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1.
Dermatol Online J ; 26(2)2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-32239897

RESUMEN

Erythema nodosum (EN) is a form of septal panniculitis, which is believed to represent a delayed hypersensitivity reaction activated by infectious agents, drugs, granulomatous and autoimmune diseases, pregnancy, and malignancies. There are only four reported cases of EN during oral isotretinoin therapy to our knowledge, all of them occurring in patients with severe acne. Since acne itself can trigger EN, the question as to whether there is indeed a causative relationship between isotretinoin and EN in the reported cases remains to be elucidated. We present herein a 20-year-old woman with multiple vulvar condylomata acuminata who developed EN two weeks after onset of oral isotretinoin therapy. To the best of our knowledge, this is the first report of EN occurring during isotretinoin treatment in a patient without acne and strongly indicates that the pathogenesis of EN can be directly related to the biological actions of isotretinoin. Erythema nodosum should be regarded as a rare side effect of oral isotretinoin therapy, regardless of the underlying disease. Physicians should be aware of this rare side effect.


Asunto(s)
Condiloma Acuminado/tratamiento farmacológico , Fármacos Dermatológicos/efectos adversos , Eritema Nudoso/inducido químicamente , Isotretinoína/efectos adversos , Piel/patología , Administración Oral , Biopsia , Fármacos Dermatológicos/uso terapéutico , Eritema Nudoso/patología , Femenino , Seronegatividad para VIH , Humanos , Isotretinoína/uso terapéutico , Adulto Joven
2.
Zhonghua Nei Ke Za Zhi ; 59(3): 222-224, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32146750

RESUMEN

To analyze the perceptions of cardiovascular specialists about Behcet's disease and its cardiovascular lesions in Beijing Anzhen Hospital, Capital Medical University. A survey using questionnaires was conducted among cardiovascular specialists in the hospital, the differences among groups were analyzed with χ(2) analyses. Less than half of the cardiovascular specialists were familiar with the diagnostic criteria of Behcet's disease (32.6%), and its skin lesions, as acne-like rash (41.3%), erythema nodosum (42.0%), acupuncture response (47.8%). The knowledge of its cardiovascular lesions was too superficial, especially in the awareness of heart conduction block. Most of the specialists preferred to use low dose of glucocorticoids before operation in their practice. To improve the knowledge and awareness of Behcet's disease and its cardiovascular lesions is of great significance for the early diagnosis, improvement of prognosis, and reduction of postoperative complications.


Asunto(s)
Síndrome de Behçet/diagnóstico , Cardiólogos , Competencia Clínica , Conocimientos, Actitudes y Práctica en Salud , Síndrome de Behçet/patología , Eritema Nudoso , Humanos , Pronóstico
6.
J Immunol Res ; 2019: 3405103, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31781675

RESUMEN

Leprosy reactions are acute immunological events that occur during the evolution of chronic infectious disease causing neural damage and disabilities. A study using blood samples of 17 leprosy reaction patients and 17 reaction-free was carried out by means of associations between antigens, receptors, and expression of cytokines, using path analysis providing new insights into the immunological mechanisms involved in triggering leprosy reactions. Toll-like receptors (TLR) such as TLR1 and TLR2, presented balanced expression in the reaction-free multibacillary (MB) group (TLR1: 1.01 ± 0.23, TLR2: 1.22 ± 0.18; p = 0.267). On the other hand, downgrading type 1 reaction (T1R) (TLR1: 1.24 ± 0.17, TLR2: 2.88 ± 0.37; p = 0.002) and erythema nodosum leprosum (ENL) (TLR1: 1.93 ± 0.17, TLR2: 2.81 ± 0.15; p = 0.004) revealed an unbalance in relation to the expression of these receptors. When the path analysis was approached, it was noted that interleukin 10 (IL-10) expression showed a dependence relation with phenolic glycolipid I (PGL-I) in downgrading T1R (direct effect = 0.503 > residual effect = 0.364), whereas in ENL, such relationship occurred with lipoarabinomannan (LAM) (direct effect = 0.778 > residual effect = 0.280). On the contrary, in the reaction-free leprosy group, interferon-gamma (IFN-γ) levels were dependent on the association between TLR2 and TLR1 (0.8735). The high TLR2 expression associated with IL-10 levels, in the leprosy reaction groups, may be hypothetically related to the formation of TLR2/2 homodimers and/or TLR2/6 heterodimers linked to evasion mechanisms in downgrading reactions and pathophysiology of ENL.


Asunto(s)
Eritema Nudoso/etiología , Regulación de la Expresión Génica , Interferón gamma/genética , Interleucina-10/genética , Lepra/etiología , Receptor Toll-Like 1/genética , Receptor Toll-Like 2/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Susceptibilidad a Enfermedades , Eritema Nudoso/diagnóstico , Eritema Nudoso/epidemiología , Eritema Nudoso/metabolismo , Femenino , Humanos , Interferón gamma/metabolismo , Interleucina-10/metabolismo , Lepra/diagnóstico , Lepra/epidemiología , Lepra/metabolismo , Masculino , Persona de Mediana Edad , Modelos Biológicos , Unión Proteica , Transducción de Señal , Receptor Toll-Like 1/metabolismo , Receptor Toll-Like 2/metabolismo , Adulto Joven
8.
J Med Case Rep ; 13(1): 276, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31472695

RESUMEN

BACKGROUND: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. CASE PRESENTATION: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still's disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. CONCLUSION: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Lepromatosa/diagnóstico , Diagnóstico Tardío , Errores Diagnósticos , Humanos , Masculino , Nepal , Enfermedad de Still del Adulto/diagnóstico , Tuberculosis Ganglionar/diagnóstico , Adulto Joven
9.
Adv Rheumatol ; 59(1): 35, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31370889

RESUMEN

The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.


Asunto(s)
Paniculitis/patología , Reumatólogos , Síndrome de Behçet/patología , Biopsia/métodos , Eritema Indurado/patología , Eritema Nudoso/patología , Etanercept/efectos adversos , Humanos , Inmunosupresores/efectos adversos , Infecciones/patología , Paniculitis/clasificación , Paniculitis de Lupus Eritematoso/patología , Poliarteritis Nudosa/patología , Grasa Subcutánea/patología , Tejido Subcutáneo/patología , Vasculitis/patología
11.
Ann Dermatol Venereol ; 146(8-9): 571-576, 2019 Sep.
Artículo en Francés | MEDLINE | ID: mdl-31151772

RESUMEN

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare, chronic, granulomatous, inflammatory disorder with potentially misleading clinical and radiological features. IGM is diagnosed after exclusion of infectious or tumoral diseases. Herein we report a case of erythema nodosum associated with IGM, which serves as a reminder that erythema nodosum may constitute an extra-mammary sign of IGM. PATIENTS AND METHODS: A 36-year-old nulliparous woman presented with fever and skin rash at our dermatology clinic at the North Franche-Comté hospital in July 2017. Symptoms had occurred 2 days previously. The patient had a fever of 38.8°C and typical erythema nodosum on the limbs. Physical examination showed an irregular, inflammatory, abscessed mass measuring 20cm with multiple shrinkage zones that had been developing for 4 weeks and for which breast examinations were being performed. Laboratory tests showed an inflammatory state (CRP 155mg/mL, WBC 14.6×109/L), other tests (serum electrolytes and calcium, hepatic and renal tests, Streptotest, T-spot, HIV, HBV, HCV serology, anti-streptolysin, anti-streptodornase, local microbiology samples, antinuclear antibodies, soluble antigens antibodies, hemocultures, angiotensin-converting-enzyme and chest x-rays) were normal. Microbiology investigations were negative. Mammography revealed invasive mastitis. Breast sample biopsies showed giant cell granulomas without caseous necrosis or tumor cells, and histochemical staining (PAS, Ziehl, Grocott, Gram) was negative. The final diagnosis was of IGM associated with erythema nodosum. Symptoms rapidly improved with oral steroids. DISCUSSION: As reported herein, erythema nodosum may be associated with IGM and support the diagnosis thereof. This association is rare, with fewer than 30 case reports described in the literature. IGM is an uncommon benign disorder of the breast that can mimic two frequent breast disorders: breast carcinoma and breast abscess. It usually occurs in young sexually active women. It appears as a tumor with an inflammatory solid painful mass, with nipple and skin retraction, occasionally with abscesses and accompanied by homolateral axillary lymphadenopathies. Radiologic findings are usually not specific for or suggestive of cancer. The histopathological picture of IGM is characterized by the presence of multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Minor ductal and periductal inflammation is usually present. IGM is rarely associated with autoimmune system manifestations, especially erythema nodosum, arthritis, episcleritis or hidradenitis suppurativa. Although the physiopathology of IGM remains unclear, this case serves as additional evidence that the etiology of IGM is of autoimmune origin. While there is no recommendation for the treatment of IGM, oral steroids remain the cornerstone of therapy. CONCLUSION: We report a case of IGM associated with erythema nodosum. Dermatologists must be aware of this association.


Asunto(s)
Eritema Nudoso/complicaciones , Mastitis Granulomatosa/complicaciones , Adulto , Eritema Nudoso/diagnóstico , Femenino , Mastitis Granulomatosa/diagnóstico , Humanos
12.
Int J Mycobacteriol ; 8(2): 208-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31210170

RESUMEN

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. Histoid Hansen's disease is an important emerging lepromatous subset of Hansen's disease known to mimic varied dermatoses. Occurrence of reactions, especially erythema nodosum leprosum (ENL), is rare in this form of leprosy. We report a case of Histoid Hansen's disease with initial presentation of ENL while undergoing management for infertility.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/microbiología , Lepra Lepromatosa/microbiología , Lepra Multibacilar/diagnóstico , Adulto , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Masculino , Piel/microbiología , Piel/patología
13.
Pharmacogenomics ; 20(7): 503-516, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31124417

RESUMEN

Aim: To evaluate the effects of gene polymorphisms in the treatment of erythema nodosum leprosum with prednisone/thalidomide. Patients & methods: A total of 152 patients from different regions of Brazil were included. Generalized estimating equation was used to evaluate the influence of polymorphisms and haplotypes on the drug dose variation throughout the treatment. Results: An association between the genotype tuberculoid of polymorphism ABCB1 3435C>T (rs1045642; p = 0.02) and prednisone dose was found in the recessive model. An association between the haplotypes 1031T/-863C/-857C/-308A/-238G (p = 0.006) and 1031T/-863C/-857T/-308A/-238G (p = 0.040) of the TNF gene and the CYP2C19*2 polymorphism were also identified, in relation to thalidomide dosage variation over the course of treatment. Conclusion: This work presents the first pharmacogenetic report of association between gene polymorphisms and erythema nodosum leprosum treatment with prednisone/thalidomide.


Asunto(s)
Citocromo P-450 CYP2C19/genética , Eritema Nudoso/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/genética , Subfamilia B de Transportador de Casetes de Unión a ATP/genética , Adulto , Brasil/epidemiología , Relación Dosis-Respuesta a Droga , Eritema Nudoso/genética , Eritema Nudoso/patología , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Haplotipos/genética , Humanos , Masculino , Polimorfismo Genético , Prednisona/administración & dosificación , Prednisona/efectos adversos , Receptores de Glucocorticoides/genética , Talidomida/administración & dosificación , Talidomida/efectos adversos
16.
Clin Nucl Med ; 44(6): e406-e408, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30932977

RESUMEN

The present article presented a 47-year-old woman with areas of nodular swelling and discoloration involving bilateral lower limbs since 12 months. Biopsy from skin lesions revealed erythema nodosum. As erythema nodosum can be secondary to multiple etiologies, whole-body F-FDG PET/CT was performed to assess the disease distribution and guide the site of biopsy. F-FDG PET/CT revealed metabolically active mediastinal lymphadenopathy in addition to the skin lesions. Endobronchial ultrasound-guided biopsy from subcarinal lymph node revealed tuberculosis.


Asunto(s)
Eritema Nudoso/etiología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tuberculosis/diagnóstico por imagen , Eritema Nudoso/patología , Femenino , Fluorodesoxiglucosa F18 , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/etiología , Persona de Mediana Edad , Radiofármacos , Piel/patología , Tuberculosis/complicaciones
17.
Clin Dermatol ; 37(2): 129-135, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30981293

RESUMEN

Erythematous painful cutaneous nodular lesions are associated with a host of disorders that may erupt acutely as a generalized or localized dermatitis or be associated with chronic and/or recurrent illnesses. This review discusses such disorders presenting with painful nodular lesions and attempts to provide a systematic approach to their clinical diagnosis.


Asunto(s)
Eritema Nudoso/etiología , Eritema Nudoso/patología , Exantema/etiología , Exantema/patología , Dolor/etiología , Síndrome de Behçet , Enfermedad Crónica , Diagnóstico Diferencial , Eritema Nudoso/diagnóstico , Hidradenitis , Humanos , Paniculitis , Poliarteritis Nudosa , Recurrencia , Síndrome de Sweet , Tromboflebitis , Vasculitis
18.
Turk J Med Sci ; 49(2): 624-634, 2019 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-30997978

RESUMEN

Background/aim: Erythema nodosum (EN) is an inflammatory disorder of subcutaneous tissue. Although etiopathogenesis of the disease is unknown, many predisposing factors such as infections, systemic disease, and drugs have been identified. Neutrophil to lymphocyte ratio (NLR) has been shown to be a novel inflammatory marker in many dermatological diseases. The aim of our study is to investigate NLR in EN patients and evaluate its relation to the underlying cause of the disease. Materials and methods: Between 2014 and 2018, clinical and laboratory data of 395 patients diagnosed with EN and 395 controls were extracted from patient files. EN patients were grouped as idiopathic EN and secondary EN (EN with an identified underlying cause). Clinical and laboratory characteristics of the two groups were compared Results: NLR was elevated in EN patients compared to controls (median of 2.38 vs. 1.55, P < 0.001). Among EN patients, NLR was also elevated in patients with secondary EN. In multivariate logistic regression model NLR (> 2.11), RDW-CV (> 13.65), and CRP (> 5.5) were identified as risk factors for secondary EN (relative risks were 17.16, 2.69, and 2, respectively). Conclusion: Elevated NLR (> 2.11) may be used as a parameter to discriminate secondary EN from idiopathic EN.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/complicaciones , Eritema Nudoso/diagnóstico , Índices de Eritrocitos/fisiología , Infecciones/complicaciones , Neoplasias/complicaciones , Neutrófilos/metabolismo , Adulto , Biomarcadores/metabolismo , Diagnóstico Diferencial , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/metabolismo , Eritema Nudoso/etiología , Eritema Nudoso/metabolismo , Femenino , Humanos , Infecciones/metabolismo , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Neoplasias/metabolismo , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo
19.
Brain Nerve ; 71(4): 345-349, 2019 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-30988218

RESUMEN

Cutaneous lesions of sarcoidosis show varied clinical features. They are categorized into specific types; skin sarcoid, scar infiltrations with granulomas and foreign bodies, and non-specific lesions like erythema nodosum. Identification of the cutaneous lesions is important for the diagnosis of sarcoidosis, because they are an easily accessible source of tissue for histologic examination. The commonest cutaneous lesions in sarcoidosis are the nodular and plaque types of skin sarcoid, and scar infiltrations. Since the preferential sites for skin sarcoid and scar infiltrations are the face and knees, respectively, these areas should be carefully examined.


Asunto(s)
Sarcoidosis/patología , Piel/patología , Eritema Nudoso/patología , Humanos , Placa Amiloide/patología
20.
Indian J Pharmacol ; 51(1): 72-74, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31031470

RESUMEN

The distressing consequences of immunology in leprosy is the lepra reaction. Erythema nodosum leprosum(ENL) in special cases need to be managed with capsule thalidomide in varying doses. We report such a case of bradycardia in thalidomide dose dependent manner in a young ENL male.


Asunto(s)
Bradicardia/inducido químicamente , Eritema Nudoso/tratamiento farmacológico , Leprostáticos/efectos adversos , Lepra Lepromatosa/tratamiento farmacológico , Talidomida/efectos adversos , Adulto , Relación Dosis-Respuesta a Droga , Humanos , Leprostáticos/administración & dosificación , Masculino , Talidomida/administración & dosificación , Adulto Joven
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