Fatima Zahraa Sassine, Chourouq Mustapha Eid, Ilyass Anouar, Youssef Zemmez, Rachid Frikh, Naoufal Hjira
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 6
Date of Publication: 2026/06/13
Prurigo pigmentosa is a rare inflammatory dermatosis characterized by recurrent pruritic erythematous papules arranged in a reticulated pattern, which resolve leaving characteristic net-like hyperpigmentation. While classically described in association with ketogenic diets, prurigo pigmentosa has been increasingly recognized as a cutaneous marker of ketosis from various etiologies, including diabetic ketoacidosis (DKA).
We report the case of a 19-year-old male with no prior history of diabetes who presented to the emergency department with altered consciousness, tachycardia, and a 48-hour history of pruritic reticulated erythematous papules on the trunk. Laboratory investigations revealed severe hyperglycemia (408 mg/dL), metabolic acidosis (pH 7.18, bicarbonate 8 mEq/L), and ketonuria, confirming the diagnosis of DKA as the initial presentation of type 1 diabetes mellitus. Dermoscopy showed a reticular pigmentation pattern with a negative network, erythema, and telangiectatic vessels. Histopathological examination revealed neutrophilic perivascular infiltration and spongiosis, consistent with prurigo pigmentosa. Following treatment of DKA with intravenous fluids and insulin, both the metabolic derangements and skin lesions resolved within one week without specific dermatologic therapy.
This case highlights prurigo pigmentosa as an important dermatologic clue to underlying ketosis, which may precede or coincide with the diagnosis of DKA. Clinicians should be aware of this association, as recognition of this distinctive eruption may facilitate early diagnosis of potentially life-threatening metabolic emergencies, particularly in patients with previously undiagnosed diabetes.
dermatology, endocrinology, prurigo pigmentosa, inflammatory skin disease, diabetes
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