RESUMO
Generalized verrucosis has been described in the past as synonymous with epidermodysplasia verruciformis. It has been shown, however, that epidermodysplasia verruciformis and other genetic or immunodeficiency diseases are just a subset of diffuse infections with human papillomavirus termed "generalized verrucosis." This article defines generalized verrucosis and distinct diseases associated with generalized warts. The indications for histopathologic testing, human papillomavirus typing, and other laboratory analyses and potential treatment options are discussed.
Assuntos
Infecções por Papillomavirus/complicações , Verrugas/complicações , Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/terapia , Imunodeficiência de Variável Comum/virologia , Infecções por HIV/complicações , Humanos , Síndrome de Imunodeficiência com Hiper-IgM/complicações , Síndrome de Imunodeficiência com Hiper-IgM/terapia , Síndrome de Imunodeficiência com Hiper-IgM/virologia , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/terapia , Terapia de Imunossupressão/efeitos adversos , Papillomaviridae/genética , Infecções por Papillomavirus/terapia , Infecções por Papillomavirus/virologia , Doenças da Imunodeficiência Primária , Imunodeficiência Combinada Severa/complicações , Imunodeficiência Combinada Severa/terapia , Imunodeficiência Combinada Severa/virologia , T-Linfocitopenia Idiopática CD4-Positiva/complicações , T-Linfocitopenia Idiopática CD4-Positiva/terapia , Verrugas/terapia , Verrugas/virologiaRESUMO
Tumor necrosis factor-a (TNF-a) inhibitors, such as adalimumab, are often used to treat psoriasis and psoriatic arthritis. While it is well known that these agents increase the risk of reactivation tuberculosis, recent evidence suggests that the risk of other nontuberculous mycobacterial (NTM) infections is on the rise. We report cutaneous Mycobacterium fortuitum in a 60-year-old woman with psoriasis who had been receiving adalimumab therapy for psoriatic arthritis for six months. No other risk factors were identified. M. fortuitum was cultured from a lesion on the right leg. Following resolution of the lesion, the patient has been successfully treated with infliximab infusions and subsequently certalizumab without complication for the past three years. To our knowledge, this is the first report of M. fortuitum occurring in a patient receiving adalimumab with successful subsequent treatment without complication while on another TNF-a inhibitor.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium fortuitum/efeitos dos fármacos , Polietilenoglicóis/uso terapêutico , Psoríase/tratamento farmacológico , Receptores do Fator de Necrose Tumoral/antagonistas & inibidores , Adalimumab , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Certolizumab Pegol , Feminino , Humanos , Fragmentos Fab das Imunoglobulinas/efeitos adversos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Polietilenoglicóis/efeitos adversos , Psoríase/patologia , Resultado do TratamentoRESUMO
A 52-year-old male with a history of renal transplantation and chronic iatrogenic immunosuppression presented with a several-week history of hyperpigmented cutaneous nodules on bilateral upper and lower extremities. Biopsy showed inflammatory granulomatous dermatitis caused by acid-fast bacilli (AFB). However, tissue cultures for mycobacterium were repeatedly negative. The patient was diagnosed with Mycobacterium haemophilum based on PCR results and was placed on empiric antibiotic therapy.
Assuntos
Transplante de Rim/efeitos adversos , Mycobacterium haemophilum/isolamento & purificação , Tuberculose Cutânea/diagnóstico , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium haemophilum/efeitos dos fármacos , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/patologiaRESUMO
Tumor necrosis factor alpha (TNF-alpha) inhibitors, such as infliximab, decrease the body's inflammatory response and thus the body's reaction to infection. Given the immune-mediated processes in psoriasis and psoriatic arthritis, patients with these disorders may benefit from infliximab therapy but may also suffer from an increased risk of infection. We present the first case of osteomyelitis in a patient receiving infliximab therapy for severe psoriasis and psoriatic arthritis. Infliximab and its serious adverse effects are discussed, and other cases of osteomyelitis with infliximab use are also reviewed.