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1.
F1000Res ; 9: 668, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32913640

RESUMO

The COVID-19 outbreak caused by the novel coronavirus, SARS-CoV-2, typically presents with symptoms including fever, cough, headache, myalgia, asthenia, anosmia, diarrhea, and sometimes pneumonia, which can be fatal.  Recently, new dermatologic findings have been described in association with the disease that can potentially be a distinguishing feature of infection. One such feature resembles chilblains and this case report represents a presentation of this feature with a 48-year-old female with violaceous lesions with surrounding pink erythema on her toes who tested negative for COVID-19.


Assuntos
Pérnio/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias/virologia , Animais , Betacoronavirus , Gatos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Dedos do Pé/patologia
3.
Dermatol Online J ; 26(5)2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621713

RESUMO

Acral purpura is generally a hallmark for severe internal disease. However, exogenous pigmentation related to contact with invertebrates, can induce acral purpura-like lesions. Data regarding the beetle's ability to cause skin hyperpigmentation or purpura-like lesions are scarce. We report a case of exogenous pigmentation caused by accidental contact with a darkling beetle, clinically simulating acral purpuric lesions. The history of recent drug inhalation and abnormal autoimmunity tests made this diagnosis difficult.


Assuntos
Besouros , Hiperpigmentação/etiologia , Dedos do Pé/patologia , Animais , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
4.
Pathog Glob Health ; 114(6): 283-284, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32576095

RESUMO

Dermatological manifestations have shown to be associated with COVID-19 infections. The numbers of papers have quadrupled within May 2020 alone. One particular cutaneous manifestation named pseudo chilblains (COVID toe), expressed mostly in otherwise asymptomatic younger patients, has had particular media attention. Public health bodies, on the other hand, have been slow to recognize it as a symptom. This article will be discussing two case studies to demonstrate the lack of public knowledge and of public health guidance associated with this symptom. We will further explore the use of COVID toe in the epidemiology of COVID-19 and its utility as a sign for total cases and contact tracing.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Saúde Pública , Adulto , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Dedos do Pé/patologia , Dedos do Pé/virologia , Adulto Jovem
5.
J Infect Chemother ; 26(8): 843-846, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402735

RESUMO

Mycobacterium chelonae is a rapidly growing mycobacterium that has the potential to cause refractory infections in humans. Mycobacteremia resulting from the organism is extremely rare, and its clinical features are yet to be uncovered. We herein present a case of M. chelonae bloodstream infection involving an immunocompromised older patient. A 79-year-old woman, on a long-term treatment with prednisolone plus tacrolimus for rheumatoid arthritis, visited our outpatient department complaining of deteriorating pain and swelling at her right 1st toe. Laboratory parameters showed elevated C-reactive protein and leukocytosis, and magnetic resonance imaging indicated osteomyelitis at the proximal phalanx of her right 1st toe. Considering the refractory course, the infected toe was immediately amputated. M. chelonae was isolated from bacterial cultures of the resected tissue and blood (BD BACTEC™ FX blood culture system, Becton Dickinson, Sparks, MD, USA), leading to a diagnosis of disseminated M. chelonae infection. We treated the patient with an antibiotic combination of clarithromycin, minocycline, and imipenem (2 weeks), which was converted to oral therapy of clarithromycin, doxycycline, and levofloxacin. This case highlighted the potential pathogenesis of M. chelonae to cause mycobacteremia in an immunocompromised patient.


Assuntos
Bacteriemia/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium chelonae/isolamento & purificação , Osteomielite/diagnóstico , Dedos do Pé/patologia , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Quimioterapia Combinada , Feminino , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/etiologia , Osteomielite/complicações , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Dedos do Pé/diagnóstico por imagem , Resultado do Tratamento
6.
J Cancer Res Ther ; 16(1): 161-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32362628

RESUMO

Kaposi's sarcoma (KS) is an uncommon neoplastic vascular disease. The standard treatment for localized classic KS lesions is surgical excision or radiation. Superficial skin lesions are generally treated with electrons or low-energy photon fields using boluses. Radiotherapy (RT) can be used for poor surgical candidates or when surgery is expected to result in a poor cosmetic or functional outcome. This study is the first to describe a case of KS of the toe and web treated with electron RT, which precisely targeted the irregular skin lesion with a markedly higher presided effective treatment. An electron field is often limited in its effectiveness to deliver a homogeneous dose in cases with irregular contours. Here, we report our successful experience using low-energy electron beam radiation to treat KS of the toe and web. The patient was a 78-year-old woman who was diagnosed with KS located on the first and second toe and web, based on radiology, pathology, and immunohistochemical examinations. KS was located on the left foot and measured more than 2.5 cm. No regional nodal or distant organ metastasis was observed. She was medically inoperable. RT was performed using a 6-MeV electron with a 0.5-cm bolus and a dose of 50 Gy delivered in 25 fractions. Follow-up computed tomography 2 months after RT revealed a complete tumor response. Toxicity was limited to mild skin desquamation during treatment. The patient remains alive and has shown no evidence of disease for 2 years. This study suggests that electron RT is a safe and effective treatment option for skin lesions located on the toe and web.


Assuntos
Elétrons/uso terapêutico , Sarcoma de Kaposi/radioterapia , Neoplasias Cutâneas/radioterapia , Dedos do Pé/efeitos da radiação , Idoso , Feminino , Humanos , Indução de Remissão , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/patologia , Dedos do Pé/patologia , Resultado do Tratamento
8.
Clin Immunol ; 214: 108390, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32200113

RESUMO

Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory musculoskeletal disease. The non-specific and often subtle manifestations make early diagnosis and subsequent treatment challenging. In the absence of diagnostic criteria and biomarkers, the diagnosis is often delayed leading to poor long-term outcomes. In addition, the differential diagnosis of a patient presenting with arthritis in the setting of skin psoriasis is wide due to symptom overlap with many other diseases. Peripheral arthritis, dactylitis, enthesitis and axial arthritis are the 4 domains of musculoskeletal involvement in PsA and careful examination of each domain by a rheumatologist is the first step for a correct diagnosis. Other extra-musculoskeletal features such as the presence of uveitis, inflammatory bowel disease, nail psoriasis and elevated acute phase reactants aid in the diagnosis of PsA. Screening patients with skin psoriasis using validated questionnaires might help in early diagnosis especially when coupled with imaging.


Assuntos
Artrite Psoriásica/diagnóstico , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Dor nas Costas/etiologia , Biomarcadores , Diagnóstico Diferencial , Progressão da Doença , Entesopatia/etiologia , Dedos/patologia , Gota/diagnóstico , Humanos , Hiperostose/diagnóstico , Doenças Inflamatórias Intestinais/complicações , Degeneração do Disco Intervertebral/diagnóstico , Articulações/diagnóstico por imagem , MicroRNAs/sangue , Doenças da Unha/etiologia , Osteoartrite/diagnóstico , Inquéritos e Questionários , Sinovite/etiologia , Dedos do Pé/patologia , Ultrassonografia , Uveíte/etiologia
13.
BMJ Case Rep ; 12(12)2019 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-31818886

RESUMO

Digital dry gangrene is commonly seen in cases of connective tissue disease such as systemic sclerosis. In systemic lupus erythematosus (SLE) digital gangrene is rare. As initial manifestation, it is again a rare phenomenon because it occurs late in the course of disease. Here we are reporting the case of a woman who was having extensive cutaneous gangrene of her fingers and toes, as a first and foremost presentation without any other typical signs and symptoms of SLE. Her serology was positive for SLE. The patient was treated conservatively and responded well.


Assuntos
Dedos/patologia , Gangrena/etiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/patologia , Dedos do Pé/patologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Resultado do Tratamento
15.
J Am Podiatr Med Assoc ; 109(4): 334-337, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762311

RESUMO

Osteoid osteoma is a benign tumor originating from osteoblasts, and it is mostly seen in long bones of lower limbs. The distal phalanx of the foot is an atypical location for an osteoid osteoma, and lesions occurring in this location may be a diagnostic challenge. A 22-year-old man presented with a complaint of severe pain on the second distal phalanx of his right foot. An osteoid osteoma was suspected after radiologic evaluation. The lesion was surgically excised and removed completely by curettage. Histopathologic evaluation confirmed the diagnosis of an osteoid osteoma. The patient was followed-up for a 9-month period without any symptoms or recurrence.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Osteoma Osteoide/diagnóstico por imagem , Dedos do Pé/patologia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Doenças do Pé/patologia , Doenças do Pé/cirurgia , Humanos , Masculino , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Radiografia , Dedos do Pé/diagnóstico por imagem , Adulto Jovem
16.
BMJ Case Rep ; 12(10)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653621

RESUMO

Peripheral limb ischaemia and gangrene are devastating complications of pneumococcal sepsis. We report a 43-year-old professional pianist who presented with early sepsis and rapid development of this syndrome. No vasopressor medication was ever administered. We urgently reviewed the medical literature on a range of therapies recommended by consulting teams, to ensure he received optimal care. Based on our review and on feedback from the patient himself, we gained valuable insights into this illness and the merits of selected treatment options. His fingers ultimately recovered their function, intact, although several toes were later amputated. More recently published reviews postulate that imbalances in coagulation factors and natural anticoagulants occur as a result of disseminated intravascular coagulopathy and 'shock liver' in the sepsis syndrome, leading to microcirculatory thromboses. We submit this report as we believe it supports this hypothesis and adds further valuable information. We hope our observations will assist other critical care clinicians confronting this serious condition.


Assuntos
Dedos/patologia , Gangrena/etiologia , Isquemia/etiologia , Sepse/complicações , Dedos do Pé/patologia , Adulto , Amputação , Anticoagulantes/uso terapêutico , Diagnóstico Diferencial , Gangrena/tratamento farmacológico , Heparina/uso terapêutico , Humanos , Isquemia/tratamento farmacológico , Masculino , Milrinona/uso terapêutico , Música , Sepse/tratamento farmacológico , Dedos do Pé/cirurgia , Vasodilatadores/uso terapêutico
18.
BMC Cancer ; 19(1): 1002, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653251

RESUMO

BACKGROUND: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. METHODS: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institution's Institutional Review Board prior to patient enrollment. DISCUSSION: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. TRIAL REGISTRATION: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Unha/epidemiologia , Doenças da Unha/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Polegar/patologia , Polegar/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Adulto Jovem
19.
BMC Dermatol ; 19(1): 12, 2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31401977

RESUMO

BACKGROUND: Ainhum is an idiopathic dermatological disease characterized by a progressive constricting ring usually on the fifth toe, which may lead to spontaneous auto-amputation of the affected toe. Timely diagnosis and treatment are the key elements to avert amputations with resultant mutilating deformities, permanent handicaps and psychological sequelae. Though common in African descents, this pathology has not been described in the Cameroonian literature. Herein, we report the case of an adult Cameroonian woman presenting with ainhum. CASE PRESENTATION: A 54-year old Cameroonian was admitted to our primary healthcare centre with a 6-month history of a painful constriction band developing at the base of her right fifth toe. Her past history was uneventful. Based on the absence of trauma and spontaneous onset of the condition, the diagnosis of ainhum was most suggestive. She was managed surgically by excision of the band, disarticulated at right fifth metatarsophalangeal joint and skin closure. Her post-operative course after 1 year was uneventful. CONCLUSION: Here we presented a case of ainhum, a rare dermatological disease with few reports. In view of the serious complications of ainhum such as mutilating deformities with permanent physical disabilities and psychological trauma, we draw clinicians' attention, especially wound care specialists to this rare but potentially handicapping disease, for timely diagnosis and management.


Assuntos
Ainhum/patologia , Dedos do Pé/patologia , Ainhum/complicações , Ainhum/diagnóstico , Camarões , Constrição Patológica/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade
20.
J Am Podiatr Med Assoc ; 109(3): 241-245, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31268784

RESUMO

Polyarteritis nodosa is a progressive, often life-threatening, vasculitis affecting multiple organs, including the skin and peripheral nerves. We report a patient presenting with systemic features of the disease and with characteristic lesions in the feet 3 weeks after vaccination against hepatitis B virus infection.


Assuntos
Vacinas contra Hepatite B/efeitos adversos , Hepatite B/prevenção & controle , Poliarterite Nodosa/etiologia , Lobo Temporal/diagnóstico por imagem , Adulto , Humanos , Imagem por Ressonância Magnética , Masculino , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/patologia , Lobo Temporal/patologia , Dedos do Pé/patologia
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