Successful treatment of bullous lupus with corticosteroids and belimumab: A case report.

Cutaneous lupus erythematosus (CLE) is one of the most common manifestations of systemic lupus erythematosus (SLE), although it can manifest as an independent entity as well. Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous manifestation of SLE presenting as tense vesiculobullous eruptions in a photosensitive distribution. Pathophysiology is secondary to autoantibodies against noncollagenous domain 1 and 2 (NC1 and NC2) type VII collagen, and histopathology reveals dense neutrophilic infiltration of the dermis with direct immunofluorescence showing IgG deposition at dermoepidermal junction. There is lack of data on available therapeutic options to treat BSLE, and varying responses to dapsone, methotrexate, azathioprine and corticosteroids have been reported. Belimumab, a fully humanised Change to Immunoglobulin G1λ (IgG1λ) monoclonal antibody targeting soluble B lymphocyte stimulator protein, was the first Food and Drug Administration-approved drug for SLE and has been reported to be effective for CLE. We present the case of a 41-year-old black female with SLE presenting with BSLE, who was successfully treated with corticosteroids and belimumab and did not experience disease relapse even after discontinuation of corticosteroids. To our knowledge, this is the first reported case of successful treatment of BSLE with belimumab, and further research can help determine the role of belimumab in the treatment of BSLE.

Symmetrical drug-related intertriginous and flexural exanthema (Baboon syndrome) associated with Infliximab: a case-based review.

BACKGROUND: SDRIFE is a rare cutaneous eruption characterized by symmetrical intertriginous dermatitis, caused by delayed Type-IV immune reaction, with several reported drug-triggers. OBJECTIVE: We present a case of SDRIFE associated with infliximab in a 70-year-old female with rheumatoid arthritis, and review cases of SDRIFE associated with TNF-inhibitors. METHODS: A literature review about SDRIFE cases associated with TNF-inhibitors was performed. Articles published in English from inception to January 6th, 2022, restricted to humans, and directly related to this review were included. RESULTS: Ours is the third reported case of SDRIFE associated with TNF-inhibitors, and second with infliximab. SDRIFE can occur anytime during treatment with TNF-inhibitors, and presents with similar clinical and histopathological features as SDRIFE secondary to other drugs. No systemic manifestations have been reported, and the rash resolves after discontinuation of the TNF-inhibitor without any long-term sequelae. CONCLUSION: SDRIFE is benign, and an accurate diagnosis and discontinuation of the responsible drug remain the cornerstone of management.

A Case of Linear Cutaneous Lupus Erythematosus in a 55-Year-Old Woman.

BACKGROUND Linear cutaneous lupus erythematosus (LCLE) is uncommon and occurs mainly in children and young adults. To our knowledge, only ten cases of LCLE in adults have been previously reported. A case is presented of LCLE of the left arm in a 55-year-old woman. CASE REPORT A 55-year-old Caucasian woman from the Midwestern United States presented with a three-month history of a pruritic linear eruption on the left arm. She had a previous history of methicillin-resistant Staphylococcus aureus (MRSA) infection of the left forearm. She had previously been treated with topical triamcinolone, hydrocortisone cream, hydroxyzine, and two courses of prednisone. Physical examination showed a unilateral and linear erythematous skin lesion of the left arm that contained papules and followed the embryonal developmental epidermal lines of Blaschko. Histopathology of a 4 mm skin punch biopsy showed an interface dermatitis with keratinocyte necrosis and increased dermal mucin. Immunofluorescence of the skin biopsy, including for antinuclear antigen (ANA), was negative. Prednisone treatment reduced the symptoms of pruritis but did not resolve the rash. However, following topical treatment with betamethasone dipropionate cream for between two and three weeks, and the use of sunblock, the skin lesions resolved. CONCLUSIONS This rare case of LCLE in an older adult showed a similar response to treatment as other forms of cutaneous lupus erythematosus, with treatment that included topical steroids and sun protection. Also, this case supports that environmental trigger factors, such as prior infections, might provide insights into the etiology of LCLE.

Larval tick infestation: a case report and review of tick-borne disease.

Tick-borne disease in the United States continues to be a threat as people interact with their natural surroundings. We present a case of an 8-year-old boy with a larval tick infestation. Ticks within the United States can carry Lyme disease, Rocky Mountain spotted fever (RMSF), ehrlichiosis, babesiosis, tularemia, tick-borne relapsing fever, and tick paralysis. These preventable diseases are treatable when accurately recognized and diagnosed; however, if left untreated, they can cause substantial morbidity and mortality. This article highlights the knowledge necessary to recognize, treat, and prevent tickborne disease.

:wound healing outcomes: the impact of site of care and patient stratification.

UNLABELLED:  As healthcare providers prepare for pay for performance (P4P) and outcomes-based reimbursement strategies, it is increasingly important to document clinical results. Historically, healing rates have been reported from hospital-based, outpatient wound clinics. Time-to-healing curves from one site of care may not accurately reflect the entire healing "episode of care." Few outpatients from a wound clinic require hospitalization and even fewer are admitted to sub-acute care. Care setting and population risk strata must be clearly identified before comparing wound outcomes data. AIM: Primary objectives were to determine comparability of complete healing and 50% wound volume reduction of current and prior sub-acute care programs. Predictive value of Minimum Data Set (MDS 2.0) items on admission was also explored in discriminating healing versus nonhealing patients. METHODS: Wound outcomes were analyzed for all patients (N = 101) treated at a dedicated sub-acute wound unit from January 2006 through April 2007 in a prospective, longitudinal, intent-to-treat, cohort study. Results were compared to prior sub-acute care wound outcomes reported by a similarly composed team using similar protocols. RESULTS: Of 101 evaluable patients with 209 wounds, 41.6% healed in a median of 7.9 weeks while 31.6% achieved > 50% volume reduction. Outcomes were similar to prior sub-acute results, but less than the 72%-74% healing rate reported by a similar team in hospital outpatient clinic programs. Minimum Data Set comorbidities analyzed did not significantly predict nonhealing. CONCLUSION: To allow risk-adjusted P4P and reimbursement metrics, wound outcome reports should include clinical team involved, protocol utilization, care setting, and case mix severity to control for variables associated with different settings.