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1.
Dtsch Med Wochenschr ; 134(21): 1106-9, 2009 May.
Article in German | MEDLINE | ID: mdl-19437374

ABSTRACT

HISTORY AND CLINICAL FINDINGS: A 46-year-old man presented with suberythrodermia and an acral-accentuated sclerosis, which had been progressing over the past 6 months, with extensive, painful ulcers within the sclerotic areas of the calf. Due to acute myelotic leukemia (AML), an allogenic peripheral blood stem-cell transplantation with subsequent immunosupression with mycophenolatmofetil (MMF) and ciclosporin A had been performed 8 years previously. The patient had discontinued treatment on his own after about 2 years, having suffered a cerebroischemic insult in the meantime. INVESTIGATIONS: Histological examinations revealed sclerodermatous changes. Titres of antinuclear antibodies were unremarkable. Laser-Doppler-flowmetry also indicated an active inflammatory and sclerosing process. FACS analysis of the peripheral blood did not reveal signs of AML recurrence. DIAGNOSIS, THERAPY AND COURSE: The histological pattern in conjunction with the anamnesis indicated a cutaneous chronic graft-versus-host disease (GvHD). No further organ involvement was observed. The MMF therapy which the patient had discontinued was restarted. In addition, PUVA therapy was initiated. These measures and intensive physiotherapeutic exercises in parallel prevented further progression of the sclerosis and secondary mobility limitations. The ulcers healed completely with pentoxifylline and anti-infective treatment. CONCLUSION: After stem-cell transplantation, early diagnosis of GvHD is especially important due to possible irreversible sclerodermatous changes and other organ manifestations. Also for this reason, strict clinical follow-up is especially important with respect to compliance and efficacy of the immunosuppression.


Subject(s)
Graft vs Host Disease/etiology , Leukemia, Myeloid, Acute/therapy , Peripheral Blood Stem Cell Transplantation/adverse effects , Scleroderma, Localized/etiology , Anti-Infective Agents/therapeutic use , Cyclosporine/therapeutic use , Graft vs Host Disease/diagnosis , Graft vs Host Disease/therapy , Humans , Immunosuppressive Agents/therapeutic use , Laser-Doppler Flowmetry , Leg Ulcer/diagnosis , Leg Ulcer/etiology , Leg Ulcer/therapy , Male , Middle Aged , Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/therapeutic use , PUVA Therapy , Patient Compliance , Pentoxifylline/therapeutic use , Physical Therapy Modalities , Scleroderma, Localized/diagnosis , Scleroderma, Localized/therapy , Transplantation, Homologous , Vasodilator Agents/therapeutic use
2.
Dtsch Med Wochenschr ; 132(49): 2624-6, 2007 Dec.
Article in German | MEDLINE | ID: mdl-18050026

ABSTRACT

HISTORY: A 60-year-old man with diabetes mellitus and chronic renal insufficiency needing hemodialysis was admitted with a 3 months history of multiple hyperkeratotic papules on the trunk and extremities partly ulcerated with a keratotic central plug. INVESTIGATIONS: Laboratory tests revealed elevated levels of blood urea nitrogen, creatinine, and HbA (1c). Histopathology showed vertical strands of collagen perforating from the ulcerated lesions. COURSE, DIAGNOSIS AND TREATMENT: The biopsy specimen was consistent with acquired reactive perforating collagenosis. The progression was stopped and secondary wound healing was initiated after two weeks of therapy with allopurinol and PUVA. CONCLUSION: Acquired reactive perforating collagenosis should be considered when ulcera with oystershell-like keratotic plugs are found especially in patients with predisposing diseases like diabetes and renal insufficiency. A good interdisciplinary cooperation between internist and dermatologist is crucial for the early recognition by histopathology and the immediate treatment.


Subject(s)
Collagen Diseases/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Kidney Failure, Chronic/epidemiology , Skin Diseases/epidemiology , Allopurinol/therapeutic use , Antimetabolites/therapeutic use , Blood Urea Nitrogen , Collagen Diseases/drug therapy , Collagen Diseases/pathology , Creatinine/blood , Diabetes Mellitus, Type 2/complications , Glycated Hemoglobin/analysis , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , PUVA Therapy , Skin/pathology , Skin Diseases/drug therapy , Skin Diseases/pathology , Skin Ulcer/drug therapy , Skin Ulcer/epidemiology , Skin Ulcer/pathology , Treatment Outcome
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