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Tatuaje , Verrugas , Humanos , Tatuaje/efectos adversos , Verrugas/etiología , Masculino , AdultoRESUMEN
Cryotherapy with liquid nitrogen has been established as the first-line treatment for pediatric patients with viral warts. Cold-induced urticaria (CU) is a rare skin reaction triggered by cold stimuli. We present the case of a pediatric patient with viral warts who developed CU after receiving cryotherapy.
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Urticaria por Frío , Urticaria , Verrugas , Humanos , Niño , Crioterapia/efectos adversos , Verrugas/etiología , Verrugas/terapia , Nitrógeno , Urticaria/etiología , Urticaria/terapia , Resultado del TratamientoRESUMEN
Tattoos are a form of decorative body art in which pigment dyes of different colors are inoculated into the skin. It is estimated that 15-25% of general population has one or more tattoos (1), and the reasons for the popularity of this procedure may include greater social acceptance, aesthetic appeal, or perhaps the option of using laser removal techniques to eliminate unwanted tattoos. Even though modern professional tattoos are usually performed in sterile conditions, complications still occur, and with increasing numbers of people getting tattoos, the incidence of tattoo-associated side-effects presenting to dermatologists, which may be as high as 2%, is likely to increase (2). Herein we present a case of a 43-year-old male patient with multiple HPV-associated flat warts (verrucae planae) confined to the black pigment of a tattoo done 15 years ago. A 43-year-old patient presented to our clinic due to eczema on the trunk. However, during skin examination, we observed asymptomatic verrucous papules confined to the black ink of a tattoo done 15 years ago on the lateral side of his right lower leg (Figure 1a). Clinical examination showed multiple, discrete, skin-colored, verrucous papules disseminated exclusively within the lines of the black-colored tattoo. Full skin examination did not reveal any similar lesions anywhere else on the body. Dermoscopically, papules showed a discretely papillomatous surface and sharp borders (Figure 1b). The patient had another black tattoo on his trunk, in which no similar lesions were found. All his tattoos had been done more than 15 years ago in a professional tattoo salon and with no previous history of cutaneous lesions within tattoos. The patient had no other medical conditions and was not taking any medications. Additionally, no history of warts or other HPV-related lesions of the skin or mucosal membranes could be established. A biopsy of an individual papule was taken and sent for a histopathological analysis, which subsequently showed hyperkeratotic, orthokeratotic, and parakeratotic acanthotic epidermis with hypergranulosis and rare cells with perinuclear halo indicative of koilocytes (Figure 3b). Immunohistochemical analysis showed negative reaction for p16 and p53, while Ki67 was positive only in rare basal and suprabasal cells. These findings were indicative of low-risk HPV, and the diagnosis of HPV-induced verruca plana was ultimately established. The patient was then successfully treated with cautious curettage of the lesions, leaving no scars. Due to the growing popularity of tattoos, especially among younger populations, it is necessary to emphasize the possibility of various tattoo-related side-effects that can still occur due to improper preparation of the tattoo location, contamination of ink products, improperly sterilized instruments, or due to insufficient personal hygiene following tattooing (3). In the past, tattoo-associated infections were significantly more frequent, with the highest prevalence of Staphylococcus and Streptococcus infections causing impetigo, folliculitis, cellulitis, erysipelas, or sepsis (2), but recent improvement and efforts in using sterile techniques in tattooing has led to a significant drop in the number of tattoo-related infections. In this short report, we present a case of a different and a relatively rare type of tattoo-associated infection - flat warts i.e., verrucae planae. Flat warts are usually caused by HPV-3, -6B, -10, -28, and -49. Typical predilection sites are the face, dorsal sides of the hands or feet, arms, and legs, and they usually appear as skin-colored, pink, or brown, flat-topped discrete papules. It is believed that HPV can be inoculated through contaminated ink, instruments, the artist's saliva, or that it may be a pre-existing unnoticed wart in the tattooed area (4-6). The latency period between tattooing and HPV infection can range from several months to 10 years, with a mean period of 5 years (3). This may suggest that the immune system can control the infection for some time, and that some form of immune suppression may result in the development of a clinical disease. In our case, the latency period could not be established due to the patient's unawareness of the lesions, and no potential trigger could be identified. The occurrence of lesions on only one of the patient's tattoos as well as their confinement to the black pigmented ink may indicate a correlation to this specific pigment. Ramey et al. (6) conducted a study in which they assessed the localization of warts in differently colored tattoos. The results showed that black ink tattoos had a seven times higher risk of developing warts when compared with colored ink. At first it was thought that this was due to HPV inoculation via contaminated instruments, ink, or autoinoculation of the patient's own warts, but some evidence indicates that it is unlikely for HPV to survive in ink and that if the warts were inoculated they would occur equally in all ink colors. A different theory by Ruocco et al. (7) explains this phenomenon through an "immunocompromised district" mechanism, in which polycyclic aromatic hydrocarbons found in black ink produce reactive oxygen species (ROS) that can damage cellular structures and consequently increase the risk of a variety of infections, including HPV. Moreover, black ink contains almost pure nanoparticles, which are associated with greater ROS production than the larger particles found in colored ink (7,8). There are several treatment options for verrucae planae, such as liquid nitrogen cryotherapy, topical 5% fluorouracil, topical 5% imiquimod, 0.025-0.050% tretinoin, 10% salicylic acid, or 10-30% glycolic acid. These treatments have differing success rates. Destructive modalities, such as surgical excision, curetting, or laser ablation may significantly damage the tattoo and cause scarring, and are thus not regularly performed. It's necessary to emphasize that despite today's sterile methods of tattooing, complications may still occur and medical professionals, namely dermatologists, should be aware of them. A person who wishes to get a tattoo should be advised to visit a licensed tattoo artist at a licensed tattoo parlour only. Patients with pre-existing dermatoses characterized by an isomorphic phenomenon, such as psoriasis or lichen planus, are particularly prone to developing a tattoo-associated adverse reaction, and those with severe dermatoses should be advised to avoid tattooing. Additionally, people with a previous history of warts should be aware of the possibility of warts occurrence, even years or decades after tattooing. Even though most of tattoo-related side effects are merely inconveniences, there is a potential for serious complications and patients should be advised as such.
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Infecciones por Papillomavirus , Tatuaje , Verrugas , Masculino , Humanos , Adulto , Tatuaje/efectos adversos , Infecciones por Papillomavirus/etiología , Especies Reactivas de Oxígeno , Verrugas/diagnóstico , Verrugas/etiología , Verrugas/terapia , Cicatriz/etiologíaRESUMEN
BACKGROUND: WHIM syndrome corresponds to an inborn error of innate and intrinsic immunity, characterized by: warts (Warts), Hypogammaglobulinemia, Infections and Myelocathexis, for its acronym in English. CASE REPORT: 4-year-old male, with severe neutropenia and B-cell lymphopenia from birth, without severe infections or warts; the panel genetic sequencing study of primary immunodeficiencies with the CXCR4 c.1000C>T (p.Arg334*) variant, which is associated with WHIM syndrome. CONCLUSIONS: The diagnosis of severe neutropenia from birth should include the search for inborn errors of immunity, through genetic sequencing studies, especially in asymptomatic or oligosymptomatic patients.
ANTECEDENTES: El síndrome WHIM corresponde a un error innato de la inmunidad innata e intrínseca, caracterizada por verrugas (Warts), hipogammaglobulinemia, infecciones y mielocatexis, por sus siglas en inglés. REPORTE DE CASO: Paciente masculino de 4 años, con neutropenia severa y linfopenia de células B desde el nacimiento, sin infecciones severas ni verrugas. El estudio de secuenciación genética informó la variante CXCR4 c.1000C>T (p.Arg334*), relacionada con el síndrome de WHIM. CONCLUSIÓN: El diagnóstico de neutropenia severa desde el nacimiento debe incluir la búsqueda de errores innatos de la inmunidad, mediante estudios de secuenciación genética, especialmente en pacientes asintomáticos u oligosintomáticos.
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Agammaglobulinemia , Síndromes de Inmunodeficiencia , Neutropenia , Enfermedades de Inmunodeficiencia Primaria , Verrugas , Masculino , Humanos , Preescolar , Enfermedades de Inmunodeficiencia Primaria/diagnóstico , Verrugas/diagnóstico , Verrugas/etiología , Agammaglobulinemia/diagnóstico , Neutropenia/complicaciones , Neutropenia/diagnóstico , Neutropenia/genética , Síndromes de Inmunodeficiencia/diagnósticoRESUMEN
Human papillomavirus (HPV), a common sexually transmitted virus infecting mucosal or cutaneous stratified epithelia, is implicated in the rising of associated cancers worldwide. While HPV infection can be cleared by an adequate immune response, immunocompromised individuals can develop persistent, treatment-refractory, and progressive disease. Primary immunodeficiencies (PIDs) associated with HPV-related disease include inborn errors of GATA, EVER1/2, and CXCR4 mutations, resulting in defective cellular function. People living with secondary immunodeficiency (e.g. solid-organ transplants recipients of immunosuppression) and acquired immunodeficiency (e.g. concurrent human immunodeficiency virus (HIV) infection) are also at significant risk of HPV-related disease. Immunocompromised people are highly susceptible to the development of cutaneous and mucosal warts, and cervical, anogenital and oropharyngeal carcinomas. The specific mechanisms underlying high-risk HPV-driven cancer development in immunocompromised hosts are not well understood. Current treatments for HPV-related cancers include surgery with adjuvant chemotherapy and/or radiotherapy, with clinical trials underway to investigate the use of anti-PD-1 therapy. In the setting of HIV co-infection, persistent high-grade anal intraepithelial neoplasia can occur despite suppressive antiretroviral therapy, resulting in an ongoing risk for transformation to overt malignancy. Although therapeutic vaccines against HPV are under development, the efficacy of these in the setting of PID, secondary- or acquired- immunodeficiencies remains unclear. RNA-based therapeutic targeting of the HPV genome or mRNA transcript has become a promising next-generation therapeutic avenue. In this review, we summarise the current understanding of HPV pathogenesis, immune evasion, and malignant transformation, with a focus on key PIDs, secondary immunodeficiencies, and HIV infection. Current management and vaccine regimes are outlined in relation to HPV-driven cancer, and specifically, the need for more effective therapeutic strategies for immunocompromised hosts. The recent advances in RNA-based gene targeting including CRISPR and short interfering RNA (siRNA), and the potential application to HPV infection are of great interest. An increased understanding of both the dysregulated immune responses in immunocompromised hosts and of viral persistence is essential for the design of next-generation therapies to eliminate HPV persistence and cancer development in the most at-risk populations.
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Neoplasias del Ano , Infecciones por VIH , Infecciones por Papillomavirus , Verrugas , Humanos , Virus del Papiloma Humano , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Verrugas/etiología , Verrugas/terapia , Neoplasias del Ano/etiología , Neoplasias del Ano/terapiaRESUMEN
The treatment of warts has always been a challenging prospect for dermatologists. In some cases, these warts can become resistant or recalcitrant to treatment. Although a plethora of therapeutic and destructive options is available for wart management, to date no treatment has been found to be completely effective because none of the agents induce specific antiviral immunity. We conducted a study to evaluate the efficacy and safety of skin needling with topical 100% trichloroacetic acid (TCA) against the same type of skin needling with bleomycin in patients with recalcitrant cutaneous warts. In total, 33 (63.5%) patients in the TCA group and 35 (81.4%) in the bleomycin group had complete clearance of all the warts, which was not statistically significant (P = 0.13). There was also no statistically significant difference between the treated and untreated warts in the bleomycin group, whereas in the TCA group there was a significantly higher response rate in the treated warts. The most common adverse event (AE) in both groups was transient procedure site pain. We found that the use of needling plus TCA leads to a faster resolution of warts compared with needling plus bleomycin, with a comparable safety profile. Additionally, we found that TCA is superior to bleomycin for management of multiple warts. However, needling with either TCA or bleomycin has excellent and fairly comparable efficacy, and these methods should be used for the management of multiple or recalcitrant warts, as they have minimal AEs and recurrence rates.
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Ácido Tricloroacético , Verrugas , Administración Cutánea , Bleomicina/efectos adversos , Bleomicina/uso terapéutico , Humanos , Inyecciones Intralesiones , Resultado del Tratamiento , Ácido Tricloroacético/efectos adversos , Verrugas/tratamiento farmacológico , Verrugas/etiologíaAsunto(s)
Neoplasias Cutáneas , Tatuaje , Verrugas , Humanos , Tatuaje/efectos adversos , Verrugas/etiologíaRESUMEN
PURPOSE: T cell receptor excision circle (TREC) quantification is a recent addition to newborn screening (NBS) programs and is intended to identify infants with severe combined immunodeficiencies (SCID). However, other primary immunodeficiency diseases (PID) have also been identified as the result of TREC screening. We recently reported a newborn with a low TREC level on day 1 of life who was diagnosed with WHIM (warts, hypogammaglobulinemia, infections, myelokathexis) syndrome, a non-SCID primary immunodeficiency caused by mutations in the chemokine receptor CXCR4. METHODS: We have now retrospectively reviewed the birth and clinical histories of all known WHIM infants born after the implementation of NBS for SCID. RESULTS: We identified six infants with confirmed WHIM syndrome who also had TREC quantification on NBS. Three of the six WHIM infants had low TREC levels on NBS. All six patients were lymphopenic but only one infant had a T cell count below 1,500 cells/µL. The most common clinical manifestation was viral bronchiolitis requiring hospitalization. One infant died of complications related to Tetralogy of Fallot, a known WHIM phenotype. CONCLUSION: The results suggest that WHIM syndrome should be considered in the differential diagnosis of newborns with low NBS TREC levels. TRIAL REGISTRATION: Not applicable.
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Tamizaje Neonatal/métodos , Enfermedades de Inmunodeficiencia Primaria/epidemiología , Enfermedades de Inmunodeficiencia Primaria/etiología , Receptores de Antígenos de Linfocitos T/genética , Verrugas/epidemiología , Verrugas/etiología , Biomarcadores , Análisis Mutacional de ADN , Diagnóstico Diferencial , Susceptibilidad a Enfermedades , Femenino , Humanos , Recién Nacido , Masculino , Mutación , Fenotipo , Enfermedades de Inmunodeficiencia Primaria/diagnóstico , Receptores CXCR4/genética , Inmunodeficiencia Combinada Grave/diagnóstico , Inmunodeficiencia Combinada Grave/epidemiología , Inmunodeficiencia Combinada Grave/etiología , Verrugas/diagnósticoRESUMEN
A 65-year-old man with acute myeloid leukemia 6 was treated by bone marrow allograft, developed a systemic classic chronic graft versus host disease with hepatic, rheumatologic, ophthalmic, and muco-cutaneous involvement. He received systemic corticosteroid, ruxolitinib and extracorporeal photopheresis which resulted in complete remission. During follow-up the patient presented with viral cutaneous warts on his neck and submandibular area. After various subsequent topical treatments, he developed localized cutaneous GVHD without any general GVHD reactivation symptoms. To the best of our knowledge, there has been no description in the literature of a graft versus host disease developing after local immunomodulatory or cytotoxic treatments. Topical therapies are commonly used by dermatologists for superficial skin cancers and some viral skin lesions, in high risk populations such as organ transplant patients with regular follow-up.Practitioners should be made aware of a possible localized cutaneous GVHD reactivation induced by Koebner phenomenon after local therapy.
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Enfermedad Injerto contra Huésped/etiología , Inmunomodulación , Enfermedades de la Piel/etiología , Verrugas/etiología , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Anciano , Aloinjertos , Trasplante de Médula Ósea/efectos adversos , Enfermedad Crónica , Dermatitis/etiología , Dermatitis/patología , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Humanos , Enfermedad Iatrogénica , Leucemia Mieloide Aguda/terapia , Masculino , Nitrilos , Psoriasis/etiología , Pirazoles/efectos adversos , Pirimidinas , Enfermedades de la Piel/patologíaRESUMEN
Poorly controlled and long-standing hidradenitis suppurativa (HS) increases the risk of squamous cell carcinoma (SCC). We report a 54-year-old woman with an over 20-year history of HS, who had previously undergone wide perineal excision with secondary intention healing and presented with a painful verrucous vulvar plaque and proximal non-healing perineal wound. The patient had four perineal scouting biopsies performed and excisional biopsy with no evidence of high-grade dysplasia or carcinoma on histology. Chromogenic in situ hybridization was negative for HPV 16 and 18 mRNA; the patient's HIV and HSV PCR were also negative. Our patient was treated with interferon alfa-2b with notable clinical improvement. There is currently no standardized stepwise approach to monitoring verrucous lesions in HS patients with significant risk factors for SCC. Our report highlights a vigilant approach to monitoring. If scouting biopsies are negative, complete testing for high risk HPV strains (HPV 16 and 18) is warranted. If negative, we recommend follow up every 6 months with no further biopsies except if overt clinical changes are observed. We also recommend treatment of verrucous changes to decrease risk of possible malignant conversion. Interferon alfa-2b was effective in decreasing the verrucous lesion burden in our patient and may be considered.
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Hidradenitis Supurativa/complicaciones , Interferón alfa-2/uso terapéutico , Verrugas/tratamiento farmacológico , Biopsia , Carcinoma de Células Escamosas/prevención & control , Transformación Celular Neoplásica , Condiloma Acuminado/patología , Diagnóstico Diferencial , Femenino , Hidradenitis Supurativa/cirugía , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/aislamiento & purificación , Humanos , Persona de Mediana Edad , Perineo/patología , ARN Viral/análisis , Insuficiencia del Tratamiento , Vulva/patología , Verrugas/etiología , Cicatrización de HeridasRESUMEN
Introduction: Severe Combined Immunodeficiency (SCID) is a life-threatening immunodeficiency caused by several pathogenic genetic variants, and it is characterized by profound defects in T-cell numbers and immune function. First performed in the late 1960's, hematopoietic stem cell transplantation remains the standard treatment for most cases of SCID. There is a growing number of post-transplant SCID patients, and it is imperative to assess the long-term outcomes of these patients. We have reported here the longest follow-up of a post-transplant SCID patient who, to our knowledge, bears the first gamma chain (γc) variant to show intact IL-21 signaling. Case Presentation: The patient presented at 5 months of age with recurrent thrush and Pneumocystis jiroveci pneumonia. In 1971, at the age of 11 months, he received an unconditioned, matched, related donor transplant comprising whole, unprocessed bone marrow. He is now 48 years old without significant illness and has never required immunoglobulin replacement. He exhibits T-dependent vaccine responses. He does suffer from chronic warts and bacterial infections that have worsened in recent years. We confirmed a known pathogenic variant in the IL2RG gene showing a hemizygous variant NM_000206.2:c.675C>A, resulting in p.Ser225Arg. His chimerism studies revealed donor T cells, host B cells, host myeloid cells, and mixed NK cells. Lymphocyte enumeration revealed normal numbers and distribution of B cells. The host B cells carry the pathogenic variant in IL2RG, but, when stimulated with IL-21, they demonstrated intact, γc-dependent signaling. Conclusions: Even with host B cells, reconstitution with donor T cells can be sufficient to allow over four decades of survival when B-cell function is intact. Our case demonstrates that satisfactory B-cell function can arise as a consequence of both intact IL-21 signaling due to a hypomorphic γc variant, and close HLA matching with the donor to allow for effective T-cell help.
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Linfocitos B/inmunología , Trasplante de Médula Ósea , Supervivencia de Injerto/inmunología , Reconstitución Inmune , Enfermedades por Inmunodeficiencia Combinada Ligada al Cromosoma X/cirugía , Aloinjertos , Cromosomas Humanos X/genética , Trasplante de Córnea , Femenino , Genes Ligados a X , Rechazo de Injerto , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/inmunología , Humanos , Infecciones/etiología , Subunidad gamma Común de Receptores de Interleucina/genética , Donadores Vivos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Mutación Missense , Mutación Puntual , Recurrencia , Hermanos , Verrugas/etiología , Enfermedades por Inmunodeficiencia Combinada Ligada al Cromosoma X/inmunologíaRESUMEN
RATIONALE: Tattooing is a procedure where ink is inserted typically in the intraepidermal space of the skin. Multiple incidences of viral infections following tattooing which lead to warts have been reported in recent years. The aim of this report was to show a relatively rare adverse effect after tattooing - verruca plana. PATIENT CONCERNS: A 27-year-old female presented to our department with complains of multiple verrucous papules over her 2-year-old tattoo without itch. DIAGNOSES: Pathological investigation confirmed the diagnosis as verruca plana. INTERVENTIONS: The patient was treated with 3 cycles of liquid nitrogen cryotherapy and 5% imiquimod cream for 5 months. OUTCOMES: A significant improvement in her lesions was observed after the combined treatment. LESSONS: Clinically, verruca plana post-tattooing is relatively less reported. We need to combine clinical manifestations with pathological results to arrive at a definitive diagnosis. Besides, there are a large numbers of post-tattoo complications and various routes of virus inoculation. Therefore, it is important for medical professionals to caution people before considering to have a tattoo.
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Tatuaje/efectos adversos , Virosis/complicaciones , Verrugas/patología , Verrugas/terapia , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/uso terapéutico , Administración Tópica , Adulto , Terapia Combinada , Crioterapia/métodos , Femenino , Humanos , Imiquimod/administración & dosificación , Imiquimod/uso terapéutico , Resultado del Tratamiento , Virosis/patología , Verrugas/etiologíaAsunto(s)
Amputación Quirúrgica , Carcinoma de Células Escamosas/diagnóstico , Errores Diagnósticos , Recurrencia Local de Neoplasia/diagnóstico , Enfermedades del Sistema Nervioso Periférico/complicaciones , Neoplasias Cutáneas/diagnóstico , Verrugas/diagnóstico , Muñones de Amputación/patología , Biopsia , Descompresión Quirúrgica , Humanos , Pierna/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/etiología , Recurrencia Local de Neoplasia/cirugía , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Piel/patología , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Verrugas/etiología , Verrugas/patología , Verrugas/cirugíaRESUMEN
Verruciform xanthoma is a benign, wart-like lesion that can clinically mimic squamous cell carcinoma. We describe two teenage patients with severe genodermatoses, recessive dystrophic epidermolysis bullosa (RDEB), and keratitis-ichthyosis-deafness (KID) syndrome, respectively, each found to have plaques suspicious for malignancy, later demonstrated on histopathologic examination to be verruciform xanthoma. We discuss the connection between these severe genodermatoses and the suspected pathophysiology of verruciform xanthoma. In addition, we highlight the importance of recognizing verruciform xanthoma as a clinical mimicker of squamous cell carcinoma, for which patients with RDEB and KID syndrome are at increased risk.
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Xantomatosis/diagnóstico , Adolescente , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Epidermólisis Ampollosa Distrófica/complicaciones , Epidermólisis Ampollosa Distrófica/genética , Femenino , Humanos , Queratitis/complicaciones , Queratitis/genética , Masculino , Neoplasias Cutáneas/diagnóstico , Verrugas/diagnóstico , Verrugas/etiología , Verrugas/genética , Xantomatosis/etiología , Xantomatosis/genética , Xantomatosis/patologíaRESUMEN
WHIM syndrome is a rare combined primary immunodeficiency disease named by acronym for the diagnostic tetrad of warts, hypogammaglobulinemia, infections, and myelokathexis. Myelokathexis is a unique form of non-cyclic severe congenital neutropenia caused by accumulation of mature and degenerating neutrophils in the bone marrow; monocytopenia and lymphopenia, especially B lymphopenia, also commonly occur. WHIM syndrome is usually caused by autosomal dominant mutations in the G protein-coupled chemokine receptor CXCR4 that impair desensitization, resulting in enhanced and prolonged G protein- and ß-arrestin-dependent responses. Accordingly, CXCR4 antagonists have shown promise as mechanism-based treatments in phase 1 clinical trials. This review is based on analysis of all 105 published cases of WHIM syndrome and covers current concepts, recent advances, unresolved enigmas and controversies, and promising future research directions.
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Enfermedades de Inmunodeficiencia Primaria/diagnóstico , Enfermedades de Inmunodeficiencia Primaria/etiología , Enfermedades de Inmunodeficiencia Primaria/terapia , Verrugas/diagnóstico , Verrugas/etiología , Verrugas/terapia , Inmunidad Adaptativa , Alelos , Terapia Combinada , Diagnóstico Diferencial , Manejo de la Enfermedad , Susceptibilidad a Enfermedades/inmunología , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Humanos , Inmunidad Innata , Mutación , Fenotipo , Medicina de Precisión/métodos , Enfermedades de Inmunodeficiencia Primaria/epidemiología , Verrugas/epidemiologíaAsunto(s)
Enfermedad de Crohn/diagnóstico , Enfermedades Raras/diagnóstico , Verrugas/etiología , Adulto , Biopsia , Nalgas , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/patología , Diagnóstico Diferencial , Femenino , Hidradenitis Supurativa/diagnóstico , Humanos , Infliximab/uso terapéutico , Perineo , Piodermia Gangrenosa/diagnóstico , Enfermedades Raras/complicaciones , Enfermedades Raras/patología , Piel/patología , Ombligo , Verrugas/tratamiento farmacológico , Verrugas/patologíaRESUMEN
The harmful effects of khat chewing on the oral mucosa membrane are still uncertain. Verruca vulgaris (common warts) is a benign lesion of skin and mucous membranes and can be caused by human papillomavirus. The lesions are typically self-limited but may vary in size and number. The occurrence on the floor of mouth is extremely rare. To the best of our knowledge, there are few number of oral lesions reported in connection with khat users. This case report shows that the chronic khat chewing has contributed to the development of verruca vulgaris warts that were confined to the chewing side of the mouth. A rare case of verruca vulgaris of the floor of mouth occurring in a 27-year-old Yamani male is presented with a discussion on etiopathogenesis and the treatment methods. Verruca vulgaris must be remembered in the differential diagnosis of the floor of mouth lesions, and surgical treatment may provide satisfactory outcomes.
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Catha/efectos adversos , Enfermedades de la Boca/etiología , Enfermedades de la Boca/cirugía , Mucosa Bucal/virología , Verrugas/etiología , Verrugas/cirugía , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Masticación , Enfermedades de la Boca/diagnóstico , Suelo de la Boca/virología , Hojas de la Planta/efectos adversos , Verrugas/diagnósticoAsunto(s)
Antivirales/uso terapéutico , Cejas/virología , Dermatosis Facial/terapia , Imiquimod/uso terapéutico , Láseres de Estado Sólido/uso terapéutico , Tatuaje/efectos adversos , Verrugas/terapia , Anciano , Terapia Combinada , Técnicas Cosméticas/efectos adversos , Dermatosis Facial/virología , Femenino , Humanos , Crema para la Piel , Verrugas/etiologíaRESUMEN
BACKGROUND: Fingolimod is used to reduce relapse rates in relapsing-remitting multiple sclerosis (MS). It is a sphingosine 1-phosphate (S1P) analogue having antagonistic effects on S1P receptors. Its immunosuppressive effect is due to reduced circulating lymphocyte numbers, and it may also be associated with impaired intrinsic cancer surveillance. Fingolimod side effects include increased rates and severity of viral infections particularly varicella zoster. METHODS: We present five cases of chronic and treatment refractory warts associated with fingolimod therapy. RESULTS: Each of the five cases presenting with chronic warts while receiving fingolimod therapy had prolonged periods of lymphopenia and improvements were seen following dose reduction or cessation of fingolimod. CONCLUSION: Cutaneous warts are associated with human papilloma virus (HPV) infection, suggesting an increased risk of other HPV-driven conditions such as cervical cancer following fingolimod administration. HPV viruses are responsible for approximately 90% of cervical cancers as well as a significant portion of anogenital cancers and have a high prevalence in sexually active adults. Given the reduced immune response to viral infections and potential impaired cancer surveillance in those receiving fingolimod, HPV vaccination and frequent assessment for the development of HPV-associated malignancies are recommended.
Asunto(s)
Neoplasias del Ano/etiología , Carcinoma de Células Escamosas/etiología , Clorhidrato de Fingolimod/efectos adversos , Inmunosupresores/efectos adversos , Linfopenia/inducido químicamente , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Infecciones por Papillomavirus/etiología , Verrugas/etiología , Tobillo , Antineoplásicos/uso terapéutico , Neoplasias del Ano/inmunología , Carcinoma de Células Escamosas/inmunología , Crioterapia , Dedos , Dermatosis del Pie/etiología , Dermatosis del Pie/inmunología , Dermatosis del Pie/terapia , Dermatosis de la Mano/etiología , Dermatosis de la Mano/inmunología , Dermatosis de la Mano/terapia , Humanos , Imiquimod/uso terapéutico , Infecciones por Papillomavirus/inmunología , Verrugas/inmunología , Verrugas/terapiaRESUMEN
Cysteine-X-cysteine chemokine receptor 4 (CXCR4) is a broadly expressed and multifunctional G protein-coupled chemokine receptor critical for organogenesis, hematopoiesis, and antimicrobial host defense. In the hematopoietic system, the binding of CXCR4 to its cognate chemokine ligand, CXCL12, mediates leukocyte trafficking, distribution, survival, activation, and proliferation. Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is a rare, autosomal dominant, combined immunodeficiency disorder caused by mutations in the C-terminus of CXCR4 that prevent receptor downregulation and therefore result in pathologically increased signaling. The "M" in the acronym WHIM refers to myelokathexis, the retention of neutrophils in the bone marrow resulting in neutropenia, which explains in part the increased susceptibility to bacterial infection. However, WHIM patients also present with B and T lymphopenia, which may explain the susceptibility to human papillomavirus (HPV), the cause of warts. The impact of WHIM mutations on lymphocytes and adaptive immunity has received less attention than myelokathexis and is the focus of this review.