RESUMO
BACKGROUND: Levamisole is present as a contaminant or additive in most cocaine sold in the United States. Cases of agranulocytosis attributed to levamisole-tainted cocaine have been widely described. A vasculopathic reaction to levamisole has also been reported; however, diagnostic features such as antineutrophil cytoplasmic antibody (ANCA) and additional autoimmune marker positivity are not well recognized. As such, many patients are given a misdiagnosis, prompting aggressive and often unnecessary treatment. OBJECTIVE: We hope to educate practitioners about the clinical and laboratory features of levamisole-induced vasculopathy to ensure accurate diagnosis and management. METHODS: This was a case series. RESULTS: Six patients were admitted with purpuric lesions and vasculitic changes on biopsy specimen; 5 of them were given the diagnosis of and treated for autoimmune conditions before their true diagnosis was revealed. All patients had ANCA positivity, and 4 had additional abnormalities in autoimmune markers. All patients reported recent cocaine abuse, and were ultimately given the diagnosis of levamisole-induced vasculopathy. LIMITATIONS: This observational study is limited by sample size. CONCLUSIONS: Patients presenting with purpuric lesions with ANCA positivity should be assessed for cocaine exposure. It is important to recognize that levamisole may not only induce ANCA positivity but also other autoimmune marker abnormalities. Patients can often be treated with less aggressive therapeutic strategies than what is used for primary ANCA-associated vasculitides.
Assuntos
Doenças Autoimunes/diagnóstico , Transtornos Relacionados ao Uso de Cocaína , Levamisol/toxicidade , Doenças Vasculares/induzido quimicamente , Doenças Vasculares/diagnóstico , Adulto , Idoso , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To describe our patient selection, design, execution, and results with the spiral flap for distal nasal surgical defects after Mohs micrographic surgery. MATERIALS AND METHODS: We performed a retrospective analysis of all spiral flaps performed over a 5-year period. Sixty-three patients were identified, and charts and photographs were examined. Surgical defects were classified according to alar location. All follow-up encounters were reviewed to assess for complications and need for revisionary procedures. Intraoperative photographs were taken of representative cases to describe the surgical technique. RESULTS: Sixty-three patients on whom the spiral flap was performed were identified over a 5-year period. The flap was used to successfully reconstruct alar defects ranging in size from 5 to 15 mm in diameter. No persistent complications were noted. CONCLUSION: The spiral flap is a reproducible, one-stage flap for small to medium-sized defects of the nasal ala and alar groove that consistently produces topographic restoration with minimal risk of aesthetic or functional complication.
Assuntos
Cirurgia de Mohs , Neoplasias Nasais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Sporotrichosis is a subcutaneous mycosis that is caused by Sporothrix schenckii. Whereas the most common clinical presentation is the lymphocutaneous form, the fixed cutaneous form is not uncommon. Important clues from the clinical history, such as travel and occupation, can help to raise the suspicion of this infection in the differential diagnosis. However, histopathologic and tissue culture, which often require multiple specimens, are necessary to confirm the diagnosis. We present a patient with fixed cutaneous sporotrichosis whose delayed diagnosis led to appreciable scars and morbidity.
Assuntos
Esporotricose/patologia , Humanos , Masculino , Adulto JovemRESUMO
Lepromatous leprosy is a form of chronic granulomatous disease that is caused by infection with Mycobacterium leprae. Early involvement is marked by widespread, ill-defined, erythematous papules and plaques. With early intervention, leprosy is a curable disease; however, if not recognized and treated promptly, permanent sequelae and disability result. We present a patient with long-standing lepromatous leprosy who exhibits many of these sequelae.
Assuntos
Hanseníase Virchowiana/patologia , Contratura/etiologia , Progressão da Doença , Sobrancelhas/patologia , Úlcera do Pé/etiologia , Deformidades Adquiridas da Mão/etiologia , Hepatite B Crônica/complicações , Humanos , Hipestesia/etiologia , Hanseníase Virchowiana/complicações , Masculino , Pessoa de Meia-Idade , Mianmar/etnologia , Deformidades Adquiridas Nasais/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Tuberculose/complicaçõesRESUMO
Eccrine poromas are benign, adnexal tumors that most often occur as a solitary lesion on the palm or sole. The occurrence of multiple eccrine poromas is extremely rare. In this report, we describe the development of several eccrine poromas in an acral distribution in a 42-year-old man. Before the appearance of these tumors, the patient had received total body irradiation and allogeneic bone marrow transplantation for treatment of acute lymphocytic leukemia. As a complication of the bone marrow transplant, the patient developed chronic graft-versus-host disease, which was treated with immunosuppressive therapy. We discuss this patient and review the available literature regarding multiple eccrine poromas.
Assuntos
Acrospiroma/etiologia , Doença Enxerto-Hospedeiro/tratamento farmacológico , Imunossupressores/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Neoplasias das Glândulas Sudoríparas/etiologia , Irradiação Corporal Total/efeitos adversos , Acrospiroma/imunologia , Acrospiroma/patologia , Adulto , Transplante de Medula Óssea/efeitos adversos , Doença Crônica , Terapia Combinada , Humanos , Masculino , Neoplasias Induzidas por Radiação/imunologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias das Glândulas Sudoríparas/imunologia , Neoplasias das Glândulas Sudoríparas/patologiaRESUMO
BACKGROUND: Despite efforts to promote sun protection behaviors, melanoma incidence continues to increase. The prognosis of advanced melanoma remains extremely poor in spite of treatment advances, emphasizing the importance of exploring additional preventive measures. OBJECTIVE: We sought to summarize the results of published research on candidate chemoprevention agents for melanoma. METHODS: We conducted a narrative review of the literature. RESULTS: Investigation into a possible role in melanoma chemoprevention continues for multiple agents, including sunscreen, lipid-lowering medications, nonsteroidal anti-inflammatory drugs, dietary nutrients, immunomodulators, and other drugs, including retinoids, difluoromethylornithine, and T4 endonuclease V. LIMITATIONS: Systematic review of the literature was not performed. CONCLUSION: Because no agent yet emerges as a clear choice for effective melanoma chemoprevention, sun avoidance and sun protection remain the mainstay of melanoma prevention for persons at high risk.
Assuntos
Quimioprevenção , Melanoma/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Hipolipemiantes/uso terapêutico , Fatores Imunológicos/uso terapêutico , Terapia Nutricional , Protetores Solares/uso terapêutico , Vacinas/uso terapêuticoRESUMO
A 14-month-old girl and a 7-month-old boy each presented with a diffuse dermatitis, whole body edema, and hypoalbuminemia. The diets of both infants consisted almost entirely of Rice Dream, a rice-based, protein-poor beverage. Both infants were diagnosed with kwashiorkor, which resolved with protein supplementation. Clues from the physical examination, a diet history, appropriate laboratory examinations, and an index of suspicion are crucial in promptly diagnosing and treating infants with kwashiorkor. Manufacturers of rice beverages should appropriately warn parents about the dangers of using their products as infant nourishment.