Systemic lupus erythematosus and antiphospholipid syndrome with retiform purpura as the initial skin lesion: A case study.

Retiform purpura-like lesions are rarely seen clinically and can be induced by cutaneous vascular wall damage or a lumen-occlusive disease arising from a broad range of triggers, including infection, drugs, emboli, cryoglobulinemia, disseminated intravascular coagulation, and autoimmune disease. Here, we present the case of a patient suffering from both systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), with retiform purpura as the first lesion and lacking other typical symptoms of SLE, such as photosensitivity, malar rash, ulceration of the mouth and nose, alopecia, and joint pain.

[Exertional dyspnea, myalgia, petechiae of the lower extremities and pronounced gingivitis in a 64-year-old female patient]. / Belastungsdyspnoe, Myalgien und Petechien der unteren Extremitäten sowie ausgeprägte Gingivitis bei einer 64-jährigen Patientin.

A female patient presented with exertional dyspnea, myalgia, a petechial rash of the lower extremities and pronounced gingivitis. The biochemical test results showed the presence of anemia. The patient had a known eating disorder and on questioning about eating habits admitted that she did not eat any fruit or vegetables. This led to the suspicion of a vitamin C deficiency, which was confirmed by high-pressure liquid chromatography. The patient was subsequently treated with 1000 mg ascorbic acid daily for 1 month whereby the clinical symptoms and anemia improved within a few weeks.

Multiple myeloma with an unusual oral presentation.

Multiple myeloma (MM) is a dyscrasia caused by neoplastic proliferation of somatically mutated plasma cells. Myeloma cells divide and expand within the bone marrow affecting multiple locations in the body where bone marrow is present. Oral manifestations, though common are usually not diagnosed. This report describes rare oral manifestations of multiple myeloma like oral petechiae and gingival swelling presented in a 40-year-old male patient. The diagnosis was established by blood examination & skeletal survey, while oral findings were later correlated with the diagnosis of MM. A brief review on MM is presented along with the demonstration of rare oral manifestations.

Severe Thrombocytopenia Induced by First Infliximab Administration for Rheumatoid Arthritis.

Thrombocytopenia due to antitumor necrosis factorα agents is very rare. A 68-year-old woman with rheumatoid arthritis on methotorexate received infliximab (IFX). Three days after the first IFX infusion, she developed gingival bleeding, petechia, and gross hematuria. Her platelet count fell to 2000/µL. We administered a platelet transfusion and intravenous methylprednisolone. Three days after admission, her platelet count was 7000/µL and her bleeding persisted. After double filtration plasmapheresis, her bleeding stopped and her platelet count recovered over 2 weeks. Thrombocytopenia is a rare but severe complication of IFX. Double filtration plasmapheresis may be useful for removing IFX or possible antibodies against platelets when IFX remaining in the patient's blood interferes with improvement of the patient's condition.

A Case of Scurvy-Uncommon Disease-Presenting as Panniculitis, Purpura, and Oligoarthritis.

IMPORTANCE: Scurvy remains prevalent in certain populations, including addicts, people of low socioeconomic status, and the severely malnourished. It classically presents as follicular hyperkeratosis and perifollicular hemorrhage of the lower extremities, as well as bleeding in other areas such as the gingiva and joints. This case presentation and literature review highlights the common pathophysiological findings associated with scurvy and current methods of diagnosis and treatment. OBSERVATION: The patient described in this case presented with sudden oligoarthritis and purpura of the lower extremities. Following progression of the patient's symptoms and a low vitamin C serum concentration, the patient was treated with vitamin C supplementation and dramatically improved. This was considered to be the result of an underlying vitamin C deficiency secondary to insufficient fruit and vegetable intake due to allergies. CONCLUSIONS AND RELEVANCE: This case highlights the importance of maintaining a high index of suspicion for scurvy in atypical presentations of purpura not better explained by another disease or in additional populations at high risk of vitamin C deficiency. Early diagnosis by either a primary care physician or dermatologist can expedite the treatment process and improve patient prognosis.

A Quick Review of the Cutaneous Findings of the Zika Virus.

The current outbreak of Zika virus is a growing public health concern, especially for pregnant women. Zika virus infection may manifest as a maculopapular skin eruption that progresses rostrocaudally, with or without hemorrhagic manifestations such as petechiae and gingival bleeding. Recognizing the cutaneous findings associated with Zika virus may aid in early diagnosis, particularly in individuals at increased risk for the disease.

Spontaneous Gingival Bleeding A Surprising and Sinister Etiology: A Case Report.

It is rare for a dentist to be confronted with a situation where the immediate well-being of a patient is dependent upon his or her diagnosis. Spontaneous gingival bleeding, as in this case report, may present such a situation. The patient had no remarkable medical history, was not taking medication and had a recent (two weeks) normal CBC. Only by noticing petechiae on the patient's palate and buccal mucosa was the dentist convinced of an underlying clotting problem. A patient visit to his physician confirmed thrombocytopenia due to quinine in the tonic water he was taking.

[Infantile scurvy: Two cases]. / Scorbut chez l'enfant: deux cas.

BACKGROUND: Scurvy is the classic and most severe form of vitamin C deficiency. This condition has become extremely rare among children in the industrialized countries. PATIENTS AND METHODS: We report the case of two boys presenting bone pain associated with haemorrhagic gingivitis, with perifollicular purpura of the lower limbs in one boy. The children had an unbalanced diet. Scurvy was associated with vitamin D and iron deficiency. The dermatological and radiological abnormalities seen were characteristic and a favourable outcome was rapidly obtained following supplementation. DISCUSSION: The possibility of this forgotten historical illness should not be overlooked in the presence of these dermatological and rheumatologic signs, since this can help avoid unnecessary or excessively aggressive investigations.

A rare cause of petechial rash in the 21st century.

Scurvy was first described by Hippocrates (460-370 BC) as a condition characterised by poor dental health, bruising, bleeding and fragile skin. Despite the widespread availability of foods rich in vitamin C in Australia, scurvy continues to afflict certain high-risk subgroups of the population. Cutaneous signs may be the only manifestation of the disease, as in the case presented below, and therefore scurvy continues to be relevant to dermatologists.

Purpura and fillers: a review of pre-procedural, intra-procedural, and post-procedural considerations.

Injectable aesthetic fillers are associated with the common and expected side effect of purpura or bruising. There are pre-procedural, intra-procedural and post-procedural considerations that can potentially minimize bruising. Traditional and newer techniques are discussed in this review and the benefits and risks of each technique will be provided.

Fellatio-associated petechiae of the palate: report of purpuric palatal lesions developing after oral sex.

Fellatio--a sexual act in which the penis is placed into the mouth of another person--can result in submucosal hemorrhage of the palate. A young woman with fellatio-associated palatal petechiae is reported and the features of irrumation-induced oral lesions of the palate are reviewed. Fellatio-associated petechiae and purpura can potentially occur in anyone who engages in receptive penile oral sex. The lesions are asymptomatic and typically appear on the soft palate. Because the fellatrix or fellator may be unaware of the etiology of the lesions or may be reluctant to provide these details of the sexual history, the clinician needs to have a high index of suspicion based on the patient's clinical presentation and collaborating history of preceding fellatio.

What is the cause of palate lesions? A case report.

OBJECTIVES: Trauma to the oral tissues can be caused by fellatio. Few cases are reported in the literature. METHODS: A case of oral palate lesions is presented and discussed. RESULTS: The patient developed a large band of petechial haemorrhage extending across the soft palate following the practice of fellatio. The diagnosis was made through an interview with the patient, which disclosed a probable case for fellatio as the cause of the palatal spots. At the follow-up visit 14 days later, the lesions disappeared. CONCLUSIONS: Oral sex activity has increased over the last decades. The dental care professional should be aware that lesions of the palate may result from sexual behaviour. With this possibility in mind, those working in the area of head and neck medicine should consider fellatio as an addition to the differential aetiology of intraoral petechiae.

Reduced platelet aggregation in a boy with scurvy.

Pediatric scurvy is a rare condition characterized by perifollicular petechiae and bruising, hemorrhagic gingivitis and musculoskeletal symptoms, all assumed to be predominantly related to abnormal collagen structure. We report on a 9-year-old autistic boy with vitamin C deficiency due to a highly limited food range presenting with multiple petechiae, gum bleeding and debilitating bone pain, in whom platelet aggregometry revealed a distinctly reduced thrombocyte aggregation, normalizing after vitamin C supplementation. This observation indicates that platelet dysfunction may additionally contribute to the hemorrhagic diathesis in scurvy, and demonstrates that ascorbic acid deficiency should be considered in children with an otherwise unexplained acquired thrombocytopathy.

Primary Sjögren syndrome: report of a 10 years old girl with local edema and positivity of anti SS-A and anti SS-B autoantibodies.

Sjogren-Larsson syndrome (SLS) is an autoimmune disease, uncommon in childhood. We report a case of SLS in a 10-year-old girl with a history of tumor, calor and rubor in the back of her toes almost every month, which resolved in 4-5 days without therapy. She did not complain of dry mouth or dry eyes. The laboratory findings showed high inflammation markers, rheumatoid factor 128 IU, Waaler-Rose 256 IU, anti nuclear antibody (ANA) 1/640, SSA (anti Sjogren antigen A) and SSB (anti Sjogren antigen B) positive and hypergammaglobulinemia. The Schirmer's test resulted to be pathologic, the ultrasonography images and biopsy of minor salivary glands revealed focal periductal lymphocytic infiltrate and sialoduct ectasia class IV of juvenile Sjogren syndrome. The juvenile Sjogren syndrome is frequently under-diagnosed. Clinical manifestations in children might be different from the adult form, although laboratory findings may be similar to those found in adults.

Experimental design in formulation optimization of vitamin K1 oxide-loaded nanoliposomes for skin delivery.

Due to the vitamin K1 sensitizing potential, the oxidized-isoform of vitamin K1 (vitamin K1 oxide, VKO), has been recently used for treating laser-induced purpura and hyperpigmentation in cosmetics. The objective of this study was to formulate VKO in nanoliposomes by using Box-Behnken experimental design to obtain an optimized formula with higher efficiency. The ratio of phospholipid to cholesterol (PC/CHO ratio), VKO concentration and sonication time in low, medium, and high levels were independent variables, while the percent of VKO entrapment efficiency (EE%) and vesicle size were selected as dependent variables. Optimum desirability was identified and an optimized formulation was prepared, characterized, and selected for in vitro VKO release and ex vivo skin permeation. The PC/CHO ratio showed the greatest effect on both responses (P < 0.0001). This effect was positive on EE%, while a negative effect was shown on vesicle size. The optimized formulation showed controlled drug release of 79.2% through a silicon membrane, and achieved flux of 327.36 ± 22.1 µg/cm2 through human skin after 24 h. So, nanoliposomes were proven as a suitable drug delivery system for topical delivery of VKO.

[A girl with a purple chin]. / Een meisje met een paarse kin.

A 9-year-old healthy girl visited the general practitioner with a recurring purple discoloration of the skin around the mouth without any other complaints. She was diagnosed with factitious purpura due to a vacuum that was caused by creating a negative pressure through placement of a plastic cup around the mouth.