Eruptive Xanthoma: A Case of Extreme Hypertriglyceridemia

Introduction: Eruptive xanthoma (EX) is a cutaneous marker of severe hypertriglyceridemia and uncontrolled diabetes mellitus, often preceding life-threatening complications such as acute pancreatitis and cardiovascular disease.Case presentation: A 30-year-old man with type 2 diabetes mellitus (T2DM) and recent heavy alcohol intake (> 200 g/day) presented with a 3-day history of generalized, non-pruritic papules. Examination revealed erythematous-to-yellowish papules on the trunk and extremities, predominantly on extensor surfaces. Dermoscopy revealed a central yellowish structureless area surrounded by an erythematous brown halo. Biopsy showed dermal foam cells and cholesterol clefts, confirming EX. Laboratory findings included fasting glucose 28.00 mmol/L, glycated hemoglobin (HbA1c) 13.9%, triglycerides 77.10 mmol/L, and total cholesterol 19.03 mmol/L.Results: The patient was managed with intravenous continuous infusion of regular insulin, prophylactic subcutaneous unfractionated heparin, oral atorvastatin 20 mg daily plus fenofibrate 200 mg once daily, and a strict low-fat diet. On day 7, insulin was transitioned to oral metformin 850 mg twice daily plus sitagliptin 100 mg once daily. At discharge, fasting glucose (5.70 mmol/L), total cholesterol (5.14 mmol/L), and triglycerides (9.77 mmol/L) had improved substantially, with triglycerides remaining elevated. The cutaneous lesions began to involute within 3 weeks, with near-complete resolution documented at 3-month follow-up.Discussion: EX serves as an early cutaneous biomarker of severe dyslipidemia, most commonly associated with uncontrolled diabetes and hypertriglyceridemia. Histopathology remains the diagnostic gold standard when clinical features are equivocal. In patients without hypertriglyceridemia, a paraneoplastic syndrome should be considered. Timely management of the underlying metabolic disorder not only resolves skin lesions but also reduces the risk of acute pancreatitis and cardiovascular events.Conclusion: This case highlights that systematic evaluation of metabolic parameters, including glucose, lipid profile, and family history, enables prompt diagnosis of EX. Effective control of hypertriglyceridemia and diabetes leads to complete resolution of cutaneous manifestations and prevents serious systemic complications.