RESUMEN
BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors are targeted therapies that frequently induce skin eruptions such as acneiform rash. Due to their increasing use in oncology as well as the expanding number of exposed patients, new adverse events may emerge. PATIENTS AND METHODS: A 54-year-old female patient treated with erlotinib for 8 months for pulmonary adenocarcinoma presented inflammatory alopecia that had been ongoing for 1 month. Her condition did not improve with doxycycline 100mg/day. Diffuse erythema of the scalp was associated with painful keratotic plaques and several oozing lesions. A skin biopsy showed signs of acute suppurative and destructive folliculitis. Histology and dermatoscopy were consistent with a diagnosis of folliculitis decalvans. Marked improvement was observed after discontinuation of erlotinib followed by introduction of amoxicillin+clavulanic acid and application of a topical corticosteroid. Unfortunately, the lesions recurred after reintroduction of the anti-EGFR, despite a dosage reduction, requiring up-titration of doxycycline to 200mg/day. DISCUSSION: Scarring alopecia with a folliculitis decalvans-like presentation secondary to anti-EGFR is a rare adverse event. The exact pathophysiology remains poorly understood. Treatment is difficult, and while systemic antibiotics are effective, they must be maintained for a long duration in order to avoid recurrence. Early recognition is important to limit the development of scarring alopecia due to the difficulties of stopping treatment in advanced-stage carcinoma.
Asunto(s)
Cicatriz , Foliculitis , Alopecia/inducido químicamente , Cicatriz/inducido químicamente , Clorhidrato de Erlotinib/efectos adversos , Eritema , Femenino , Foliculitis/inducido químicamente , Humanos , Persona de Mediana Edad , Recurrencia Local de NeoplasiaAsunto(s)
Queilitis/etiología , Dermatosis Facial/etiología , Linfoma de Células del Manto/diagnóstico , Macroglosia/etiología , Anciano , Antígenos CD/análisis , Linfocitos B/patología , Queilitis/patología , Diagnóstico Diferencial , Dermatosis Facial/patología , Humanos , Inmunofenotipificación , Enfermedad de Lyme/diagnóstico , Linfoma de Células del Manto/complicaciones , Macroglosia/patología , Masculino , Síndrome de Melkersson-Rosenthal/diagnóstico , Seudolinfoma/diagnóstico , Sarcoidosis/diagnóstico , Sífilis/diagnósticoAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Síndrome de Stevens-Johnson/etiología , Síndrome de Stevens-Johnson/patología , Adulto , Anticuerpos Monoclonales Humanizados/administración & dosificación , Antineoplásicos Inmunológicos/administración & dosificación , Resultado Fatal , Humanos , Masculino , Melanoma/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Síndrome de Stevens-Johnson/diagnósticoAsunto(s)
Carcinoma de Células Escamosas/cirugía , Dermatosis de la Pierna/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Neoplasias Cutáneas/cirugía , Trasplante de Piel , Administración Oral , Corticoesteroides/uso terapéutico , Anciano de 80 o más Años , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/patología , Biopsia , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/patología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/patología , Recurrencia , Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/patología , Neoplasias Cutáneas/patología , Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/patología , Zinc/deficienciaAsunto(s)
Enfermedad por Rasguño de Gato/diagnóstico , Ganglios Linfáticos/patología , Adulto , Animales , Anticuerpos Antibacterianos/sangre , Bartonella henselae/inmunología , Gatos , Terapia Combinada , Diagnóstico Diferencial , Femenino , Ingle , Humanos , Interferón-alfa/uso terapéutico , Ligamentos , Linfogranuloma Venéreo/diagnóstico , Melanoma/diagnóstico , Melanoma/tratamiento farmacológico , Melanoma/secundario , Melanoma/cirugía , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/cirugía , Muslo/lesiones , Infección de Heridas/diagnósticoAsunto(s)
Mastocitosis Cutánea/diagnóstico , Telangiectasia/diagnóstico , Biomarcadores , Diagnóstico Diferencial , Femenino , Hemangioma/diagnóstico , Humanos , Lactante , Mastocitos/química , Mastocitos/patología , Mastocitosis Cutánea/clasificación , Mastocitosis Cutánea/metabolismo , Mastocitosis Cutánea/patología , Proteínas Proto-Oncogénicas c-kit/análisis , Telangiectasia/metabolismo , Telangiectasia/patología , MusloRESUMEN
INTRODUCTION: Periarteritis nodosa (PAN) is a form of vasculitis affecting the small and medium-sized arteries. Below, we report a case of cutaneous PAN relapsing in streptococcal infections over a period of 30 years and progressing towards systemic vasculitis. CASE REPORT: A 35-year-old man was hospitalised for a retro-pharyngeal access associated with fever, arthralgia, myalgia and inflammatory subcutaneous nodules. Peripheral neurological signs were also seen with deficiency of the elevator muscles in the right foot. Examination of a biopsy from a nodule showed a characteristic image of PAN. Following drainage of the abscess, a favourable outcome was obtained with antibiotics and systemic corticosteroids. History taking showed that the patient had presented similar episodes since the age of 5 years involving arthralgia, myalgia and inflammatory subcutaneous nodules. These episodes appeared to follow a streptococcal infection, of which there was either clinical suspicion or objective elevation of antistreptolysin O (ASLO) titre. Skin biopsy resulted in diagnosis of cutaneous PAN 25 years earlier. In all cases, improvement was achieved by oral corticosteroids combined with treatment of the actual infection. DISCUSSION: In addition to the classic association with hepatitis B, and occasionally hepatitis C, PAN may be associated with streptococcal infections. The cases of post-streptococcal PAN described in the literature are predominantly cutaneous, although it is not rare to find associated arthromyalgia and sensory neurological impairment. We examined three cases of cutaneous PAN with long-term follow-up described in the literature. They began in childhood and the outcome was benign, with no systemic manifestations. Our case differed in terms of the appearance of motor neurological involvement. CONCLUSION: Post-streptococcal PAN of childhood onset generally carries a better prognosis than adult systemic forms. However, our case shows that on rare occasions, there may be very long progression complicated by systemic involvement.
Asunto(s)
Poliarteritis Nudosa/diagnóstico , Infecciones Estreptocócicas/complicaciones , Adulto , Progresión de la Enfermedad , Humanos , Masculino , Recurrencia , Absceso Retrofaríngeo/microbiologíaRESUMEN
BACKGROUND: Brachioradial pruritus is a rare form of pruritus localised to one or more brachioradial dermatomes, initially classified as a photodermatosis but which in fact is generally brought on by nervous compression. We report a case of a brachioradial pruritus revealing an intramedullary tumour. PATIENTS AND METHODS: A 53-year-old man had presented pruritus for seven years under the left clavicle, then on the left forearm followed by the right forearm. Finally cervicodynia appeared associated with dysaesthesia of the two upper limbs, fulgurating pains and paresis of the left cubital region. The examination revealed suspended bilateral hypoaesthesia (C4, C5, C6, C7), proprioceptive disorders of the left upper limb, mild motor deficit in the left C8 area and tetrapyramidal syndrome. Cervical radiography did not show cervical osteoarthritis. The MRI revealed a bulky cervical intramedullary tumour extending from C2 to C6. After ruling out cavernoma by medullary angiography, surgery was performed and histopathological analysis of the complete lesion revealed a benign ependymoma. Four months later, this patient complained about residual pains requiring treatment with gabapentin and class 2 analgesics. DISCUSSION: The case presented underlines the possibility of a brachioradial pruritus revealing an intramedullary tumour. Ependymomas are usually seen in children and are frequently evoked in the presence of dysaesthesia. We report the third case of brachioradial pruritus revealing a medullary tumour. The two other cases involved syringomyelia revealed by pruritus in C5 and ependymoma revealed by pruritus in C5-C6. The patient with ependymoma had refused surgical treatment. CONCLUSION: Atypical brachioradial pruritus complicated by neuropathic pains and disorders should prompt screening for a medullary tumour.
Asunto(s)
Ependimoma/diagnóstico por imagen , Ependimoma/cirugía , Prurito/etiología , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Ependimoma/patología , Resultado Fatal , Antebrazo/patología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Neoplasias de la Columna Vertebral/patologíaRESUMEN
Fat embolism syndrome (FES) is a rare but serious complication occurring after long bone fractures. Presence of fat droplets in cells obtained by bronchoalveolar lavage has been proposed as a specific tool for FES diagnosis in trauma patients. We evaluated this technique over a 15-month period in 85 patients. Twenty-eight patients were excluded. The remaining 57 patients were divided into three groups: group 1, 26 patients without trauma as control; group 2, 22 patients with trauma but without evidence of FES; and group 3, nine patients with trauma and evidence of FES. Six of 26 patients in group 1 and nine of 22 patients in group 2 exhibited fat droplets in alveolar macrophages, whereas three of nine patients of group 3 had not. This study suggests that (1) presence of fat droplets in alveolar macrophages is not a reliable method for diagnosis of FES after long bone trauma, and (2) many conditions are associated with fat droplets in alveolar macrophages.
Asunto(s)
Líquido del Lavado Bronquioalveolar/patología , Embolia Grasa/diagnóstico , Heridas y Lesiones/complicaciones , Adulto , Recuento de Células , Embolia Grasa/etiología , Femenino , Fracturas Óseas/complicaciones , Humanos , Lípidos/análisis , Macrófagos/ultraestructura , Masculino , Persona de Mediana Edad , Neumonía/etiología , Estudios Prospectivos , Factores de Riesgo , Vacuolas/ultraestructuraRESUMEN
Brain synaptosomal membranes were prepared from rats sacrificed 18 hr after a single intragastric dose of water or of ethanol (100 mmol/kg), when blood ethanol had fallen almost to zero. Fluorescence polarization of DPH, and (Na+ + K+)ATPase activity, were studied in these membranes in the presence of 0, 0.175, 0.3 or 0.7 M ethanol in vitro. After in vivo ethanol, basal ATPase activity was slightly increased, membrane fluidity was unchanged, but both measures showed increased sensitivity to the effects of ethanol in vitro. Similar results were found after an equivalent in vivo dose of isopropanol, but not of t-butanol. These findings indicate that the sensitization to in vitro effects of ethanol or isopropanol, after in vivo treatment with these alcohols, is probably not dependent principally on their lipid solubilities.