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1.
BMJ Case Rep ; 14(6)2021 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-34099443

RESUMEN

Sarcoidosis is an autoimmune multisystem granulomatous disorder of unknown aetiology, which mainly affects the adults in the age group of 20-39 years. The disease can affect any organ in the body but mainly presents as bilateral hilar lymphadenopathy, pulmonary infiltrates, cutaneous lesions, ocular manifestations and arthropathy. Lofgren's syndrome is an uncommon initial presentation of sarcoidosis which is recognised by the classical triad of acute arthritis, erythema nodosum and bilateral hilar lymphadenopathy. We describe a newly diagnosed case of sarcoidosis who presented as Lofgren's syndrome. Acute sarcoid arthritis should be kept as one of the differential diagnoses for patients presenting with acute arthritis and skin lesions; and chest X-ray should be considered to rule out bilateral hilar lymphadenopathy in these patients. Early suspicion and identification of classical clinical features are essential to establish early diagnosis.


Asunto(s)
Artritis , Eritema Nudoso , Exantema , Sarcoidosis , Adulto , Artritis/diagnóstico , Artritis/etiología , Eritema Nudoso/diagnóstico , Exantema/etiología , Humanos , Sarcoidosis/complicaciones , Sarcoidosis/diagnóstico , Síndrome , Adulto Joven
2.
J Radiol Case Rep ; 15(1): 21-29, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33717404

RESUMEN

Erythema nodosum (EN) is the commonest inflammation of the subcutaneous fat tissue (panniculitis). Erythema nodosum (EN) requires an interdisciplinary approach and exclusion of all underlying causes. We present a case of an 18-year-old female with a history of recurrent streptococcal infections over the years, who developed pain and swelling in the left ankle. To evaluate the persistent ankle swelling, the physician ordered a magnetic resonance imaging (MRI) of the left lower extremity. The MRI appearance of EN has not been described in detail in the literature so far.


Asunto(s)
Eritema Nudoso/diagnóstico por imagen , Adolescente , Femenino , Humanos , Imagen por Resonancia Magnética
3.
BMJ Case Rep ; 14(3)2021 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-33664030

RESUMEN

A 17-year-old previously healthy man presented with a 4-week history of progressive bilateral leg swelling with discomfort and erythema, but no signs of arthritis or erythema nodosum. An incidental finding of a query pulmonary nodule on chest X-ray prompted chest CT for further evaluation, revealing bilateral hilar and mediastinal lymphadenopathy. The patient then underwent endobronchial ultrasound and transbronchial needle aspiration biopsies of mediastinal lymph nodes. Biopsies and bronchoalveolar lavage samples were negative for microbiology, including mycobacterial culture. Pathology demonstrated non-caseating granulomas consistent with a diagnosis of sarcoidosis. Weeks later, he developed arthralgias of the left metacarpophalangeal joints and erythema nodosum and was diagnosed with Löfgren syndrome, a phenomenon rarely described in the paediatric population. This case highlights an approach to lower extremity swelling as well as hilar lymphadenopathy in the paediatric population. In addition, it emphasises the importance of multidisciplinary teamwork for accurate and timely diagnoses.


Asunto(s)
Eritema Nudoso , Sarcoidosis , Adolescente , Niño , Eritema Nudoso/diagnóstico , Humanos , Pierna , Ganglios Linfáticos , Masculino , Mediastino
4.
Int J Dermatol ; 60(6): 724-729, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33580883

RESUMEN

BACKGROUND: Panniculitides are a heterogeneous group of inflammatory dermatoses involving the subcutaneous fatty tissue. Histologically, they are classified into septal and lobular panniculitis, according to the predominant localization of the inflammatory infiltrate. Neutrophils are frequently found in panniculitis, mainly at the early stages. Here, we investigated whether neutrophils contribute to various types of cutaneous panniculitis by releasing neutrophil extracellular traps (NETs). MATERIALS AND METHODS: Formalin-fixed paraffin-embedded skin biopsies from 25 patients with panniculitis were included in the study. Our cohort was divided into n = 10 erythema nodosum (septal panniculitis) and n = 15 lobular panniculitis, including n = 7 lupus panniculitis, n = 1 pancreatic panniculitis, n = 1 Weber-Christian disease, n = 1 deep fungal infection, n = 2 lipodermatosclerosis, and three cases did not have an identified etiology. The presence of neutrophils and NETs was assessed by double immunofluorescence using antibodies against elastase, a neutrophilic marker, and citrullinated histone 3, a marker of NETs. RESULTS: The mean percentages (±SEM) of elastase-positive neutrophils showing NETs were 44% ± 3% in erythema nodosum and 43% ± 7% in lobular panniculitis. The difference was not statistically significant and reflects the implication of NETs not only in severe scarring lobular panniculitis but also in benign non-scarring self-remitting reactive inflammation such as erythema nodosum. In tissues, NETs were located in the interlobular septa in erythema nodosum and in the inflamed fat lobules in lobular panniculitis. CONCLUSIONS: NETs are massively present in septal and lobular subtypes of panniculitides, suggesting their involvement in tissue damage.


Asunto(s)
Eritema Nudoso , Trampas Extracelulares , Paniculitis de Lupus Eritematoso , Paniculitis , Humanos , Piel
5.
J Dermatol ; 48(4): 431-438, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33608949

RESUMEN

Inflammatory bowel disease (IBD) presents with various extraintestinal manifestations. As part of them, various skin diseases are suggested to be related to IBD. We aimed to identify the epidemiology and risk of developing skin manifestations in patients with IBD. We used Korean insurance claims data and selected patients with IBD and age/sex-matched non-IBD subjects between 2013 and 2017 using the diagnosis code and prescription records of IBD-specific medications. The prevalence and risk of concurrent skin diseases were estimated. We identified 64 837 patients with IBD. Reactive skin eruptions including pyoderma gangrenosum and erythema nodosum were associated with IBD with highest odds ratios among three categories of reactive, inflammatory, and autoimmune skin diseases. Inflammatory skin diseases including rosacea, psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne conglobata were significantly associated with IBD, but the association was less marked compared to reactive skin eruptions. The patients with IBD also had a higher risk of autoimmune skin diseases including vitiligo and alopecia areata than non-IBD subjects. We determined that IBD was related to various skin diseases including reactive, inflammatory, and autoimmune skin diseases. Considering these relationships can allow better management of patients with IBD and comorbid skin diseases.


Asunto(s)
Colitis Ulcerosa , Eritema Nudoso , Enfermedades Inflamatorias del Intestino , Piodermia Gangrenosa , Estudios Transversales , Eritema Nudoso/epidemiología , Eritema Nudoso/etiología , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/epidemiología , Piodermia Gangrenosa/epidemiología , Piodermia Gangrenosa/etiología , República de Corea/epidemiología
8.
Clin Nucl Med ; 46(7): e395-e397, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-33512954

RESUMEN

ABSTRACT: Behçet disease is a rare multisystemic vasculitis that can affect all sizes and types of blood vessels. Recurrent painful erythematous nodular lesions called erythema nodosum are the most common skin lesions of Behçet disease. Herein, we present 18F-FDG PET/CT images of erythema nodosum lesions in a patient with Behçet disease.


Asunto(s)
Síndrome de Behçet/complicaciones , Eritema Nudoso/complicaciones , Eritema Nudoso/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Eritema Nudoso/patología , Humanos , Masculino , Persona de Mediana Edad
10.
Int J Infect Dis ; 103: 549-551, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33326870

RESUMEN

Type 2 leprosy reaction (T2LR), or Erythema Nodosum Leprosum (ENL), often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are known to achieve control and lower steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19, with the concern of worsening COVID-19 with long-term immunosuppression has not previously been encountered. We report a case of severe T2LR treated with oral steroids and methotrexate, with COVID-19 infection acquired during hospital stay, and a favourable outcome achieved despite the continued use of immunosuppressants. We discuss the possible reasons for this both in terms of the drug pharmacodynamics and the immunological profile of T2LR.


Asunto(s)
Corticoesteroides/administración & dosificación , COVID-19/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Metotrexato/administración & dosificación , SARS-CoV-2 , Adulto , COVID-19/inmunología , Eritema Nudoso/inmunología , Humanos , Lepra Lepromatosa/inmunología , Masculino
11.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(8): 683-687, oct. 2020. tab
Artículo en Español | IBECS | ID: ibc-197156

RESUMEN

El eritema nudoso (EN) es la paniculitis más frecuente y aunque puede ser idiopático, presenta múltiples procesos causales. Elaboramos un estudio retrospectivo, observacional y descriptivo de las causas de EN en pacientes ingresados en un hospital español de tercer nivel durante un período de 11 años, y comparamos los resultados obtenidos con los publicados en otros trabajos. Comparamos los marcadores analíticos de inflamación entre causas inflamatorias y no inflamatorias de EN. La cohorte final quedó compuesta por 52 pacientes, con un 20% de casos idiopáticos, un 34% de casos secundarios a infecciones y otro 34% de casos secundarios a enfermedades autoinmunes. No hubo casos secundarios a fármacos o linfomas. No observamos diferencias significativas en los parámetros analíticos de inflamación en función de causa inflamatoria o no inflamatoria de EN


Erythema nodosum (EN) is the most frequent panniculitis, and although it can be idiopathic, it presents multiple causal processes. We made a retrospective, observational and descriptive study about causes of EN in patients admitted to a third-level Spanish hospital over a period of 11 years, and we compared the results obtained with those published in other studies. We compared the analytical markers of inflammation between inflammatory and non-inflammatory causes of EN. The final cohort was composed by 52 patients, with 20% of idiopathic cases, 34% of cases secondary to infections and another 34% of cases secondary to autoimmune diseases. There were no cases secondary to drugs or lymphomas. We did not observe significant differences in the analytical parameters of inflammation between inflammatory or non-inflammatory cause of EN


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Eritema Nudoso/etiología , Eritema Nudoso/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Estudios Retrospectivos , Distribución por Edad y Sexo , Estadísticas no Paramétricas , España/epidemiología
12.
Rev Soc Bras Med Trop ; 53: e20190454, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32935774

RESUMEN

INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.


Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra Multibacilar , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Leprostáticos , Masculino , Persona de Mediana Edad , Talidomida , Adulto Joven
13.
Am J Trop Med Hyg ; 103(5): 1841-1843, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32815503

RESUMEN

We report two cases of pediatric melioidosis. Both presented with erythema nodosum (EN) on the lower limbs. They both resided in an endemic region for this condition, and a presumptive diagnosis was made by high indirect hemagglutination assay titers of > 5,120 in both. Before this, there has been no recorded association between melioidosis and EN.


Asunto(s)
Antibacterianos/uso terapéutico , Eritema Nudoso/complicaciones , Melioidosis/complicaciones , Melioidosis/tratamiento farmacológico , Niño , Preescolar , Humanos , Masculino
14.
PLoS Negl Trop Dis ; 14(8): e0008329, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32760161

RESUMEN

The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.


Asunto(s)
Lepra/tratamiento farmacológico , Talidomida/efectos adversos , Talidomida/uso terapéutico , Anomalías Inducidas por Medicamentos/epidemiología , Brasil/epidemiología , Eritema Nudoso/tratamiento farmacológico , Femenino , Humanos , Leprostáticos/efectos adversos , Leprostáticos/uso terapéutico , Lepra/epidemiología , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Embarazo
15.
An Bras Dermatol ; 95(6): 737-739, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32843250

RESUMEN

Sporothrix spp. infection can occur through the inoculation of the organism in the skin through direct contact with the soil (sapronotic infection), through contact with animals, such as infected cats and dogs (zoonotic infection), or less frequently via inhalation. With a subacute or chronic evolution, approximately 80% of patients affected by the disease present with the lymphocutaneous form; episodes associated with a hypersensitivity reaction are rare. The authors report the case of a 12-year-old child with immunoreactive sporotrichosis manifested clinically as erythema nodosum lesions in the lower limbs, associated with an ulcerated lesion in the left arm.


Asunto(s)
Eritema Nudoso , Hipersensibilidad , Esporotricosis , Animales , Gatos , Niño , Perros , Humanos , Sporothrix , Esporotricosis/diagnóstico , Zoonosis
16.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-32641310

RESUMEN

Erythema nodosum (EN) is a common dermatological manifestation with many different aetiologies. Often however, the aetiology remains unidentified. We present here a 42-year-old male patient with an EN that is due to an acute COVID-19 infection. Most of the usual aetiologies were excluded by laboratory testing and imaging studies. This case is, to our knowledge, the first report of this cutaneous manifestation in the context of a COVID-19 infection. The EN was successfully treated with the disappearance of the COVID-19 infection and topical corticosteroids.


Asunto(s)
Analgésicos/administración & dosificación , Infecciones por Coronavirus , Eritema Nudoso , Glucocorticoides/administración & dosificación , Pandemias , Neumonía Viral , Tomografía Computarizada por Rayos X/métodos , Adulto , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Eritema Nudoso/diagnóstico , Eritema Nudoso/etiología , Eritema Nudoso/terapia , Humanos , Masculino , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Radiografía Torácica/métodos , Crema para la Piel/administración & dosificación , Resultado del Tratamiento
18.
Am J Trop Med Hyg ; 103(4): 1439-1440, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32700675

RESUMEN

Leprosy is a rare, chronic granulomatous disease, and India accounts for two-thirds of the new cases reported worldwide. Hypercalcemia is a rare complication of granulomatous disease. Here, we report a case of an older adult patient with leprosy and type I lepra reaction presenting with severe hypercalcemia.


Asunto(s)
Hipercalcemia , Lepra/complicaciones , Anciano , Eritema Nudoso/tratamiento farmacológico , Humanos , Hipercalcemia/complicaciones , Hipercalcemia/tratamiento farmacológico , India , Leprostáticos/uso terapéutico , Masculino
19.
BMC Med Genet ; 21(1): 126, 2020 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-32513120

RESUMEN

BACKGROUND: Nakajo-Nishimura syndrome (NNS) is an autosomal recessive heredity disorder, one of a spectrum of autoinflammatory diseases named proteasome-associated autoinflammatory syndrome (PRAAS) caused by mutations of PSMB8 gene. NNS is characterized by pernio-like skin rashes, intermittent fever, and long clubbed fingers and toes with joint contractures, partially with progressive lipomuscular atrophy, emaciation, hepatosplenomegaly and basal ganglion calcification. CASE PRESENTATION: We presented a sporadic case of NNS with compound heterozygous mutations in the PSMB8 gene. The 4-year-old boy was affected by progressive erythematous plaques on his nose and gradually involved hands and feet later with characteristic appearance of long clubbed fingers. The repetitive periodic intermittent fever was recorded. By gene sequencing, novel compound heterozygous mutations c.373C > T (p.R125C) and c.355G > A (p.D119N) in the PSMB8 gene were found. The patient responded well to low dosage of oral methylprednisolone. CONCLUSIONS: We reported novel compound heterozygous mutations in PSMB8 in a sporadic Chinese NNS patient.


Asunto(s)
Grupo de Ascendencia Continental Asiática/genética , Eritema Nudoso/genética , Dedos/anomalías , Mutación/genética , Complejo de la Endopetidasa Proteasomal/genética , Secuencia de Bases , Preescolar , Eritema Nudoso/patología , Dedos/patología , Heterocigoto , Humanos , Masculino
20.
Ter Arkh ; 92(5): 33-38, 2020 Jun 05.
Artículo en Ruso | MEDLINE | ID: mdl-32598773

RESUMEN

AIM: To study clinical and laboratory features of panniculitis (Pn) in modern rheumatology. MATERIALS AND METHODS: The study included 690 patients with Pn (615 women and 75 men, average age 39.410.26) with the prevailing referral diagnosis of Erythema nodosum (59.2%), Pn (27.5%), Rheumatic disease Rd (9%), other diseases (4.4%),who had been on outpatient and/or inpatient treatment for 10 years. All patients were examined according to our diagnostic algorithm: general clinical, immunological and histological examinations, computed tomography of the chest organs, tuberculin tests. RESULTS: Pn with Rd was diagnosed in 140 patients (118 women and 22 men, average age 40.2114.87), average disease duration 31.06 [0.1; 541] months. In most cases (49%) patients had idiopathic lobular Pn which belongs to the group of systematic lesions of connective tissue (M35.6), as well as systemic lupus erythematosus and Behcet disease (13% each), rheumatoid arthritis (8%), dermatomyositis (6.4%), etc. Matching of the referral and final diagnoses was 35% in case of Rd. Among the examined patients prevailed those with a moderate (51.07%) degree of activity of the underlying disease. Within the study group Pn was represented by all forms, but mainly by nodular form (64.02%). Mesenteric form was characteristic only for idiopathic lobular Pn. The main features of Pn associated with Rd were identified. In modern clinical practice the type of Pn and the activity of the underlying disease determine the approaches to treatment.


Asunto(s)
Eritema Nudoso , Lupus Eritematoso Sistémico , Paniculitis , Enfermedades Reumáticas , Reumatología , Niño , Preescolar , Femenino , Humanos , Masculino
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