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1878464 tn?1320563037

Necrolytic Dermatitis with Nausea?

I am a 42 year old male, and I have had seemly disconnected symptoms, for about 1 1/2 years now, which I hope someone my shed some light. I will be consulting my doctor again very soon but hope to get a little more information prior. I have had severe nausea, some vomiting, loose stool - those are the GI symptoms. An abdominal ultrasound was normal except the liver was "fuzzy" (doctor's words) (maybe "blurry").. Lab work did show my platelet levels to be 140 (normal range is 100-400) (so just on the low end of the normal range) for all lab testing during this time. Now the symptom perplexing the doctors. I have "soft" holes forming on my scalp: Started with one, now about 7-8. A punch biopsy reveal necrolytic dermatitis. (And yes, they are very painful...I and taking Promethazine for the nausea and Tramadol for the pain).

I have been tested for many things already: SPEP and UPEP for multiple myloma showed no M-protein, Lupis test negative, MS-battery normal, upper and lower GI (both normal) full body bone scan normal, skull X-rays normal, CT scan showed encephalomalacia in the left frontal lobe (likely from a stroke about 15 years ago), and a MRI revealed a porencephalic cyst in the left frontal lobe.

The symptoms any the pain are getting worse, so any direction that a knowledgeable person may have for me would be greatly appreciated. Thank you in advance.

I am adding some photo links that show the soft "holes" for reference.




- Jason
7 Responses
1340994 tn?1374197577
Maatson usually has good answers.  If that doesn't pan out, I usually suggest people rule out food allergies when they have weird skin or digestive complaints.  You could just stop dairy, nuts, soy.  If that makes no difference, you could get blood tests for Celiac disease, even though you do not yet have symptoms in your small intestines by endoscopy.  

You look like you are eating a lean diet with vegetables and not smoking already.  
Avatar universal
Hello, To me this looks like a case of 'panniculitis' and effort should be directed to rule out pancreatitis (chronic).
1878464 tn?1320563037
My GI has order the test for Celiac Disease, so I will know about that shortly as well. I have tried to vary my diet looking for food allergies but have yet to find any foods that may be causing any issues.

The abdominal ultrasound did show the pancreas to be normal as my dermatologist thought 'panniculitis' was a possibility. I have be referred to one of the leading dermopathologists now, so hopefully this can be figured out.

I hate taking pills so having to be on pain medication because the "holes" hurt so much is the worse part (and the medication is not as effective anymore). The number of "holes" are increasing so if anyone can think of anything that we may be missing I would love to know. The doctors are running out of options for tests, and still they are not sure of the cause. Furthermore, I will have the doctors review the tests done and see if something can be figured out.
1878464 tn?1320563037
To post an update, I was just diagnosed with non-systemic lupus. The ICD9 code given is 695.4 which is discoid lupus. Looking at pictures from http://dermnetnz.org/immune/cutaneous-lupus.html it appears that lupus profundus is more accurate. I have started another thread in regards to the question of the type, but I wanted to conclude this thread with the diagnosis.
Avatar universal
'Lupus profundus panniculitis'  Best wishes for speedy recovery
Avatar universal
After looking at your histopathology report, despite the apparent clinical diagnosis, the firm diagnosis now could be placed on Discoid LE.Though both these conditions are known to co-exist(Children), there is no evidence of fat involvement in histopathology (the hall-mark of panniculitis).
Guess you should be happier with this diagnosis, since it is better controlled and a much better prognosis.
With my best wishes.
1878464 tn?1320563037
Thank you very much for you responses. I go for my eye exam tomorrow and then I start Plaquenil along with Locoid Lipocream. Hopefully with the treatment the pain will ease, and the soft "holes" will stop growing in size.
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