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

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Eruptive Xanthoma
A B C

A
30-year-old woman with diabetes who had poor glucose control, Jaya Kala, M.D.
hypertension, and hyperlipidemia was referred for the evaluation of a rash Akron General Medical Center
of 1-month duration. She reported no history of fevers, chills, or joint pain, Akron, OH
nor had she taken glucocorticoids or had contact with anyone with similar symp- jayakala13@gmail.com
toms. Her medications included insulin, pioglitazone, labetalol, fenofibrate, and
n–3 fatty acid esters. On physical examination, the lesions were reddish yellow, Eliot N. Mostow, M.D.
pruritic, and painful and were present on the backs of both legs and on the but- Case Western Reserve University School
tocks and knees (Panels A and B). The blood glucose level was 260 mg per deciliter of Medicine
(14.4 mmol per liter), the triglyceride level was 8168 mg per deciliter (92.2 mmol per Cleveland, OH
liter), and the total cholesterol level was 611 mg per deciliter (15.8 mmol per liter).
Levels of glycated hemoglobin and rheumatoid factor and other cholesterol levels
(low-density lipoprotein, very-low-density lipoprotein, and the ratio of low-density
to very-low-density lipoprotein) could not be assessed because of a grossly lipemic
specimen. Histologic analysis of a lesion-biopsy specimen (Panel C) showed foamy
macrophages and loose lipids, which confirmed the suspicion that the lesions were
eruptive xanthomas. One week later, the patient was hospitalized for acute pancre-
atitis. As a result of this admission, she underwent 6 months of strict glycemic and
lipid control. During this period, the lesions began to resolve. If the skin signs of
systemic disease had been recognized earlier, however, the episode of pancreatitis
might have been avoided.
Copyright © 2012 Massachusetts Medical Society.

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