Necrolytic migratory erythema as the first manifestation of pancreatic neuroendocrine tumor

Abstract

Necrolytic migratory erythma (NME) is an obligatory paraneoplastic syndrome. Here we describe a woman admitted to the dermatology ward with NME which was later found to be associated with glucagonoma, a slow-growing, rare pancreatic neuroendocrine tumor. Even more rarely, the tumor was located in the pancreas head, while most of such lesions are located in the distal pancreas. The diagnosis of this rare tumor requires an elevated serum glucagon level and imaging confirming a pancreatic tumor. After surgical removal of the tumor, the patient's cutaneous and systemic features resolved. It is therefore imperative that clinicians recognize NME early in order to make an accurate diagnosis and to provide treatment for this rare tumor.

Figure 1

Close-up view of well demarcated erythematous plaques, with fragile vesicles on gluteal area.

Figure 2

Contrast-enhanced computed tomography scan of the abdomen. A 3-cm nodular mass in the head of the pancreas was seen. There was no evidence of metastases.