Cutaneous Manifestation of Eruptive Xanthoma as a Consequence of Severe Hypertriglyceridemia: A Case Report Highlighting Diagnostic and Therapeutic Challenges

TL;DR

A 29-year-old woman with severe obesity and diabetes developed yellow skin bumps due to extremely high triglycerides, highlighting the importance of early diagnosis and treatment.

Contribution

This case report emphasizes the diagnostic and therapeutic challenges of eruptive xanthomas linked to severe hypertriglyceridemia.

Findings

Eruptive xanthomas were linked to metabolic syndrome, diabetes, obesity, and oral contraceptive use.

Extreme hypertriglyceridemia (>4000 mg/dL) and elevated cholesterol were identified as key contributors.

Prompt treatment resolved the xanthomas and prevented complications like pancreatitis.

Abstract

Eruptive xanthomas are clinical manifestations of lipid-laden foam cells in the dermis. The morphological subtype and anatomical location of xanthomas can provide insight into the underlying lipid disorder. Hyperlipidemia, a common condition in the general population, is categorized as primary or secondary depending on disruptions in endogenous or exogenous lipoprotein pathways.

We describe the case of a 29-year-old female with severe obesity who presented with numerous yellow papules on the trunk, buttocks, and extensor surfaces of the lower limbs, persisting for three months without subjective symptoms. Examination revealed inflammatory halos around some of the lesions. Dermoscopy showed irregularly shaped, light-yellow areas on a dense, yellowish background. Laboratory investigations revealed extreme hypertriglyceridemia (>4000 mg/dL), elevated total cholesterol (>1000 mg/dL), reduced high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels and undetectable aminotransferase levels. The patient met the criteria for metabolic syndrome and was newly diagnosed with diabetes mellitus.

A diagnosis of eruptive xanthomas was made, linked to impaired triglyceride clearance and hepatic overproduction of triglyceride-rich lipoproteins secondary to diabetes, obesity, excessive caloric intake, and oral contraceptive use. The Fredrickson classification system identified hypertriglyceridemia as part of types I, IV, and V hyperlipoproteinemia.

This case highlights the significance of a comprehensive diagnostic approach in patients with xanthomas, taking into account associated risk factors, family history, and lipoprotein abnormalities for early detection. Prompt treatment can lead to the complete resolution of eruptive xanthomas and prevent fatal complications such as acute pancreatitis.

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