Necrolytic Migratory Erythema

Abstract

To the Editor.— I read with interest the report by Goodenberger et al1of two cases of necrolytic migratory erythema without glucagonoma. Both patients, besides having the typical rash, had diarrhea associated with a small-bowel disorder of uncertain cause. Amino acid levels in one patient were low on two occasions. Four of nine patients with the glucagonoma syndrome and necrolytic migratory erythema described by Mallinson et al2had serum amino acid determinations. All four patients had low levels. In addition, the majority of the patients had substantial weight loss, malnutrition, diarrhea, and an abnormal upper gastrointestinal tract on radiological examination. Pedersen et al3have also reported low serum amino acid levels in the glucagonoma syndrome with necrolytic migratory erythema. Recently, another case of necrolytic migratory erythema without glucagonoma has been reported.4This patient had cirrhosis, hyperglucagonemia, and chronic ulcerative colitis. Serum amino acid assay showed low