Question of the Week # 424

424)  A 30 year old man presents to the emergency room with complaints of  right lower extremity swelling and pain over the past two days. He has had recurrent diarrhea with loose, watery bowel movements for several weeks without any blood in it. He also reports developing a red, scaly rash around his nose, mouth , genital area and on the buttocks.  He has itching and pain in the areas affected by the rash. He denies any fever or night sweats or weightloss.  He does not drink alcohol. He is sexually active with his girl friend and always uses condoms. On examination, his vitals are stable. Cardiac and respiratory examination is normal. There is  angular cheilitis.  Laboratory investigations reveals a normocytic, normochromic anemia. Stool analysis does not show any leucocytes or blood and is negative for ova and parasites. Venous doppler reveals right lower extremity deep vein thrombosis extending up to common femoral vein. Skin examination shows findings as below:

 

In addition to starting anticoagulation, which of the following should be performed next?

A) Serum Zinc Level

B) CT scan of the abdomen

C) Protein C and S levels

D) Serum Glucagon Levels

E) Factor V leiden mutation

11 Responses

  1. D) Serum Glucagon Levels

    • Doesn,t Glucagon only interact with oral anticoagulants.

      • Sorry…don’t know what u r talking about…but this is Glucagonoma and is associated with increased risk of DVT (as with all cancers i guess) the rash is Necrolytic Migratory Erythema

  2. B

  3. e, 4% to 6% of the U.S. population

  4. D.

  5. c

  6. D

  7. D

  8. serum glucagon level,its nerolytic migratory erythema associated with glucagonoma in 70% cases

  9. Determining the level of glucagonemia by means of radioimmunoassay (RIA) testing is mandatory. A positive test result for glucagonoma exceeds 1000 pg/mL (reference range is 50-200 pg/mL).

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