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Solving up the jigsaw puzzle: Necrolytic Migratory Erythema Associated with Multifocal Neuroendocrine Tumor of Pancreas: A case report

Aun Jamal, Zahra Jahangir, Tabish Saleem, Jibran Mohsin, Ihtisham ul Haq, Faizan Ullah, Osama Shakeel, Hassaan Bari, Aamir Ali Syed, Shahid Khattak, Faisal Hanif.

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Introduction: Necrolytic migratory erythema (NME) is a disorder that is recognized by reddish, migrating areas of blistering that heal with pigmentation. It is a characteristic rash that is often recognized by its distinct appearance and history. It has strong association with glucagonoma, a pancreatic neuroendocrine tumor arising from the alpha type islet cells. In such cases NME presents as a paraneoplastic manifestation of the disease. The diagnosis of this rare tumor depends on high index of suspicion on the basis of history and examination and relevant pathological and radiological investigations. This tumor is potentially curable by surgery.
Case Presentation: In this article the authors describe a 36 years old female patient with NME and a multifocal pancreatic neuroendocrine tumor with clinical features of glucagonoma syndrome. After investigations she underwent total pancreatectomy and within a few days her skin lesions and clinical symptoms started improving.
Conclusion: Prompt diagnosis and management are of paramount importance in the management of glucagonoma. It is possible if there is high index of suspicion and the management is done appropriately.

Key words: Necrolytic migratory erythema, glucagonoma, neuroendocrine tumor, blistering skin rash

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