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1.
J Med Case Rep ; 16(1): 5, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34986884

RESUMO

INTRODUCTION: Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection. CASE PRESENTATION: We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered. CONCLUSION: Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered.


Assuntos
Febre de Chikungunya , Exantema , Dermatopatias , Adolescente , Adulto , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Exantema/etiologia , Feminino , Febre , Humanos , Lactente , Gravidez , Gestantes
2.
Praxis (Bern 1994) ; 110(1): 45-48, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34983213

RESUMO

Systemic Inflammatory Response in a Young Woman Abstract. A 21-year-old patient with fever attacks, arthralgias, salmon-colored skin rash, neutrophilic leukocytosis, elevated CRP, ferritin, ASAT and ALAT was diagnosed with the rare systemic autoinflammatory disease, called adult Still disease, after having excluded other possible causes. An initial treatment with non steroidal anti-inflammatory drugs (NSAID) and prednisolone was not sufficiently effective, consecutively the therapy was escalated with the IL-6 antagonist tocilizumab. This immunosuppressive therapy resulted in fairly well controlled symptoms.


Assuntos
Exantema , Doença de Still de Início Tardio , Adulto , Artralgia , Feminino , Humanos , Prednisolona/uso terapêutico , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adulto Jovem
3.
Pediatrics ; 149(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972223

RESUMO

A 9-year-old girl presented to her primary care pediatrician via telemedicine during the initial months of the coronavirus disease 2019 pandemic because of 4 days of warmth perceived by her mother, decreased energy, and a new rash on her upper extremities. After 10 additional days of documented fever >38°C, worsening fatigue, and 1 day of nausea, vomiting, and diarrhea, she was allowed to schedule an in-person visit with her pediatrician after testing negative for severe acute respiratory syndrome coronavirus 2. She appeared ill on arrival to clinic, and her pediatrician recommended evaluation in an emergency department. Her initial laboratory testing revealed nonspecific elevation in several inflammatory markers and leukopenia, and she responded well to intravenous hydration. Over the next 2 weeks, her fever persisted, constitutional symptoms worsened, and she developed progressively painful cervical lymphadenopathy and pancytopenia. She was evaluated in clinic by several specialists and eventually was urged to present to the emergency department again, at which time she was admitted to the PICU. After consulting additional specialists and waiting for laboratory results, the team reached a definitive diagnosis and initiated therapy; however, she experienced rapid clinical decline shortly thereafter. The specialists who assisted with identification of the underlying etiology of her symptoms were able to work together to manage the subsequent complications.


Assuntos
Exantema , Febre , Unidades de Terapia Intensiva Pediátrica , Lúpus Eritematoso Sistêmico/diagnóstico , Telemedicina , COVID-19/complicações , COVID-19/diagnóstico , Criança , Progressão da Doença , Exantema/diagnóstico , Exantema/etiologia , Feminino , Febre/etiologia , Linfadenite Histiocítica Necrosante/diagnóstico , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/complicações , Linfadenopatia/diagnóstico , Linfadenopatia/etiologia , Pancitopenia/diagnóstico , Avaliação de Sintomas , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
5.
Pediatr Dermatol ; 38(6): 1563-1564, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34931362
6.
J Drugs Dermatol ; 20(12): 1353-1354, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34898159

RESUMO

Disseminate and recurrent infundibulofolliculitis (DRIF) is a pruritic papular eruption that predominantly affects young adults with Fitzpatrick skin types 4-6. Due to DRIF’s rarity and under-recognition, no standardized treatment guidelines exist. However, several oral agents have been used, including vitamin A, antibiotics, and retinoids. Topical agents, such as calcineurin inhibitors and mid-potency steroids, can also be efficacious. This brief communication summarizes treatments for DRIF in the published literature. J Drugs Dermatol. 2021;20(12):1353-1354. doi:10.36849/JDD.6173.


Assuntos
Exantema , Foliculite , Neoplasias , Foliculite/diagnóstico , Foliculite/tratamento farmacológico , Humanos , Recidiva , Retinoides , Adulto Jovem
7.
J Med Case Rep ; 15(1): 590, 2021 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-34903290

RESUMO

BACKGROUND: Adult patients with coronavirus disease present primarily with respiratory symptoms, but children and some adults may display a more systemic inflammatory syndrome with rash, fever, mucosal changes, and elevated inflammatory biomarkers. CASE PRESENTATION: Here, we report the case of a 29-year-old Hispanic patient presenting with significant rash and multisystem inflammation. We describe his clinical course, review dermatological manifestations of coronavirus disease, and summarize the pathophysiology of coronavirus disease-associated multisystem inflammation. CONCLUSION: This case should alert physicians to the atypical nature of presenting rash with minimal respiratory symptoms in coronavirus disease.


Assuntos
COVID-19 , Exantema , Adulto , COVID-19/complicações , Criança , Exantema/etiologia , Febre/etiologia , Humanos , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica
9.
BMJ Case Rep ; 14(10)2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620638

RESUMO

With increasing presentations of headaches following COVID-19 vaccination, we present one of the UK's earliest proven cases of vaccine-induced thrombotic thrombocytopaenia (VITT), with the aim of giving colleagues a case to compare other patients against. Our patient was a 48-year-old man who presented with frank haematuria, a widespread petechial rash, and headaches, 2 weeks after receiving the first dose of the Oxford AstraZeneca ChAdOx1 nCoV-19 vaccine. He had a platelet count of 14×109/L and an extensive cerebral venous sinus thrombosis (CVST) with subarachnoid haemorrhage on imaging. He developed localising neurological signs and experienced a cardiopulmonary arrest. He was successfully resuscitated and transferred to a tertiary care centre for urgent thrombectomy. This case illustrates how the diagnosis of VITT should be based on the platelet count and imaging-and how patients with VITT should be cared for in centres with urgent neurosurgical and interventional radiology services.


Assuntos
COVID-19 , Exantema , Trombose dos Seios Intracranianos , Vacinas contra COVID-19 , Cefaleia , Hematúria , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Vacinação
11.
Am J Dermatopathol ; 43(12): 962-964, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34608003

RESUMO

ABSTRACT: One of the most common patterns of presentations that have been described in COVID-19 patients includes the erythematous/papular/morbilliform eruptions. However, actually, the diffuse exanthems containing macules and papules were not specific to COVID-19, and even histopathology does not show any specific signs that could help to differentiate COVID-19 skin lesions from non-COVID-19 causes such as drugs or other viral infections. We present the case of a COVID-19-positive woman with a morbilliform rash, whose skin biopsy showed the presence of some peculiar cytopathic epidermal changes that could represent a possible distinctive histopathological feature related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection The presence of viral particles in the keratinocytes with additional positivity of endothelial cells and eccrine glands by immunohistochemistry using an anti-SARS-CoV-2 Spike S1 antibodies supports a causal relation of the lesions with SARS-CoV-2 infection.


Assuntos
COVID-19/complicações , Exantema/patologia , Exantema/virologia , Adulto , Feminino , Humanos , Queratinócitos/patologia , Queratinócitos/virologia , SARS-CoV-2
13.
Acta Med Indones ; 53(3): 315-318, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611071

RESUMO

Coronavirus disease (COVID-19) infection attacks the mucosal structures of the respiratory tract, especially the bronchial mucosa and immune cells. The skin changes and manifestations related to COVID-19 infection remain not clearly understood. Cutaneous manifestations related to COVID-19 had been reported. Our patient manifested atypical cutaneous exanthem on her legs, with no other abnormalities found. We used oral azithromycin 500 mg, dexamethasone 0.5 mg, vitamin C 100 mg, and paracetamol 500 mg, which are available at Badak Baru Primary Health Care. The exanthem has improved after 10 days of treatment.


Assuntos
Azitromicina/administração & dosagem , COVID-19 , Dexametasona/administração & dosagem , Exantema , SARS-CoV-2/isolamento & purificação , Adulto , Anti-Inflamatórios/administração & dosagem , Antivirais/administração & dosagem , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , COVID-19/fisiopatologia , Teste para COVID-19/métodos , Redução da Medicação/métodos , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/etiologia , Feminino , Humanos , Distanciamento Físico , Resultado do Tratamento
14.
Pediatr Dermatol ; 38(5): 1342-1344, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34595767

RESUMO

BASCULE syndrome, characterized by Bier anemic spots, cyanosis, and an urticaria-like eruption, has been described as a benign vasomotor dermatosis that occurs in the setting of transient tissue hypoxia. It has been postulated that dermal ischemia triggers an exaggerated vasoconstrictive arteriolar reaction, which then causes a paradoxical urticarial rash by an unknown mechanism. In patients with COVID-19, there is evidence of angiocentric inflammation leading to vasoconstriction, endothelial damage, and thrombosis. We present a case of acute-onset BASCULE syndrome appearing after asymptomatic infection with COVID-19. BASCULE syndrome should be considered in the expanding spectrum of dermatologic manifestations associated with COVID-19.


Assuntos
COVID-19 , Exantema , Urticária , Criança , Cianose , Humanos , SARS-CoV-2 , Urticária/diagnóstico , Urticária/etiologia
15.
Cutis ; 108(2): 63-64, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34661521
16.
17.
Am J Case Rep ; 22: e932921, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34634004

RESUMO

BACKGROUND Allopurinol is the first-line therapy for the treatment of symptomatic hyperuricemia (gout). In clinical practice, there is a tendency to overmedicate asymptomatic patients who have elevated serum urate. Because of this practice, serious and life-threatening reactions such as Stevens-Johnson syndrome (SJS) or the more dramatic toxic epidermal necrolysis (TEN), both frequently caused by uricostatics, may occur. To increase awareness of these complications, we present a case with fulminant TEN caused by allopurinol. CASE REPORT A 75-year-old woman noticed a mildly itching skin rash accompanied by fever, shivering, and weakness approximately 3 weeks after taking newly prescribed allopurinol. The initial clinical examination revealed a generalized maculopapular exanthema. An adverse drug reaction was recognized, and allopurinol was discontinued. Ambulatory supportive therapy using prednisolone and cetirizine was started but failed. The patient developed a progressive exanthema with painful widespread blistering, skin peeling, and mucosal and conjunctival lesions. After recurrent presentations to the Emergency Department, the patient was transferred to our Intensive Care Unit (ICU). The clinical picture confirmed the suspected diagnosis of TEN. Massive fluid replacement, prednisolone, and cyclosporine were used as anti-inflammatory therapy. Polyhexanide and octenidine were applied for local treatment. All treatment measures were guided daily by a multidisciplinary team. After 7 days in the ICU, the patient was transferred to the Dermatology Department and was discharged from the hospital 42 days later. CONCLUSIONS With the prescription of allopurinol, there should be awareness of potentially life-threatening complications such as SJS or TEN. Patients with SJS or TEN should be immediately transferred to an ICU with dermatological expertise and multidisciplinary therapy.


Assuntos
Exantema , Síndrome de Stevens-Johnson , Idoso , Alopurinol/efeitos adversos , Vesícula , Ciclosporina , Feminino , Humanos , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiologia
18.
J Drugs Dermatol ; 20(10): 1117-1119, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34636515

RESUMO

Palmoplantar pustulosis (PPP) is a rare, recurrent skin disorder that presents a major challenge to clinical therapy. We report a case of a 69-year-old woman with a 20-year history of psoriasis with skin manifestations and clinical and pathologic features consistent with PPP. After intolerance to apremilast and unsuccessful use of topical corticosteroids and phototherapy, tildrakizumab therapy was initiated and resulted in complete lesion clearance. Clinical improvement was maintained for several months after discontinuation of systemic treatment due to the need to initiate chemotherapy. Tildrakizumab may be an effective and safe therapeutic option for chronic PPP. J Drugs Dermatol. 2021;20(10):1116-1118. doi:10.36849/JDD.6031THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.


Assuntos
Exantema , Psoríase , Dermatopatias Vesiculobolhosas , Idoso , Anticorpos Monoclonais Humanizados , Feminino , Humanos , Psoríase/diagnóstico , Psoríase/tratamento farmacológico
19.
BMJ Case Rep ; 14(10)2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34642219

RESUMO

Drug reaction with eosinophilia and systemic symptoms (DRESS) is designated as a potentially lethal adverse drug effect with characteristic signs and symptoms such as skin rash, fever, leucocytosis with eosinophilia or atypical lymphocytes, lymphadenopathy and liver or renal dysfunction. In addition to most commonly implicated drug category (aromatic anticonvulsants), lamotrigine, sulfonamides, dapsone and abacavir may also induce this syndrome. We describe here a case a sulfasalazine-induced DRESS with coexisting chikungunya fever. The shared presentation of fever with rash in both conditions made it a challenging diagnosis. Sulfasalazine hypersensitivity manifesting as DRESS has rarely been reported. Furthermore, we document chikungunya virus (CV) as a possible triggering agent for DRESS. To the best of our knowledge, CV as a viral aetiology in DRESS has not been reported previously in the literature.


Assuntos
Febre de Chikungunya , Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia , Exantema , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Humanos , Sulfassalazina/efeitos adversos
20.
Nat Commun ; 12(1): 5954, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34642329

RESUMO

Leptomeningeal disease (LMD) is a common complication from solid tumor malignancies with a poor prognosis and limited treatment options. We present a single arm Phase II study of 18 patients with LMD receiving combined ipilimumab and nivolumab until progression or unacceptable toxicity (NCT02939300). The primary end point is overall survival at 3 months (OS3). Secondary end points include toxicity, cumulative time-to-progression at 3 months, and progression-free survival. A Simon two-stage design is used to compare a null hypothesis OS3 of 18% against an alternative of 44%. Median follow up based on patients still alive is 8.0 months (range: 0.5 to 15.9 months). The study has met its primary endpoint as 8 of 18 (OS3 0.44; 90% CI: 0.24 to 0.66) patients are alive at three months. One third of patients have experienced one (or more) grade-3 or higher adverse events. Two patients have discontinued protocol treatment due to unacceptable toxicity (hepatitis and colitis, respectively). The most frequent adverse events include fatigue (N = 7), nausea (N = 6), fever (N = 6), anorexia (N = 6) and rash (N = 6). Combined ipilimumab and nivolumab has an acceptable safety profile and demonstrates promising activity in LMD patients. Larger, multicenter clinical trials are needed to validate these results.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Encefálicas/tratamento farmacológico , Ipilimumab/administração & dosagem , Carcinomatose Meníngea/tratamento farmacológico , Neoplasias Meníngeas/tratamento farmacológico , Nivolumabe/administração & dosagem , Adulto , Idoso , Anorexia/induzido quimicamente , Anorexia/mortalidade , Anorexia/patologia , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Colite/induzido quimicamente , Colite/mortalidade , Colite/patologia , Exantema/induzido quimicamente , Exantema/mortalidade , Exantema/patologia , Fadiga/induzido quimicamente , Fadiga/mortalidade , Fadiga/patologia , Feminino , Febre/induzido quimicamente , Febre/mortalidade , Febre/patologia , Hepatite/etiologia , Hepatite/mortalidade , Hepatite/patologia , Humanos , Ipilimumab/efeitos adversos , Masculino , Carcinomatose Meníngea/mortalidade , Carcinomatose Meníngea/patologia , Neoplasias Meníngeas/mortalidade , Neoplasias Meníngeas/patologia , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/mortalidade , Náusea/patologia , Nivolumabe/efeitos adversos , Análise de Sobrevida
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