title: Iatrogenic necrolytic migratory erythema: a case report and review of nonglucagonoma-associated necrolytic migratory erythema.
abstract: Necrolytic migratory erythema is characterized by waves of irregular erythema in which a central bulla develops, and subsequently erodes and becomes crusted. It usually occurs in patients with an alpha-islet cell tumor of the pancreas. However, necrolytic migratory erythema has also been observed in patients without an associated glucagonoma. We describe a woman with iatrogenic necrolytic migratory erythema. She received intravenous glucagon for hypoglycemia associated with an insulin-like growth factor II-secreting hemangiopericytoma. After chemotherapy, she developed necrolytic migratory erythema. The characteristics of the previously reported patients with nonglucagonoma-associated necrolytic migratory erythema are reviewed. In patients with nonglucagonoma-associated necrolytic migratory erythema, the dermatosis-related conditions most commonly observed were celiac disease or malabsorption, cirrhosis, malignancy, and pancreatitis; less common conditions included hepatitis, inflammatory bowel disease, heroin abuse, and odontogenic abscess. Although the pathogenesis of necrolytic migratory erythema remains unknown, hyperglucagonemia appears to have had a causative role in the development of this dermatosis in our patient. Patients who develop necrolytic migratory erythema should be evaluated for the presence of a glucagonoma; if a glucagonoma is ruled out, evaluation for other conditions known to occur with necrolytic migratory erythema, such as liver disease, malabsorptive disorders, and nonislet-cell tumors is warranted.
authors.affiliation: Department of Dermatology, University of Texas-Houston Medical School, 77030, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Mullans
authors.forename: P R
authors.initials: PR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004890:Erythema / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D005934:Glucagon / Q000009:adverse effects*; D005935:Glucagonoma / Q000150:complications / Q000175:diagnosis; D006393:Hemangiopericytoma / Q000378:metabolism / Q000556:secondary; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000209:etiology; D007049:Iatrogenic Disease; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D007680:Kidney Neoplasms / Q000556:secondary; D008113:Liver Neoplasms / Q000556:secondary; D009336:Necrosis; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000209:etiology; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology
chemical_list: D005765:Gastrointestinal Agents; D007335:Insulin-Like Growth Factor II; D005934:Glucagon