Manifestaciones dermatológicas en los pacientes con trasplante renal / Dermatologic Manifestations in kidney transplant recipients

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Dissecting cellulitis of the scalp / Celulitis disecante del cuero cabelludo

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Úlcera crónica en paciente con trasplante renal / Chronic Ulceration in a Kidney Transplant Recipient

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Urticaria vasculitis: estudio retrospectivo de 15 casos / Urticarial Vasculitis: A Retrospective Study of 15 Cases

Introducción: La urticaria vasculitis (UV) es un subtipo de vasculitis caracterizada clínicamente por lesiones de tipo urticarial e histológicamente por vasculitis necrotizante. Objetivo: El objetivo de este trabajo es el estudio de los pacientes con urticaria vasculitis que han sido atendidos en el Servicio de Dermatología del Hospital Universitario Virgen del Rocío (Sevilla, España) para determinar las características de presentación clínicas e histológicas, así como el despistaje de hipocomplementemia, en estrecha relación con enfermedad sistémica asociada. Material y métodos: Se han extraído de la base de datos de nuestro servicio los casos de urticaria vasculitis confirmados histológicamente durante un período de 10 años. Resultados: Quince pacientes fueron diagnosticados de urticaria vasculitis (9 mujeres y 6 hombres, con una mediana de edad de 51 años). En 14 pacientes (93%) las lesiones persistían más de 24 horas. En 9 pacientes (60%) las lesiones se resolvían con púrpura e hiperpigmentación residual. Siete pacientes (47%) presentaron niveles disminuidos de complemento en sangre, 12 pacientes (80%) asociaron síntomas extracutáneos y 8 pacientes (53%) asociaban enfermedad sistémica, siendo la entidad más frecuente el lupus eritematoso sistémico. Conclusiones: La urticaria vasculitis constituye a menudo una entidad infradiagnosticada, con una variable respuesta al tratamiento y en la que la existencia de niveles de complemento disminuidos y de síntomas extracutáneos puede ser indicativa de enfermedad sistémica asociada (AU)

Introduction: Urticarial vasculitis is a subtype of vasculitis characterized clinically by urticarial lesions and histologically by necrotizing vasculitis. Objective: To study the clinical and histologic features of urticarial vasculitis in patients seen in the dermatology department of Hospital Universitario Virgen de Rocío in Seville, Spain, and to examine the association between hypocomplementemia and systemic disease. Material and methods: We performed a chart review of histologically confirmed cases of urticarial vasculitis in the database of our department covering a period of 10 years. Results: Fifteen patients (9 women and 6 men with a median age of 51 years) were included. In 14 patients (93%), the lesions persisted for more than 24 hours, and in 9 cases (60%) the lesions resolved leaving residual purpura or hyperpigmentation. Seven patients (47%) had low complement levels in the blood, 12 (80%) had extracutaneous symptoms, and 8 (53%) had associated systemic disease, the most common of which was systemic lupus erythematosus. Conclusions: Urticarial vasculitis may be underdiagnosed. Response to treatment is variable, and hypocomplementemia and extracutaneous symptoms may indicate the presence of associated systemic disease (AU)

Urticarial vasculitis: a retrospective study of 15 cases.

INTRODUCTION: Urticarial vasculitis is a subtype of vasculitis characterized clinically by urticarial lesions and histologically by necrotizing vasculitis. OBJECTIVE: To study the clinical and histologic features of urticarial vasculitis in patients seen in the dermatology department of Hospital Universitario Virgen de Rocío in Seville, Spain, and to examine the association between hypocomplementemia and systemic disease. MATERIAL AND METHODS: We performed a chart review of histologically confirmed cases of urticarial vasculitis in the database of our department covering a period of 10 years. RESULTS: Fifteen patients (9 women and 6 men with a median age of 51 years) were included. In 14 patients (93%), the lesions persisted for more than 24hours, and in 9 cases (60%) the lesions resolved leaving residual purpura or hyperpigmentation. Seven patients (47%) had low complement levels in the blood, 12 (80%) had extracutaneous symptoms, and 8 (53%) had associated systemic disease, the most common of which was systemic lupus erythematosus. CONCLUSIONS: Urticarial vasculitis may be underdiagnosed. Response to treatment is variable, and hypocomplementemia and extracutaneous symptoms may indicate the presence of associated systemic disease.

Xantogranuloma juvenil diseminado del adulto asociado a linfoma folicular, respuesta completa a quimioterapia y rituximab. Revisión de la literatura / Disseminated Juvenile Xanthogranuloma Associated With Follicular Lymphoma in an Adult: Successful Treatment With Chemotherapy and Rituximab. A Review of the Literature

El xantogranuloma juvenil es una histiocitosis de células no Langerhans que acontece en la edad infantil; sin embargo, se han descrito varios casos en el adulto, algunos de ellos en relación con hemopatías malignas. Presentamos el caso de una mujer de 61 años de edad con lesiones diseminadas de xantogranuloma juvenil que a los 4 años de seguimiento desarrolló un linfoma de tipo folicular. Tras 6 meses de tratamiento con quimioterapia y rituximab se consiguió remisión del linfoma y la involución de las lesiones cutáneas. Destacamos este caso por tratarse de una entidad poco frecuente y de difícil diagnóstico en el adulto, así como por ser el primer caso asociado con linfoma folicular y que ha presentado una excelente respuesta con quimioterapia y rituximab. Además, dada su posible asociación con enfermedades hematológicas, el xantogranuloma juvenil podría representar una manifestación de una neoplasia oculta (AU)

Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that typically affects children, but several cases have been reported in adults, some in connection with hematologic malignancies. We present the case of a 61-year-old woman with multiple xanthogranulomas who developed a follicular lymphoma after 4 years of follow-up. After 6 months of treatment with chemotherapy and rituximab, the cutaneous lesions disappeared and the patient achieved remission from lymphoma. We highlight this case because xanthogranuloma is a rare disorder that is difficult to diagnose in adults and also because this is the first report of an association between xanthogranuloma and follicular lymphoma. Excellent response was achieved with chemotherapy and rituximab. Finally, given the possible association between xanthogranulomas and hematologic diseases, these lesions may be a cutaneous manifestation of an occult malignancy (AU)

Interconsulta hospitalaria en Dermatología sobre una cohorte prospectiva en un hospital español de tercer nivel / Inpatient Dermatology Consultation in a Spanish Tertiary Care Hospital: A Prospective Cohort Study

Fundamentos y objetivos: La Dermatología se ha considerado clásicamente una especialidad limitada a las consultas externas. Sin embargo, los pacientes ingresados presentan frecuentemente problemas dermatológicos. El objetivo de este estudio es describir y cuantificar el volumen de la interconsulta hospitalaria del Servicio de Dermatología del Hospital Universitario Virgen del Rocío. Material y métodos: Se trata de un estudio observacional sobre una cohorte prospectiva de 429 pacientes durante un año. Se recogieron todas las interconsultas sobre pacientes ingresados desde julio de 2010 a junio de 2011, a través de la utilización de una ficha. Resultados: Se recogieron un total de 429 interconsultas durante 12 meses; esto supuso el 1,56% de todas las primeras consultas durante este periodo, con una media de 1,75 pacientes nuevos/día. La edad media de los pacientes atendidos fue 52,63 años (±19). La distribución entre ambos sexos, a razón mujer/hombre, fue de 1,21. Más de un tercio de los pacientes atendidos estaban inmunodeprimidos. Las especialidades médicas más demandantes fueron Medicina Interna (n=115) y Hematología (n=66). El diagnóstico más frecuente correspondió a las dermatosis inflamatorias (36,2%), seguido por las dermatosis infecciosas (26,5%). Discusión y conclusiones: Hasta el momento el papel de la interconsulta en Dermatología ha sido escasamente valorado. Nuestros resultados nos permiten afirmar que la Dermatología desempeña un papel fundamental dentro del ámbito hospitalario, así como ha posibilitado que conozcamos la dolencia dermatológica más frecuente en pacientes ingresados y la evolución de los mismos (AU)

Background and objective: Although dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. Material and methods: In this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011.Results: The 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n = 115) and hematology (n = 66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). Discussion and conclusions: To date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course (AU)

Disseminated juvenile xanthogranuloma associated with follicular lymphoma in an adult: successful treatment with chemotherapy and rituximab. A review of the literature.

Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that typically affects children, but several cases have been reported in adults, some in connection with hematologic malignancies. We present the case of a 61-year-old woman with multiple xanthogranulomas who developed a follicular lymphoma after 4 years of follow-up. After 6 months of treatment with chemotherapy and rituximab, the cutaneous lesions disappeared and the patient achieved remission from lymphoma. We highlight this case because xanthogranuloma is a rare disorder that is difficult to diagnose in adults and also because this is the first report of an association between xanthogranuloma and follicular lymphoma. Excellent response was achieved with chemotherapy and rituximab. Finally, given the possible association between xanthogranulomas and hematologic diseases, these lesions may be a cutaneous manifestation of an occult malignancy.

Inpatient dermatology consultation in a Spanish tertiary care hospital: a prospective cohort study.

BACKGROUND AND OBJECTIVE: Although dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. MATERIAL AND METHODS: In this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011. RESULTS: The 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n=115) and hematology (n=66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). DISCUSSION AND CONCLUSIONS: To date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course.