Diabetes insipidus, bone lesions, and new-onset red-brown papules in a 42-year-old man

A 42-year old Caucasian man was referred to the National Institutes of Health (NIH) for evaluation. His symptoms began approximately 10 years before referral with pituitary dysfunction that manifested as diabetes insipidus, secondary hypogonadism, and hyperprolactinemia, treated with desmopressin and testosterone gel. Eight years later, he began to experience vertigo, dizziness, diplopia, and difficulty focusing and tracking. This was followed by progressive left-sided weakness, poor coordination, and balance difficulties. Magnetic resonance imaging without contrast revealed multiple nonspecific white-matter lesions. Subsequent evaluation failed to identify an underlying infection or inflammatory origin. Systemic corticosteroid therapy was initiated with minimal improvement. Corticosteroids were tapered off 2 months later and the patient noted new asymptomatic skin lesions on his bilateral upper and lower extremities, leading to reinitiation of systemic steroids and introduction of interferon alfa. He denied fevers, chills, weight loss, or difficulty breathing.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Authors: Tags: Dermatology Grand Rounds at the NIH Source Type: research