Eruptive Xanthomas Precipitated by Severe Hypertriglyceridemia From Diabetes and Alcohol Use

Hypertriglyceridemia is a common abnormality found in patients in the clinical setting. Severe hypertriglyceridemia may manifest phenotypically as eruptive xanthomas, which are red or yellow papules found on the skin, most commonly on extensor surfaces and buttocks. We present a case of severe hypertriglyceridemia in a patient found in the outpatient setting, which manifested as eruptive xanthomas in his posterior upper arms, back, buttocks, axilla, and legs. Laboratory testing of his lipid profile revealed extremely high triglyceride levels, and the patient was immediately referred to the nearest hospital where he was admitted to the intensive care unit (ICU). He was promptly managed with a low-fat diet, anti-hypertriglyceridemic agents, and insulin infusion, with a dramatic reduction in triglyceride levels. He subsequently underwent a skin biopsy which confirmed the diagnosis of eruptive xanthoma. Rapid reduction in triglyceride levels is instrumental in the prevention of complications, most notably, acute pancreatitis. This article highlights the importance of a high index of suspicion for recognition of the signs and symptoms of severe hypertriglyceridemia, as well as the different management options available for the control of triglyceride levels and the prevention of complications.