Acute pancreatitis with eruptive xanthoma

Correspondence to Dr Zeynel Abidin Sayiner, [email protected]

Background

Cutaneous xanthomas develop as a result of intracellular and dermal deposition of lipid. One of the major distinguishing clinical features of xanthomatous tissue is a characteristic yellow to orange hue. Xanthomas may present with a variety of morphologies, from macules and papules to plaques and nodules. Xanthomas can develop in the setting of primary or secondary disorders of lipid metabolism or monoclonal gammopathy. The major forms of xanthomas associated with hyperlipidaemia are eruptive, tuberous, tendinous and plane (including xanthelasma). Hypertriglyceridaemia can lead to complications such as myocardial infarctions, cerebrovascular accidents, hepatic steatosis and acute pancreatitis.¹ Here we report the development of acute pancreatitis due to hypertriglyceridaemia in an eruptive xanthomic case and therapeutic plasma exchange (TPE) administration as a treatment.

Case presentation

A 27-year-old male patient was admitted to the dermatology clinic because of the numerous yellowish-brown bumps that lasted for about 6 months on the arms and thighs. There was no pathological finding except the lesions. The patient’s body mass index was 31.04 kg/m².

Dermatological examination revealed a large number of yellowish papules ranging from 3 to 6 mm in the arms, elbows and thighs^{(figure 1}). Punch biopsy was obtained. Histopathological examination revealed vacuolar cytoplasmic histiocytes (foam cells) and perivascular lymphocytic infiltration distributed between the collagen fibres in the upper and middle dermis. Immunohistochemically histiocytes stained positively with CD68. The case was found to be compatible with eruptive xanthoma (^{figure 2}). Laboratory findings include triglycerides 105 mmol/L (normal: 0.25–5 mmol/L), total cholesterol 11.5 (normal: 2.8–5 mmol/L), high-density lipoprotein cholesterol 3.8 mmol/L, low-density lipoprotein cholesterol 0.3 mmol/L, aspartate aminotransferase 80 U/L (normal: 5–50 U/L) and alanine transaminase 67 U/L (normal: 5–50 U/L). Fasting blood glucose was 4.3 mmol/L (normal: 1.8–2.5 mmol/L) and HbA1c was 54.1 mmol/mol (normal: 20–42 mmol/mol). Total blood count, thyroid function tests and amylase were normal. On abdominal ultrasound (USG), the liver was in normal size and localisation and the parenchymal echo was seen...