Hospitalization and mortality in Asian autoimmune bullous dermatosis patients: A 17-year retrospective study.

Limited data exist on the factors associated with hospitalization and mortality in Asian inpatients with autoimmune bullous dermatoses (AIBDs). This study aimed to elucidate the risk factors affecting hospitalization and mortality rates in Asian patients with AIBDs. A retrospective analysis of patients with AIBDs treated at Siriraj Hospital during a 17-year period was performed using the International Classification of Diseases 10th revision codes. The characteristics of inpatients and outpatients were compared, and mortality rates and associated factors were identified. The study included 360 AIBD patients (180 inpatients, 180 outpatients). Inpatients were significantly younger than outpatients. The identified risk factors for hospitalization were malignancy (odds ratio [OR] 2.83, 95% confidence interval [CI] 1.13-8.04; p = 0.034), moderate to severe disease (OR 2.52, 95% CI 1.49-4.34; p < 0.001), systemic corticosteroid use ≥15 mg/day (OR 2.27, 95% CI 1.21-4.41; p = 0.013) and oral cyclophosphamide treatment (OR 9.88, 95% CI 3.82-33.7; p < 0.001). Kaplan-Meier analysis revealed mortality rates of 26%, 36% and 39% for inpatients with pemphigus at 1, 3 and 5 years, respectively. For inpatients with pemphigoid, the corresponding rates were 28%, 38% and 47%. Infections, particularly pneumonia, were the predominant cause of death in both conditions. This study confirmed that both Asian ethnicity and healthcare disparities may be correlated with adverse outcomes in patients with AIBDs. Pemphigus mortality rates were substantially greater in Asian patients than in Caucasian patients. Continuous monitoring of factors contributing to hospitalization and mortality is imperative to improve treatment outcomes.

Herpes zoster duplex bilateralis symmetricus in an immunocompromised patient with recent varicella infection.

A single varicella infection usually causes lifelong immunity, so recurrent varicella infection is considered rare. Reactivation of the virus as herpes zoster usually develops after a latent period. Here, we report a case of a 48-year-old immunosuppressed patient who presented with rapid-onset symmetrical bilateral papulovesicular eruptions on both legs 3 weeks after having recurrent varicella infection that had been treated with intravenous acyclovir. Varicella zoster virus (VZV) Ag testing was performed on vesicular lesions. The positive result confirmed that VZV had reactivated. It presented in the form of herpes zoster duplex bilateralis symmetricus. This condition is rare and occurs primarily in immunocompromised female hosts.

Clinical characteristics, mortality, and prognostic factors for bullous pemphigoid in a Thai population.

Bullous pemphigoid is an uncommon, autoimmune, blistering disease. Clinical features, associated conditions, and outcomes differ according to country. We aimed to determine the mortality rate and clinical characteristics of Thai patients and to evaluate the risk factors associated with survival.A retrospective analysis was conducted on 119 patients, over a ten-year period, at Songklanagarind Hospital, the largest tertiary university hospital in Southern Thailand.The median age of onset was 82 years [interquartile range 72, 90], and 60 (50.4%) patients were men. The underlying diseases were hypertension (53.8%), neurological disease (42.8%), and diabetes mellitus (31.9%). Fifty-eight patients (48.7%) experienced pruritus, and 61.3% of patients had mild cutaneous lesions (less than 10% of the body surface area) on the day of diagnosis. Nine percent of patients presented with mucosal involvement. Complete blood counts showed anemia (32.8%), neutrophilia (30.3%), and eosinophilia (42.9%). The 1-, 3- and 5-year overall mortality rates were 28.1% [95% confidence interval (CI), 7.8-36.6], 55.7% (95% CI, 44.4-64.7) and 71.9% (95% CI 59.9-80.2), respectively. On multivariate analysis, high neutrophil/lymphocyte ratio [odds ratio (OR) 5.55, P < .001] and anemia (OR 2.93, P = .025) were found to be independently associated with mortality rate, whereas disease remission (OR 0.25, P = .003) was demonstrated to be a good prognostic factor.This is the first study to analyze the mortality rate of Bullous pemphigoid in Thailand. Mortality was associated with high neutrophil/lymphocyte ratio and anemia.

Burkitt lymphoma initially mimicking varicella zoster infection.

Burkitt lymphoma is an aggressive type of nodal non-Hodgkin lymphoma. This disease commonly involves the gastrointestinal tract, bone marrow, central nervous system, and in rare instances, the skin. We report the case of a 78-year-old Asian man who had experienced subacute fever and significant weight loss. He initially presented with a zosteriform skin rash on his right temporal area, which primary physicians diagnosed as varicella zoster infection and treated with antiviral drugs. The rash developed on the left forehead and chest. Dermatopathological studies on a skin lesion on the chest wall showed characteristics of Burkitt lymphoma. After a week of palliative chemotherapy, regression of all skin lesions was observed. This report aims to demonstrate an unusual zosteriform pattern of cutaneous involvement in Burkitt lymphoma.