Indian Dermatology Online Journal

SKINDIA QUIZ
Year
: 2011  |  Volume : 2  |  Issue : 1  |  Page : 47-

SkIndia Quiz 2 - Asymptomatic skin coloured nodules in a pregnant lady


Satyaki Ganguly1, Kranti C Jaykar1, Rajesh Kumar2,  
1 Department of Dermatology, Venereology and Leprosy, Katihar Medical College, Katihar -854 105, Bihar, India
2 Department of Pathology, Katihar Medical College, Katihar -854 105, Bihar, India

Correspondence Address:
Satyaki Ganguly
Department of Dermatology, Venereology and Leprosy, Katihar Medical College, P.O. Box No 23, Karim Bagh, Katihar - 854 105, Bihar
India




How to cite this article:
Ganguly S, Jaykar KC, Kumar R. SkIndia Quiz 2 - Asymptomatic skin coloured nodules in a pregnant lady.Indian Dermatol Online J 2011;2:47-47


How to cite this URL:
Ganguly S, Jaykar KC, Kumar R. SkIndia Quiz 2 - Asymptomatic skin coloured nodules in a pregnant lady. Indian Dermatol Online J [serial online] 2011 [cited 2020 Jul 10 ];2:47-47
Available from: http://www.idoj.in/text.asp?2011/2/1/47/79850


Full Text

A 25-year-old female patient in the fifth month of pregnancy presented with multiple firm skin coloured to yellowish elevated lesions on her extremities since the last 7 months. According to her the lesions became more extensive after she became pregnant.

The systemic examination did not reveal abnormality. Cutaneous examination showed multiple firm skin coloured to yellowish nodules on the dorsum and margins of feet, tendo-achilles, pretibial area, dorsum of the hand and extensor aspect of the forearm [Figure 1]. Blood counts and routine chemistry were normal. A skin biopsy [Figure 2] from one of the nodules showed plenty of foam cells with few fibroblasts and collagen bundles in the dermis.{Figure 1}{Figure 2}

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 Answer



Tuberous xanthoma in a normolipemic pregnant lady

 Discussion



Tuberous xanthomas are firm, yellow or orange indurated nodules commonly occurring on face, buttocks, over the extensor aspects of the limbs like elbows, knees, heels, knuckles, etc. They are histologically characterized by large and small aggregates of foam cells with aging lesions showing many foam cells replaced by fibroblasts and collagen bundles. They are usually associated with hypercholesterolemia and increased levels of low density lipoprotein, or sometimes due to secondary hyperlipidemia associated with hypothyroidism, biliary disease and monoclonal gammopathy. All these were ruled out in our case. Tuberous xanthomas have been reported very rarely in normolipemic patients.[1],[2] They are hypothesized to be due to some abnormality in the local lipid metabolism like preceding inflammation at the site. No such history was available in this case. In this case the lesions increased in number and size after the patient became pregnant. There are reports of eruptive xanthomas occurring in pregnancy and are hypothesized to be due to increased estrogen stimulus resulting in hyperlipidemia.[3] This makes it a very rare case of tuberous xathomas occurring in a normolipemic patient, exacerbated in pregnancy.

References

1Handa R, Gupta K, Wali JP. Normolipemic xanthomatosis. Postgrad Med J 1995;71:555-6.
2Fleischmajer R, Tint GS, Bennett HD. Normolipemic tendon and tuberous xanthomas. J Am Acad Dermatol 1981;5:290-6.
3Jaber PW, Wilson BB, Johns DW, Cooper PH, Ferguson JE 2nd. Eruptive xanthomas during pregnancy. J Am Acad Dermatol 1992;27:300-2.