Pioderma gangrenoso y criptococosis cutánea primaria en un paciente con colitis ulcerosa / Pyoderma gangrenosum and primary cutaneous cryptococcosis in an ulcerative colitis patient

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Glucocorticosteroids and ciclosporin do not significantly impact canine cutaneous microbiota.

BACKGROUND: As prednisone and ciclosporin can have immunosuppressive effects and have been considered potential predisposing factors for skin infections, we investigated the impact of these drugs on the diversity of the cutaneous microbiota, the abundance of Malassezia and infection with Papillomaviruses. RESULTS: Six atopic, asymptomatic Maltese-beagle dogs were treated with ciclosporin for one month and then with prednisone for another month, with a one-month wash-out between treatments. The dogs were sampled on the abdomen and pinna before and after each treatment using a swab. Samples for Papillomavirus detection were obtained with cytobrush sticks. The bacterial microbiota was characterized using 16S amplicon high-throughput sequencing. Malassezia populations were quantified with nested real-time PCR targeting the ribosomal internal transcribed spacer 1. The diversity and composition of cutaneous microbiota was not impacted in a detectable manner by any of the treatments. As observed for the bacterial microbiota, Malassezia populations were not affected by treatment. Three dogs were positive for Papillomavirus at more than one timepoint, but an association with treatment was not apparent. CONCLUSIONS: Ciclosporin and prednisone at doses used for the treatment of atopic dermatitis do not impact the canine cutaneous microbiota in a detectable manner.

Elconixis por isotretinoína / Isotretinoin-induced elkonyxis

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Skin lesions in patients treated with imatinib mesylate: a 5-year prospective study.

Imatinib mesylate (IM) represents the first-line treatment of patients with chronic myeloid leukemia (CLM) or gastrointestinal stromal tumor (GIST). It presents several side effects. However, less than 10% are nonhematologic including nausea, vomiting, diarrhea, muscle cramps, and cutaneous reactions. The aim of our study was to identify data regarding IM cutaneous adverse effects (AEs) to improve the clinical diagnosis and management of the more frequent side effects. Skin examination should be done before and during IM treatment so that AEs can be diagnosed and treated early with less impact on chemotherapy treatments and on the quality of life of the patient.

Opportunistic deep cutaneous mycoses in solid organ transplant recipients.

Invasive fungal infections are a major cause of morbidity and mortality among organ transplant recipients, despite many progresses concerning diagnosis, preventions and treatment. Risk factors for invasive fungal infections in transplanted recipients include type and severity of immunosuppression, especially in life-saving organs as lung or liver, older age at transplantation, and technical complexity of surgery, living in endemic areas or exposure to a contaminated environment. Superficial fungal infections are caused by Candida, Dermatophytes, and Malassezia. In invasive mycoses, skin lesions may occur as a consequence of the systemic dissemination of invasive mycoses, or after direct inoculation in the skin. Aspergillosis, cryptococcosis, Zygomycoses, dark mould infections, fusariosis and infections attributable to Scedosporium and Pseudallescheria species are the most common etiological agents. Cutaneous manifestations of fungal infection are not specific, and a high degree of suspicion is required, and prompt biopsy for histology and culture is needed. Therapy with lyposomal amphotericin B and new triazoles are effective.

[Factors influencing on the prevalence frequency of infectious skin changes of bacterial and fungal origin in patients after kidney transplantation]. / Czynniki wplywajace na czestosc wystepowania infekcyjnych zmian skórnych o etiologii bakteryjnej i grzybiczej u chorych po przeszczepieniu nerki.

UNLABELLED: Infective skin changes are frequent complications in patients after kidney transplantation receiving immunosuppressive therapy. The aim of the study was to evaluate factors influencing on frequency and type of skin infections of bacterial and fungal origin in patients after kidney transplantation. The study was performed in 486 patients, 296 male (60.9%) and 190 female (39.1%) aged 46.1 +/- 13.1 years (18-74 years) 74.3 +/- 52.1 months after kidney transplantation remain mainly on triple immunosupresive therapy. Type, size and localization of skin changes revealed during dermatological evaluation were described according age, sex, and applied immunosuppression. The obtained results were analyzed based on t-Student's, Mann-Whitney's, chi-square and Fisher tests. It was shown that fungal infective skin changes in patients after kidney transplantation are more frequent in older population (48.4 +/- 11.8 vs. 45.2 +/- 13.4 years; p < 0.017). The significant differences concern interdigitale mycoses 49.7 +/- 11.1 vs. 45.4 +/- 13.3 years; p < 0.009, nail mycoses 51.5 +/- 10.4 vs. 45.5 +/- 13.2 years; p < 0,004 and foot mycoses 51.8 +/- 10.7 vs. 45.5 +/- 13.2 years; p < 0.0005. In male more frequent as compare with female were also fungal infections (30.7% vs. 18.4%; p < 0.002) including pityriasis versicolor 37.0% vs. 9.5%; p < 0.016 and interdigitale mycoses 18.6% vs. 9.0%; p < 0.004. CONCLUSIONS: Infective skin changes frequency in patients after kidney transplantation on immunosuppressive therapy depends on advanced age, male sex, and applied immunosuppressive therapy.

Cutaneous Alternaria infectoria infection in a dog in association with therapeutic immunosuppression for the management of immune-mediated haemolytic anaemia.

A 4-year-old, ovariohysterectomized, English springer spaniel on immunosuppressive therapy was re-examined for the review of its immune-mediated haemolytic anaemia and the recent development of skin lesions. For the 3 months since hospital discharge, the dog had been receiving 1.3 mg/kg prednisolone and 2.6 mg/kg ciclosporin, both administered orally twice daily. Physical examination revealed hepatomegaly and multiple, purulent, crusting, erosive to ulcerative lesions over different body areas. Onychorrhexis had occurred on one digit and the underlying corium had blackened. There were two proliferative and one plaque-like lesions in the mouth. Thick walled fungal hyphae were detected in impression smears from all skin lesions and staining with periodic acid-Schiff's stain confirmed the presence of multiple fungal hyphae and spores in all biopsies examined. Fungal culture isolated a heavy, pure growth of an Alternaria sp. which was identified as A. infectoria by sequencing the internal transcribed spacer 1 region of the rRNA gene. The animal's condition prevented detailed investigation of the oral lesions. Withdrawal of the ciclosporin and reduction of the prednisolone dosage resulted in spontaneous resolution of the skin lesions within 40 days. Further gradual decrements in the prednisolone dosage to zero were carried out without recurrence of the immune-mediated haemolytic anaemia. After 12 months, there has been no recurrence of either the skin lesions or the anaemia. To the authors' knowledge, this is the first reported case of A. infectoria infection in a dog.

Acute graft-versus-host disease after liver transplant: novel use of etanercept and the role of tumor necrosis factor alpha inhibitors.

Acute graft-versus-host disease following orthotopic liver transplantation is a rare but feared complication arising in 1% to 2% of cases with a dismal prognosis. It most often presents as fever, rash, and diarrhea with or without pancytopenia. Patients die from complications of marrow failure such as sepsis or bleeding. Because of its low incidence, there is no clear treatment protocol for this complication. Both increasing and withdrawing immunosuppression have been attempted with variable success. Although anti-tumor necrosis factor alpha therapy has been widely used for the treatment of steroid-resistant acute graft-versus-host disease in the hematopoietic stem cell transplant setting, there previously have been no reported cases of its use in liver transplantation. The aim of this report is to review a case of acute graft-versus-host disease and the use of etanercept to manage this complication. Etanercept has never previously been used in liver transplantation complicated by acute graft-versus-host disease. In the hematology literature, the success of its use is offset by significant rates of serious infectious (especially fungal) complications. However, preliminary results are encouraging and offer insight into its use as a potentially viable therapeutic option. We report the first successful use of etanercept in liver transplantation-associated graft-versus-host disease, albeit complicated by invasive aspergillosis, and recommend concurrent antifungal prophylaxis when the drug is used in this setting.

Pustulosis exantemática aguda generalizada: a proposito de un caso / Acute generalized exanthematous pustulosis: a report of a case

La pustulosis exantemática aguda generalizada (PEAG) es una patología poco frecuente en la población general y más rara aún en la infancia. Cursa con fiebre y una erupción de pequeñas pústulas estériles, no foliculares, sobre base eritematosa, que comienza en rostro o pliegues para luego generalizarse y resuelve con descamación en 4 a 10 días. El hallazgo histopatológico característico es la presencia de pústulas espongióticas intraepidérmicas. La mayoría de los casos es gatillada por drogas sistémicas, pero también puede ocurrir luego de infecciones. El tratamiento incluye la suspensión de la droga desencadenante si la hubiere y el uso de corticoides tópicos o sistémicos. Presentamos un varón de 12 años de edad que consultó por fiebre, eritema generalizado y pústulas, que aparecieron 48 horas luego de la ingesta de acetaminofén. El diagnóstico clínico presuntivo de PEAG fue confirmado con biopsia de piel. Se indicó suspensión del acetaminofén y se manejó ambulatoriamente con corticoides tópicos, presentando resolución completa del cuadro. Destacamos que la PEAG es una patología rara en la infancia y que en la literatura se describe un único caso asociado a la ingesta de acetaminofén

Acute generalized exanthematous pustulosis (AGEP) is an extremely rare condition in the general population and even more in children. Clinically it consists on an eruption of small, sterile and nonfollicular pustules on an erythematous background, beginning in the face or intertriginous areas that then generalized and resolve with desquamation in 4 to 10 days together with fever. Main histopathological findings are spongiotic intraepidermal pustules. Most cases are triggered by systemic drugs but they can also follow some infections. Treatment includes suspension of the responsible drug and the use of topical or systemic corticosteroids. We describe a 12-year-old boy that presented fever and generalized erythema and pustules that appeared 48 hours after the intake of acetaminophen. Clinical diagnosis of AGEP was confirmed by a skin biopsy. Acetaminophen discontinuation was indicated together with topical corticosteroids and complete resolution was achieved. We highlight that AGEP is uncommon in children and that the literature reports only one case secondary to acetaminophen consumption

Topical antibiotic induced otomycosis.

UNLABELLED: Prior to 1999, the diagnosis of otomycosis as a cause of persistent otorrhea was rare. An increase incidence has been seen in among our outpatient pediatric otolaryngology practice. The purpose of this study is to assess the contribution of ototopical antibiotic drops to the development of otomycosis. DESIGN: Retrospective study. SETTING: Pediatric otolaryngology outpatient center. METHODS: Chart review of all patients diagnosed with otomycosis between June 1999 and September 2001. Twenty-six patients (ages 17 months-29 years) were diagnosed with otomycosis based on clinical and microbiological findings after treatment with topical ofloxacin antibiotic drops. All patients had used ototopical antibiotics, including ofloxacin in every case, for presumed bacterial otorrhea. Once the fungal source was recognized, therapy succeeded in each case (26/26). Physicians need an elevated suspicion of otomycosis as a cause of persistent otorrhea, especially following treatment with topical antibiotic drops. Appropriate treatment of otomycosis eliminates otorrhea. Ofloxacin remains an excellent choice for bacterial otorrhea, but it appears to increase the incidence of otomycosis. Thus, its usage warrants careful post-treatment follow-up.