グルカゴノーマを伴わない壊死性遊走性紅はん

• Published in: Skin research Vol. 25; no. 5; pp. 842 - 848
• Main Authors: SAKATA Mioko, KAWATSU Tomoyuki
• Format: Journal Article
• Language: Japanese
• Published: Meeting of Osaka Dermatological Association 1983; 日本皮膚科学会大阪地方会
• ISSN: 0018-1390; 1884-541X
• DOI: 10.11340/skinresearch1959.25.842

A case of necrolytic migratory erythema without glucagonoma in a 47-year-old man was reported.The patient had had severe diabetes mellitus and essential hypertension for more than ten years and had been a heavy drinker since hisyouth. On physical examination he was found cachectic and looked considerably older than hisage. The tongue was red and atrophic; nails of all digits were soft and dystrophic; and hairs of the head, axillae and pubic area were sparse.The eruptions were annular and diffuse erythema with scales and tiny papules. Flaccid bullae and erosions were also noted. These eruptions were mainly located on the lumbosacral and genital areas and lower extremities. The cutaneous lesions disappeared within aboutone week, and some of them showed a central healing tendency.Three subsequent attacks of cutaneous symptom were noted in 20 months until the patient died of malnutrition.Laboratory examination revealed normochromic-normocytic anemia, hypoproteinemia, hypoalbuminemia and hypocholesteremia. Most ofthe plasma amino acids showed a very low level and serum zinc was slightly decreased, but the serum glucagon level was within normallimits.Autopsy revealed severe pancreatic atrophy with calcification and severe fatty liver; however, no malignant neoplasma including glucagonoma was noted. The diagnosis of necrolytic migratory erythema without glucagonoma was made.The similar eruptions in necrolytic migratory erythema, acquired zinc deficiency syndrome and malnutrition syndrome were discussed. 重症の糖尿病, 高血圧症と大酒癖のある47才男性にみられた壊死性遊走性紅斑様皮疹を報告した。皮疹は全経過1年8カ月間に4回, 主として下半身に生じ, 1～2週間で消退した。このほか脱毛, 爪甲の変化, 舌の発赤・萎縮や, 高度の栄養障害があり, 血清たん白, アルブミン, コレステロール値は皮疹発症時に低下する傾向がみとめられた。血清グルカゴン値は正常で, 生前および剖検時に膵腫瘍はなく, グルカゴノーマを伴わない壊死性遊走性紅斑と診断した。種々の栄養障害患者にみられる本症例に類似した皮疹につき考察を加えた。