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Necrolytic Migratory Erythema

A B

A
63-year-old woman with a 41/2-year history of diabetesRETAKE
AUTHOR McGevna
mellitus
1st
Laura McGevna, M.D.
ICM
presented with an ulcerating rash, primarily
REG F FIGURE on
a&b the shins, groin, and face
2nd
University of Vermont
(Panel A); cheilitis (Panel B); and CASE
glossitis.
TITLEHer symptoms had been Revised worsening
3rd
Burlington, VT
for 4 years despite specialized wound care. EMail In addition, she noted
Line concurrent
4-C weight
Enon SIZE
loss, depression, abdominal pain, and FILL intractable
ARTIST: nausea.
mst She wasH/T
H/T
Combo
taking39p6
500 mg Zarry Tavakkol, M.D.
of metformin daily. Given her history of diabetesAUTHOR, mellitus and the
PLEASE NOTE:
skin findings,
University of Washington
abdominal computed tomography was performed, and
Figure has been glucagon
redrawn levels
and type has beenwere
reset. mea- Seattle, WA
Please check carefully.
sured. An enhancing, lobulated mass measuring 7 cm in diameter was found in the
tail of the pancreas, and the patients fasting glucagon level was elevated,
JOB: 36201
at 890 pg
ISSUE: 1-7-10
per milliliter (normal range, 0 to 80). The mass was resected, and pathological ex-
amination of the specimen confirmed a diagnosis of glucagonoma. Glucagonomas
are rare neuroendocrine tumors that can cause diabetes and a rash known as necro-
lytic migratory erythema, which has a characteristic annular pattern of erythema
with central crusting and bullae. The prognosis correlates with the stage of tumor
development and the potential for resection. In this patient, 1 day after resection,
the rash had faded significantly. Four weeks after discharge, the patient had normal
glucose levels (while taking no medication), and the necrolytic migratory erythema
had completely resolved.
Copyright 2010 Massachusetts Medical Society.

n engl j med 362;1 nejm.org january 7, 2010 e1

The New England Journal of Medicine
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