ABSTRACT
Cutaneous polyarteritis nodosa (cutaneous PAN) is a form of necrotizing vasculitis of small- and medium-sized arteries, primarily involving the skin. In juvenile cases, cutaneous PAN is known to be frequently associated with Group A ß-hemolytic Streptococcus (GAS) infections. We herein describe the first reported juvenile case of GAS-associated recurrent cutaneous PAN successfully improved with tonsillectomy. To avoid the use of steroids and immunosuppressive drugs, especially in juvenile cases, tonsillectomy is a possible treatment for GAS-associated recurrent cutaneous PAN.
Subject(s)
Polyarteritis Nodosa/surgery , Streptococcal Infections/surgery , Tonsillectomy , Child, Preschool , Female , Humans , Polyarteritis Nodosa/complications , Streptococcal Infections/complications , Streptococcus , Treatment OutcomeABSTRACT
An absence of skin lesions at the neurological onset may obscure the diagnosis of neuro-Sweet disease (NSD). We herein report a 32-year-old man with NSD in whom neurological symptoms preceded the development of skin lesions by 10 years. The patient exhibited four distinct neurological episodes: meningoencephalitis, scattered brain lesions, ocular flutter, and isolated seizures. Acute relapses responded to corticosteroid therapy, and the patient was successfully maintained on corticosteroid and dapsone combination therapy. NSD should be considered in the differential diagnosis of patients with recurrent neurological manifestations, especially with both meningeal and brain parenchymal involvement, even if no skin lesions are observed.
Subject(s)
Nervous System Diseases/etiology , Sweet Syndrome/diagnosis , Administration, Oral , Adrenal Cortex Hormones/administration & dosage , Adult , Anti-Infective Agents/administration & dosage , Dapsone/administration & dosage , Diagnosis, Differential , Diplopia/drug therapy , Diplopia/etiology , Drug Administration Schedule , Drug Therapy, Combination , Gait Disorders, Neurologic/drug therapy , Gait Disorders, Neurologic/etiology , Humans , Infusions, Intravenous , Male , Meningoencephalitis/drug therapy , Meningoencephalitis/etiology , Methylprednisolone/administration & dosage , Nervous System Diseases/diagnosis , Nystagmus, Pathologic/drug therapy , Nystagmus, Pathologic/etiology , Prednisolone/administration & dosage , Recurrence , Seizures/drug therapy , Seizures/etiology , Skin Diseases/pathology , Sweet Syndrome/complicationsABSTRACT
BACKGROUND: Symptom of herpes zoster is sometimes difficult to distinguish from sciatica induced by spinal diseases, including lumbar disc herniation and spinal canal stenosis. Here we report a case of sciatica mimicking lumbar canal stenosis. CASE PRESENTATION: A 74-year-old Chinese male patient visited our hospital for left-sided sciatic pain upon standing or walking for 5 min of approximately 1 month's duration. At the first visit to our hospital, there were no skin lesions. A magnetic resonance imaging showed spinal canal stenosis between the 4th and 5th lumbar spine. Thus, we diagnosed the patient with sciatica induced by spinal canal stenosis. We considered decompression surgery for the stenosis of 4th and 5th lumbar spine because conservative therapy failed to relieve the patient's symptom. At that time, the patient complained of a skin rash involving his left foot for several days. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of the great toe and lateral malleolus. The patient was diagnosed with herpes zoster in the left 5th lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the 5th lumbar spinal dermatome. The patient was treated with famciclovir (1,500 mg/day) and non-steroidal anti-inflammatory drugs. After 1 week of medication, the skin rash resolved and pain relief was obtained. CONCLUSION: In conclusion, spinal surgeons should keep in mind herpes zoster infection as one of the possible differential diagnoses of sciatica, even if there is no typical skin rash.