Asunto(s)
Antituberculosos/uso terapéutico , Peces , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/patología , Mycobacterium marinum/aislamiento & purificación , Animales , Biopsia con Aguja , Progresión de la Enfermedad , Femenino , Granuloma/etiología , Granuloma/patología , Dermatosis de la Mano/tratamiento farmacológico , Dermatosis de la Mano/microbiología , Dermatosis de la Mano/patología , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
INTRODUCTION: Breast cancer is common in women and its metastases involve the skin in approximately one quarter of patients. Accordingly, metastatic breast cancer shown to be cutaneous through histology must be distinguished from a wide variety of other neoplasms as well as the diverse morphologic variants of breast cancer itself. CASE PRESENTATION: We report the case of a 61-year-old Caucasian woman with cutaneous metastases of a bilateral ductal breast carcinoma that in histopathological examination mimicked an adnexal neoplasm with sebaceous differentiation. CONCLUSION: Against the background of metastatic breast carcinoma, dermatopathological considerations of sebaceous differentiation of skin lesions are presented and discussed focusing on the rare differential diagnosis of sebaceous carcinoma of the breast.
Asunto(s)
Criptococosis/diagnóstico , Cryptococcus neoformans , Dermatomicosis/diagnóstico , Neoplasias Faciales/diagnóstico , Huésped Inmunocomprometido , Neoplasias Cutáneas/diagnóstico , Úlcera Cutánea/diagnóstico , Anciano , Dermatomicosis/microbiología , Diagnóstico Diferencial , Humanos , Leucemia Linfocítica Crónica de Células B/epidemiología , Masculino , Neumonía por Mycoplasma/complicacionesRESUMEN
INTRODUCTION: Insulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare. CASE PRESENTATION: A 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15 cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated. CONCLUSION: As reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin allergy may present an easy form of therapy that is successful within a few days.
