RESUMO
We present a case of a patient with bullous pemphigoid presenting with acquired haemophilia A. This is characterized by formation of antibodies or inhibitors against coagulation Factor VIII, leading to a prolonged activated partial thromboplastin time with normal prothrombin time and international normalized ratio. Our case emphasizes the need for increased awareness among dermatologists of this uncommon and potentially life-threatening condition. Click here for the corresponding questions to this CME article.
Assuntos
Hemofilia A , Penfigoide Bolhoso , Humanos , Penfigoide Bolhoso/complicações , Penfigoide Bolhoso/diagnóstico , Hemoptise/etiologia , Hematoma/complicaçõesAssuntos
Anormalidades da Pele/patologia , Doenças da Medula Espinal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Anormalidades da Pele/complicações , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagemAssuntos
Vírus da Hepatite B , Hepatite B , Antivirais/uso terapêutico , Antígenos de Superfície da Hepatite B/farmacologia , Antígenos de Superfície da Hepatite B/uso terapêutico , Humanos , Terapia de Imunossupressão , Imunossupressores/efeitos adversos , Estudos Retrospectivos , Singapura/epidemiologia , Ativação Viral/efeitos dos fármacosRESUMO
BACKGROUND: Unfamiliarity with the presentation, diagnostic process, and treatment of cutaneous non-tuberculous mycobacterium (NTM) infection leads to poorer outcomes. We describe our experience with managing cutaneous NTM infection in a regional hospital in Singapore from 2005 to 2014. METHODS: Adult patients with cutaneous NTM infections were identified through positive skin tissue cultures in this retrospective case series. We excluded patients younger than 21 years of age, patients whose care was transferred to another hospital, and patients with catheter-related infections. Data including demographic variables, as well as disease and treatment outcomes, were collected. We compared the data between patients with and without risk factors for immunosuppression to look for any significant difference. RESULTS: Fifty-eight cases were reviewed. Mycobacterium abscessus was the commonest organism isolated (51.7%), and abscesses or inflamed cysts were the most common presentation. Nineteen specimens (57.6%) showed suppurative or necrotizing granulomatous dermatitis on biopsy and acid-fast bacilli were identified in 2 of 21 histologic specimens (9.5%) stained for mycobacterium. Treatment included systemic antibiotics, surgery, or both. In total, 33 cases had clinical resolution while 25 cases were lost to follow-up. Our study was limited by the under-reporting of cases, bias due to data from a single center, and high dropout rates, thereby precluding a detailed assessment of treatment outcomes. CONCLUSIONS: A high index of suspicion is required to diagnose cutaneous NTM infection. Education of both patients and physicians will help to raise the level of awareness and reduce treatment delays.
Assuntos
Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Mycobacterium abscessus/isolamento & purificação , Dermatopatias Bacterianas/epidemiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/terapia , Mycobacterium abscessus/imunologia , Estudos Retrospectivos , Fatores de Risco , Singapura/epidemiologia , Pele/microbiologia , Pele/patologia , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/terapia , Resultado do TratamentoAssuntos
Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Pênfigo/tratamento farmacológico , Idoso de 80 Anos ou mais , Feminino , Glucocorticoides/efeitos adversos , Humanos , Imunossupressores/uso terapêutico , Doenças Maxilomandibulares/cirurgia , Ácido Micofenólico/uso terapêutico , Osteonecrose/cirurgia , Osteoporose/induzido quimicamente , Osteoporose/complicações , Pênfigo/complicações , Prednisolona/efeitos adversosAssuntos
Acne Vulgar/induzido quimicamente , Antibacterianos/efeitos adversos , Doxiciclina/efeitos adversos , Acne Vulgar/tratamento farmacológico , Administração Tópica , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Humanos , Isotretinoína/administração & dosagem , Isotretinoína/uso terapêutico , Masculino , TóraxAssuntos
Lúpus Eritematoso Sistêmico/complicações , Doenças da Boca/etiologia , Mucosa Bucal/patologia , Adulto , Anticorpos Monoclonais Murinos/uso terapêutico , Antirreumáticos/uso terapêutico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/patologia , Doenças da Boca/tratamento farmacológico , Doenças da Boca/patologia , Rituximab , Resultado do TratamentoRESUMO
BACKGROUND: Treatment of keloids is a therapeutic challenge. OBJECTIVES: To determine the outcome and the risk of recurrence after debulking cold steel surgery or carbon dioxide (CO2) laser ablation of earlobe keloids. MATERIAL AND METHODS: The case records of 16 patients with earlobe keloids managed at Changi General Hospital, Singapore, from 2003 to 2009 were reviewed retrospectively. RESULTS: Fourteen patients were females, and the mean age at presentation was 20 years. Eight patients underwent CO2 laser ablation, six patients underwent cold steel surgery, one patient underwent both surgery and CO2 laser ablation, and one patient received only 40 mg/ml of intralesional triamcinolone acetonide. Fourteen patients were followed up for 1-24 months post procedure, and two patients defaulted. Both modalities were equally effective in debulking the earlobe keloids. All 13 patients who had either CO2 laser ablation or cold steel surgery had recurrence of keloid growth at 2-18 weeks post procedure. The patient who received intralesional triamcinolone acetonide therapy alone had only partial response to the therapy. CONCLUSIONS: Both the CO2 laser ablation and cold steel surgery were equally useful in reducing the size of the earlobe keloids, but were not effective in preventing regrowth of the keloids, even with adjunctive intralesional steroids. Patients should be clearly counselled regarding this.
Assuntos
Orelha Externa/cirurgia , Queloide/cirurgia , Lasers de Gás/uso terapêutico , Adolescente , Adulto , Anti-Inflamatórios/uso terapêutico , Feminino , Humanos , Injeções Intralesionais , Queloide/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Triancinolona Acetonida/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Derangements in blood cell counts have been described in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) but are not well characterized. We aim to describe the relationship between our patients' hematological results and the evolution of disease and hypothesize on the possible roles of granulocyte-colony-stimulating factor (G-CSF) in the management of these conditions. MATERIALS AND METHODS: Clinical records of our patients with SJS and TEN from January 2005 to 2010 were analyzed. RESULTS: Anemia and lymphopenia were most commonly seen, while thrombocytopenia was uncommon. Leukopenia and neutropenia were seen in patients with more severe disease, and the trend of leukopenia and neutropenia followed the evolution of disease. Two patients received G-CSF for febrile neutropenia and had a rapid recovery of their neutrophil counts as well as a shorter time to re-epithelialization. CONCLUSION: Our patients tended to have leukopenia and neutropenia that followed a predictable trend of decline and subsequent improvement depending on the stage of disease. This may be of pathogenic significance, and G-CSF may be used in these cases to manage febrile neutropenia and aid re-epithelialization. Further basic science research is required to prove our hypotheses.
Assuntos
Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Neutropenia/tratamento farmacológico , Síndrome de Stevens-Johnson/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Febre/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Previous reports regarding the characteristics of patients with drug-induced hypersensitivity syndrome (DIHS) are mostly limited to small case reports and drug-specific case series, mainly involving Caucasian patients. OBJECTIVE: We describe the trends in the clinical presentation and laboratory findings of our patients with DIHS and their response to therapy. METHODS: This is a retrospective case series. Clinical records of patients treated in the Department of Dermatology, Changi General Hospital, Singapore, with a diagnosis of DIHS from January 2003 to January 2008 were retrieved and analyzed. RESULTS: In all, 27 patients were analyzed. The 3 most consistent features in our patients were 1) history of drug exposure (100%); 2) a morbilliform cutaneous eruption in 81.5% of the patients; and 3) systemic involvement with hepatitis (96.3%), hematologic abnormalities (81.5%), and fever (77.8%) being most common. Superficial perivascular dermatitis was the most common skin biopsy specimen findings, with tissue eosinophilia occurring in half the biopsy specimens. Severe complications included renal failure requiring dialysis in two patients and hyperthyroidism and myocarditis occurring in one patient. LIMITATIONS: This is a retrospective study with a small number of patients during a 5-year period. We did not routinely document the presence of lymphadenopathy and hepatosplenomegaly in our patient's records. We do not measure viral serologies routinely as part of the workup for DIHS. CONCLUSION: DIHS is not uncommon. The presentation in an Asian population is similar to published studies. Treatment includes discontinuation of the offending drug, monitoring for organ involvement, and using systemic steroids.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Hipersensibilidade a Drogas/etiologia , Eosinofilia/induzido quimicamente , Hipertireoidismo/induzido quimicamente , Injúria Renal Aguda/patologia , Injúria Renal Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Doença Hepática Induzida por Substâncias e Drogas/terapia , Hipersensibilidade a Drogas/patologia , Hipersensibilidade a Drogas/terapia , Eosinofilia/patologia , Eosinofilia/terapia , Feminino , Febre/induzido quimicamente , Febre/patologia , Febre/terapia , Seguimentos , Humanos , Hipertireoidismo/patologia , Hipertireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Miocardite/induzido quimicamente , Miocardite/patologia , Estudos Retrospectivos , Doenças Vasculares/induzido quimicamente , Doenças Vasculares/patologia , Doenças Vasculares/terapia , Adulto JovemRESUMO
INTRODUCTION: Inflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition. CLINICAL PICTURE: A 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics. TREATMENT: The patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings. OUTCOME: Her condition improved with the antifungal therapy, and there was no residual alopecia. CONCLUSION: Physicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.