Uncommon Purplish-Red Skin Discoloration in Acute Pancreatitis Patient on Maintenance Hemodialysis: Case Report

The researchers suggest that this phenomenon may be due to inflammation caused by acute pancreatitis and the accumulation of myoglobin in the body.

Skin conditions frequently affect patients undergoing maintenance hemodialysis and those with pancreatitis. However, there is limited research on dermatological issues in individuals who experience both conditions simultaneously. Zhen Wang, Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University), Shanghai, China, and colleagues reported the case of a 62-year-old male patient with a four-year history of maintenance hemodialysis, who presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. The patient exhibited significantly elevated levels of blood amylase, creatine kinase, and myoglobin, along with a distinctive purplish-red skin discoloration.

The treatment regimen included measures to inhibit digestive fluid secretion, anti-infection therapies, blood purification, fasting, rehydration, and symptomatic care. Notably, the patient was treated with continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP). Initially, the patient’s dialysis effluent appeared red. However, a peripheral blood smear did not reveal red blood cell debris. Analysis of the dialysis effluent on Day 0 showed no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L.

Following the therapeutic interventions, there was notable improvement in various indicators, including blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin levels. The patient’s sternal and upper abdominal pain resolved within two days. After four consecutive days of CRRT and HP treatment, the skin color normalized, and the clarity of the dialysis effluent improved.

Subsequently, the patient's blood purification method was changed back to conventional hemodialysis. By the eighth day of hospitalization, the patient resumed a normal diet and was discharged.

"In the case of a patient with acute pancreatitis undergoing MHD, a distinctive purplish-red skin discoloration was observed. After implementing standard treatment protocols, along with CRRT and hemoperfusion, the patient’s condition significantly improved. Remarkably, the abnormal skin color returned to normal," the researchers wrote.

They suggested that skin discoloration is likely linked to inflammation caused by acute pancreatitis and the accumulation of myoglobin in the body. However, they note that the evidence available is not sufficient to draw definitive conclusions.

"Further research is necessary to gain a deeper understanding of dermatological manifestations in patients undergoing MHD who also have concurrent pancreatitis and muscle injury," the research team concluded.

Reference:

Wang, Z., Zhang, L. & Chen, J. Rare skin color changes in an acute pancreatitis patient undergoing maintenance hemodialysis. BMC Nephrol 25, 287 (2024). https://doi.org/10.1186/s12882-024-03738-0