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1.
West Afr J Med ; 37(1): 53-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030712

RESUMO

BACKGROUND: Pruritic papular eruption (PPE) is a frequent cause of substantial morbidity in Human Immunodeficiency Virus (HIV) patients in Nigeria. This skin condition remains the most common cutaneous manifestation in HIV-infected patients and it is more prevalent in developing countries. AIMS: To describe the clinical and pathologic features of PPE in our patients, and compare with those seen in other parts of the world. MATERIALS AND METHODS: Specimen collection, analysis and write-up of the study lasted 18 months (January 2015 to June 2016) after ethical approval of the proposal. The study design was a cross-sectional descriptive study of confirmed HIV-infected patients with clinically active PPE lesions presenting at the Dermatology outpatient clinic, the HIV/ART clinic, and those admitted as in-patients in the medical wards of the University of Benin Teaching Hospital, Benin. Data generated from the study were entered into and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: Only 106 patients were histologically confirmed to be PPE and subsequently recruited for the study. The pattern of distribution of PPE-HIV suggested that the rash has a predilection for exposed parts of the body. The body regions most significantly affected were lateral surface of lower limb, upper limb extensor surface, dorsal surface of foot and dorsal surface of hand. The most common secondary changes observed among the patients were excoriated papules, post-inflammatory hyper- and hypopigmentation, scarring, lichenification. CONCLUSION: Lesions of pruritic papular eruptions (PPE) of HIV in this study were distributed predominantly on the exposed parts of the body especially the upper and lower limbs.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Exantema/patologia , Infecções por HIV/tratamento farmacológico , Prurido/patologia , Estudos Transversais , Exantema/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Nigéria/epidemiologia , Prurido/epidemiologia , Prurido/etiologia
2.
Am J Forensic Med Pathol ; 41(1): 48-51, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31977345

RESUMO

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.


Assuntos
Febre de Chikungunya/diagnóstico , Doença Relacionada a Viagens , Artralgia/virologia , Vírus Chikungunya/genética , El Salvador , Doenças Endêmicas , Exantema/patologia , Exantema/virologia , Patologia Legal , Humanos , Los Angeles , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Reação em Cadeia da Polimerase , Edema Pulmonar/patologia , Edema Pulmonar/virologia
3.
Medicine (Baltimore) ; 99(1): e18503, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895784

RESUMO

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease. In clinical practice, we have observed that some HLH patients who have features of systemic autoinflammatory diseases (SAIDs) exhibit unique clinical manifestations and outcomes different from other HLH patients.We analyzed data from 25 HLH patients who were considered to have SAIDs; data were collected from patients of our center between January 1, 2015 and September 1, 2018.The median age of the patients was 1.75 years. In the early phase, all patients had a fever and 92% of patients had a rash; 96% of patients had high white blood cell count (WBC), C-reaction protein, and erythrocyte sedimentation rate. With progression, the above laboratory results decreased gradually. During the HLH period, we compared SAIDs-related HLH and Epstein-Barr virus (EBV)-related HLH and found that rash was more common (92%, P < .001) and splenomegaly was less common (64%, P = .023) in SAIDs-related HLH. Further, WBC, ferritin, and Interleukin-6 levels in SAIDs-related HLH patients were higher than those in EBV-related HLH patients. In contrast, hemoglobin, triglyceride, sCD25, Interleukin-10, and interferon-γ levels in SAIDs-related HLH patients were lower compared with those in EBV-related HLH patients. SAIDs-related HLH patients received a modified HLH-2004 protocol at our center. Most patients had a good prognosis.We provide a summary of the unique clinical and laboratory features, treatment protocols, and outcomes of SAIDs patients with HLH at onset. The findings indicate that these patients had a better response to corticosteroids and cyclosporin compared with EBV-related HLH patients.


Assuntos
Doenças Autoimunes/patologia , Infecções por Vírus Epstein-Barr/patologia , Exantema/etiologia , Herpesvirus Humano 4 , Linfo-Histiocitose Hemofagocítica/patologia , Corticosteroides/uso terapêutico , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Sedimentação Sanguínea , Proteína C-Reativa , Ciclosporina/uso terapêutico , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/virologia , Exantema/patologia , Exantema/virologia , Feminino , Humanos , Lactente , Contagem de Leucócitos , Linfo-Histiocitose Hemofagocítica/imunologia , Linfo-Histiocitose Hemofagocítica/virologia , Masculino , Esplenomegalia/imunologia , Esplenomegalia/virologia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(37): e17158, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517863

RESUMO

RATIONALE: Glucagonoma is a rare neuroendocrine tumor of the pancreas. Glucagonoma syndrome is often misdiagnosed as other skin lesions by clinicians due to a typical clinical sign of necrolytic migratory erythema (NME) with severe erythematous rash. PATIENT CONCERNS: A 48-year-old female patient was admitted to our department because she presented with unclear recurrent severe erythematous rash. The patient was diagnosed as skin disease. DIAGNOSES: Histopathologic examination revealed a pancreatic glucagonoma. Immnohistochemical staining of tumor tissue was positive for glucagon. INTERVENTIONS: The distal pancreatectomy plus splenectomy was performed in 2017. OUTCOMES: The skin lesions disappeared after surgery. She was followed up and showed no recurrence until now. LESSONS: Clinicians should consider the diagnosis of glucagonoma according to the typical initial symptoms. Early diagnosis is very important to provide a better prognosis. A multidisciplinary approach is effective in patients with unresectable metastatic tumors.


Assuntos
Exantema/complicações , Glucagonoma/complicações , Eritema Migratório Necrolítico/complicações , Neoplasias Pancreáticas/complicações , Diagnóstico Diferencial , Exantema/diagnóstico , Exantema/patologia , Exantema/cirurgia , Feminino , Glucagonoma/diagnóstico , Glucagonoma/patologia , Glucagonoma/cirurgia , Humanos , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/diagnóstico , Eritema Migratório Necrolítico/patologia , Eritema Migratório Necrolítico/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia
10.
Medicine (Baltimore) ; 98(33): e16493, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415349

RESUMO

RATIONALE: Unlike other enteroviruses which can cause herpangina or hand-foot-and-mouth disease, enterovirus D68 (EV-D68) has usually been linked to respiratory and neurological problems in young children. Skin manifestations had rarely been described in current literatures. PATIENT CONCERNS: We report a 17-year-old girl with fever and painful skin rash over legs and soles for 9 days. Pitting edema was also noted below the knees. There was no respiratory tract or neurological symptoms in this patient. DIAGNOSES: EV-D68 was detected from a throat swab by RT-PCR and confirmed to be subclade B3 by sequencing. INTERVENTIONS: Supportive management. OUTCOMES: The patient was afebrile after 9 days and got full recovery on the 23rd day at outpatient follow-up. LESSONS: To the best of our knowledge, this is the first report of EV-D68 infection with skin manifestations, clinical images, and detailed clinical course. Our findings in this particular case extend the understanding of the disease spectrum.


Assuntos
Dor Aguda/virologia , Enterovirus Humano D , Infecções por Enterovirus/virologia , Exantema/virologia , Dor Aguda/patologia , Adolescente , Infecções por Enterovirus/patologia , Exantema/patologia , Feminino , Humanos
11.
Ned Tijdschr Geneeskd ; 1632019 08 19.
Artigo em Holandês | MEDLINE | ID: mdl-31433141

RESUMO

BACKGROUND As a result of climate change, we will have to deal more and more often with the consequences of the oak processionary caterpillar. CASE DESCRIPTION In June, we saw a 6-year-old girl with a severely itchy rash all over her body. The rash had developed a day after school and consisted of erythematous papules on an erythematous base. Several other children at the school were suffering from a similar skin rash. The girl also seemed to have a bad cold. We diagnosed 'oak processionary caterpillar dermatitis'. It turned out there was indeed an oak processionary caterpillar nest at her school. The nest was removed. We prescribed cetirizine oral solution, followed by triamcinolone cream, after which the itch and skin rash disappeared. CONCLUSION The oak processionary caterpillar can cause a lot of symptoms in the period from April to July, including skin rash and eye and upper airway symptoms. The symptoms are usually self-limiting and automatically disappear within 2 weeks. In case of severe itching, menthol-based creams, topical corticosteroids and antihistamines may be prescribed.


Assuntos
Dermatite de Contato/etiologia , Exposição Ambiental/efeitos adversos , Exantema/etiologia , Lepidópteros , Animais , Criança , Dermatite de Contato/patologia , Exantema/patologia , Feminino , Humanos
12.
BMJ Case Rep ; 12(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31377719

RESUMO

Systemic drug exposure can produce a skin reaction consisting of symmetrical erythema involving the gluteal and intertriginous areas in the absence of systemic involvement. Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) occurs after systemic exposure to a drug in which the patient was not previously sensitised, either in the first dose or after several doses. The mechanism of SDRIFE is unknown but is hypothesised to be the result of a delayed hypersensitivity response resulting in a cutaneous eruption some days after the exposure to the drug. The diagnosis should be clinical, based on the history and examination, but skin tests can also be performed to confirm sensitisation. But, as always, the gold-standard test is oral provocation. It is important to know this clinical entity to prevent re-exposure to the responsible allergen in the future.


Assuntos
Clindamicina/efeitos adversos , Erupção por Droga/diagnóstico , Exantema/induzido quimicamente , Intertrigo/induzido quimicamente , Administração Oral , Biópsia , Erupção por Droga/tratamento farmacológico , Erupção por Droga/patologia , Exantema/tratamento farmacológico , Exantema/patologia , Feminino , Humanos , Intertrigo/tratamento farmacológico , Intertrigo/patologia , Pessoa de Meia-Idade , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
13.
Clin Dermatol ; 37(3): 213-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178104

RESUMO

Viral exanthems are frequent in children and are mostly self-limited. Early recognition and differentiation from other childhood illnesses are important to direct further investigations and treatment initiation. The clinical presentation of viral exanthems in children includes a polymorphic spectrum of skin eruptions ranging from classic viral exanthems to "atypical" presentations that can mimic nonviral diseases; thus, viral exanthems of childhood can be readily diagnosed on clinical grounds, but not rarely do they represent a diagnostic challenge. In this review, we focus on viral diseases in children that may be difficult to diagnose due to their clinical similarities with nonviral diseases, and we offer clues for the differential diagnosis and proper diagnostic testing in such cases.


Assuntos
Exantema/diagnóstico , Exantema/virologia , Pele/virologia , Acrodermatite , Angiomatose , Febre de Chikungunya , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Dengue , Diagnóstico Diferencial , Exantema/patologia , Feminino , Doença de Mão, Pé e Boca , Herpesvirus Humano 4 , Humanos , Hospedeiro Imunocomprometido , Lactente , Masculino , Testes Sorológicos , Pele/patologia , Zika virus
14.
J Dermatol ; 46(7): 618-621, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144726

RESUMO

Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B-cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.


Assuntos
Eosinofilia/tratamento farmacológico , Exantema/tratamento farmacológico , Lenalidomida/uso terapêutico , Linfoma de Célula do Manto/complicações , Síndromes Paraneoplásicas/tratamento farmacológico , Prurido/tratamento farmacológico , Eosinofilia/etiologia , Eosinofilia/patologia , Exantema/etiologia , Exantema/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Prurido/etiologia , Prurido/patologia , Pele/patologia , Resultado do Tratamento
15.
J Am Acad Dermatol ; 81(1): 111-122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103317

RESUMO

BACKGROUND: Eruptive squamous atypia (ESA), which is an idiopathic, sometimes koebnerizing, proliferation of atypical but well-differentiated keratinocytes (also termed eruptive keratoacanthoma), is often misdiagnosed as cancer and managed by excisional surgery, provoking further koebnerization. A clear definition of this phenomenon and treatment outcome data are lacking. OBJECTIVE: To define ESA and evaluate efficacy of intralesional (IL) 5-fluorouracil (5-FU) treatment. METHODS: A retrospective cohort study examined patients with ESA that arose spontaneously or within a recent surgical scar and was treated with IL 5-FU at a tertiary academic center between January 2008 and December 2016. Complete clearance, partial clearance, and number of surgical excisions performed were tabulated. RESULTS: Of 30 patients with 136 ESA lesions, 20 (67%) had resolution of ESA with IL 5-FU monotherapy. In all, 10 patients (33%) required additional therapy (topical 5-FU, steroids, cryotherapy, or acitretin). No IL 5-FU-treated ESA lesions required surgical excision. The number of excisional procedures decreased significantly (P = .006), with 27 patients (90%) needing fewer excisions 12 months after versus 12 months before initiation of IL 5-FU therapy. Dyspigmentation was the only adverse event. LIMITATIONS: Limitations include retrospective analysis and use of data from a single institution. CONCLUSION: With close clinical monitoring, IL 5-FU can be used to successfully treat ESA.


Assuntos
Carcinoma de Células Escamosas/patologia , Exantema/patologia , Fluoruracila/administração & dosagem , Ceratoacantoma/tratamento farmacológico , Ceratoacantoma/patologia , Neoplasias Cutâneas/patologia , Adulto , Biópsia por Agulha , Carcinoma de Células Escamosas/diagnóstico , Estudos de Coortes , Bases de Dados Factuais , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Esquema de Medicação , Exantema/tratamento farmacológico , Exantema/fisiopatologia , Feminino , Humanos , Imuno-Histoquímica , Injeções Intralesionais , Ceratoacantoma/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Neoplasias Cutâneas/diagnóstico , Estatísticas não Paramétricas , Resultado do Tratamento
17.
Clin Dermatol ; 37(2): 109-118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981291

RESUMO

There is a broad differential diagnosis for the presentation of fever and maculopapular rash in an adult. Although some causative conditions are benign, others are medical emergencies that require prompt diagnosis. We describe various conditions that result in a fever and maculopapular rash in adults. These include infectious processes (meningococcemia, infectious mononucleosis, West Nile virus, zika virus, rubella, primary human immunodeficiency virus, parvovirus B19, ebolavirus), tick-borne illnesses (Rocky Mountain spotted fever, ehrlichiosis), and hypersensitivity reactions (exanthematous drug reactions). We also provide an algorithm to aid in the diagnosis of the patient with fever and maculopapular rash. Such conditions that can occur in adults but are seen predominantly in children are discussed in the article "Rash with maculopapules and fever in children" of this issue.


Assuntos
Erupção por Droga/etiologia , Erupção por Droga/patologia , Exantema/etiologia , Exantema/patologia , Febre/etiologia , Parapsoríase/etiologia , Parapsoríase/patologia , Pele/patologia , Adulto , Diagnóstico Diferencial , Erupção por Droga/diagnóstico , Erupção por Droga/terapia , Exantema/diagnóstico , Exantema/terapia , Febre/diagnóstico , Febre/terapia , Humanos , Incidência , Parapsoríase/diagnóstico , Parapsoríase/terapia , Viroses/complicações
18.
Clin Dermatol ; 37(2): 119-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981292

RESUMO

Several medical conditions can cause children to present with fever and a maculopapular rash Although some presentations are benign, others may be medical emergencies, which warrant a prompt diagnosis. We review some of the more common causes of fever and maculopapular dermatitirs, rash including infectious processes (roseola; rubeola; rubella; parvovirus B19; hand, foot, and mouth disease; scarlet fever; meningococcemia; Epstein-Barr virus infection), hypersensitivity reactions (exanthematous drug reactions), and vasculitis syndromes (Kawasaki disease). We have included a diagnostic algorithm to facilitate rapid identification of the etiology of the rash and fever. Those conditions that can occur in children but are seen predominantly in adults are discussed in the contribution "Rash with maculopapules and fever in adults" in this issue.


Assuntos
Erupção por Droga/etiologia , Exantema/diagnóstico , Exantema/etiologia , Febre/etiologia , Parapsoríase/diagnóstico , Parapsoríase/etiologia , Pele/patologia , Adolescente , Criança , Pré-Escolar , Erupção por Droga/diagnóstico , Erupção por Droga/patologia , Erupção por Droga/terapia , Exantema/patologia , Exantema/terapia , Humanos , Incidência , Síndrome de Linfonodos Mucocutâneos/complicações , Parapsoríase/patologia , Parapsoríase/terapia , Viroses/complicações
19.
Clin Dermatol ; 37(2): 129-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981293

RESUMO

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.


Assuntos
Eritema Nodoso/etiologia , Eritema Nodoso/patologia , Exantema/etiologia , Exantema/patologia , Dor/etiologia , Síndrome de Behçet , Doença Crônica , Diagnóstico Diferencial , Eritema Nodoso/diagnóstico , Hidradenite , Humanos , Paniculite , Poliarterite Nodosa , Recidiva , Síndrome de Sweet , Tromboflebite , Vasculite
20.
Clin Dermatol ; 37(2): 136-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981294

RESUMO

Dermatology is frequently viewed by physician and surgical colleagues as a specialty with few emergencies. Although the majority of dermatology practice is in the office setting, cutaneous emergencies do occur through referrals from primary care and as ward consults. Even though cutaneous signs of poisoning would be an uncommon emergency consultation, it is important for dermatologists to be aware of the clinical presentations so as to be able instigate appropriate time critical treatments.


Assuntos
Intoxicação por Arsênico/complicações , Intoxicação por Arsênico/patologia , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/patologia , Dioxinas/envenenamento , Exantema/etiologia , Exantema/patologia , Intoxicação por Mercúrio/complicações , Intoxicação por Mercúrio/patologia , Pele/patologia , Doença Aguda , Agente Laranja/envenenamento , Doença Crônica , Feminino , Humanos , Masculino
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