ABSTRACT
We present a case of a man in his 40s who was on haemodialysis for over 20 years presenting with rapidly progressive decline in mobility, associated with fixed flexion deformities of joints and peau d'orange appearance of skin together with areas of ulceration that was concerning for calciphylaxis. Skin biopsies were consistent with both nephrogenic systemic fibrosis and calciphylaxis. He has never had exposure to gadolinium-based contrast agent. His treatment included daily dialysis sessions, which were challenging due to vascular access issues and three times weekly sodium thiosulfate. He rapidly declined in hospital and died within 2 weeks of presentation while being treated for a hospital-acquired pneumonia.
Subject(s)
Calciphylaxis , Kidney Failure, Chronic , Nephrogenic Fibrosing Dermopathy , Male , Humans , Nephrogenic Fibrosing Dermopathy/chemically induced , Renal Dialysis , Gadolinium/adverse effects , Calciphylaxis/chemically induced , Calciphylaxis/complications , Skin/pathology , Contrast Media/adverse effects , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/pathology , FibrosisABSTRACT
We report nine travellers with confirmed chikungunya virus infection, returning from tourist areas of Thailand to Sweden, Switzerland, the United Kingdom, Romania, Israel and France, diagnosed in January and February 2019. These sentinel tourists support the intensification of chikungunya virus circulation in Thailand and highlight the potential for importation to areas at risk of local transmission.
Subject(s)
Aedes/virology , Chikungunya Fever/diagnosis , Chikungunya virus/isolation & purification , Disease Outbreaks , Sentinel Surveillance , Travel , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Animals , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthralgia/drug therapy , Arthralgia/etiology , Chikungunya Fever/drug therapy , Chikungunya Fever/epidemiology , Dengue/epidemiology , Europe , Fever/drug therapy , Fever/etiology , Humans , Male , Middle Aged , Middle East , Mosquito Vectors , Real-Time Polymerase Chain Reaction , Thailand/epidemiology , Young AdultABSTRACT
Cutaneous toxicities associated with BRAF inhibitor treatment in patients with metastatic melanoma have been well described. We present a rare association of granulomatous dermatitis in association with the BRAF inhibitor vemurafenib. Three patients with metastatic melanoma all presented with asymptomatic papular eruptions 8-21 months into vemurafenib therapy. Skin biopsies confirmed the diagnosis of granulomatous dermatitis. Other causes of granulomatous dermatitis including infectious agents and sarcoid were excluded. Treatment with potent topical and oral steroids improved the eruptions, but only after the cessation of vemurafenib did all 3 cases of granulomatous dermatitis completely resolve within 2 weeks. It is important to recognize that this association, unlike most other BRAF inhibitor-related skin toxicities, can occur many months after commencement of therapy and that vemurafenib treatment can be continued without clinically significant adverse effects.