RESUMO
BACKGROUND: Dermatologists play an important role in diagnosing and managing hospitalized patients with cutaneous abnormalities. Skin biopsies remain an indispensable tool for aiding dermatologists in accurate diagnosis and treatment. We aimed to determine the range of conditions, and the most common conditions, prompting skin biopsy by dermatology hospital consultation (HCON) services to aid in evaluation of hospitalized patients. METHODS: All hospitalized patients seen by a single tertiary care center dermatology HCON service between 2015 and 2018 who had associated skin biopsies were identified. Histologic features and clinical diagnoses of each patient were classified into 13 histologic reaction pattern categories. RESULTS: Eight hundred and thirty one inpatients evaluated by our dermatology HCON service had 914 skin biopsies. The most frequent diagnostic categories prompting biopsy were vasculopathic (17.6%), interface dermatitis (16.5%), infectious (12.6%), and spongiotic dermatitis (10.9%). The most frequent diagnostic categories included drug reaction (13.2%), leukocytoclastic vasculitis (8.5%), skin cancer (5.4%), graft-vs-host disease (3.5%), connective tissue disease (3.3%), and calciphylaxis (3.0%). CONCLUSION: Our study suggests a variety of serious diseases affecting inpatients prompts biopsy by dermatology consultation services. Educational curricula for dermatology and pathology residents, fellows, and staff designed with these data may enhance knowledge that improves the quality of inpatient dermatology care.
Assuntos
Dermatopatias/diagnóstico , Dermatopatias/patologia , Pele/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermatologistas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Dermatopatias/classificação , Centros de Atenção Terciária , Adulto JovemAssuntos
Metotrexato/uso terapêutico , Pneumonia por Pneumocystis/prevenção & controle , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Adulto , Doenças Autoimunes/tratamento farmacológico , Contraindicações de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Leucopenia/induzido quimicamente , Fígado/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Transaminases/sangue , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Antígeno Ki-1/análise , Micose Fungoide/diagnóstico , Síndrome de Sézary/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso , Bexaroteno/administração & dosagem , Humanos , Antígeno Ki-1/metabolismo , Masculino , Pessoa de Meia-Idade , Micose Fungoide/sangue , Micose Fungoide/tratamento farmacológico , Micose Fungoide/patologia , Fotoferese , Síndrome de Sézary/sangue , Síndrome de Sézary/tratamento farmacológico , Síndrome de Sézary/patologia , Neoplasias Cutâneas/sangue , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Linfócitos T/metabolismo , Resultado do Tratamento , Vorinostat/administração & dosagemAssuntos
Produtos Biológicos/efeitos adversos , Hidradenite Supurativa/tratamento farmacológico , Tuberculose Latente/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Feminino , Hidradenite Supurativa/sangue , Hidradenite Supurativa/imunologia , Humanos , Incidência , Testes de Liberação de Interferon-gama/estatística & dados numéricos , Tuberculose Latente/sangue , Tuberculose Latente/diagnóstico , Tuberculose Latente/imunologia , Masculino , Pessoa de Meia-Idade , Soroconversão , Fator de Necrose Tumoral alfa/imunologiaRESUMO
INTRODUCTION: Dermatologic manifestations of diseases in solid organ transplant recipients are common due to long-term immunosuppression. CASE PRESENTATION: We present the case of a 63-year-old man with a kidney transplant who exhibited subcutaneous nodules on lower extremities, cytopenia, and asymptomatic pulmonary infiltrate. Through a skin biopsy and 16S ribosomal RNA (rRNA) sequencing, Mycobacterium haemophilum was identified. His clinical course was complicated by empyema, septic arthritis, and recurrence of his skin manifestations, despite ongoing antimicrobial treatment. DISCUSSION: This case emphasizes the challenges and potential complications associated with M haemophilum infections in solid organ transplant recipients receiving long-term immunosuppressive therapy. It highlights the importance of employing advanced diagnostic techniques when evaluating dermatologic manifestations in these patients. The patient's complex clinical course also underscores the difficulties involved in effectively addressing and managing complications that may arise even after initiating therapy.
Assuntos
Transplante de Rim , Mycobacterium haemophilum , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mycobacterium haemophilum/isolamento & purificação , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/tratamento farmacológico , Hospedeiro ImunocomprometidoRESUMO
This drawing considers how achieving balance between allopathic, Western medical practices and spiritual practices can be critical for clinicians hoping to offer compassionate health care. Ethical and clinical challenges of consistently offering compassionate care to patients from all backgrounds requires cultivating and practicing spiritual awareness while maintaining professional boundaries.