2 | CASE HISTORY/EXAMINATION
A 35-year-old Chinese man was admitted to Kurume University Hospital on
May, 2020 owing to fatigue and hyperglycemia. He stated that
hyperlipidemia and hyperglycemia started 2 years prior but that he
discontinued any treatment. He had neither any familial history of
dyslipidemia and diabetes mellitus nor a life history of drug, alcohol,
or smoking abuse. On examination, his body mass index and abdominal
circumference were 32 kg/m² and 106.1 cm, respectively. Multiple
clustered papules were observed on the bilateral extremities (Figure 1).
Histopathological examinations of skin biopsy specimens led to the
diagnosis of eruptive xanthomas
(Figure 2). Laboratory
examinations demonstrated high
levels of fasting serum triglyceride (1871 mg/dL)
and total cholesterol (371 mg/dL)
and low levels of high-density
lipoprotein cholesterol (22 mg/dL). However, low-density lipoprotein
(LDL) cholesterol levels were within the normal range. Examination of
lipoprotein fraction showed that the mid-band and small-dense LDL was
contained (Figure 3). Chronic hyperglycemia was also denoted, with a
fasting plasma glucose level of 203 mg/dL and HbA1c value (NGSP) of
9.9% (Table 1). Other examinations, including electrocardiogram and
chest radiograph, were unremarkable. Ultrasonography revealed moderate
to severe fatty liver (Figure 4). Diet therapy with 1600 kcal/day
calorie restriction and 0.2 mg/day of pemafibrate, which was ultimately
increased to 0.4 mg/day orally, were initiated to reduce serum lipids.
Additionally, 500 mg/day of metformin and 10 mg/day of empagliflozin
were administrated to improve insulin sensitivity and hyperglycemia.
Finally, both serum triglyceride and plasma glucose levels improved to
425 and 101 mg/dL, respectively, with a concomitant change in color of
the skin lesions from red to white and a decrease in the number of
eruptions until total eradication.