Images in Clinical Medicine

Eruptive Xanthomas Associated with Hypertriglyceridemia and New-Onset Diabetes Mellitus

Keshav R. Nayak, M.D., and Richard G. Daly, M.D.

N Engl J Med 2004; 350:1235March 18, 2004

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A previously healthy, 38-year-old man with a family history of early cerebrovascular accidents presented with a sudden eruption of pink papules with creamy-colored centers on his arms and upper torso (Panels A and B). He was otherwise asymptomatic and had no abdominal pain. The results of laboratory tests performed while the patient was fasting included a total cholesterol level of 1268 mg per deciliter (32.8 mmol per liter), a total triglyceride level of 8869 mg per deciliter (100.1 mmol per liter), a glucose level of 241 mg per deciliter (13.4 mmol per liter), and a glycosylated hemoglobin value of 13.4 percent. Triglyceride-lowering therapy with gemfibrozil was initiated to enhance lipoprotein lipase activity, and insulin therapy was initiated to treat the hyperglycemia. Twenty-four hours later, his total triglyceride level was 6466 mg per deciliter (73.0 mmol per liter). At follow-up visits three and five months later, the patient's eruptive xanthomas had decreased in size and number. After eight months of treatment with gemfibrozil, glyburide, and glucophage, his total cholesterol level was 218 mg per deciliter (5.6 mmol per liter), his total triglyceride level was 302 mg per deciliter (3.4 mmol per liter), and his glycosylated hemoglobin value was 8.3 percent; the eruptive xanthomas had completely resolved. Review of his records revealed a preexisting, untreated dyslipidemia (total cholesterol level, 216 mg per deciliter [5.6 mmol per liter]; total triglyceride level, 422 mg per deciliter [4.8 mmol per liter]), which was consistent with the presence of Frederickson's type IV familial hypertriglyceridemia. This case, however, would be better classified as a type V phenotype, mixed hypertriglyceridemia, owing to the coincident new-onset diabetes mellitus.

Keshav R. Nayak, M.D.
Richard G. Daly, M.D.
Naval Medical Center, San Diego, CA 92134-1005

Citing Articles (7)

Citing Articles

1. 1

   Lucía Gámez Pérez, Irela Reig Macías, Eva Gutiérrez Paredes, Carlos Monteagudo Castro, Esperanza Jordá Cuevas. (2011) Xantomas eruptivos. Causas, diagnóstico y tratamiento. Piel 26:10, 505-507
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2. 2

   Prerna Batra, Rashi Singhal, Dheeraj Shah. (2011) Diabetic lipemia presenting as eruptive xanthomas in a child with autoimmune polyglandular syndrome type IIIa. Journal of Pediatric Endocrinology and Metabolism---
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3. 3

   Wayne Tsuang, Udayakumar Navaneethan, Luis Ruiz, Joseph B Palascak, Andres Gelrud. (2009) Hypertriglyceridemic Pancreatitis: Presentation and Management. The American Journal of Gastroenterology 104:4, 984-991
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   G. Villalón, J.M. Martín, C. Monteagudo, V. Alonso, E. Montesinos, E. Jordá. (2008) Xantomas eruptivos en el debut de diabetes mellitus. Actas Dermo-Sifiliográficas 99:5, 426-427
   CrossRef

5. 5

   Axel Trautmann, Eva-B. Bröcker, Cornelia S. Seitz. (2007) A Pickled Plum of a Problem. The American Journal of Medicine 120:9, 775-777
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6. 6

   Satoshi Shinozaki, Naoki Itabashi, Kumiko Rokkaku, Kenji Ichiki, Shoichiro Nagasaka, Koji Okada, Mitsuo Fujimoto, Mamitaro Ohtsuki, Shun Ishibashi. (2005) Diabetic lipemia with eruptive xanthomatosis in a lean young female with apolipoprotein E4/4. Diabetes Research and Clinical Practice 70:2, 183-192
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7. 7

   E. Roller, K.-W. Schulte, U. Hengge, T. Ruzicka, A. Kuhn, M. Megahed. (2004) Eruptive Xanthome. Der Hautarzt
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