Eosinophilic fasciitis (EF) is characterized by symmetrical thickening of subcutaneous muscular fascia, causing skin induration with wrinkles and prominent hair follicles: the classic peau d'orange. Eosinophilia is a characteristic-albeit not universal-finding. We present the case of a 43-year-old pregnant woman diagnosed with EF during pregnancy who had extensive cutaneous involvement and severe functional repercussions, including worsening of lung function and intrauterine growth restriction as a possible complication. Treatment with prednisone was initiated during gestation and it was necessary to increase the dose. After delivery, methotrexate treatment was initiated and the corticosteroid dose progressively decreased, with progressive worsening in the torso and abdomen and secondary dyspnea due to thoracic pressure. Treatment with infliximab was then initiated, with favorable progress, though residual ankle and tarsal joint stiffness and significant muscular atrophy in the limbs continued. The triggering factor of EF was not identified. In a systematic search of the medical literature, three cases of EF in pregnant woman without clear triggers were found. Interestingly, all three cases progressed favorably with steroid treatment. Apart from this case, there are only seven published cases of infliximab use in the literature, all with moderate or complete response. Infliximab could be an option for corticosteroid-dependent EF with no response to other options.
Antirheumatic Agents/therapeutic use , Eosinophilia/drug therapy , Fasciitis/drug therapy , Infliximab/therapeutic use , Pregnancy Complications/drug therapy , Adult , Female , Humans , Prednisolone/administration & dosage , Pregnancy , Skin/pathology
Basal cell carcinoma (BCC) is the most commonly occurring carcinoma among humans. However, despite their overall frequency, cases of BCC featuring metastases are extremely rare. We present the case of a male patient with BCC located in the chest, measuring 10 cm and with an evolution of 15 years. After several years, an axillary recurrence developed as a tumor mass affecting the lymph nodes. After 14 months, a further lymph node recurrence was observed and resected. Six months later, a pulmonary nodule was detected, which was resected with tumor-free margins. Histopathological report revealed infiltration by BCC. After 13 years of follow-up (after the removal of the primary tumor), the patient remained alive and received close clinicoradiological monitoring. Taking advantage of this opportunity, we also provide a brief review of the corresponding literature.
No disponible
Humans , Female , Infant , Nevus/diagnosis , Skin Neoplasms/diagnosis , Nevus/pathology , Skin Neoplasms/pathology , Syndrome
DNA, Neoplasm/genetics , Mutation , Nevus/genetics , Proto-Oncogene Proteins B-raf/genetics , Skin Neoplasms/genetics , Vemurafenib/therapeutic use , Adult , Antineoplastic Agents/therapeutic use , Cell Line, Tumor , DNA Mutational Analysis , Dermoscopy , Fatal Outcome , Humans , Male , Nevus/drug therapy , Nevus/pathology , Proto-Oncogene Proteins B-raf/metabolism , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology
Aminoquinolines/administration & dosage , Antineoplastic Agents/administration & dosage , Dermoscopy , Hutchinson's Melanotic Freckle/drug therapy , Hutchinson's Melanotic Freckle/pathology , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Administration, Topical , Aged, 80 and over , Female , Humans , Imiquimod , Male
La tuberculosis diseminada es un proceso que suele afectar a pacientes inmunodeprimidos. Su manifestación inicial como fascitis necrosante es excepcional, sobre todo si no se asocia a tuberculosis ósea. El diagnóstico de esta rara complicación requiere un alto índice de sospecha por parte del clínico y el aislamiento del Mycobacterium tuberculosis en el tejido muscular, ya que los síntomas pueden remedar a la enfermedad de base, por lo que la biopsia muscular se presenta como la principal herramienta diagnóstica. Presentamos el caso de un paciente que recibía terapia inmunodepresora por síndrome nefrótico asociado a nefropatía por cambios mínimos y que desarrolló esta rara complicación, donde el diagnóstico se hizo basándose en los hallazgos de la biopsia muscular. También se realiza una revisión de los casos similares encontrados en la literatura médica(AU)
Disseminated tuberculosis is a process that mainly affects immunocompromised hosts. Its initial appearance as necrotising fasciitis is exceptional especially if it is not associated to a bone disorder. The diagnosis of this rare complication requires a high degree of suspicion and the evidence of Mycobacterium tuberculosis in the muscular tissue, since the symptoms may mimic the underlying illness itself, for this reason the most sensitive method for demonstrating tuberculous infection is a muscular biopsy. Here we present the case of a patient who was receiving immunosuppressant therapy for nephrotic syndrome by minimal lesion glomerulonephritis and who developed this rare complication, where diagnosis was made by muscular biopsy. So we do a review of similar case reports in the literatura(AU)
Humans , Male , Middle Aged , Fasciitis, Necrotizing/diagnosis , Tuberculosis/diagnosis , Immunocompromised Host , Mycobacterium tuberculosis/isolation & purification , Nephrotic Syndrome/drug therapy , Immunosuppressive Agents/adverse effects
Disseminated tuberculosis is a process that mainly affects immunocompromised hosts. Its initial appearance as necrotising fasciitis is exceptional especially if it is not associated to a bone disorder. The diagnosis of this rare complication requires a high degree of suspicion and the evidence of Mycobacterium tuberculosis in the muscular tissue, since the symptoms may mimic the underlying illness itself, for this reason the most sensitive method for demonstrating tuberculous infection is a muscular biopsy. Here we present the case of a patient who was receiving immunosuppressant therapy for nephrotic syndrome by minimal lesion glomerulonephritis and who developed this rare complication, where diagnosis was made by muscular biopsy. So we do a review of similar case reports in the literature.
OBJETIVOS: Aportamos un caso de una tumoración de células granulosas en una localización poco habitual. MÉTODO: Un paciente de 38 años acudió a nuestro servicio por presentar un nódulo indoloro de 10 mm de diámetro sobre el escroto de 2 años de evolución, el cual se extirpó mediante excisión quirúrgica. RESULTADO: El estudio anatomopatológico evidenció que se trataba de un tumor de células granulares, con tinción inmunohistoquímica para la proteína S-100 altamente positiva y negativa para las citoqueratinas AE1-AE3 y el CEA. CONCLUSIONES: Los tumores de células granulares son muy frecuentes en la cabeza y el cuello, siendo raramente observados en el área genitourinaria, los cuales cursan de forma asintomática. Su diagnóstico histológico es fácil, pero la confirmación debe hacerse mediante tinción para la proteína S-100, que es positiva en todos los casos. La excisión simple es el tratamiento de elección. Existen algunos trabajos que observan la reaparición de la lesión y metástasis, para lo cual es necesario un seguimiento de la misma (AU)
Adult , Male , Humans , Scrotum , Granular Cell Tumor , Genital Neoplasms, Male
