The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Erythema Gyratum Repens Associated

with Anal Cancer
A B

A
73-year-old woman presented to the dermatology clinic with Megan Prouty, M.D.
an 11-month history of an evolving pruritic, erythematous rash on her Deede Liu, M.D.
thighs, buttocks, trunk, and axillae (Panel A). The rash initially consisted University of Kansas Medical Center
of pruritic annular lesions with central duskiness and was treated with prednisone Kansas City, KS
and antihistamines without improvement. The rash evolved into polycyclic erythem- mprouty@kumc.edu
atous plaques during the next 4 months, during which abdominal pain, vomiting,
and diarrhea also developed. After colonoscopy and imaging, stage IIA anal
squamous-cell carcinoma was diagnosed. Before undergoing radiation and chemo-
therapy, the patient was referred to the dermatology clinic for assessment of the
persistent, evolving rash. She received a clinical diagnosis of erythema gyratum
repens, a rare paraneoplastic rash usually associated with breast, lung, or esopha-
geal cancer. The patient started treatment with topical glucocorticoids and began
a trial of gabapentin for pruritus. The rash abated 3 months after the initiation of
chemotherapy and radiation (Panel B). At a follow-up visit at 8 months, the cancer
remained in remission, and the rash had not recurred.
DOI: 10.1056/NEJMicm1805833
Copyright © 2019 Massachusetts Medical Society.

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