Image Based Question-71442

This 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face ; cheilitis ; and glossitis.Her symptoms had been worsening for 4 years .In addition, she noted concurrent weight loss, depression, abdominal pain, and intractable nausea.

Abdominal computed tomography showed an enhancing, lobulated mass measuring 7 cm in diameter was found in the tail of the pancreas and the patient’s fasting glucagon level was elevated, at 890 pg per milliliter (normal range, 0 to 80).What can be the most possible diagnosis?

A. Staphylococcal Scalded Skin Syndrome

B. Necrolytic Migrating Erythema

C. Erysipelas

D. Erythema Multiforme

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Correct Answer » B Explanation

Ans:B. Necrolytic Migrating Erythema.

The patient in question is suffering from Necrolytic Migrating Erythema due to Glucagonoma.

NECROLYTIC MIGRATING ERYTHEMA

• Necrolytic migratory erythema (NME) is a red, blistering rash that spreads across the skin. It particularly affects the skin around the mouth and distal extremities; but may also be found on the lower abdomen, buttocks, perineum, and groin. It is strongly associated with glucagonoma, a glucagon-producing tumor of the pancreas, but is also seen in a number of other conditions including liver disease and intestinal malabsorption.

Clinical features:

• NME features a characteristic skin eruption of red patches with irregular borders, intact and ruptured vesicles, and crust formation.

• It commonly affects the limbs and skin surrounding the lips, although less commonly the abdomen, perineum, thighs, buttocks, and groin may be affected.

• Frequently these areas may be left dry or fissured as a result. All stages of lesion development may be observed synchronously