CITW: Case 3

A 15 y/o male with a history of  diabetes mellitus and hypothyroidism presents to the ED with a diffuse rash. It is not painful or pruritic. Of note, he was seen at the at his primary care doctors office earlier that week and found to have hyperglycemia (400’s) and hypertriglyceridemia (>10,000 mg/dL):

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What’s the diagnosis?

Eruptive Xanthoma

This rash is a manifestation of the patient’s significant hypertriglyceridemia.  Here are some quick facts:

1: Serum triglyceride levels above 1,000 mg/dL occur in fewer than 1 in 5,000 patients.
2: These patients (>1,000 mg/dL) typically have an underlying familial dyslipidemia as well as an acquired condition.
3: Acquired conditions include diabetes, hypothyroidism, obesity, nephrotic syndrome, pregnancy, medication side effects (steroids, beta-blockers, estrogen).
4: These patients have an increased risk of coronary heart disease and acute pancreatitis.

Bonus Material:

A case report of hypertriglyceridemia-induced acute pancreatitis, and its successful management by Dr. Anatoly Kazakin!

https://www.rimed.org/rimedicaljournal/2015/03/2015-36-cpc-kazakin.pdf

Case Conclusion:

The patient was admitted to the hospital, and through the use of insulin, fenofibrate, and omega-3 fatty fish oil, his triglyceride levels trended down and rash resolved. Genetic testing was pursued to assess for any underlying familial dyslipdemia, although the patient’s history of diabetes and hypothyroidism were presumed to have contributed.

Shout out to Dr. Courteney Mackuen and Dr. Elizabeth Jacobs for this case!

The contents of this case were deliberately altered to protect the identity of the patient. All content in this report are for educational purposes only. The patient consented to the use of these images.

See you next week!

Source: UptoDate

 

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