Successful Management of Severe Hypertriglyceridemia Presenting With Eruptive Xanthomas as an Outpatient Without Development of Acute Pancreatitis: A Case Report

Eruptive xanthomas are a rare manifestation of severe hypertriglyceridemia and are commonly associated with uncontrolled diabetes mellitus and an increased risk of acute pancreatitis. We report the case of a 41-year-old man who presented with diffuse papular skin lesions and neuropathic symptoms. He had no previous diagnosis of diabetes; however, initial investigations revealed a markedly elevated glycated hemoglobin (HbA1c) of 13.8%, and he was subsequently diagnosed with diabetes mellitus. Further testing showed severe hypertriglyceridemia (85.6 mmol/L), elevated cholesterol, and widespread eruptive xanthomas on examination. Despite the markedly raised triglyceride level, he remained clinically stable and reported no abdominal pain, nausea, or vomiting, with no abdominal tenderness on examination to suggest acute pancreatitis. He was managed as an outpatient with insulin therapy, a statin, a fibrate, and lifestyle modification. This led to a rapid improvement in triglyceride levels, glycemic control, and cutaneous lesions, with no development of pancreatitis. This case highlights eruptive xanthomas as a potential initial presenting feature of previously undiagnosed diabetes mellitus with severe hypertriglyceridemia, and illustrates that carefully selected clinically stable patients may be managed in the outpatient setting with early recognition and prompt metabolic optimisation.