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A UNIQUE CASE OF XANTHOMATOSIS
Chest ; 160(4):A907, 2021.
Article in English | EMBASE | ID: covidwho-1466114
ABSTRACT
TOPIC Critical Care TYPE Medical Student/Resident Case Reports

INTRODUCTION:

Hypertriglyceridemia (TGL) is the abnormal concentration of triglycerides in the blood associated with atherosclerosis. It is known to cause skin lesions when the blood levels are more than 3000 mg/dl. It is also associated with 1 to 10 percent cases of acute pancreatitis and 10 to 20 percent when levels are higher than 2000 mg/dl. CASE PRESENTATION A 36-year old morbidly obese man with medication non-compliance was evaluated by a dermatologist via a video tele visit due to COVID19 Pandemic. He has a history of uncontrolled IDDM, hypertriglyceridemia status post plasmapheresis a year ago associated with pancreatitis. He has no family history of hypertriglyceridemia. He reported rashes on his forearms and thighs for 3 weeks and was advised to go to the Emergency Department to rule out cutaneous manifestation of his underlying conditions. He initially reported epigastric pain radiating to his back, but his lipase and CT abdomen were negative for pancreatitis. He was vitally stable, and his exam was significant for yellowish papules on his forearms, legs bilaterally with erythematous borders. Labs TGL 1618, total cholesterol 647, Glucose 223, A1c 12.6%, no Anion Gap.Imaging Splenomegaly with Hepatic Steatosis likely due to TGL deposition.Patient was placed on Insulin drip to prevent pancreatitis and was started on fenofibrate, fish oil and rosuvastatin. Kept NPO initially with dextrose infusion to increase insulin drip & metabolize the triglycerides. Triglycerides gradually improved, and insulin drip was d/c. Shave Biopsy confirmed Eruptive Xanthoma.

DISCUSSION:

Eruptive xanthomas are characterized by an eruption of yellowish skin papules, encircled by an erythematous halo, most commonly arising over the extensor surfaces of the extremities, buttocks and shoulders in the setting of high triglyceride levels secondary to diabetes, diet or familial causes. The lipid deposits in these xanthomas are derived from circulating plasma lipoproteins.

CONCLUSIONS:

This case was unique as our patient developed eruptive xanthomas even at TGL level under 2000 mg/dl which is rarely seen. Clinically diagnosing Xanthomas are extremely important in order to treat hypertriglyceridemia in order to prevent pancreatitis, which has a grim prognosis. It is also important for reducing CAD risk. Xanthomas should be evaluated to prevent pancreatitis and long-term cardiac events rather than the lipid deposit itself. They can also be the only signs of underlying metabolic diseases like diabetes. Management should include pharmacological agents, counseling for compliance, nutrition & lifestyle modifications. All these patients with high TGLs will benefit from E3/E4 genotype testing as it is associated with higher cardiac disease and low response to statins. REFERENCE #1 Severe hypertriglyceridemia presenting as eruptive xanthomatosisSameera S Vangara, Kyle D Klingbeil, Raymond M Fertig, Jason L RadickDepartment of Internal Medicine, University of Miami Miller School of Medicine, Florida, USA REFERENCE #2 Eruptive Xanthomas as a cutaneous Manifestation of HypertriglyceridemiaA Case ReportMichael Digby, Md, Robert Belli, MS, Timothy McGraw, and Abigail Lee, MD DISCLOSURES no disclosure on file for Moses Bachan;no disclosure on file for Zinobia Khan;No relevant relationships by Robert Siegel, source=Web Response No relevant relationships by Goutham Talluri, source=Web Response

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2021 Document Type: Article