Visceral leishmaniasis with cutaneous symptoms in a patient treated with infliximab followed by fatal consequences.

Leishmaniasis is an infectious disease caused by parasitic flagellates of the genus Leishmania. The authors present a case of 44-year-old man with Crohn's disease treated successfully with infliximab. This case report shows rare visceral leishmaniasis with cutaneous symptoms in an immunocompromised patient. Skin manifestations may occur before or after the visceral infection and they are often diverse.

Juvenile generalized pustular psoriasis treated with etanercept.

An 8-year-old boy with general pustular psoriasis (GPP) and iatrogenic secondary Cushing syndrome was treated successfully with etanercept after he had failed on acitretin, methotrexate, and methylprednisolone therapy. GPP is a severe and very rare variant of psoriasis in children often accompanied by life-threatening complications. Retinoids, cyclosporine, methotrexate, or dapsone used in a small number of case series and case reports were effective. Etanercept is a recombinant human tumor necrosis factor-alpha (TNF-alpha) receptor protein fused with Fc portion of IgG1 that binds to TNF-alpha, approved by Food and Drug Administration for the treatment of moderate-to-severe plaque psoriasis in children and teens who have not responded to other psoriasis treatments. In our patient, etanercept demonstrated significant clinical response associated with long-term efficacy without acute exacerbation, excellent tolerability, and good safety profile.

The rare case of Alternaria alternata cutaneous and pulmonary infection in a heart transplant recipient treated by azole antifungals.

We report a case of Alternaria alternata cutaneous and pulmonary infection in a 62-year-old man after heart transplantation treated by azole antifungals. Alternaria spp. belong to a group of opportunistic dematiaceous fungi with worldwide distribution. The cutaneous form of the infection in human is very rare and occurs predominantly among immunosuppressed patients. Therefore, diagnosis is often delayed or not reached at all. Appropriate treatment is not standardized and remains a matter of discussion. According to current studies, the best results are obtained with systemic azole antifungal therapy combined with surgical intervention.

Risk factors for comorbidities in Czech psoriatic patients: results of a hospital-based case-control study.

BACKGROUND: Psoriasis is now known to be associated with multiple other diseases/comorbidities - including the metabolic syndrome, atherosclerosis and gastrointestinal diseases which are all significantly higher in psoriasis patients. Research results however are highly variable and the conclusions are ambiguous. As no similar study has been performed to date in Czech psoriatic patients, this study aimed at identifying risk factors and early stages of selected diseases/comorbidities in the patients. METHODS AND RESULTS: The study was designed as a hospital-based case-control study. 131 patients with chronic plaque psoriasis formed the cases and 267 patients with other skin disorders formed the controls. A comparison was made of basic demographic and anthropometric indicators, metabolic parameters, the presence of specific antibodies (ASCA, AEP, p-ANCA, AGC, EMA, ARA, t-TG, AGA) and non-specific signs of gastrointestinal diseases. The chi squared, MWU tests and binary logistical model were used to evaluate the data. The results showed significant differences (P<0.05) for the following parameters: blood pressure, waist circumference, weight, BMI values, leucocytes values, HDL cholesterol level, glycemia and gliadine antibody IgA level. All differences were to the detriment of psoriasis patients. In the binary logistical model the following parameters were associated with psoriasis: diastolic blood pressure, leucocyte value and glycemia. For all variables included in the logistical model P≤0.001. CONCLUSIONS: The results were coherent and consistent with existing data. They indicate that psoriasis is interconnected with hypertension, higher BMI and a decreased level of HDL cholesterol. These parameters have been clearly demonstrated as risk factors for the development of cardiovascular diseases. Higher levels of gliadine IgA antibodies are one of the diagnostic markers of celiac disease. Higher values of leukocytes may be interpreted as a nonspecific indicator of gastrointestinal inflammatory diseases. The associations between psoriasis and diastolic blood pressure, BMI value and glycemia are statistically significant in the binary logistic regression model. Care for psoriatic patients should focus especially on secondary prevention of predisposing diseases.

Management of lymphedema.

The basic principle of the management of lymphedema is so called complex decongestive physical therapy. This therapy is divided into two phases: (i) edema reduction phase--an initial intensive treatment phase aiming for limb volume reduction; and (ii) maintenance phase--following long-term phase to sustain a manageable limb volume. The first phase consists of a number of physical therapeutic approaches which are: manual lymph drainage, pneumatic pump drainage, low-stretch bandaging, exercises, and skin care. Long-term maintenance phase consists of self-lymph drainage, low-stretch bandaging, or compressive garments, and sometimes when indicated pneumatic pump drainage, exercises, and skin care.

Pemphigus vulgaris treated with adalimumab: case study.

The study describes the case of a patient with a clinical and histopathological diagnosis of pemphigus vulgaris accompanied by severe side-effects of combined immunosuppressive therapy, who achieved a remission of the disease with adalimumab. Pemphigus vulgaris is a chronic blistering disease of the skin and mucous membranes. Before corticosteroids were introduced, mortality was high. Corticosteroids are currently used as first-line therapy. To reduce the dose of corticosteroids, therapeutic combinations with corticosteroid-sparing immunosuppressive agents are used. The therapy brings a number of complications due to its side effects. To achieve a remission of the disease by treating our patient with combined immunosuppressives, we administered adalimumab and achieved a very good clinical response.

A comparative study of the impairment of quality of life in Czech children with atopic dermatitis of different age groups and their families.

BACKGROUND: Atopic dermatitis (AD) still remains one of the most common childhood inflammatory skin diseases. As a chronic disease, it can have a physical and psychological effect on social functioning of the affected child as well as their family. The objective of this study was to evaluate the quality of life of children with AD of different age groups and their families. METHODS: A total of 203 children with a diagnosis of AD from newborn to 18 years of age and 202 of their parents took part in our study (as one parent did not return the questionnaire). All participants, according to their age, completed the following questionnaires: Infants' Dermatitis Quality of Life Index (IDQOL); Children's Dermatology Life Quality Index (CDLQI) - text and cartoon version; and Dermatitis Family Impact questionnaire (DFI). RESULTS: The mean total IDQOL score in our study was 8.18 (SD = 5.84, n = 120). The mean total CDLQI scores in the groups of children from 7 to 13 and from 14 to 18 years were 8.58 (SD = 4.98, n = 48) and 9.89 (SD = 5.26, n = 35). There was also a proven influence of the child's AD on the quality of life of his parents with the mean score: 7.98 (SD = 6.41, n = 202). CONCLUSIONS: The study demonstrated and confirmed that AD significantly impairs the children's quality of life in all age groups and also quality of life of their families. Such data give us patient-oriented information that is of great importance for understanding the situation of individuals with AD and its influence on members of their family.

[Lymphogranuloma venereum]. / Lymphogranuloma venereum.

Lymphogranuloma venereum is a sexually transmitted disease caused by serovars L1-3 of Chlamydia trachomatis. This infection was originally endemic in tropics and transmitted predominantly by heterosexual contact but since the beginning of the century it spreads in industrialized countries mainly among men having sex with men causing them severe proctitis. In the Czech Republic the first case was diagnosed in 2011. Lymphogranuloma venereum can resemble other forms of anorectal disorders inclusive inflammatory bowel diseases and thus it must be included into differential diagnostic considerations. Definitive diagnosis is based on detection of specific serovars of Chlamydia trachomatis by polymerase chain reaction. In patients with lymphogranuloma venereum it is also necessary to exclude other sexually transmitted diseases, particularly syphilis, HIV and also hepatitis C. The therapy of choice is doxycycline administered for three weeks.