Author(s): Roxanne Jillan V Mauleon*, Ma Flordeliz Abad Casintahan and Melanie Joy Doria Ruiz
ABSTRACT
Background: Xanthomas are cutaneous lesions, ranging from papules to nodules and plaques, consisting of infiltrates of lipid-containing histiocytic foam cells. These usually result from disturbances in lipoprotein metabolism leading to the accumulation and/or deposition of lipoproteins in plasma or tissue. This case report aims to present a patient with coexisting tubero-eruptive and planar xanthomas, associated with underlying hyperlipidemia.
Case Report: A 49-year-old Filipino female presented with multiple, well-defined, yellowish papules, nodules and plaques on the elbows, hands, knees, feet, antecubital and popliteal fossae, which started 8 years prior. Initially diagnosed as a case of benign fibrous histiocytoma, she was lost to follow-up until new lesions emerged. Blood tests done revealed hyperlipidemia. Histopathological examinations were consistent with xanthoma. She was referred to Internal Medicine and was prescribed Atorvastatin 40 mg ODHS and Fenofibrate 200 mg OD. She also underwent a series of surgical excisions for some of the large nodules that caused discomfort and mobility problems.
Conclusion: This case highlights the importance of the groundwork that history-taking and physical examination establish. Accurate diagnosis of xanthoma is crucial because it may uncover underlying atherosclerotic cardiovascular disease, which, when managed promptly, can delay its progression. Given the potential familial or hereditary nature of hyperlipidemia, it is essential to stress the importance of testing not only the patient, but also family members, even those without cutaneous manifestations. Despite the limited use of complex assays and genetic testing in the Philippines, returning to basics such as simple lipid profile tests can reveal serious health implications.
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