Elevated Glucagon in a Patient with Necrolytic Acral Erythema: A Case Report and Review of the Literature

Necrolytic acral erythema (NAE) is a relatively newly described dermatologic disease that is often associated with hepatitis C virus (HCV). Oral zinc therapy is a successful treatment; however, therapy is often delayed due to misdiagnosis. There are limited reports of NAE in the literature. This paper presents a case of NAE in a 68-year-old male with untreated HCV, whose NAE was diagnosed and treated as recurrent cellulitis for 12 years. He had low serum zinc and elevated serum glucagon levels. Elevated glucagon is not often reported in NAE, but the patient’s CT abdomen was negative, ruling out glucagonoma and necrolytic migratory erythema. He improved with oral zinc replacement and was referred to the hepatology department for HCV treatment. This paper additionally presents a review of the literature for NAE cases.

Necrolytic acral erythema as a manifestation of Crohn’s disease and celiac disease - A report of two cases

Necrolytic acral erythema (NAE) is considered as a diagnostic marker of hepatitis C infection. Here, we report two cases of NAE in Crohn’s disease and celiac disease. Both the patients were seronegative for hepatitis C virus. The first case presented with recurrent diarrhea, weight loss, bullae on hyperpigmented plaque over extremities and gastrointestinal endoscopy and biopsy consistent with Crohn’s disease. The second case presented with recurrent diarrhea, vomiting, vesiculopustules and scaly plaques over extremities and duodenal biopsy diagnostic of celiac disease. NAE presents as papules and plaques with bullae over extremities, but tend to spare palms and soles. Our first patient had lesions on sole and the second patient had pustular lesions. To the best of our knowledge, there are no available reports of association of NAE with Crohn’s disease or celiac disease.

Bilateral Foot Skin Eruption in a Hepatitis C Patient

Case Presentation: A 58-year-old female with history of hepatitis C virus presented to the emergency department with a bilateral skin eruption to her feet for one year. Following skin biopsy, the patient was diagnosed with Necrolytic acral erythema (NAE). She was treated with clobetasol ointment, zinc supplementation, and mupirocin, which resulted in improvement in her symptoms. Discussion: NAE is a rash described as sharply demarcated, lichenified plaques on the dorsal foot and is a rare extra-hepatic manifestation of hepatitis C. This case details a patient with a skin eruption consistent with NAE.