RESUMO
BACKGROUND: Contact dermatitis caused by electroencephalography electrodes is rare and insufficiently studied. We described a case of contact dermatitis caused by Bispectral Index (BIS) monitor electrodes. CASE PRESENTATION: A 38-year-old woman underwent tooth extraction under general anesthesia with BIS monitoring. She noticed erythema on her forehead 3 days after surgery, which peaked on the fifth postoperative day. Slight pigmentation was observed at 42 days after surgery. We performed patch testing and confirmed positive reactions to the sensor and some allergens. CONCLUSIONS: Many reports have attributed contact dermatitis to an allergen present in electrocardiogram electrodes. It is important to recognize that complications similar to those caused by electrocardiogram electrodes can occur with this sensor.
RESUMO
We report the case of a 71-year-old Japanese man with a history of chronic kidney disease and sarcoidosis receiving chronic corticosteroids who presented with disseminated Nocardia brasiliensis infection. He initially showed improvement with empiric antimicrobial therapy including trimethoprim-sulfamethoxazole. However, he deteriorated after modifying the empiric regimen due to complicated hyperkalemia and ultimately died. In general, elderly patients have decreased renal function. Standard therapy for nocardiosis with trimethoprim-sulfamethoxazole may not be used for a prolonged period of time. This case emphasizes the challenges and importance of prudent selection of empiric antimicrobial therapy for disseminated nocardiosis in elderly patients with underlying kidney disease.
RESUMO
The corneocyte lipid envelope, composed of covalently bound ceramides and fatty acids, is important to the integrity of the permeability barrier in the stratum corneum, and its absence is a prime structural defect in various skin diseases associated with defective skin barrier function. SDR9C7 encodes a short-chain dehydrogenase/reductase family 9C member 7 (SDR9C7) recently found mutated in ichthyosis. In a patient with SDR9C7 mutation and a mouse Sdr9c7-KO model, we show loss of covalent binding of epidermal ceramides to protein, a structural fault in the barrier. For reasons unresolved, protein binding requires lipoxygenase-catalyzed transformations of linoleic acid (18:2) esterified in ω-O-acylceramides. In Sdr9c7-/- epidermis, quantitative liquid chromatography-mass spectometry (LC-MS) assays revealed almost complete loss of a species of ω-O-acylceramide esterified with linoleate-9,10-trans-epoxy-11E-13-ketone; other acylceramides related to the lipoxygenase pathway were in higher abundance. Recombinant SDR9C7 catalyzed NAD+-dependent dehydrogenation of linoleate 9,10-trans-epoxy-11E-13-alcohol to the corresponding 13-ketone, while ichthyosis mutants were inactive. We propose, therefore, that the critical requirement for lipoxygenases and SDR9C7 is in producing acylceramide containing the 9,10-epoxy-11E-13-ketone, a reactive moiety known for its nonenzymatic coupling to protein. This suggests a mechanism for coupling of ceramide to protein and provides important insights into skin barrier formation and pathogenesis.
Assuntos
Ceramidas/metabolismo , Epiderme/enzimologia , Oxirredutases/metabolismo , Animais , Catálise , Ceramidas/genética , Modelos Animais de Doenças , Doenças Genéticas Inatas/enzimologia , Doenças Genéticas Inatas/genética , Humanos , Ictiose/enzimologia , Ictiose/genética , Camundongos , Camundongos Knockout , Oxirredutases/genéticaAssuntos
Eritema/parasitologia , Prurido/parasitologia , Trichinella/isolamento & purificação , Triquinelose/diagnóstico , Zoonoses/diagnóstico , Animais , Humanos , Japão , Masculino , Produtos da Carne/parasitologia , Anamnese , Triquinelose/parasitologia , Triquinelose/transmissão , Ursidae/parasitologia , Adulto Jovem , Zoonoses/parasitologia , Zoonoses/transmissãoAssuntos
Tratamento de Ferimentos com Pressão Negativa/instrumentação , Pele/lesões , Lesões dos Tecidos Moles/terapia , Cicatrização , Idoso de 80 Anos ou mais , Feminino , Humanos , Pele/patologia , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/etiologia , Resultado do TratamentoAssuntos
Carcinoma/metabolismo , Neoplasias Primárias Múltiplas/metabolismo , Segunda Neoplasia Primária/metabolismo , PTEN Fosfo-Hidrolase/metabolismo , Neoplasias das Glândulas Sudoríparas/metabolismo , Idoso , Glândulas Apócrinas , Axila , Carcinoma/secundário , Humanos , Metástase Linfática , Masculino , Neoplasias Primárias Múltiplas/patologia , Segunda Neoplasia Primária/patologia , Neoplasias das Glândulas Sudoríparas/patologiaAssuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/patologia , Fosfato de Sitagliptina/efeitos adversos , Idoso , Biópsia por Agulha , Convertases de Complemento C3-C5/imunologia , Diabetes Mellitus Tipo 2/diagnóstico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Ensaio de Imunoadsorção Enzimática , Técnica Direta de Fluorescência para Anticorpo , Seguimentos , Humanos , Imunoglobulina G/imunologia , Imuno-Histoquímica , Masculino , Medição de Risco , Índice de Gravidade de Doença , Fosfato de Sitagliptina/uso terapêutico , Suspensão de TratamentoAssuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Penfigoide Bolhoso/induzido quimicamente , Pirimidinas/efeitos adversos , Vildagliptina/administração & dosagem , Administração Cutânea , Idoso de 80 Anos ou mais , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Glicemia/análise , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/sangue , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Substituição de Medicamentos/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/tratamento farmacológico , Pirimidinas/administração & dosagem , Resultado do TratamentoRESUMO
Minor damage to the scalp may lead to intracranial infection. Moreover, the postoperative state of the scalp, skull and meninges is especially noteworthy with respect to invasion of pathogens into the skull. Therefore, a detailed medical history should be obtained from patients with even minor scalp injuries to avoid intracranial infection. We herein report a case of intracranial infection caused by a minor scalp injury associated with previous craniotomy, which was missed at first.
Assuntos
Abscesso Encefálico/etiologia , Craniotomia , Fístula Cutânea/etiologia , Infecções por Pseudomonas/complicações , Couro Cabeludo , Infecções Estreptocócicas/complicações , Infecção dos Ferimentos/complicações , Idoso , Abscesso Encefálico/diagnóstico por imagem , Contusões/complicações , Traumatismos Craniocerebrais/complicações , Testa , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Deficiency of multiple vitamins can be identified in alcoholic and malnourished patients. We report a patient with Wernicke encephalopathy, a B1 deficiency and pellagra, a niacin deficiency. A 61-year-old Japanese man presented with generalised weakness. He had drunk alcohol heavily for more than a year without eating adequate meals. Physical examination showed disorientation, eye movement impairment, muscle wasting and a rash over the limbs. Multivitamin supplementations improved all the symptoms. Pellagra causes dementia, diarrhoea, or dermatitis, and can mimic non-specific erythaema in alcoholics. The differential diagnosis between pellagra and non-specific erythaema is important because of the treatability of pellagra by niacin supplementation.
Assuntos
Alcoolismo/complicações , Pelagra/diagnóstico , Encefalopatia de Wernicke/diagnóstico , Confusão/etiologia , Demência/etiologia , Dermatite/etiologia , Diarreia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Niacina/administração & dosagem , Pelagra/complicações , Tiamina/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Encefalopatia de Wernicke/complicaçõesRESUMO
Bronchiolitis is a rare condition mainly affecting the intralobular conducting and transitional small airways. The present study describes a case of severe airflow limitation in a patient with ulcerative colitis who developed toxic epidermal necrolysis following mesalazine therapy. Forced expiratory volume in one second was decreased and a flow-volume curve showed airflow limitation, but the single-breath diffusing capacity of the lung for carbon monoxide (DLCO) and DLCO divided by alveolar volume (DLCO/VA) were not decreased. This rare clinical condition should be considered as a differential diagnosis for subjects presenting with sub-acutely developed airflow obstruction if the findings in chest computed tomography scans demonstrate hyperinflation but few low-attenuation areas. Relatively well-preserved DLCO and DLCO/VA provide a clue to establishing the correct diagnosis.
RESUMO
Graft-versus-host disease (GVHD) is a frequent complication of bone marrow transplantation (BMT) that can be classified as acute or chronic. Characteristic cutaneous manifestations of acute GVHD, which generally occurs within 3 months following BMT, include maculopapular exanthema and perifollicular papular lesions. Psoriasiform skin eruption as a manifestation of acute GVHD is rare. We report the case of a 4-year-old boy who developed a generalized psoriasiform eruption shortly after undergoing an allogeneic BMT. Histologic features of both psoriasis and acute GVHD were present.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/fisiopatologia , Psoríase/etiologia , Dermatopatias/etiologia , Pré-Escolar , Humanos , Masculino , Psoríase/patologia , Dermatopatias/patologia , Fatores de Tempo , Transplante HomólogoRESUMO
Proliferation and differentiation in the epidermis must be tightly regulated. This regulation is known to involve a range of transcription factors, including pituitary tumor transforming gene 1 (PTTG1), a ubiquitously distributed transcription factor that regulates keratinocyte proliferation and differentiation. Psoriasis is a common but refractory skin disorder, the pathophysiology of which is characterized by hyperproliferation and impaired differentiation in the epidermis. The present study was conducted to clarify the less well-known roles of PTTG1 in the pathophysiology of psoriasis, focusing on its relationship with tumor necrosis factor-α (TNF-α), which is a critical mediator of the disease. The levels of PTTG1 expression were increased in the psoriatic epidermis. Overexpression of PTTG1 resulted in the overproduction of TNF-α, and TNF-α itself had an inductive effect on PTTG1 expression, suggesting that their expression may involve autoinduction. Moreover, overexpression of PTTG1 involved augmented the expression of cyclin A and B1 proteins in both cultured keratinocytes and the psoriatic epidermis. Therefore, enhanced expression of PTTG1 in the psoriatic epidermis may result in aberrant regulation of the cell cycle and impaired differentiation via the interplay between PTTG1 and TNF-α.