Thursday, December 14, 2017


Q: 62 year old male with metastatic renal cell carcinoma is transferred from the oncology floor to ICU with sepsis. Physical exam showed marked yellowish discoloration of the skin. Which of the following diseases can cause carotenemia (xanthoderma = yellow discoloration of skin) which may be confused with jaundice

A) nephrosis
B) diabetes mellitus
C) liver insufficiency
D) hypothyroidism
E) all of the above


Objective of above question is to signify the importance of  good physical examination in various conditions. Skin discoloration can be of many types and can be confusing. All of the above diseases can cause carotenemia by decreasing conversion of beta carotene into retinol. Many diseases require treatment with retinol and may present with this clinical finding (case in the question) 5 . Another important cause of carotenemia is anorexia nervosa, which may present with many nutritional, electrolyte and vitamin deficiencies simultaneously. Also, it is more common in population with predominantly vegetarian diet. 


1.  Aktuna D, Buchinger W, Langsteger W, Meister E, Sternad H, Lorenz O, et al. [Beta-carotene, vitamin A and carrier proteins in thyroid diseases]. Acta Med Austriaca. 1993. 20(1-2):17-20.

2. Stawiski MA, Voorhees JJ. Cutaneous signs of diabetes mellitus. Cutis. 1976 Sep. 18(3):415-21.

3. Sale TA, Stratman E. Carotenemia associated with green bean ingestion. Pediatr Dermatol. 2004 Nov-Dec. 21(6):657-9

4. Takita Y, Ichimiya M, Hamamoto Y, Muto M. A case of carotenemia associated with ingestion of nutrient supplements. J Dermatol. 2006 Feb. 33(2):132-4.

5. Dasanu CA, Dutcher J, Alexandrescu DT. Yellow skin discoloration associated with sorafenib use for treatment of metastatic renal cell carcinoma. South Med J. 2007 Mar. 100(3):328-30.

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