Indian Journal of Dermatology
QUIZ
Year
: 2014  |  Volume : 59  |  Issue : 3  |  Page : 318-

A 68 year old male with abdominal pain, anorexia, and facial skin pigmentation


Nasim Valizadeh 
 Department of Internal Medicine, Urmia University of Medical Sciences, Emam Khomeini Hospital, Urmia, Iran

Correspondence Address:
Nasim Valizadeh
Department of Internal Medicine, Section of Hematology/Medical Oncology, Urmia University of Medical Sciences, Emam Khomeini Hospital, Urmia
Iran




How to cite this article:
Valizadeh N. A 68 year old male with abdominal pain, anorexia, and facial skin pigmentation.Indian J Dermatol 2014;59:318-318


How to cite this URL:
Valizadeh N. A 68 year old male with abdominal pain, anorexia, and facial skin pigmentation. Indian J Dermatol [serial online] 2014 [cited 2019 Oct 14 ];59:318-318
Available from: http://www.e-ijd.org/text.asp?2014/59/3/318/131482


Full Text

A 68-year-old, heavy smoker male was admitted with abdominal pain and distention. He had weight loss and constipation since 1 year ago and loss of appetite since 2 months ago. He complained from facial skin darkening since 1 year ago.

Physical examination showed skin thickening, pigmentation in his face, and upper parts of neck [Figure 1] and hepatomegaly.{Figure 1}

Laboratory findings are included: WBC = 13000/μl, Hb = 15 gr/dl, Plt count = 254000/μl. AST = 48 (normal < 50 U/L), ALT = 20 (normal < 50 U/L), alkaline phosphatase = 1048, high (normal: 80-306 U/L), CEA = 38 (normal < 8 for smokers).

FBS, Na, K, BUN, and Cr all were reported normally. HBs Ag and HCV Ab were negative. Sonograpghy showed hepatomegaly with multiple mass lesions in liver lobes suggestive of liver metastasis. Upper GI endoscopy showed severe erosive gastritis. Liver biopsy showed carcinoma (primary or secondary). Immunohistochemistrical (IHC) study on biopsy was reported positive for keratin, EMA, SMA, and negative for S100, PSA, MA, CD117) that recommended epithelial, myoepithelial origin for cancer.

 Question



What is your diagnosis for [Figure 1]?

 View Answer

 Answer



Acanthosis nigricans is a paraneoplastic dermatosis which is characterized by skin thickening and pigmentation with a velvety appearance especially on flexor surfaces and skin folds such as axilla, posterior neck folds and inguinal areas. It is reported rarely in skin of face in literature. [1] It may be idiopathic. Secondary forms may be due to endocrinopathies [2] underlying cancer [1],[3] ; some drugs (Nicotinic acid, Stilbesterol, and Corticosteroids) [4] and familial forms. [5]

References

1Mukherjee S, Pandit S, Deb J, Dattachaudhuri A, Bhuniya S, Bhanja P. A case of squamous cell carcinoma of lung presenting with paraneoplastic type of acanthosis nigricans. Lung India 2011;28:62-4.
2Stoddart ML, Blevins KS, Lee ET, Wang W, Blackett PR. Cherokee Diabetes Study. Association of acanthosis nigricans with hyperinsulinemia compared with other selected risk factors for type 2 diabetes in Cherokee Indians: The Cherokee Diabetes Study. Diabetes Care 2002;25:1009-14.
3Krawczyk M, Mykala-Ciesla J, Kolodziej-Jaskula A. Acanthosis nigricans as a paraneoplastic syndrome. Case reports and review of literature. Pol Arch Med Wewn 2009;119:180-3.
4Brown J, Winkelmann RK. Acanthosis nigricans: A study of 90 cases. Medicine (Baltimore) 1968;47:33-51.
5Berk DR, Spector EB, Bayliss SJ. Familial acanthosis nigricans due to K650T FGFR3 mutation. Arch Dermatol 2007;143:1153-6.