Mixed hypercholesterolemic and hypertriglyceridemic xanthomatosis: four classic types of xanthomas in one patient at the same time

Xanthomas are localized infiltrates of lipid-containing cells found within the dermis. Cutaneous xanthomas are mostly cosmetic disorders but xanthomas can indicate the presence of an underlying generalized disturbance in lipid metabolism possibly associated with coronary artery disease. Because hyperlipidemia may present as xanthomatosis, a dermatologist might be the first to diagnose these associated lipid abnormalities. We report a 36-year-old male who presented with four classic types of xanthomas [Xanthelasma, Tuberous, Eruptive and Plane xanthomas] at the same time. Laboratory tests confirmed hypercholesterolemia and hypertriglyceridemia of dysbetalipoprotein Type III of the Fredrickson classification. The occurrence of four clinical types of xanthomas simultaneously in the same patient is rarely reported in the literature. The clinical, histopathology, laboratory investigation and management of hyperlipidemia and cutaneous lesions is fully discussed together with a review of the literature