Assuntos
Dermatite Atópica/complicações , Erupção Variceliforme de Kaposi/patologia , Pele/patologia , Adulto , Dermatite Atópica/patologia , Diagnóstico Diferencial , Exantema/etiologia , Evolução Fatal , Feminino , Febre/etiologia , Humanos , Erupção Variceliforme de Kaposi/complicações , Erupção Variceliforme de Kaposi/diagnósticoAssuntos
Doença Celíaca/patologia , Dapsona/efeitos adversos , Dermatite Herpetiforme/etiologia , Diabetes Mellitus Tipo 1/complicações , Duodeno/patologia , Metemoglobinemia/diagnóstico , Oxigênio/sangue , Pele/patologia , Doença Celíaca/complicações , Tosse/etiologia , Dapsona/uso terapêutico , Dermatite Herpetiforme/tratamento farmacológico , Dermatite Herpetiforme/patologia , Diagnóstico Diferencial , Hemoglobinas Glicadas/análise , Hemólise , Humanos , Masculino , Metemoglobinemia/sangue , Metemoglobinemia/induzido quimicamente , Pessoa de Meia-Idade , OximetriaRESUMO
Cutaneous manifestations of tuberculosis are uncommon, can be nonspecific, and may demonstrate a wide variety of morphologies, including ulcerative papules, verrucous plaques, or nodules. We report the case of a 36-year-old Moroccan man who presented with nearly 2 years of generalized folliculocentric pustules and nodules, night sweats, and weight loss. Workup revealed necrotic right axillary lymphadenopathy, multiple ill-defined hepatic lesions, and a positive interferon-γ release assay. These findings were most consistent with papulonecrotic tuberculosis.
RESUMO
Mucormycosis is a rare and aggressive fungal infection, most often caused by species of the Mucor, Rhizomucor, Rhizopus, Absidia, and Cunninghamella genera. The condition most commonly affects patients with uncontrolled diabetes, HIV/AIDS, malignancy, and those receiving long-term immunosuppressive therapy. We report the case of a 39-year-old male with biopsy-proven cutaneous mucormycosis of the left axilla 4 months after an orthotopic heart transplant for congenital tricuspid atresia.
RESUMO
Patients who present with papular rashes have a wide differential diagnosis particularly in the setting of immune compromise. A 30-year-old male diagnosed with HIV since 2009, never on antiretroviral therapy, with a nadir CD4 count of 333 cells/mm3 and a current viral load of 44,300 copies/mL, presented with a diffuse monomorphic papular eruption that began on his trunk and extremities and subsequently spread to the penis and scrotum, sparing the distal acral sites. A thorough infectious workup revealed a positive rapid plasma reagin (RPR) and varicella IgM and IgG antibodies. Interestingly, the patient had been diagnosed and treated for syphilis in the past with a recent downtrending RPR drawn prior to hospitalization. Repeat RPR was elevated and a preliminary histopathology report demonstrated folliculocentric inflammation with lymphocytes, plasma cells, and polymorphonuclear leukocyte predominance supported the diagnosis of syphilis. After receiving intramuscular penicillin G benzathine, he developed intermittent fevers and new papules. Intravenous (IV) acyclovir was initiated for presumed disseminated varicella given his positive varicella-zoster virus IgM and IgG. However, final pathology results revealed a large spirochete burden. The fevers and rash progression were attributed to the development of a Jarisch-Herxheimer reaction. IV acyclovir was discontinued and he completed a course of intramuscular penicillin G benzathine. He was also given a course of doxycycline for rectal chlamydia which was diagnosed during hospitalization.
Assuntos
Antineoplásicos/efeitos adversos , Dermatomicoses/patologia , Fusarium/isolamento & purificação , Leucemia Mieloide Aguda/tratamento farmacológico , Pneumopatias Fúngicas/patologia , Infecções Oportunistas/patologia , Pele/patologia , Antifúngicos/efeitos adversos , Antifúngicos/uso terapêutico , Antineoplásicos/uso terapêutico , Biópsia , Exame de Medula Óssea , Transplante de Medula Óssea , Dermatomicoses/etiologia , Diagnóstico Diferencial , Antagonismo de Drogas , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias Fúngicas/etiologia , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/tratamento farmacológico , RadiografiaAssuntos
Rim/patologia , Lúpus Eritematoso Sistêmico/patologia , Pele/patologia , Vasculite/diagnóstico , Anticorpos Antinucleares/sangue , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Exantema/etiologia , Evolução Fatal , Febre/etiologia , Vesícula Biliar/patologia , Humanos , Pulmão/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Nefrite Lúpica/patologia , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/etiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Radiografia , Vasculite/complicações , Redução de PesoAssuntos
Ascite/etiologia , Dura-Máter/patologia , Doenças do Sistema Nervoso/diagnóstico , Dermatopatias Papuloescamosas/patologia , Vasculite/diagnóstico , Dor Abdominal/etiologia , Encéfalo/patologia , Pré-Escolar , Diagnóstico Diferencial , Evolução Fatal , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Monócitos , Doenças do Sistema Nervoso/complicações , Papiledema/etiologia , Doenças Raras/diagnóstico , Dermatopatias Papuloescamosas/complicações , Derrame Subdural/diagnóstico , Derrame Subdural/etiologia , Derrame Subdural/terapia , Fator A de Crescimento do Endotélio Vascular/análise , Vasculite/complicaçõesAssuntos
Falência Renal Crônica/complicações , Dermatopatias/diagnóstico , Pele/patologia , Idoso , Biópsia , Diabetes Mellitus Tipo 2/complicações , Diagnóstico Diferencial , Síndrome de Eosinofilia-Mialgia/diagnóstico , Fibrose/etiologia , Fibrose/patologia , Humanos , Masculino , Dermatopatias/etiologiaRESUMO
BACKGROUND: Vancomycin-induced linear immunoglobulin A (IgA) disease, an autoimmune, blistering disease in response to vancomycin administration, is characterized by a subepidermal, vesiculobullous eruption and linear IgA deposition along the basement membrane zone on direct immunofluorescence. CASE REPORT: We report the case of an 81-year-old man treated with vancomycin who developed diffuse erythema multiforme and tense bullae involving the palmoplantar surfaces. Discontinuation of vancomycin therapy resulted in complete resolution of this patient's cutaneous eruption. RESULTS: Biopsy of a representative skin lesion demonstrated lichenoid interface dermatitis with focal subepidermal clefting, dyskeratosis, and prominent eosinophils. Direct immunofluorescence showed linear basement membrane staining with immunoreactants to IgA; indirect immunofluorescence demonstrated the presence of circulating IgG antibodies binding in an intercellular pattern. Immunoprecipitation studies using the patient's serum revealed 210, 130, and 83 kDa target antigens. CONCLUSIONS: Presenting with an initial clinical picture suggestive of bullous erythema multiforme, this patient's subsequent clinical course and direct immunofluorescence confirm the diagnosis of linear IgA bullous disease (LABD). His indirect immunofluorescence findings and immunoprecipitation results suggest that circulating non-IgA antibodies may represent a newly recognized immunopathologic feature of vancomycin-induced linear IgA disease, underscoring the variable and unpredictable manifestations of this drug-induced cutaneous disease.
Assuntos
Antibacterianos/efeitos adversos , Doenças Autoimunes/induzido quimicamente , Eritema Multiforme/induzido quimicamente , Imunoglobulina A , Dermatopatias Vesiculobolhosas/induzido quimicamente , Vancomicina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/patologia , Eritema Multiforme/patologia , Humanos , Masculino , Pele/patologia , Dermatopatias Vesiculobolhosas/patologiaRESUMO
BACKGROUND: Increased mortality, extensive visceral involvement, and necrotizing tracheobronchitis associated with herpes viruses have been reported after burns. It is unclear whether herpes presenting as a facial rash results in outcome changes after burns. METHODS: A retrospective study characterizing the incidence, presentation, and outcome of 14 patients with facial herpes rashes out of 95 severely burned intubated adults was performed. RESULTS: Facial rashes attributed to herpetic infections were found in at least 15% of patients. The problem was recognized during the second week after burn. There was no difference in mortality or length of stay noted between patients with or without the infection. CONCLUSION: The course of this infection was relatively benign in this group of acyclovir-treated patients. Even so, the lesions clearly contributed to patient discomfort and often produced fevers requiring costly investigations. Early recognition could help prevent diffuse spread of the lesions, decreasing patient discomfort and improving patient care.