ABSTRACT
Anti-epiligrin cicatricial pemphigoid is an autoimmune blistering disorder that has recently been associated with the development of solid organ malignancy. We describe a patient with recurrent metastatic prostate carcinoma who was diagnosed with this disorder. We provide a hypothesis as to the relationship between the development of this disease and its possible association with cancer pathogenesis.
Subject(s)
Antibodies, Neoplasm/immunology , Autoantibodies/immunology , Cell Adhesion Molecules/immunology , Neoplasm Recurrence, Local/immunology , Paraneoplastic Syndromes/immunology , Pemphigoid, Benign Mucous Membrane/immunology , Prostate/immunology , Cell Adhesion Molecules/metabolism , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Pemphigoid, Benign Mucous Membrane/pathology , Prostate/pathology , Prostatic Neoplasms/complications , Prostatic Neoplasms/immunology , KalininABSTRACT
POEMS is a rare multisystem paraneoplastic syndrome featuring polyneuropathy, organomegaly, endocrinopathy, a monoclonal protein, and skin changes. In the relatively few reported biopsies of POEMS-associated cutaneous hyperpigmentation, the most common skin finding seen in patients with the disorder, only a non-specific inflammatory infiltrate has been demonstrated histologically. We present the case of a 79-year-old man with polyneuropathy, autoimmune thyroiditis, pancytopenia, and a history of lymphadenopathy who presented to the inpatient dermatology service with cutaneous hyperpigmentation. A skin biopsy of a hyperpigmented area showed a cutaneous lymphoplasmacytic infiltrate, prompting further investigation. A monoclonal IgM-lambda paraprotein was subsequently identified, leading to administration of combination chemotherapy for a diagnosis of POEMS syndrome. The novel finding of a lymphoplasmacytic infiltrate in POEMS-associated hyperpigmentation suggests a diagnostic role for skin biopsy in these patients.
Subject(s)
Hyperpigmentation/pathology , Immunoglobulin M/blood , Immunoglobulin lambda-Chains/blood , POEMS Syndrome/pathology , Paraproteinemias/blood , Paraproteinemias/pathology , Aged , Humans , Lymphocytes/pathology , Male , Plasma Cells/pathologyABSTRACT
BACKGROUND: Radioactive iodine (RAI) treatment has been suggested to cause primary hyperparathyroidism (HPT). We describe a series of patients with HPT and a history of RAI exposure. METHODS: Patient demographic and clinical information was evaluated, including the latency time to the development of HPT after RAI exposure. RESULTS: We treated 11 patients with HPT and a history of RAI exposure. RAI treatment was administered for benign thyroid disease in 9 (82%) cases. Thirty-six cases of HPT after RAI exposure in the English literature were compiled for further analysis. In this collective experience, the average latency time to the development of HPT after RAI treatment was 13.5 +/- 9.1 years and was found to be inversely correlated with age at RAI exposure. CONCLUSIONS: Patients who undergo RAI treatment are at risk of developing HPT, and this risk appears to increase in elderly patients. Serum calcium surveillance is recommended for patients who have undergone RAI treatment.
Subject(s)
Hyperparathyroidism/etiology , Iodine Radioisotopes/adverse effects , Radiotherapy/adverse effects , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: Laser-assisted tattoo removal is effective but can be costly and time-consuming and can result in disfiguring scars and pigment alterations. Imiquimod, an immune response modifier, may play a role in tattoo removal. OBJECTIVE: The objective was to evaluate the safety and efficacy of topical 5% imiquimod cream used daily in conjunction with laser therapy to remove unwanted tattoos. MATERIALS AND METHODS: Twenty subjects with two similar tattoos were enrolled in this randomized, prospective, double-blinded, case-controlled study. Tattoos were treated with either imiquimod or placebo daily and laser therapy every 4 to 6 weeks for a total of six sessions. The primary efficacy parameter was tattoo clearance (5-point scale, poor through complete). Secondary efficacy parameters included textural changes (5-point scale, minimal through severe), pain during and between laser procedures, and undesirable pigment alterations. RESULTS: Nineteen subjects completed the study. The mean score for tattoo clearance with imiquimod versus placebo was 3.2 versus 2.9 and, for textural changes, was 1.37 versus 1.21 (differences not statistically significant). There was no difference in subjective pain during and between laser sessions and no undesirable pigment alterations were reported. Adverse reactions were more frequent with imiquimod compared to placebo. CONCLUSION: Topical imiquimod is an ineffective adjunct to laser-assisted tattoo removal.