Severe Hypertriglyceridaemia and Uncontrolled Diabetes Presenting as Eruptive Xanthoma in a 34-Year-Old Filipino Male: A Case Report

Eruptive xanthomas present as a sudden eruption of multiple yellow papules and are often associated with extreme hypertriglyceridaemia. Several reports describe eruptive xanthoma as the sole presenting symptom of unrecognised hypertriglyceridaemia in adults, but only a few cases report eruptive xanthoma associated with both unrecognised hypertriglyceridaemia and undiagnosed Type 2 diabetes. This report highlights the importance of identifying a cutaneous marker suggestive of an underlying metabolic disorder. A 34-year-old Filipino male presented with a 2-month history of sudden onset of multiple skin-coloured to yellowish papules on the extremities and trunk. He reported a strong family history of diabetes, hypertension, and premature cardiovascular death. Dermoscopy and histopathology were consistent with xanthoma. Referral to endocrinology and subsequent laboratory evaluation revealed severe dyslipidaemia, with triglyceride levels elevated to 1,989 mg/dL (approximately 13 times the upper limit of normal) and a fasting blood glucose of 13.7 mmol/L. After 16 weeks of pharmacologic therapy and lifestyle modification, the patient showed complete resolution of lesions, with normalisation of lipid and glucose levels and no recurrence. This case illustrates the critical role of dermatologic findings in the early detection of systemic metabolic disorders. Early multidisciplinary intervention is key to successful treatment and prevention of life-threatening complications.