Complicated Case | Figure 1

ReginaldoCastro

Specialty: Internal Medicine

Complicated Case

She is 38 years old, Diabetic, Hypertensive, Depressive. She uses Diazepam 60 mg per day; Amitriptyline 150 mg per day; Fenergan 150 mg per day; NPH Insulin 20 IU per day; Captopril 50 mg per day; Hydrochlorothiazide 50 mg per day. She is also an alcoholist.

She has complications of Diabetes Mellitus such as Diabetic Neuropathy. Her triglycerides are at 900 mg/dL. She also uses Ciprofibrate 100 mg per day.

Two weeks ago, these injuries appeared on the hands and legs. She said that the lesions are painful and that it started with itching.

What is the probable diagnosis in this case?

The author made an update to this case

Update 1

Differential diagnoses of these lesions:

  1. Eruptive xantomas: strongly suggested by the history of severe hypertriglyceridemia. Typically they are yellowish or reddish, painful or itchy papules/nodules, which arise in extensor areas (hands, legs, buttocks). The clinical finding and the metabolic context fit well.

  2. Skin vasculitis (palpable purpure/nodules): can also cause painful lesions in extremities. In patients with diabetes and dyslipidemia, there may be an association with vasculitic or thrombotic phenomena.

  3. Diabetic lipoid necrosis: more common in legs, brown or reddish lesions with atrophic center, less compatible with photos.

Diagnosis Added

Eruptive Xantomas