METASTATIC GLUCAGONOMA PRESENTING AS NECROLYTIC MIGRATORY ERYTHEMA

A CASE REPORT

Abstract

CASE
A 68-year-old Filipino male presented with a two-month history of generalized pruritic erythematous plaques associated with epigastric pain, progressive weight loss and angular cheilosis. Skin biopsy revealed necrolytic migratory erythema. Abdominal CT imaging showed a 2.0 x 2.5 x 3.7 cm pancreatic tail mass with hepatic nodules suggestive of metastasis. Other workups showed anemia, elevated HbA1c, and normal liver function tests. Plasma glucagon was >2.5 times the upper limit of normal. He was diagnosed with metastatic glucagonoma and given octreotide LAR 30 mg monthly. Surgery was not done due to the presence of liver metastasis and poor nutritional status. After 14 months of octreotide, improvement of skin lesions and no progression of the pancreatic tail mass on CT imaging were noted. Prompt recognition of necrolytic migratory erythema allows earlier diagnosis of glucagonoma. In patients with unresectable disease, somatostatin analogs may be used to delay progression.