Friday, December 10, 2010

Characteristic Shape of Erythema Gyratum Repens and underlying malignancy

A 83 years old man was evaluated for a 1 year history of a pruritic, progressively worsening migratory rash, with associated weakness and a 5 kilograms weight loss. He had a history of 30 pack year smoking; he had stopped smoking 45 years earlier.

On examination, he had erythematous skin lesions that Characterised by concentric, raised, serpiginous bands, with desquamation (Panel A). The rash affected mainly the trunk and proximal extremities. A clinical diagnosis of erythema gyratum repens was made.

A C.T. scan revealed a pulmonary mass measuring 59 by 43 mm (Panel B). Bronchoscopy with biopsy revealed squamous-cell carcinoma of the lung.

Erythema gyratum repens is a rare syndrome typically associated with an underlying malignant condition. It occurs most frequently in conjunction with lung cancer and next most frequently with esophageal and breast cancers. It may regress with treatment of the cancer.
Treatment with gemcitabine was initiated for this patient, but he died 3 months after diagnosis, after only one infusion; the rash had not resolved.

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