RESUMO
Tumor necrosis factor alpha (TNFα) inhibitors are now widely used to treat immune-mediated inflammatory diseases. Although they have a good safety profile, they are also associated with adverse cutaneous events. Pigmented purpuric dermatoses (PPD) include a variety of skin diseases characterized by multiple petechial hemorrhages due to capillaritis. Five major clinical types of PPD have been described and purpura annularis telangiectodes of Majocchi (PATM) is a rare subtype of PPD. The cause of PPD is unknown, but drugs are implicated in a minority of cases. There are very few cases in the literature triggered by TNFα inhibitors. We present a case of PATM induced by certolizumab pegol and perform a review including 4 articles in the literature reporting 5 PPD cases induced by TNFα inhibitors. When purpuric eruptions develop in patients treated with TNFα inhibitors, PPD and vasculitis should be differentiated. Thus, patients are not exposed to unnecessary evaluations and treatments.
Assuntos
Transtornos da Pigmentação , Púrpura , Humanos , Certolizumab Pegol/efeitos adversos , Fator de Necrose Tumoral alfa , Pele/patologia , Púrpura/induzido quimicamente , Púrpura/diagnóstico , Púrpura/complicaçõesRESUMO
BACKGROUND Cutaneous adverse drug reactions are the skin's response to a systemic exposure to drugs. Linezolid is an oral oxazolidine used to treat methicillin-resistant Staphylococcus aureus infections. Even though it has well-known adverse effects, purpuric cutaneous adverse drug reactions to linezolid have been scarcely described. This report is of a Puerto Rican man in his 80s who developed an extensive purpuric drug eruption secondary to linezolid use. Clinicians should be aware of this phenomenon, since prompt identification and discontinuation of the agent are essential for recovery. CASE REPORT An 89-year-old Puerto Rican man was given oral linezolid therapy for healthcare-associated pneumonia and developed a widespread, purpuric cutaneous eruption 5 days into therapy. His condition prompted immediate discontinuation of the drug. Forty-eight hours after stopping the medication, he visited the Emergency Department. Abdominal punch biopsy revealed a superficial and perivascular lymphocytic infiltrate with dermal eosinophils, a pathologic finding consistent with a purpuric drug eruption. This allowed for a timely diagnosis, exclusion of other mimickers, such as cutaneous vasculitis, and effective management. CONCLUSIONS Cutaneous adverse drug reactions to linezolid have been scarcely reported in the literature. Due to the low incidence of this manifestation, the identification of the causative agent and accompanying treatment may be delayed. Mainstays in therapy are avoidance of the offending agent and treatment with corticosteroids, antihistamines, barrier ointments, and oral analgesics. Primary healthcare providers should be aware of linezolid-induced cutaneous manifestations, diagnostic clues, and treatment options so they can rapidly identify and effectively treat such complications.
Assuntos
Toxidermias , Exantema , Staphylococcus aureus Resistente à Meticilina , Púrpura , Vasculite , Masculino , Humanos , Idoso de 80 Anos ou mais , Linezolida/efeitos adversos , Púrpura/induzido quimicamente , Púrpura/complicações , Púrpura/patologia , Toxidermias/diagnóstico , Toxidermias/etiologia , Toxidermias/patologia , Vasculite/complicaçõesRESUMO
BACKGROUND Immunoglobulin A (IgA) vasculitis is a systemic vasculitis that involves the small vessels. It is mainly characterized by skin symptoms such as purpura, arthritis/arthralgia, abdominal symptoms, and nephropathy, which are caused by IgA adherence to the vessel walls. Herein, we report the case of an advanced non-small cell lung cancer (NSCLC) and a purpuric skin rash of the legs that developed during fourth-line chemotherapy with tegafur/gimeracil/oteracil (S-1). CASE REPORT A 68-year-old man diagnosed with NSCLC 2 years ago was undergoing S-1 as fourth-line chemotherapy when he developed purpura and edema on the lower extremities. Biopsy renal specimens were consistent with IgA vasculitis. Considering his medical history, both IgA vasculitis induced by S-1 and a paraneoplastic syndrome were considered, although the exact cause could not be identified. Subsequently, chemotherapy was discontinued because of his deteriorating general condition, and he received optimal supportive care. The purpura spontaneously disappeared; however, his ascites and renal function deteriorated. Systemic steroids improved renal function, but the ascites did not resolve. One month after being diagnosed with IgA vasculitis, the patient died due to deterioration of his general condition. CONCLUSIONS This case emphasizes the occurrence of IgA vasculitis during lung cancer treatment and its potential impact on the disease course of lung cancer. Moreover, the possible causes of IgA vasculitis in this case were paraneoplastic syndrome or S-1 adverse effects, but further case series are needed to gain a more comprehensive understanding. Refractory, steroid-unresponsive ascites may occur as an abdominal manifestation of IgA vasculitis.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Vasculite por IgA , Neoplasias Pulmonares , Síndromes Paraneoplásicas , Púrpura , Masculino , Humanos , Idoso , Vasculite por IgA/induzido quimicamente , Vasculite por IgA/diagnóstico , Vasculite por IgA/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Ácido Oxônico/efeitos adversos , Tegafur/efeitos adversos , Ascite/complicações , Imunoglobulina A/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/complicações , Púrpura/complicações , Esteroides/uso terapêuticoRESUMO
Traumatic asphyxia, which is manifested by facial edema, cyanosis, subconjunctival hemorrhage, and petechiae on the upper chest and abdomen, is a very rare clinical syndrome in children. In adults, the incidence of traumatic asphyxia was reported as 1 case/18,500 accidents, but the actual incidence is not known for pediatric population. Traumatic asphyxia is a mechanical cause of hypoxia resulting from sudden compression of the thoracic-abdominal region and the valsalva maneuver is necessary for the development of this syn-drome. Here, we describe a case of traumatic asphyxia with an ecchymotic mask in a 14-year-old boy who was referred to our pediatric emergency department.
Assuntos
Púrpura , Traumatismos Torácicos , Masculino , Adulto , Humanos , Criança , Adolescente , Asfixia/etiologia , Púrpura/complicações , Acidentes , Abdome , Tórax , Traumatismos Torácicos/complicaçõesRESUMO
Eosinophilic granulomatosis with polyangiitis (EGPA) is a relatively rare necrotizing vasculitis that causes asthma, nasal involvement, peripheral nerve disturbance, renal disorder, and cutaneous lesions like purpura and is characterized by eosinophil infiltration into the damaged tissue. Purpura is the most common cutaneous lesion, but it remains unknown whether this skin lesion is associated with disease activity of EGPA and laboratory data including interleukin (IL)-5, a target cytokine of this disease. We conducted a search of our hospital electronic records for cases of EGPA from the last 10 years. Symptoms related to EGPA (fever, asthma, nasal and cutaneous manifestations, neuropathy), the Birmingham Vasculitis Activity Score (BVAS), and laboratory parameters, such as eosinophil count, urinalysis, antineutrophil cytoplasmic antibody (ANCA), CRP, IgE and IL-5, before and during treatment were compared among the eligible cases. A total of 28 EGPA patients (21 females and 7 males) were selected. Almost all developed peripheral neuropathy. Fever occurred in 25%, nasal symptoms in 38.1% and purpura in 44%. Glomerulonephritis developed in 7.7%. One patient had cardiac involvement (3.6%). The laboratory data showed a marked increase in peripheral eosinophil count, CRP, serum IgE and serum IL-5. ANCA was positive in 15.4%. In the univariate analysis, presence of purpura was associated with increased CRP and IL-5, and high BVAS score. Multivariate analysis revealed a robust relationship between purpura and CRP. Our findings showed that presence of purpura was associated with increased CRP and IL-5, and high disease activity in EGPA.
Assuntos
Granulomatose com Poliangiite/diagnóstico , Púrpura/etiologia , Adulto , Idoso , Anticorpos Anticitoplasma de Neutrófilos/sangue , Proteína C-Reativa/análise , Estudos Transversais , Eosinofilia/complicações , Feminino , Granulomatose com Poliangiite/fisiopatologia , Humanos , Interleucina-5/sangue , Masculino , Pessoa de Meia-Idade , Púrpura/complicações , Estudos RetrospectivosAssuntos
Acrodermatite/diagnóstico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Púrpura/diagnóstico , Acrodermatite/sangue , Acrodermatite/etiologia , Acrodermatite/patologia , Adolescente , Betacoronavirus/patogenicidade , Biópsia , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Humanos , Masculino , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Tempo de Protrombina , Púrpura/sangue , Púrpura/complicações , Púrpura/patologia , SARS-CoV-2 , Pele/patologiaAssuntos
Púrpura , Vasculite , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematúria , Humanos , Vasculite por IgA , Imunoglobulina A , Masculino , Pessoa de Meia-Idade , Púrpura/complicações , Púrpura/diagnóstico , Púrpura/fisiopatologia , Estudos Retrospectivos , Vasculite/complicações , Vasculite/diagnóstico , Vasculite/fisiopatologia , Adulto JovemAssuntos
Toxidermias/etiologia , Panitumumabe/efeitos adversos , Púrpura/induzido quimicamente , Infecções Cutâneas Estafilocócicas/etiologia , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Biópsia , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Toxidermias/complicações , Toxidermias/diagnóstico , Feminino , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Panitumumabe/administração & dosagem , Prednisolona/administração & dosagem , Púrpura/complicações , Púrpura/diagnóstico , Pele/efeitos dos fármacos , Pele/microbiologia , Pele/patologia , Infecções Cutâneas Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Vasculite Leucocitoclástica Cutânea/complicações , Vasculite Leucocitoclástica Cutânea/diagnósticoAssuntos
Dermatoses da Mão/diagnóstico por imagem , Hiperpigmentação/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Púrpura/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Biópsia , Dermoscopia , Diagnóstico Diferencial , Feminino , Dermatoses da Mão/patologia , Humanos , Hiperpigmentação/complicações , Hiperpigmentação/patologia , Pessoa de Meia-Idade , Púrpura/complicações , Púrpura/patologia , Pele/patologiaRESUMO
Resumen: Introducción: El púrpura de Schonlein-Henoch (PSH) O Vasculitis IgA es la vasculitis sistémica más frecuente de la edad pediátrica. Se manifiesta clínicamente como púrpura palpable, artralgias, dolor abdominal y compromiso renal. El púrpura palpable buloso a diferencia de lo que ocurre en la edad adulta, es muy infrecuente en la infancia. Objetivo: Reportar una forma infrecuente de presentación cutánea del PSH en niños. Caso clínico: Niña de 14 años con historia de 2 semanas con ampollas dolorosas múltiples y confluentes en ambas extremidades inferiores asociado a artralgias. A la histo-patología destacan vesículas intracórneas, epidermis con acantosis y espongiosis e infiltrado dérmico perivascular. Inmunofluorescencia directa (+) para IgA. Se plantea el diagnóstico de PSH ampollar y se realiza tratamiento inicial con corticoides intravenosos. A los tres días del traslape a corticoides orales aparecen nuevas lesiones equimóticas en ambas piernas. Se decide asociar azatriopina e iniciar descenso de corticoides, obteniéndose buena respuesta. Conclusión: Si bien la formación de bulas en el PSH no agrega morbilidad, suele ser un fenómeno alarmante que requiere realizar diagnóstico di ferencial con otras patologías. El uso de corticoides estaría indicado en estos casos ya que disminuiría la producción de las metaloproteinsas responsables de la formación de las bulas.
Abstract: Henoch-Schönlein purpura (HSP) or IgA Vasculitis is the most common childhood vasculitis. The classic tetrad of signs and symptoms include palpable purpura, arthralgia, abdominal pain and renal disease. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. Objec tive: To report an unusual cutaneous manifestation of HSP in children. Case report: A 14-year-old girl complained about a 2-week painful bullous rash in both lower extremities and multiple arthral gias. There was no history of abdominal pain or urinary symptoms. In both lower extremities, there were numerous palpable purpura and hemmorrhagic bullae. In light of clinical findings, laboratory tests and skin biopsy are requested. The histopathology described intraepidermal blisters, acanthosis, spongiosis and perivascular dermal infiltrate. Direct immunofluorescence (IFD) (+) for IgA. The diagnosis of bullous HSP was made and treatment with endovenous corticosteroids was initiated. Three days after overlapping to oral corticosteroids, new ecchymotic lesions appeared in both legs. Due to the persistence of cutaneous involvement and negative control tests, azathioprine was associa ted obtaining a good response. Conclusion: Although bullous lesions in HSP does not add morbidity, it is often an alarming phenomenon with multiple differential diagnoses. The anti-inflamatory effect of corticoids is likely to be beneficial in the treatment of patients with severe cutaneous involvement through inhibition of proinflammatory transcription factors and decreasing the production of the metalloproteinases.
Assuntos
Humanos , Feminino , Adolescente , Púrpura/diagnóstico , Vesícula/etiologia , Púrpura/complicaçõesRESUMO
Purpuric lesions appear in acral distribution in a variety of conditions and often provide clues to the clinical diagnosis. Purpuric means "hemorrhagic"-that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution from the large groups of the vasculitic diseases and their mimics. Cutaneous small vessel vasculitis is confined to the skin, involves mainly postcapillary venules, and has the hallmark manifestation of palpable purpura. Henoch-Schönlein purpura is an immune complex-mediated systemic vasculitis of the small vessels with manifestations from the skin, joints, kidneys, and gastrointestinal system. Only cases where the immune complexes contain immunoglobulin A type are classified as Henoch-Schönlein purpura. Cryoglobulinemic vasculitis is induced by the deposition of cold-precipitated immune complexes in the small vessels. Urticarial vasculitis comprises a spectrum of conditions with the characteristic course of chronic urticaria, with wheals that persist longer than 24 hours, leave hyperpigmentation, and have leukocytoclastic vasculitis on histologic examination. Polyarteritis nodosa is a rare multisystem, segmental necrotizing vasculitis of mainly the medium-sized vessels. Pigmented purpuric dermatoses are chronic benign dermatoses characterized by petechiae, purpura, and increased skin pigmentation. The hallmark of pigmented purpuric dermatoses is their orange-brown, speckled, cayenne pepper-like discoloration.
Assuntos
Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Dermatoses da Perna/etiologia , Púrpura/complicações , Dermatopatias Vasculares/complicações , Vasculite/complicações , Braço , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/patologia , Embolia/complicações , Granulomatose com Poliangiite/complicações , Humanos , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/terapia , Transtornos da Pigmentação/complicações , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/patologia , Poliarterite Nodosa/complicações , Poliarterite Nodosa/patologia , Púrpura/diagnóstico , Púrpura/patologia , Púrpura Fulminante/complicações , Vasculite/diagnóstico , Vasculite/tratamento farmacológico , Vasculite/patologiaRESUMO
A 68-year-old woman presented with an asymptomatic eruption predominantly on the proximal pretibial region of the right lower extremity, which had been present for many months. Her medical history was remarkable for diabetes and hypothyroidism. Physical examination demonstrated "cayenne pepper"-like brown macules, scattered petechiae, and multiple minute, blanching telangiectasias (Figure 1) that were more evident on dermatoscopy (Figure 2). The clinical differential diagnosis included a benign pigmented purpura (BBP; Schamberg type), telangiectasia macularis eruptiva perstans, cutaneous T-cell lymphoma, essential telangiectasia, and cutaneous collagenous vasculopathy (CCV). Results from complete blood cell count, hepatic profile, and serum tryptase were normal. Findings from skin biopsy demonstrated ectatic papillary dermal vessels with hyalinized walls (accentuated by a periodic acid-Schiff stain), a sparse superficial perivascular mononuclear infiltrate, extravasated erythrocytes, and focal siderophages (Figure 3). The diagnosis of CCV with an associated BPP was confirmed.
Assuntos
Púrpura/diagnóstico , Dermatopatias Vasculares/diagnóstico , Idoso , Feminino , Humanos , Púrpura/complicações , Dermatopatias Vasculares/complicações , Telangiectasia/diagnósticoRESUMO
Granulomatous pigmented purpuric dermatosis (PPD) is a rare subtype of pigmented purpuric dermatosis that is typically seen in women of Far East Asian descent on the distal lower extremities and feet. Granulomatous PPD is a benign condition that does not typically require treatment. Hyperlipidemia has been seen in over half of the eighteen cases reported in the literature. We report an unusual presentation of granulomatous PPD seen in a 71 year-old Caucasian female with hyperlipidemia.
Assuntos
Hiperlipidemias/complicações , Hipertensão/complicações , Transtornos da Pigmentação/complicações , Púrpura/complicações , Idoso , Feminino , Humanos , Transtornos da Pigmentação/patologia , Púrpura/patologiaRESUMO
Eczematid-like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses (PPDs) with eczematous changes in the purpuric surface. A 10-year-old male and a 44-year-old male patients were admitted to our clinics for itching and flaking of the skin rashes. Based on the clinical and histopathological evaluations, the rashes were identified as eczematid-like PPDs of Doucas and Kapetanakis. Both patients were treated with narrow band ultraviolet B. The lesions were remarkably regressed following the treatment. These cases reported due its rarity and good response to narrow band ultraviolet B.
Assuntos
Eczema/radioterapia , Transtornos da Pigmentação/radioterapia , Púrpura/radioterapia , Terapia Ultravioleta , Adulto , Criança , Eczema/complicações , Humanos , Masculino , Transtornos da Pigmentação/complicações , Prurido/etiologia , Púrpura/complicaçõesRESUMO
A 67-year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura. Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Laboratory data showed leukocytosis, hypereosinophilia (10,450/µL), troponin T(+), elevated BNP, and markedly elevated eosinophil cationic protein (ECP) (> 150 ng/mL). Echocardiography revealed diffuse left ventricular hypokinesis (ejection fraction 30%) with increased wall thickness. Coronary angiography was normal. Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infiltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected. Based on these findings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. She was administered prednisolone at a dose of 1 mg/kg, cyclophosphamide, and diuretics. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration. Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered.