A 55-year-old cachectic (BMI 16.7 kg/m 2 ) man with known Crohn disease as well as long-standing immunosuppressive therapy and alcohol abuse developed fi rm subcutaneous nodules and pustules two years after an injury to the right index fi nger. These extended over the entire index fi nger, the palm and from the dorsum of the hand to the dorsomedial forearm and were associated with burning pain and reduced function ( Figure 1). Histopathology findingsHistology revealed neutrophilic infl ammation with pustules and abscesses (Figure 2). A further biopsy additionally detected drusen with amorphous concretions and chronic neutrophil-rich granulomatous infl ammation (Figure 3). Isolation of a pathogen from pus or tissue was not possible.

Necrolytic migratory erythema is an obligatory paraneoplastic syndrome. Here we describe a patient with a neuroendocrine tumor of probably pancreatic origin. She developed the typical skin lesions under chemotherapy with temozolomide and capecitabine.

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