An uncommon case of pancreatic adenocarcinoma revealed by dermatitis.

We report a 63-year-old-woman who presented with a pruritic rash on both thighs. Radiologic investigations revealed a pancreatic mass. Pancreatic cancer was confirmed by biopsy and the rash resolved after chemotherapy followed by pancreatoduodenectomy. Urticarial dermatitis is a rare paraneoplastic manifestation of pancreatic cancer in Africa.

Introduction

Patients with pancreatic cancer can be symptomatic for many months before presentation. Not all individuals interpret their initial symptoms as serious, and some attribute them to ageing, lifestyle, or other comorbidities. Cutaneous signs are exedently rare. We report here a new case of dermatitis revealing pancreatic adenocarcinoma.

Case report

A 63‐year‐old woman with no previous medical history presented with fatigue and an erythematous, pruritic rash on both thighs (Fig. 1). Blood test revealed hyperglycemia with normal levels of creatine phosphokinase. The electromyogram was normal. The patient had a skin biopsy. Histology revealed a perivascular, lymphohistiocytic infiltrate in the dermis, which excluded the diagnosis of dermatomyositis. An abdominal ultrasound study showed a mass in the head of the pancreas. Based on a computed tomography (CT) scan, the mass was 2.5 cm in diameter and extended to the portal and superior mesenteric veins.

Figure 1

Erythematous lesions on both thighs before chemotherapy.

The patient had a pancreatic biopsy under CT, which revealed adenocarcinoma with a final diagnosis of pancreatic cancer revealed by paraneoplastic urticarial dermatitis (UD). The patient received three cycles of chemotherapy with FOLFIRINOX, which resulted in regression of skin lesions (Fig. 2). A repeat CT scan revealed regression of the pancreatic mass, after which the patient was treated by pancreatoduodenectomy. The postoperative clinical examination showed disappearance of the skin lesions. The patient is undergoing adjuvant chemotherapy with FOLFIRINOX regimen.

Figure 2

Erythematous lesions on both thighs after three cycles of FOLFIRINOX.

Discussion

To our knowledge, this is the first case of paraneoplastic dermatitis revealing pancreatic adenocarcinoma in north Africa. In a retrospective study performed by Hannon et al., 3 of 70 patients with a final diagnosis of UD had a cancer diagnosis within 4 months of the onset of their cutaneous findings. All the patients had different cancers: myelodysplastic syndrome, prostate cancer, and vulval cancer. In another study, 6 of 110 patients with dermatitis had internal malignancies with no case of pancreatic cancer. These studies provide evidence for an association between cutaneous dermatitis and systemic malignancy. Gastrin‐releasing peptide (GRP) may be important in pancreatic tumor growth. The GRP/GRP receptor system is expressed in normal human skin cells such as nerves, vessels, and keratinocytes. Therefore, there is a possibility that GRP causes skin eruption through cutaneous inflammation. The differential diagnosis is dermatomyositis. The treatment of the tumor may lead to its remission as in our case.