RESUMO
Osseous sarcoidosis is a well-recognized manifestation of systemic sarcoidosis; however, its radiological natural history is poorly described. A 29-year-old man presented with pain, swelling, and erythema at the site of a recent minimal-trauma fracture of the right index finger proximal phalanx.
RESUMO
Immunoglobulin type gamma 4-related disease (IgG4-RD) is a fibroinflammatory condition that can have systemic and/or cutaneous manifestations. The most common cutaneous features are erythematous papules, nodules and/or plaques, typically involving the head and neck (J Am Acad Dermatol. 2016;75:197). We report a case of IgG4-RD presenting with eruptive cherry angiomas, a novel cutaneous presentation.
Assuntos
Exantema , Hemangioma , Doença Relacionada a Imunoglobulina G4 , Dermatopatias , Hemangioma/complicações , Humanos , Imunoglobulina G , PeleRESUMO
BACKGROUND: Left ventricular thrombus (LVT) has a 5% incidence after anterior ST-elevation myocardial infarction (STEMI). Multiple risk factors predispose to LVT formation, including left ventricular systolic dysfunction and infarct size, however measurable predictors during index left heart catheterization (LHC) have not been determined. METHODS: We performed a retrospective analysis of patients presenting between January 2010 and September 2017 with anterior STEMI who had in-hospital transthoracic echocardiography (TTE). LHC variables that were assessed included coronary anatomy, location of culprit stenosis, presence of diffuse stenosis, number of severely diseased vessels, apical akinesis on left ventriculogram (LVG), left ventricular end diastolic pressure, and success of percutaneous coronary intervention (PCI). RESULTS: Of 598 consecutive anterior STEMI patients, records and inpatient TTE results were available in 425 patients. The incidence of LVT was 6.8% (n = 29). After multivariate adjustment, severe triple vessel coronary disease (OR = 8.27, CI = 2.97-23.00, p ≤0.001), apical akinesis on LVG (OR = 6.74, CI = 1.48-30.73, p = 0.014), wrap-around left anterior descending (LAD) anatomy (OR = 5.10, CI = 1.97-13.23, p = 0.001), and failure of recanalization after PCI (OR = 3.94, CI = 1.06-14.66, p = 0.04) were predictors for LVT formation. The combined negative predictive value (NPV) for the absence of these four indices was 99.2%. CONCLUSION: Severe triple vessel disease, apical akinesis on LVG during index admission, wrap-around LAD, and failure of recanalization after PCI are associated with increased risk of LVT formation after anterior STEMI. The high NPV for the absence of these indices could serve as a risk stratification tool for LVT risk to guide early TTE utilization.
Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose , Cateterismo Cardíaco/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/terapia , Função Ventricular EsquerdaAssuntos
Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia , Exantema , Preparações Farmacêuticas , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Eosinofilia/induzido quimicamente , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Exantema/induzido quimicamente , Exantema/diagnóstico , Exantema/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/efeitos adversosAssuntos
Azetidinas/efeitos adversos , Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Inibidores de Janus Quinases/efeitos adversos , Molusco Contagioso/induzido quimicamente , Molusco Contagioso/tratamento farmacológico , Sulfonamidas/efeitos adversos , Administração Tópica , Adulto , Azetidinas/uso terapêutico , Dermatite Atópica/diagnóstico , Seguimentos , Humanos , Inibidores de Janus Quinases/uso terapêutico , Masculino , Molusco Contagioso/fisiopatologia , Purinas , Pirazóis , Medição de Risco , Sulfonamidas/uso terapêutico , Resultado do TratamentoRESUMO
We report a case of a 67-year-old man with type 2 diabetes presented with diabetic ketoacidosis, two weeks after his first dose of nivolumab therapy for non-small-cell lung carcinoma. He was started on empagliflozin two days prior in the setting of hyperglycaemia after the initiation of nivolumab therapy. Laboratory evaluation revealed an undetectable C-peptide and a positive anti-glutamic acid decarboxylase (GAD) antibody. He was treated with intravenous fluids and insulin infusion and was subsequently transitioned to subcutaneous insulin and discharged home. He subsequently has developed likely autoimmune thyroiditis and autoimmune encephalitis. LEARNING POINTS: Glycemic surveillance in patients receiving immune checkpoint inhibitors is recommended.Early glycemic surveillance after commencement of anti-programmed cell death-1 (PD-1) inhibitors may be indicated in selected populations, including patients with underlying type 2 diabetes mellitus and positive anti-glutamic acid decarboxylase (GAD) antibody.Sodium-glucose co transporter-2 (SGLT2) inhibitors should be used with caution in patients on immunotherapy.
Assuntos
Amidas/efeitos adversos , Cosméticos/efeitos adversos , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/etiologia , Formaldeído/efeitos adversos , Amidas/química , Austrália/epidemiologia , Cosméticos/química , Formaldeído/química , Humanos , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: Melasma is a common acquired disorder of hyperpigmentation that commonly affects those with skin of color. Tranexamic acid (TXA) is a novel treatment for melasma that has a multimodal mechanism of action. OBJECTIVE: To provide a comprehensive review of the literature regarding the evidence on the mode of action, safety profile, and efficacy of TXA in the treatment of melasma. MATERIALS AND METHODS: The literature was searched for publications on TXA in the treatment of melasma using MEDLINE, Scopus, and Google Scholar. RESULTS: Oral TXA has clearly demonstrated the efficacy for melasma in Asian skin, even in low doses (e.g., 500 mg daily) over short periods (8-12 weeks). It is also a safe therapeutic option, which is easy to administer with few and mild side effects. Studies have shown that TXA does not increase the thromboembolic risk, although patients should be screened carefully for contraindications and risk factors prior to commencement of the therapy. CONCLUSION: Oral TXA is a safe and efficacious treatment for refractory melasma. It should be considered in cases that are unresponsive to topical hydroquinone and combination topical therapy over a period of approximately 12 weeks and without contraindications to oral TXA.
Assuntos
Fármacos Dermatológicos/administração & dosagem , Melanose/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Administração Oral , Ácido Ascórbico/administração & dosagem , Medicina Baseada em Evidências , Humanos , Resultado do Tratamento , Complexo Vitamínico B/administração & dosagem , Vitamina E/administração & dosagemAssuntos
Dermatomiosite/complicações , Dermatomiosite/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Úlcera Cutânea/etiologia , Úlcera Cutânea/terapia , Adulto , Procedimentos Cirúrgicos Dermatológicos , Dermatomiosite/enzimologia , Feminino , Humanos , Retratamento , Enzimas Ativadoras de Ubiquitina/metabolismoRESUMO
Keratoacanthoma formation after skin grafting is rare. We report the third case in the literature of multiple keratoacanthomas developed at both split-thickness skin graft donor and recipient sites. We provide possible explanations for this poorly understood phenomenon and highlight its implications on treatment options.