RESUMO
BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors are targeted therapies that frequently induce skin eruptions such as acneiform rash. Due to their increasing use in oncology as well as the expanding number of exposed patients, new adverse events may emerge. PATIENTS AND METHODS: A 54-year-old female patient treated with erlotinib for 8 months for pulmonary adenocarcinoma presented inflammatory alopecia that had been ongoing for 1 month. Her condition did not improve with doxycycline 100mg/day. Diffuse erythema of the scalp was associated with painful keratotic plaques and several oozing lesions. A skin biopsy showed signs of acute suppurative and destructive folliculitis. Histology and dermatoscopy were consistent with a diagnosis of folliculitis decalvans. Marked improvement was observed after discontinuation of erlotinib followed by introduction of amoxicillin+clavulanic acid and application of a topical corticosteroid. Unfortunately, the lesions recurred after reintroduction of the anti-EGFR, despite a dosage reduction, requiring up-titration of doxycycline to 200mg/day. DISCUSSION: Scarring alopecia with a folliculitis decalvans-like presentation secondary to anti-EGFR is a rare adverse event. The exact pathophysiology remains poorly understood. Treatment is difficult, and while systemic antibiotics are effective, they must be maintained for a long duration in order to avoid recurrence. Early recognition is important to limit the development of scarring alopecia due to the difficulties of stopping treatment in advanced-stage carcinoma.
Assuntos
Cicatriz , Foliculite , Alopecia/induzido quimicamente , Cicatriz/induzido quimicamente , Cloridrato de Erlotinib/efeitos adversos , Eritema , Feminino , Foliculite/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Recidiva Local de NeoplasiaAssuntos
Queilite/etiologia , Dermatoses Faciais/etiologia , Linfoma de Célula do Manto/diagnóstico , Macroglossia/etiologia , Idoso , Antígenos CD/análise , Linfócitos B/patologia , Queilite/patologia , Diagnóstico Diferencial , Dermatoses Faciais/patologia , Humanos , Imunofenotipagem , Doença de Lyme/diagnóstico , Linfoma de Célula do Manto/complicações , Macroglossia/patologia , Masculino , Síndrome de Melkersson-Rosenthal/diagnóstico , Pseudolinfoma/diagnóstico , Sarcoidose/diagnóstico , Sífilis/diagnósticoAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/patologia , Adulto , Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Evolução Fatal , Humanos , Masculino , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Síndrome de Stevens-Johnson/diagnósticoAssuntos
Carcinoma de Células Escamosas/cirurgia , Dermatoses da Perna/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Administração Oral , Corticosteroides/uso terapêutico , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/patologia , Biópsia , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Dermatoses da Perna/tratamento farmacológico , Dermatoses da Perna/patologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/patologia , Recidiva , Pele/patologia , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Dermatopatias Vesiculobolhosas/patologia , Neoplasias Cutâneas/patologia , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/patologia , Zinco/deficiênciaAssuntos
Doença da Arranhadura de Gato/diagnóstico , Linfonodos/patologia , Adulto , Animais , Anticorpos Antibacterianos/sangue , Bartonella henselae/imunologia , Gatos , Terapia Combinada , Diagnóstico Diferencial , Feminino , Virilha , Humanos , Interferon-alfa/uso terapêutico , Ligamentos , Linfogranuloma Venéreo/diagnóstico , Melanoma/diagnóstico , Melanoma/tratamento farmacológico , Melanoma/secundário , Melanoma/cirurgia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Coxa da Perna/lesões , Infecção dos Ferimentos/diagnósticoAssuntos
Mastocitose Cutânea/diagnóstico , Telangiectasia/diagnóstico , Biomarcadores , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico , Humanos , Lactente , Mastócitos/química , Mastócitos/patologia , Mastocitose Cutânea/classificação , Mastocitose Cutânea/metabolismo , Mastocitose Cutânea/patologia , Proteínas Proto-Oncogênicas c-kit/análise , Telangiectasia/metabolismo , Telangiectasia/patologia , Coxa da PernaRESUMO
INTRODUCTION: Periarteritis nodosa (PAN) is a form of vasculitis affecting the small and medium-sized arteries. Below, we report a case of cutaneous PAN relapsing in streptococcal infections over a period of 30 years and progressing towards systemic vasculitis. CASE REPORT: A 35-year-old man was hospitalised for a retro-pharyngeal access associated with fever, arthralgia, myalgia and inflammatory subcutaneous nodules. Peripheral neurological signs were also seen with deficiency of the elevator muscles in the right foot. Examination of a biopsy from a nodule showed a characteristic image of PAN. Following drainage of the abscess, a favourable outcome was obtained with antibiotics and systemic corticosteroids. History taking showed that the patient had presented similar episodes since the age of 5 years involving arthralgia, myalgia and inflammatory subcutaneous nodules. These episodes appeared to follow a streptococcal infection, of which there was either clinical suspicion or objective elevation of antistreptolysin O (ASLO) titre. Skin biopsy resulted in diagnosis of cutaneous PAN 25 years earlier. In all cases, improvement was achieved by oral corticosteroids combined with treatment of the actual infection. DISCUSSION: In addition to the classic association with hepatitis B, and occasionally hepatitis C, PAN may be associated with streptococcal infections. The cases of post-streptococcal PAN described in the literature are predominantly cutaneous, although it is not rare to find associated arthromyalgia and sensory neurological impairment. We examined three cases of cutaneous PAN with long-term follow-up described in the literature. They began in childhood and the outcome was benign, with no systemic manifestations. Our case differed in terms of the appearance of motor neurological involvement. CONCLUSION: Post-streptococcal PAN of childhood onset generally carries a better prognosis than adult systemic forms. However, our case shows that on rare occasions, there may be very long progression complicated by systemic involvement.
Assuntos
Poliarterite Nodosa/diagnóstico , Infecções Estreptocócicas/complicações , Adulto , Progressão da Doença , Humanos , Masculino , Recidiva , Abscesso Retrofaríngeo/microbiologiaRESUMO
BACKGROUND: Brachioradial pruritus is a rare form of pruritus localised to one or more brachioradial dermatomes, initially classified as a photodermatosis but which in fact is generally brought on by nervous compression. We report a case of a brachioradial pruritus revealing an intramedullary tumour. PATIENTS AND METHODS: A 53-year-old man had presented pruritus for seven years under the left clavicle, then on the left forearm followed by the right forearm. Finally cervicodynia appeared associated with dysaesthesia of the two upper limbs, fulgurating pains and paresis of the left cubital region. The examination revealed suspended bilateral hypoaesthesia (C4, C5, C6, C7), proprioceptive disorders of the left upper limb, mild motor deficit in the left C8 area and tetrapyramidal syndrome. Cervical radiography did not show cervical osteoarthritis. The MRI revealed a bulky cervical intramedullary tumour extending from C2 to C6. After ruling out cavernoma by medullary angiography, surgery was performed and histopathological analysis of the complete lesion revealed a benign ependymoma. Four months later, this patient complained about residual pains requiring treatment with gabapentin and class 2 analgesics. DISCUSSION: The case presented underlines the possibility of a brachioradial pruritus revealing an intramedullary tumour. Ependymomas are usually seen in children and are frequently evoked in the presence of dysaesthesia. We report the third case of brachioradial pruritus revealing a medullary tumour. The two other cases involved syringomyelia revealed by pruritus in C5 and ependymoma revealed by pruritus in C5-C6. The patient with ependymoma had refused surgical treatment. CONCLUSION: Atypical brachioradial pruritus complicated by neuropathic pains and disorders should prompt screening for a medullary tumour.
Assuntos
Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Prurido/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Ependimoma/patologia , Evolução Fatal , Antebraço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Neoplasias da Coluna Vertebral/patologiaRESUMO
Fat embolism syndrome (FES) is a rare but serious complication occurring after long bone fractures. Presence of fat droplets in cells obtained by bronchoalveolar lavage has been proposed as a specific tool for FES diagnosis in trauma patients. We evaluated this technique over a 15-month period in 85 patients. Twenty-eight patients were excluded. The remaining 57 patients were divided into three groups: group 1, 26 patients without trauma as control; group 2, 22 patients with trauma but without evidence of FES; and group 3, nine patients with trauma and evidence of FES. Six of 26 patients in group 1 and nine of 22 patients in group 2 exhibited fat droplets in alveolar macrophages, whereas three of nine patients of group 3 had not. This study suggests that (1) presence of fat droplets in alveolar macrophages is not a reliable method for diagnosis of FES after long bone trauma, and (2) many conditions are associated with fat droplets in alveolar macrophages.
Assuntos
Líquido da Lavagem Broncoalveolar/patologia , Embolia Gordurosa/diagnóstico , Ferimentos e Lesões/complicações , Adulto , Contagem de Células , Embolia Gordurosa/etiologia , Feminino , Fraturas Ósseas/complicações , Humanos , Lipídeos/análise , Macrófagos/ultraestrutura , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Estudos Prospectivos , Fatores de Risco , Vacúolos/ultraestruturaRESUMO
Brain synaptosomal membranes were prepared from rats sacrificed 18 hr after a single intragastric dose of water or of ethanol (100 mmol/kg), when blood ethanol had fallen almost to zero. Fluorescence polarization of DPH, and (Na+ + K+)ATPase activity, were studied in these membranes in the presence of 0, 0.175, 0.3 or 0.7 M ethanol in vitro. After in vivo ethanol, basal ATPase activity was slightly increased, membrane fluidity was unchanged, but both measures showed increased sensitivity to the effects of ethanol in vitro. Similar results were found after an equivalent in vivo dose of isopropanol, but not of t-butanol. These findings indicate that the sensitization to in vitro effects of ethanol or isopropanol, after in vivo treatment with these alcohols, is probably not dependent principally on their lipid solubilities.