The presentation of Zollinger-Ellison syndrome includes all of the following except:

C. Migratory rash.

DISCUSSION: Zollinger-Ellison syndrome occurs in two settings: sporadically and in association with MEN 1 syndrome. MEN 1 syndrome includes parathyroid adenomas, and the initial presentation is often related to this parathyroid disease. Diarrhea is a common presentation for Zollinger-Ellison syndrome, since hyperacidity can result in diarrhea due to the volume of acid secreted or from a steatorrhea-type diarrhea when the high levels of acids inactivate the pancreatic enzymes. Migratory rash is commonly associated with glucagonoma but not with Zollinger-Ellison syndrome. Both jejunal and duodenal ulcers can be found with Zollinger-Ellison syndrome.