Enoxaparin-induced hemorrhagic bullous dermatosis in a leprosy patient.

Enoxaparin is a low-molecular-weight heparin that has been used widely to prevent and treat thromboembolic disorders for at least 30 years. The most common adverse skin reactions to enoxaparin are ecchymosis and skin necrosis due to vasculitis, urticaria, angioedema and erythema. Side effects from heparin administration are rare and usually located at the injection site. However, recent reports have suggested that they can also occur at a distance from the site of injection. Moreover, the etiopathogenesis has not been fully explained. In this article, we present a case of hemorrhagic bullous dermatosis associated with enoxaparin for the treatment of ischemic heart disease that developed in a patient with a past history of lepromatous leprosy.

Histopathological study of cutaneous manifestations in HIV and AIDS patients.

OBJECTIVES: Most human immunodeficiency virus (HIV)-infected patients develop various skin diseases. These skin manifestations not only act as markers but also reflect the patient's underlying immune status. Investigating CD4 counts is costly and not always possible. Thus, the potential value to be gained by using skin manifestations as predictors of low CD4 counts and disease progression should be explored. The present study attempted to correlate the association of various cutaneous disorders found in HIV patients with CD4 and CD8 counts, the CD4 : CD8 ratio and stage of HIV infection. METHODS: This was a prospective study involving 61 patients who were HIV-positive and demonstrated skin lesions. Punch biopsies of skin were taken for histopathological diagnosis. CD4 and CD8 T cell counts were performed. RESULTS: The study sample included a majority of male patients, most of whom were aged 21-40 years. Pruritic papular dermatitis was the most common skin manifestation, followed by molluscum contagiosum, eosinophilic folliculitis, and Hansen's disease. Most of the lesions were associated with CD4 counts of <220/µl (n = 38). All skin lesions associated with HIV or acquired immune deficiency syndrome (AIDS) showed a CD4 : CD8 ratio of <0.50. CONCLUSIONS: The study findings demonstrate an inverse relationship between CD4 counts and the occurrence of skin lesions. The majority of lesions were associated with stage 3 or stage 4 infection. Thus, specific cutaneous manifestations can be considered as good clinical indicators for predicting underlying immune status in resource-poor countries.

Annular vesiculobullous eruptions in type 2 reaction in borderline lepromatous leprosy: a case report.

An untreated case of BL presented with clinical features of type 2 reaction (T2R) confirmed by histopathology. The case was a 18-year-old female with borderline lepromatous leprosy who developed annular vesiculobullous eruptions oversome of the pre-existing plaques on arms and upper back along with fever and severe neuritis after a short course of ofloxacin intake prescribed for urinary tract infection. In addition to the above lesions, some of the existing lesions showed acute exacerbation characterized by erythema, oedema, tenderness and vesiculobullous eruption. This can be considered as an example of leprous exacerbation as described in older literature. T2Rs are common in lepromatous leprosy and not so uncommonly are observed in borderline lepromatous leprosy. The vesiculobullous and crusted lesions developing over the existing borderline plaques, some of them presenting in an annular pattern in T2R in the form of leprous exacerbation, have been reported rarely in the literature.

Manifestaciones cutáneas de la sarcoidosis / No disponible

Aunque las manifestaciones cutáneas de la sarcoidosis, las agudas, pueden presentar remisiones, las crónicas pueden ser persistentes, y ser motivo importante de consulta. En nuestra serie de 110 pacientes, 25 presentaron afección cutánea (22,52%), de estos 20 tenían lesiones dérmicas específicas (18,2%) y 5 (4,5%) lesiones inespecíficas. Las lesiones específicas que predominaron fueron las erupciones maculopapulares y las placas y todas presentaron relaciones con estadios radiográficos de esta entidad, fundamentalmente en el estadio I y II. La presencia de afectación clínica fue más representativa en forma de erupciones maculopapulares y en placas, al igual que la evolución crónica. El estudio histopatológico, que según el órgano afectado ayudará al diagnóstico, y la piel por su accesibilidad y su especificidad con la demostración de granulomas sarcoideos, orienta a su confirmación y evita otros exámenes más agresivos y más costosos

Although acute cutaneous manifestations of sarcoidosis may present recurrences, those chronic may persist and be important causes of patient remission to health clinics and dermatologists. In our serie of 110 patients, 25 presented cutaneous affection (22,52 %), 20 out of them had specific skin lesions (18,2%) and 5 (4,5%) non specific lesions. The specific lesions that prevailed were maculopapular eruptions and plates, and all had relationships with radiographic studies of this entity, mainly in I and II stages. The persistence of affections were more representative in maculopapular eruptions and disease, biopsy with the histopathology study which depends of the affected organ, will help to the diagnosis; and the skin due to its accessibility and specificity with the demonstration in sarcoid granulomas guides to its confirmation and prevent more aggressive and expensive exams

Generalized anetoderma in a patient with HIV and dual mycobacterial infection.

A middle-aged HIV infected man receiving treatment for pulmonary tuberculosis, presented with a febrile illness along with evanescent, erythematous nodular lesions all over the body. On examination, he had features suggestive of lepromatous leprosy with lesions of erythema nodosum leprosum. In addition, there were multiple small, circumscribed areas of slack skin, clinically and histopathologically suggestive of anetoderma. Both leprosy and HIV infection are known to give rise to lesions of anetoderma. Pathogenesis of anetoderma in these infectious conditions is discussed.

[Bullous erythema nodosum leprosum. A case report in French Guiana]. / Erythème noueux lépreux bulleux. Une observation en Guyane française.

BACKGROUND: Polar and borderline lepromatosis leprosy can be complicated by type 2 reactional states, including erythema nodosum leprosum. CASE REPORT: A 36-year-old man was treated for lepromatous leprosum. He consulted for recurrent erythema nodosum leprosum. Certain nodular lesions were bullous. Histopathology demonstrated major dermal edema causing bullous blisters. Treatment with thalidomide led to rapid regression. DISCUSSION: The bullous form of erythema nodosum leprosum is rarely described in the literature. It raises the diffential diagnosis with other bullous dermatoses, particularly Sweet's syndrome.