SHM Converge Scientific Abstract ePoster Gallery-Necrolytic Migratory Erythema in a Patient With Roux en Y Gastric Bypass

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This case report describes necrolytic migratory erythema (NME), a rare skin disorder usually linked to glucagonoma but also associated with nutritional deficiencies, liver disease, celiac disease, and cystic fibrosis. The authors present a unique case of NME in a 46-year-old man who had undergone Roux-en-Y gastric bypass 10 years earlier.<br /><br />The patient, with a history of alcohol use disorder, necrotizing pancreatitis, and partial gastrectomy, developed a progressively worsening bilateral rash on the arms, legs, and trunk over three months, with bullae, skin sloughing, and new weakness. Laboratory studies showed severe anemia, thrombocytopenia, hypernatremia, and metabolic abnormalities. Skin biopsy demonstrated findings compatible with NME and suggested nutritional deficiency.<br /><br />Additional workup revealed low zinc, vitamin E, and vitamin A levels. The patient also reported daily copper supplementation, which may have further worsened zinc deficiency because copper can interfere with zinc absorption. He was diagnosed with NME secondary to nutritional deficiencies after Roux-en-Y surgery.<br /><br />Treatment included oral zinc, copper, and multivitamins, along with topical zinc oxide ointment and petrolatum for skin care. His rash improved, and he was discharged on zinc sulfate and copper gluconate with outpatient follow-up.<br /><br />The discussion emphasizes that NME should be considered in patients with a history of Roux-en-Y gastric bypass, especially when skin lesions are progressive and associated with malnutrition. Because bariatric surgery can lead to multiple long-term micronutrient deficiencies, regular monitoring is essential. The report also notes that zinc supplementation can lead to full recovery when NME is caused by deficiency rather than glucagonoma.

Asset Subtitle

Brittany S. Maner

Meta Tag

Author List Alisha Patel, Brittany S. Maner, Cassandre M. Perard, Chance A. Crossland

Category Clinical Vignettes

Concept Necrolytic Migratory Erythema

Concept Zinc Deficiency

Concept Nutritional Deficiency

Concept Zinc Supplementation

Concept Skin Eruption

Distinguished Non-Finalist

Presenter Organization Augusta University Department of Family & Community Medicine

Presenting Author Brittany S. Maner

Track Adult

Keywords

necrolytic migratory erythema

Roux-en-Y gastric bypass

nutritional deficiencies

zinc deficiency

skin rash

micronutrient deficiency

bariatric surgery

copper supplementation

skin biopsy

glucagonoma

Necrolytic Migratory Erythema

Zinc Deficiency

Nutritional Deficiency

Zinc Supplementation

Skin Eruption