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Unremitting chronic skin lesions: A case of delayed diagnosis of glucagonoma
Kawsar, Hameem I. Habib, Alma Saeed, Azhar Saeed, Anwaar
Kawsar, Hameem I.
Habib, Alma
Saeed, Azhar
Saeed, Anwaar
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Abstract
A 54-year-old Caucasian male with history of hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, and chronic skin rash of 4 years presented to the emergency department with worsening rash and weight loss. Physical examination revealed diffuse erythematous rash, skin ulceration, bullae with associated paresthesia in the lower extremities, trunk, bilateral upper extremities, and palms and soles. A computed tomography (CT) scan with contrast showed a large, heterogenously enhancing pancreatic mass measuring 9.4 × 3.8 cm with surrounding low-attenuation soft tissue thickening. Blood tests showed hemoglobin A1C of 10.0%. Glucagon level was elevated to 2,178 (normal < 80 pg/dl). Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) from the pancreatic mass was suggestive of pancreatic endocrine tumor. The tumor cells were positive for synaptophysin, chromogranin, CD56, and pan-cytokeratin with focal positivity for glucagon, suggestive of glucagonoma. The patient underwent distal pancreatectomy along with splenectomy and cholecystectomy. The glucagon level normalized to 25 pg/dl within a week of tumor resection, and during his 6-week outpatient follow up, skin rash had completely resolved.
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A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.
Date
2019-11-01
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Taylor & Francis Open Access
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Keywords
Glucagonoma, Necrolytic Migratory Erythema (NME), Neuroendocrine tumor, MEN-1, Alpha cell tumor
Citation
Hameem I. Kawsar, Alma Habib, Azhar Saeed & Anwaar Saeed (2019) Unremitting chronic skin lesions: a case of delayed diagnosis of glucagonoma, Journal of Community Hospital Internal Medicine Perspectives, 9:5, 425-429, DOI: 10.1080/20009666.2019.1671574