A Leser–Trélat-Like Eruption in an Elderly Woman With Gastrointestinal Alarm Symptoms and No Identified Malignancy: A Case Report

A Leser-Trélat sign is traditionally characterized by the abrupt appearance or rapid increase of multiple seborrheic keratoses in association with an underlying malignancy, particularly gastrointestinal (GI) adenocarcinoma.However, the specificity of this sign remains controversial because seborrheic keratoses and malignancy are both prevalent in older adults, and Leser-Trélat-like eruptions can appear without identifiable malignancy.We present the case of an 89-year-old woman with hypertension and osteoarthritis who developed diffuse seborrheic keratoses involving the trunk and extremities over approximately two years, accompanied by unintentional 20-pound weight loss, progressive dysphagia, anemia, melena, and cachexia.Her hemoglobin declined from approximately 12.5 g/dL to 9.8 g/dL, prompting investigation for GI malignancy.Anemia was clinically managed as iron deficiency.Esophagogastroduodenoscopy revealed esophagitis without an identified gastric or esophageal mass.Esophageal biopsy documented reactive squamous epithelial changes without malignant cells.Although earlier clinical documentation referenced multifocal esophageal squamous dysplasia, this diagnosis was reconciled with the available biopsy description stating focal low-grade squamous intraepithelial neoplasia.Helicobacter pylori testing was negative, CT of the abdomen and pelvis demonstrated no masses or lymphadenopathy, and colonoscopy was unremarkable.Iron supplementation was associated with a reported hematologic response, and subsequent fecal occult blood testing was negative.This case highlights the importance of evaluating GI alarm symptoms when widespread seborrheic keratoses raise suspicion for Leser-Trélat sign.The absence of malignancy during the documented initial evaluation does not establish a benign causal mechanism or permanently exclude occult malignancy.The gradual evolution of the cutaneous findings favors the descriptive term Leser-Trélat-like eruption.Histopathologic correlation, accurate dermatologic documentation, and longitudinal clinical assessment remain essential.