Xanthoma Diabeticorum Research Articles

Eruptive xanthomata in uncontrolled diabetes

with a two-week history of worsening symptoms of thirst, polyuria and lethargy presented to the admissions department feeling generally unwell. Five days previously he had visited his general practitioner who had made a diagnosis of diabetes mellitus and treated the patient for a presumed urinary tract infection. The patient had an otherwise unremarkable medical history, he did not take any regular medications or abuse alcohol and his grandfather was the only family member with type 2 diabetes. The patient had small, yellow nodules located across his torso and upper arms (figure 1). He said that these nodules, ranging from 2–4 mm in diameter, had appeared over the preceding week or so. The rest of the examination, including fundoscopy, was normal. Routine blood biochemistry was undertaken: liver and thyroid function tests as well as urea and creatinine were normal. Abnormal results included a random glucose sample of 22.5 mmol/L, sodium 120 mmol/L and total cholesterol 24.7 mmol/L. Subsequent testing found that his high density lipoprotein (HDL) cholesterol was 2.2 mmol/L, triglycerides were 96.0 mmol/L and upon close inspection, the serum was noticeably lipaemic; and the lipid content was clearly visible after settling the specimen bottle in the fridge (figure 2). The patient commenced insulin therapy (Humalog Mix 25; 36 & 18 units) and was seen by both the diabetes nurse specialist and the dietitian for education and advice. After six weeks he was seen in the Outpatients Clinic and his blood biochemistry had improved: total cholesterol 7.8 mmol/L, HDL cholesterol 1.1 mmol/L, triglycerides 19.4 mmol/L and HbA1C 6.6%. Eruptive xanthomata or xanthoma diabeticorum appear in patients who have greatly elevated serum triglycerides, very low density lipoproteins (VLDLs) and chylomicrons. The lesions themselves consist of mainly triglycerides and small amounts of cholesterol. In severe cases, fundoscopy may reveal lipaemia retinalis, when blood vessels of the retina appear milky due to exudation of abnormal triglyceride-rich plasma. The low sodium in this patient was a spurious result due to

Cutaneous xanthomas; a reappraisal of their significance.

Xanthomas have been known to man for centuries and their clinical description was recorded by Thomas Addison in 1848, 1 long before modern medical diagnostic techniques were evolved. Accordingly, our understanding of xanthomas resulted chiefly through observation of minute morphological differences in lesions, the recording of various distributional patterns, and the occasional detection of some associated state such as jaundice, diabetes, or a familial tendency. A relatively complex terminology resulted, i. e. xanthoma disseminatum, xanthoma diabeticorum, biliary xanthomatosis, etc. This nomenclature frequently did not reflect distinguishing morphological characteristics among various xanthomatous lesions but merely reflected differences of associated conditions in individual patients and histories. The growth of physiological chemistry and the development of modern serum analytic techniques has largely replaced the need for such a complex morphological approach and has rendered much of this traditional terminology obsolescent. Morphology Xanthomas are circumscribed dermal infiltrations of cholesterol

Serum lipids in lipemia retinalis: report of a case.

Excerpt Lipemia retinalis and xanthoma diabeticorum are occasionally seen in patients with diabetes mellitus and are thought to be due to abnormalities in the serum lipid fractions. Since the first...

Hyperlipemic xanthomatosis in a patient with subacute glomerulonephritis (nephrotic stage).

Thannhauser has divided the xanthomatoses associated with altered blood lipids into two main groups: (1) hypercholesteremic xanthomatoses and (2) hyperlipemic xanthomatoses. In the first group, the fasting blood serum is clear; in the second group the serum is milky or chylous. The entities described in the hyperlipemic group (2) are the following: A. Idiopathic hyperlipemia with secondary xanthoma Idiopathic (familial) hyperlipemia in children with hepatosplenomegaly and secondary xanthoma Idiopathic hyperlipemia in adults with secondary xanthomas occasionally accompanied by glycosuria and hepatosplenomegaly B. Syptomatic hyperlipemia with secondary eruptive xanthoma Xanthoma diabeticorum Hyperlipemia in chronic pancreatitis and eruptive xanthoma Hyperlipemia in glycogen storage disease (von Gierke's disease) and eruptive xanthoma Hyperlipemia in lipid nephrosis It has been pointed out by Thannhauser that xanthomatosis has never been reported in association with the hyperlipemia of lipid nephrosis or the nephrotic stage of glomerulonephritis. A recent search through the

XANTHOMA DIABETICORUM

Case Reports1 September 1953XANTHOMA DIABETICORUMESAR GORDON MARGOLINESAR GORDON MARGOLINSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-39-3-629 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn recent years cholesterol and its esters have been singled out of the lipid constituents of the body for special consideration, largely because of their relationship to atheromatous changes and partly because of their chemical similarities to adrenal and sexual hormones. Clinicians have been impressed with the importance of the cholesterol levels in certain disease states, and the measurement of cholesterol is now a standard test in most clinical laboratories. A recent case of xanthoma diabeticorum, manifesting striking alterations in cholesterol metabolism occurring in the course of uncontrolled diabetes mellitus, is presented.CASE REPORTPresent Illness:A 21 year old...Bibliography1. AddisonGull TW: On a certain affection of the skin, vitiligoidea—(a) plana; (b) tuberosa, with remarks, Guy's Hosp. Rep. 7: 265, 1851. Cited by Thannhauser.8 Google Scholar2. McGavackShepardson THHC, cited by Buchanan, J. A., and Indelicato, J. C.: A case of xanthoma diabeticorum associated with diabetes mellitus and acromegaly, Am. J. M. Sc. 195: 50-53, 1938. CrossrefGoogle Scholar3. JoslinRootWhiteMarbleBailey EPHFPACC: The treatment of diabetes mellitus, 1946, Lea and Febiger, Philadelphia, pp. 593-595. Google Scholar4. Diamond , cited by Joslin.3 Google Scholar5. Major , cited by Sutton and Sutton.7 Google Scholar6. Beerman H: Lipid diseases as manifested in the skin, M. Clin. North America 35: 433-456, 1951. CrossrefMedlineGoogle Scholar7. SuttonSutton RLRL: Diseases of the skin, 1939, The C. V. Mosby Co., St. Louis, pp. 391-393, 866-871. Google Scholar8. Thannhauser SJ: Lipidoses, diseases of the cellular lipid metabolism, 1950, Oxford University Press, New York. Google Scholar9. CarfagnoSteiger SCWA: The serum lipids in lipemia retinalis, Am. J. M. Sc. 221: 379-383, 1951. CrossrefMedlineGoogle Scholar10. NadbathFauteux RPLZ: Diabetic lipemia retinalis, U. S. Armed Forces M. J. 3: 319-322, 1952. MedlineGoogle Scholar11. CurtisSheldonEckstein ACJMHC: Experimental reproduction of lipemia, Am. J. M. Sc. 186: 548-556, 1933. CrossrefGoogle Scholar12. ParkerCuller WRAM, cited by Curtis and Sheldon.11 Google Scholar13. Allen FM, cited by Curtis and Sheldon.11 Google Scholar14. Garb J: Lipid metabolism in relation to xanthoma diabeticorum with a recommendation for a new nomenclature, Ann. Int. Med. 19: 241-252, 1943. LinkGoogle Scholar15. Duncan GG: Diseases of metabolism, 1947, W. B. Saunders Co., Philadelphia. Google Scholar16. Spencer MC: Xanthoma diabeticorum, Arch. Dermat. and Syph. 64: 92-93, 1951. Google Scholar17. FrankLevitt LLM: Idiopathic hyperlipemia with secondary xanthomatosis, Arch. Dermat. and Syph. 64: 434-436, 1951. CrossrefGoogle Scholar18. DelevettBruger AFM: Plasma lipids in primary (xanthomatosis) and secondary hypercholesterolemia, Arch. Int. Med. 81: 859-867, 1948. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: MC Omaha, Nebraska*Received for publication March 18, 1953.From the Medical Service, 382d General Hospital, APO 54, c/o PM, San Francisco.Present address: 116 So. 50 St., Omaha. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDiabetes and Diseases of the SkinThe diet and the development of coronary heart disease 1 September 1953Volume 39, Issue 3Page: 629-635KeywordsApolipoproteinsCholesterolClinical laboratoriesDiabetes mellitusHormonesLipidsMedical services ePublished: 1 December 2008 Issue Published: 1 September 1953 PDF downloadLoading ...

Idiopathic hyperlipemia with secondary xanthomatosis; report of a case.

IN A RECENT publication1Thannhauser stated, clinical syndrome of idiopathic hyperlipemia in adults with secondary eruptive xanthoma, occasionally accompanied by glycosuria, hitherto was not established as a clinical entity but often confused with hyperlipemia in severe untreated diabetes and accordingly classified as `xanthoma diabeticorum' or `diabetic hyperlipemia.' The term hyperlipemia as used here indicates an opaque, milky blood serum in which the neutral fat content is markedly increased; cholesterol and other lipids are generally elevated to a lesser degree. Hyperlipemia may be idiopathic or associated with, and probably due to, other diseases. In both instances xanthoma may appear or erupt when there is a high degree of lipemia and regress when it subsides. Since the occurrence of xanthoma in idiopathic hyperlipemia is a manifestation of the underlying hyperlipemia, its appearance clinically and histologically is the same as that of xanthoma diabeticorum. The lesions are discrete papules, generally pinhead

HEREDITARY DYSTROPHY OF THE HAIR AND NAILS

In the past twelve months the opportunity to see all the cutaneous diseases referred to a station hospital from two Army divisions in training at one military reservation, the troops from a reception center and troops stopping in transit has enabled one of us (C. S. L.) to observe a number of comparatively rare dermatoses in soldiers. These have included: (1) tuberculoid leprosy, (2) xanthoma diabeticorum, (3) acquired ichthyosis, (4) erythroplasia of Queyrat, (5) glossitis rhombica mediana (2 cases), (6) symmetric erythema of the soles, first described by Pernet (12 cases) and (7) hereditary dystrophy of the hair and nails. Because of certain interesting features, the last-mentioned disease is the subject of this discourse. REPORT OF CASE The patient was a 21 year old white soldier of Slavic ancestry who was referred to this hospital from the medical dispensary of his infantry organization with a tentative diagnosis of fungous infection

BLOOD LIPIDS IN LIPAEMIA RETINALIS

Although in the literature there are reports of about forty cases of lipaemia retinalis, 1 detailed studies of the various blood lipids have been described in only a few instances. For this reason the results of the analyses made recently on two boys studied at the New England Deaconess Hospital seem worthy of record. REPORT OF CASES Case1.—Charles H. (case 8, table 3) was 16.7 years old when first seen on Jan. 15, 1934. The onset of diabetes was in December 1931, when he was 14.7 years old. Although since January 1932 he had been under dietary restrictions and had been treated with insulin, control of the diabetic condition had been poor since August 1933. Physical examination showed no noteworthy abnormalities except generalized xanthoma diabeticorum, slight thickening of the radial arteries and enlargement of the tonsils. Venous blood withdrawn on Jan. 15, 1934, was light pink. When

NECROBIOSIS LIPOIDICA DIABETICORUM (URBACH)

Until 1928 the only recognized cutaneous change in diabetes mellitus which had any possible diagnostic value was xanthoma diabeticorum. In that year Oppenheim¹observed and described a condition which had a well defined clinical appearance and occurred only in diabetes. He called the condition dermatitis atrophicans lipoides. Urbach²reported the study of a similar case in 1932. He entitled the condition necrobiosis lipoidica diabeticorum. Since the report of these first two cases, other examples have been recorded by Galewsky,³Gottron,⁴Balbi⁵and Zeisler and Caro.⁶There is, as yet, no official international nomenclature for this condition. Because the majority of the observers have used the name suggested by Urbach, we have adopted it for the sake of convenience. <h3>LITERATURE</h3> Urbach^2awrote the first formal article on necrobioosis lipoidica diabeticorum and since then has reviewed the condition in other contributions.⁷He regarded the

XANTHOMA DIABETICORUM WITH PURPURIC AND ULCERATING LESIONS*

British Journal of DermatologyVolume 46, Issue 5 p. 223-225 XANTHOMA DIABETICORUM WITH PURPURIC AND ULCERATING LESIONS* J. FERGUSON SMITH, J. FERGUSON SMITH Glasgow.Search for more papers by this author J. FERGUSON SMITH, J. FERGUSON SMITH Glasgow.Search for more papers by this author First published: May 1934 https://doi.org/10.1111/j.1365-2133.1934.tb10212.xCitations: 4 * Case shown at the Meeting of the North British Dermatological Society in Glasgow, March 22nd, 1934. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume46, Issue5May 1934Pages 223-225 RelatedInformation

II.—Schüller's Disease (A Reticulo-Endotheliosis)

Cases of Schuller's disease have been recorded under the following titles:— Schuller-Christian disease. Hand-Schuller-Christian syndrome. Christian's syndrome. Xanthomatosis. Xanthomatose cranio-hypophysaire. Lipoidgranulomatosis. Lipoid histiocytosis. Xanthomatosis Generalisata Ossium. Xanthoma Diabeticorum. In 1915, Artur Schuller, of Vienna, described two cases of bony lesions in young people. His first case was a boy of 16, who had an unusual development of fat, particularly above the clavicles, and in the arms, legs, and abdomen. X-ray examination of the skull revealed multiple erosions in the bone. The sella turcica was small but intact. Exophthalmos was present, and Schuller suggested that the tumour was an angioma of the dura or of the skull bone. His second case was a girl aged 4 years. When 2 years old, she developed left exophthalmos, and at the same time a defect in the skull was observed. A few months later, right-sided exophthalmos suddenly appeared. There was marked increase of thirst and p...

XANTHOMA DIABETICORUM: AN EARLY CASE

Xanthoma diabeticorum may be described as being a rare skin disorder occurring in glycosuric or diabetic individuals, usually in adult males; the skin lesions consisting of reddish, reddish yellow or orange papules, measuring from 0.5 to 2 cc., distributed chiefly over the extensor aspects of the arms, legs and buttocks, discrete and usually in not great numbers. The skin lesions develop suddenly. This condition was first described in 1851 by Addison and Gall. Since that time other cases have been reported and further research undertaken to clear up the subject of faulty fat metabolism and this disorder associated with it. As recently as 1922, Moore 1 reported a typical case in a girl, aged 14 years, who died in two months. In his report he states that the disorder is rare. One year later, Major 2 reported four cases seen over a period of five months, indicating, of course, that

A CASE OF XANTHOMA DIABETICORUM TREATED WITH A SULPHUR DERIVATIVE OF HISTIDINE (2-THIO-4 (OR 5)-AMINO-METHYL-GLYOXALINE).

British Journal of DermatologyVolume 37, Issue 1 p. 30-33 A CASE OF XANTHOMA DIABETICORUM TREATED WITH A SULPHUR DERIVATIVE OF HISTIDINE (2-THIO-4 (OR 5)-AMINO-METHYL-GLYOXALINE). J.E.R. McDONAGH F.R.C.S., J.E.R. McDONAGH F.R.C.S.Search for more papers by this author J.E.R. McDONAGH F.R.C.S., J.E.R. McDONAGH F.R.C.S.Search for more papers by this author First published: January 1925 https://doi.org/10.1111/j.1365-2133.1925.tb09216.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume37, Issue1January 1925Pages 30-33 RelatedInformation

DIABETES MELLITUS COMPLICATED BY LIPEMIA RETINALIS AND XANTHOMA DIABETICORUM

This case is of interest not only as an instance of severe diabetes which responded excellently to therapy, but also of two relatively rare complications; namely, lipemia retinalis and xanthoma diabeticorum. Thirty-one cases of lipemia retinalis have been reported; the thirty-first was reported last year by Muskat¹at this hospital. Eighty-one cases of xanthoma diabeticorum have been reported. The present case adds one instance to each series. A white man, aged 24, was brought into the ward in the service of Drs. Loeb and Kerr, in deep coma, with air hunger, pinched features, and a powerful acetone odor to the breath. The physical examination was grossly negative except that ophthalmoscopy showed normal disks in both eyes, but with the retinal vessels pure, shining white. There was a faint apical, systolic blow, poorly transmitted toward the axilla, but no cardiac enlargement was demonstrable. The ankles were slightly edematous. On the

XANTHOMA DIABETICORUM

Medical Journal of AustraliaVolume 1, Issue 15 p. 369-369 Current Comment XANTHOMA DIABETICORUM First published: 01 April 1924 https://doi.org/10.5694/j.1326-5377.1924.tb65655.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue15April 1924Pages 369-369 RelatedInformation

XXXI.—XANTHOMA DIABETICORUM TREATED WITH INSULIN

In our experience, the lesions of xanthoma diabeticorum usually yield to the ordinary treatment directed toward the primary diabetic condition, but they yield rather slowly; in fact, it is usually a question of several months before they involute completely. It has been our privilege to observe a recent case of this disease and its rapid involution under treatment with insulin. The patient was in the Barnes Hospital in the service of Dr. William Olmsted, and we are indebted to him for permission to report it. CASE REPORT History.— A white man, aged 23, entered the hospital on Feb. 13, 1923, in diabetic coma. About six weeks before admission, a papular eruption appeared on his arms. A few days later the eruption appeared on his legs and scalp and very many new ones appeared in all of these locations. There were no subjective symptoms. At the time of his admission his

XANTHOMA DIABETICORUM

British Journal of DermatologyVolume 4, Issue 8 p. 253-258 XANTHOMA DIABETICORUM H. RADCLIFFE CROCKER, H. RADCLIFFE CROCKERSearch for more papers by this author H. RADCLIFFE CROCKER, H. RADCLIFFE CROCKERSearch for more papers by this author First published: August 1892 https://doi.org/10.1111/j.1365-2133.1892.tb16804.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume4, Issue8August 1892Pages 253-258 RelatedInformation