]are associated with clefts and the term[/color][color=#000000] [color=black]‘necrolysis’ is used. [b]Parakeratosis with a degree of acanthosis[/b]. [/color][b]Mo[b]derate [/b]perivascular infiltrate of lymphoid cells [/b]in the dermis. [b]Necrolytic migratory erythema [/b](waves of extending annular or circinate itchy erythema with [/color][color=#231F20]a prolonged, fluctuating course [[/color][color=#000000]resolution of involved areas usually takes place within two weeks]). The skin lesions are polymorphous but the primary lesions are erythematous patches/plaques. As always, clinicopathological correlation is vital. [color=#231F20]Necrolytic migratory erythema is a cutaneous reaction that needs to be carefully investigated. Among the investigations are determination of glucose, zinc and plasma glucagon levels and pancreatic/hepatic scans. [/color][/color][/size][/font]

necrolytic migratory erythema

Necrolytic migratory erythema

Well I think everyone is in aggreement with the possible histological differenatial diagnoses in this case (i.e. necrolytic migratory erythema and nutritional deficiencies). Certainly the histology is very striking! I offered exactly the same possibilities as those listed above. Unfortunately for reasons I cannot divulge further investigation was not possible and frustratingly we do not know the final aetiology in this case. Thank you for your helpful comments and discussion and regards to all.

Thank you Richard.