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1.
Biomed Res Int ; 2020: 1236520, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32724793

RESUMO

The novel coronavirus (SARS-CoV-2), the cause of coronavirus 2019 disease (COVID-19) pandemic, is associated with some cutaneous manifestations. Although the cutaneous presentations of COVID-19 are infrequent, it is of great importance for all clinicians to be aware of these manifestations, as it may contribute to sooner and better diagnosis and management of the disease, even in asymptomatic or paucisymptomatic patients. The reported cutaneous manifestations of COVID-19 are various, dispersed, and sometimes confusing. In this article, all reported cases to date were collected and classified under 6 major groups: maculopapular rash, urticaria, chilblain, vesicular lesions, livedo reticularis, and petechiae. Different characteristics of each group were discussed in detail as well.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias Virais/etiologia , Pérnio/diagnóstico , Pérnio/etiologia , Infecções por Coronavirus/epidemiologia , Exantema/diagnóstico , Exantema/etiologia , Feminino , Humanos , Livedo Reticular/diagnóstico , Livedo Reticular/etiologia , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Púrpura/diagnóstico , Púrpura/etiologia , Dermatopatias Virais/diagnóstico , Urticária/diagnóstico , Urticária/etiologia
2.
Transl Res ; 220: 1-13, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32299776

RESUMO

Acute respiratory failure and a systemic coagulopathy are critical aspects of the morbidity and mortality characterizing infection with severe acute respiratory distress syndrome-associated coronavirus-2, the etiologic agent of Coronavirus disease 2019 (COVID-19). We examined skin and lung tissues from 5 patients with severe COVID-19 characterized by respiratory failure (n= 5) and purpuric skin rash (n = 3). COVID-19 pneumonitis was predominantly a pauci-inflammatory septal capillary injury with significant septal capillary mural and luminal fibrin deposition and permeation of the interalveolar septa by neutrophils. No viral cytopathic changes were observed and the diffuse alveolar damage (DAD) with hyaline membranes, inflammation, and type II pneumocyte hyperplasia, hallmarks of classic acute respiratory distress syndrome, were not prominent. These pulmonary findings were accompanied by significant deposits of terminal complement components C5b-9 (membrane attack complex), C4d, and mannose binding lectin (MBL)-associated serine protease (MASP)2, in the microvasculature, consistent with sustained, systemic activation of the complement pathways. The purpuric skin lesions similarly showed a pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d in both grossly involved and normally-appearing skin. In addition, there was co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the interalveolar septa and the cutaneous microvasculature of 2 cases examined. In conclusion, at least a subset of sustained, severe COVID-19 may define a type of catastrophic microvascular injury syndrome mediated by activation of complement pathways and an associated procoagulant state. It provides a foundation for further exploration of the pathophysiologic importance of complement in COVID-19, and could suggest targets for specific intervention.


Assuntos
Betacoronavirus , Proteínas do Sistema Complemento/metabolismo , Infecções por Coronavirus/complicações , Microvasos/patologia , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia , Trombose/etiologia , Adulto , Idoso , Ativação do Complemento/fisiologia , Infecções por Coronavirus/patologia , Feminino , Humanos , Masculino , Microvasos/virologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/patologia , Púrpura/etiologia , Púrpura/patologia , Púrpura/virologia , Insuficiência Respiratória/patologia , Trombose/patologia
5.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(3): 196-204, abr. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-ET2-5446

RESUMO

Las dermatosis purpúricas pigmentadas son un grupo de enfermedades benignas y de curso crónico. Las variantes descritas representan distintas formas clínicas de una misma entidad con unas características histopatológicas comunes para todas ellas. Exponemos a continuación un resumen de las variedades más frecuentes, sus características clínicas, dermatopatológicas y de epiluminiscencia. Al tratarse de una entidad clínica poco frecuente, benigna, y no conocerse claramente los mecanismos patogénicos de la misma, no existen tratamientos estandarizados. Se revisan los tratamientos publicados hasta el momento, la mayoría de ellos basados en casos aislados o pequeñas series de casos, sin poder establecer un nivel de evidencia suficiente como para ser recomendado ninguno de ellos como tratamiento de elección


The pigmented purpuric dermatoses are a group of benign, chronic diseases. The variants described to date represent different clinical presentations of the same entity, all having similar histopathologic characteristics. We provide an overview of the most common PPDs and describe their clinical, dermatopathologic, and epiluminescence features. PPDs are both rare and benign, and this, together with an as yet poor understanding of the pathogenic mechanisms involved, means that no standardized treatments exist. We review the treatments described to date. However, because most of the descriptions are based on isolated cases or small series, there is insufficient evidence to support the use of any of these treatments as first-line therapy


Assuntos
Humanos , Dermatopatias/diagnóstico , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/terapia , Púrpura/diagnóstico , Transtornos da Pigmentação/patologia , Púrpura/terapia , Derme/anatomia & histologia , Derme/patologia , Diagnóstico Diferencial , Fototerapia , Terapia PUVA
7.
Internist (Berl) ; 61(2): 213-216, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31915842

RESUMO

A female patient presented with exertional dyspnea, myalgia, a petechial rash of the lower extremities and pronounced gingivitis. The biochemical test results showed the presence of anemia. The patient had a known eating disorder and on questioning about eating habits admitted that she did not eat any fruit or vegetables. This led to the suspicion of a vitamin C deficiency, which was confirmed by high-pressure liquid chromatography. The patient was subsequently treated with 1000 mg ascorbic acid daily for 1 month whereby the clinical symptoms and anemia improved within a few weeks.


Assuntos
Deficiência de Ácido Ascórbico/diagnóstico , Gengivite , Púrpura , Ácido Ascórbico/uso terapêutico , Deficiência de Ácido Ascórbico/complicações , Deficiência de Ácido Ascórbico/tratamento farmacológico , Dispneia/etiologia , Feminino , Gengivite/etiologia , Humanos , Extremidade Inferior , Pessoa de Meia-Idade , Mialgia/etiologia , Púrpura/etiologia
8.
Asian Pac J Allergy Immunol ; 38(1): 47-51, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30447655

RESUMO

Vancomycin (VCM) has been reported to elicit adverse cutaneous drug reactions. However, VCM-associated purpuric drug eruption has not been reported yet, except leukocytoclastic vasculitis. A 16-year-old Japanese girl was admitted with a respiratory infection. We initiated intravenous administration of VCM. After the start of treatment, impalpable purpuric eruption appeared on her trunk. The eruption gradually extended to her neck, legs, and arms. Skin biopsy showed vasculitis with lymphocyte infiltration in the superficial dermis. A drug lymphocyte stimulation test yielded positive results for VCM. Her cutaneous symptoms rapidly reversed after the withdrawal of VCM. To the best of our knowledge, this is the first reported case of VCM-associated purpuric drug eruption, which differs from leukocytoclastic vasculitis. We recommend that VCM-associated purpuric drug eruption should be considered in the differential diagnosis during the administration of VCM, and a drug lymphocyte stimulation test may be useful for assessment of pathogenesis.


Assuntos
Erupção por Droga/etiologia , Púrpura/etiologia , Vancomicina/efeitos adversos , Adolescente , Biópsia , Feminino , Humanos , Japão , Pele , Vasculite Leucocitoclástica Cutânea
13.
Forensic Sci Int ; 305: 110029, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31726327

RESUMO

The question whether an injury was sustained during life or not is one of the most important subjects in forensic medicine. Therefore, vital reactions have been a main research topic in forensic medicine for a long period and many renowned forensic pathologists have devoted important papers to this field. The research area ranges from macroscopically visible organ reactions, over tissue alterations (enzyme histochemistry, later on immunohistochemistry with a wide range of enzymes and other analytes, molecular pathology) to biochemical responses to injury. Especially in the field of immunohistochemistry and molecular pathology much progress has been achieved in the last years (e.g. heat-shock-proteins or positive aquaporine3-staining in mechanical skin trauma). Furthermore, 20 years after its implementation postmortem imaging also contributes to the detection and visualization of vital signs. The aim of the present review is to provide an update on forensically relevant vital signs/vital reactions. Systemic vital reactions especially of the circulatory and respiratory system as well as local vital reactions will be addressed. Vital reactions of different organ systems will be discussed in detail regarding pathogenesis and possible postmortem evolution. Current research on immunohistochemically detectable vital reactions (heat-shock-protein expression, aquaporine3-staining in mechanical trauma of the skin) will be addressed as well as biochemical vital reactions (agonochemical stress reaction, myoglobine in electrocution death, hypoxanthine as marker of hypoxia).


Assuntos
Medicina Legal/métodos , Ferimentos e Lesões/patologia , Catecolaminas/sangue , Tosse , Deglutição , Embolia/patologia , Exsanguinação/patologia , Hemorragia/patologia , Humanos , Imuno-Histoquímica , Insulina/sangue , Absorção Intestinal , Isquemia/patologia , Pneumotórax/patologia , Proteínas/metabolismo , Enfisema Pulmonar/patologia , Ventilação Pulmonar , Púrpura/patologia , Aspiração Respiratória/patologia , Salivação
14.
Medicine (Baltimore) ; 98(45): e17870, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702653

RESUMO

RATIONALE: Bevacizumab-an inhibitor of vascular endothelial growth factor-is effective against various advanced cancers. However, it is associated with the development of hypertension and high-grade proteinuria during thrombotic microangiopathy of the kidney. In addition, there are several reports of immunoglobulin A deposition in the glomeruli, but the etiology is unclear. PATIENT CONCERNS: A 67-year-old Japanese man with metastatic rectal cancer underwent low anterior rectal resection, followed by treatment with bevacizumab and SOX (S-1 plus oxaliplatin). Six months later, the patient developed hematuria, nephrotic syndrome, and purpura. DIAGNOSES: Renal biopsy revealed endocapillary proliferative glomerulonephritis. Immunofluorescence analyses showed granular mesangial deposition of galactose-deficient immunoglobulin A1. Skin biopsy revealed leukocytoclastic vasculitis. INTERVENTIONS: We ceased bevacizumab treatment, while continuing the remaining chemotherapy regimen, as we suspected bevacizumab-induced nephropathy. OUTCOMES: Proteinuria and purpura improved immediately after cessation of bevacizumab. We identified this as a case of bevacizumab-induced immunoglobulin A vasculitis with nephritis. LESSONS: To our knowledge, this is the first case of bevacizumab-related immunoglobulin A vasculitis with nephritis, as evidenced by galactose-deficient immunoglobulin A1. When a patient's urine tests are abnormal during bevacizumab treatment, clinicians should consider not only thrombotic microangiopathy but also vasculitis.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Bevacizumab/efeitos adversos , Glomerulonefrite por IGA/induzido quimicamente , Vasculite/induzido quimicamente , Idoso , Hematúria/induzido quimicamente , Humanos , Imunoglobulina A/efeitos dos fármacos , Masculino , Síndrome Nefrótica/induzido quimicamente , Púrpura/induzido quimicamente
15.
An Bras Dermatol ; 94(5): 582-585, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777360

RESUMO

Granulomatous pigmented purpuric dermatosis clinically manifests as hyperpigmented maculae and petechiae, predominantly on the lower extremities. Histopathologically, it is characterized by a lymphocytic infiltrate in the upper dermis, extravasated erythrocytes, and hemosiderin deposits. There is an infrequent variant called granulomatous pigmented purpuric dermatosis, which histologically is characterized by the presence of non-necrotizing granulomas associated with the classic findings of other pigmented purpuric dermatoses. It more frequently affects middle-aged women of Asian origin, and predominantly on the lower extremities. The authors present the case of a female patient with granulomatous pigmented purpuric dermatosis on the lower extremities with blaschkoid distribution.


Assuntos
Granuloma/patologia , Púrpura/patologia , Dermatopatias/patologia , Biópsia , Dermoscopia , Eritrócitos/patologia , Feminino , Humanos , América Latina , Pessoa de Meia-Idade
17.
An. bras. dermatol ; 94(5): 582-585, Sept.-Oct. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1054852

RESUMO

Abstract Granulomatous pigmented purpuric dermatosis clinically manifests as hyperpigmented maculae and petechiae, predominantly on the lower extremities. Histopathologically, it is characterized by a lymphocytic infiltrate in the upper dermis, extravasated erythrocytes, and hemosiderin deposits. There is an infrequent variant called granulomatous pigmented purpuric dermatosis, which histologically is characterized by the presence of non-necrotizing granulomas associated with the classic findings of other pigmented purpuric dermatoses. It more frequently affects middle-aged women of Asian origin, and predominantly on the lower extremities. The authors present the case of a female patient with granulomatous pigmented purpuric dermatosis on the lower extremities with blaschkoid distribution.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Púrpura/patologia , Dermatopatias/patologia , Granuloma/patologia , Biópsia , Dermoscopia , Eritrócitos/patologia , América Latina
18.
Rev. clín. med. fam ; 12(3): 160-162, oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186808

RESUMO

Presentamos un caso de liquen aureus en una mujer joven de 22 años, rara lesión cutánea que pertenece al grupo de las dermatosis purpúricas pigmentadas, diagnosticada por biopsia, que no precisó otro tratamiento que la exéresis de la lesión y que ha tenido una evolución favorable. Es una lesión eritematosa de la piel, con aspecto de su fondo dorado, de etiología desconocida y que, por su escasa sintomatología y pronóstico benigno, muchas veces es infradiagnosticada, por lo que debe ser conocida para hacer un diagnóstico diferencial eficiente


We present the case of a 22-year-old young woman with lichen aureus, a rare skin lesion that belongs to the group of pigmented purpuric dermatosis. It was diagnosed by biopsy and did not require any other treatment than the excision of the lesion, with a favorable evolution. Lichen aureus is an erythematous skin lesion with a golden background of unknown etiology. It is often underdiagnosed because it presents few symptoms and has a benign prognosis, so it should be known to make an effective differential diagnosis


Assuntos
Humanos , Feminino , Adulto Jovem , Erupções Liquenoides/diagnóstico , Púrpura/diagnóstico , Eritema/diagnóstico , Dermatopatias Eczematosas/diagnóstico , Diagnóstico Diferencial , Transtornos da Pigmentação/etiologia , Biópsia
20.
Clin Adv Periodontics ; 9(1): 20-23, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31490035

RESUMO

INTRODUCTION: Monoclonal antibodies against proprotein-convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a newly-introduced therapeutic approach against hypercholesterolemia. Clinical trials have reported few adverse effects of PCSK9 inhibitors and there are no reports of oral adverse effects. We present the case of a patient that showed gingival discomfort on eating and toothbrushing, coupled with the presence of gingival ischemia and petechiae, 3 days after a subcutaneous abdominal injection of 75-mg alirocumab for hypercholesterolemia, and contemplate on their possible pathogenesis. CASE PRESENTATION: Αn 81-year-old male presented with gingival discomfort during eating and toothbrushing, 3 days after receiving a subcutaneous abdominal injection of alirocumab. Intraoral examination revealed that the anterior free and attached gingiva of both jaws appeared pale and the surrounding mucosa showed confluent petechiae that were more evident on the anterior palatal gingiva. The patient was asked to brush his teeth with a soft toothbrush and use a mouthwash containing hydrogen peroxide three times daily. At the 8-day re-examination he was symptom-free, and the mucosa appeared totally normal. At the 5-month follow-up visit he reported having the same symptoms after each one of the 12 doses of alirocumab he received. CONCLUSIONS: Adverse dugs effects associated with subcutaneous injection of alirocumab may manifest in the gingiva. Therefore, oral and periodontal examination should be included in the regular follow-up of patients medicated with this drug.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Hipercolesterolemia , Isquemia , Idoso de 80 Anos ou mais , Gengiva/diagnóstico por imagem , Humanos , Hipercolesterolemia/tratamento farmacológico , Isquemia/induzido quimicamente , Masculino , Pró-Proteína Convertase 9/antagonistas & inibidores , Púrpura
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