A Case of Necrolytic Migratory Erythema Accompanied with Various Pre-existing Diseases

Abstract

A 48-year-old man, who had medical history of partial gastrectomy and had type 1 diabetes mellitus, chronic pancreatitis, and chronic hepatitis, presented with vesicles, rashes, and edema on both legs after usage of antifungal ointment and steroid ointment. At first, we thought he showed symptoms of contact dermatitis ; however, the patient didn’t respond to treatment for contact dermatitis. Patch test of antifungal ointment and patch test panel^○R were negative. Low level of serum albumin and his comorbidities made us suspect that he had deficiency dermatitis ; thus, we examined his plasma amino acids. We found declines in the levels of various essential and nonessential amino acids and zinc. Histological examination showed parakeratosis, intracellular edema,eosinophilic necrosis of stratum spinosum, and intraepidermal bulla. He was diagnosed as necrolytic migratory erythema. He did not have glucagonoma. Our case was characteristic as the episode and skin symptoms at the first presentation were very similar to contact dermatitis and he showed various skin symptoms through the period of treatment. It is important to survey levels of plasma amino acids and zinc for patients who have had episodes or diseases that may cause deficiency dermatitis. Skin Research, 21 : 240-245, 2022