A Case of Necrolytic Migratory Erythema associated with Hepatic Cirrhosis

• Published in: Skin research Vol. 40; no. 4; pp. 359 - 364
• Main Authors: UMEDA Jiro, HIGASHIYAMA Mari, SAKURANE Junko, ITAMI Satoshi, YOSHIKAWA Kunihiko
• Format: Journal Article
• Language: Japanese
• Published: Meeting of Osaka Dermatological Association 1998; 日本皮膚科学会大阪地方会
• Subjects: cirrhosis of the liver; necrolytic migratory erythema; zinc deficiency; 亜鉛欠乏; 壊死性遊走性紅斑; 肝硬変
• ISSN: 0018-1390; 1884-541X
• DOI: 10.11340/skinresearch1959.40.359

We report a case of 54-year-old man of necrolytic migratory erythema (NME) associated with hepaticirrhosis. At the age of 47, he was pointed out liver dysfunction. On October, 1995 (age 52), he developed pruritic annular scaly erythema with erosion and crust at the edge on the elbows, legs and buttocks. The eventual appearance was a geographic circinate pattern. The erythema showed central healing tendency with pigmentation. At the age of 53, he was diagnosed as hepatitis C, cirrhosis and diabetes mellitus. Histopathological examination of the skin specimen showed intracellular edema and eosinophilic necrosis in the upper epidermis.Laboratory studies disclosed increased glucagon and decreased both serum zinc and plasma essential amino acids. Abdominal ultrasonic scan and computed tomography showed typical findings of cirrhosis, but not any pancreatic tumors. He was diagnosed as NME without glucagonoma, which was induced by malnutritional conditions in cirrhosis. The supplementation of zinc improved the eruptions remarkably. 54歳, 男性。47歳時に肝機能異常を指摘される。52歳時より肘頭, 下腿, 臀部に痒を伴う落屑性紅斑が出現した。紅斑辺縁には糜爛, 痂皮が環状に配列し, 中心治癒傾向を示した。皮疹は色素沈着を残して治癒後再出現を繰り返した。53歳時, 慢性C型肝炎, 肝硬変, 糖尿病の診断を受けた。紅斑部の生検組織は表皮上層の細胞内浮腫と好酸性壊死を示した。血中グルカゴン高値, 血清亜鉛低下, 必須アミノ酸低下を認めた。画像検査では典型的な肝硬変の所見のみで膵腫瘍は認めなかった。グルカゴノーマを伴わない, 肝硬変に基づく複合的栄養障害による壊死性遊走性紅斑と診断した。亜鉛の投与により皮疹は著明な改善を示した。本邦報告例について文献的に考察した。