RESUMO
Granuloma annulare (GA) is a common benign inflammatory skin disorder with an unknown pathogenesis. Granuloma annulare occurring in prior sites of herpes zoster (HZ) infection is rarely reported; however, it is the most common granulomatous reaction described at these sites. We report a case of localized GA on scars of prior HZ infection in a patient with multiple myeloma who had received an autologous peripheral stem cell transplant (PSCT). This patient's GA was successfully treated with intralesional corticosteroid injections.
Assuntos
Granuloma Anular/patologia , Herpes Zoster/complicações , Mieloma Múltiplo/complicações , Cicatriz , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Granuloma Anular/diagnóstico , Granuloma Anular/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico/métodos , Transplante Autólogo , Resultado do Tratamento , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/uso terapêuticoRESUMO
Tumor necrosis factor alpha (TNF-alpha) inhibitors constitute a class of biologic treatments utilized in the management of psoriasis. We report a case of a patient treated for chronic plaque psoriasis with the anti-TNF-alpha monoclonal antibody adalimumab, who developed erythema multiforme (EM). The patient had previously developed EM on two occasions while taking the TNF-alpha inhibitor etanercept. EM has previously been reported in connection with other TNF-alpha inhibitors, including etanercept and infliximab. To our knowledge, this is the first case reported in the literature documenting EM occurring subsequent to adalimumab treatment for psoriasis. The recurrent development of EM in our patient while being treated with distinct TNF-alpha inhibitors may suggest that EM is the consequence of a class effect with TNF-alpha inhibitors.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Eritema Multiforme/induzido quimicamente , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Idoso , Anticorpos Monoclonais Humanizados , Etanercepte , Humanos , Imunoglobulina G/efeitos adversos , Masculino , Receptores do Fator de Necrose Tumoral , Fator de Necrose Tumoral alfa/imunologiaRESUMO
A 34-year-old man from El Salvador was referred to our clinic with a 10-year history of a pruritic erythematous facial eruption. He reported increased pruritus and scaling of lesions when exposed to the sun. He worked as a construction worker and admitted to frequent sun exposure. Physical examination revealed well-circumscribed erythematous to violaceous papules with raised borders and atrophic centers localized to the nose (Figure 1). He did not have lesions on the arms or legs. He did not report a family history of similar lesions. A biopsy specimen was obtained from the edge of a lesion on the right ala. Histologic examination of the biopsy specimen showed acanthosis of the epidermis with focal invagination of the corneal layer and a homogeneous column of parakeratosis in the center of that layer consistent with a cornoid lamella (Figure 2). Furthermore, the granular layer was absent at the cornoid lamella base. The superficial dermis contained a sparse, perivascular lymphocytic infiltrate. No evidence of dysplasia or malignancy was seen. These findings supported a diagnosis of porokeratosis. The patient underwent a trial of cryotherapy with moderate improvement of the facial lesions.
Assuntos
Dermatoses Faciais/patologia , Poroceratose/patologia , Adulto , Crioterapia , Dermatoses Faciais/etiologia , Dermatoses Faciais/terapia , Humanos , Masculino , Poroceratose/etiologia , Poroceratose/terapia , Luz Solar/efeitos adversosRESUMO
Acquired perforating dermatosis (APD) is an uncommon skin eruption of unclear etiology that most often is associated with diabetes mellitus or chronic renal insufficiency. There are rare reports of APD in association with liver disease or thyroid disease. We report a case of APD in a patient with both primary biliary cirrhosis and Hashimoto thyroiditis in the absence of diabetes mellitus and chronic renal insufficiency. The patient had a partial response to narrowband UVB phototherapy.
Assuntos
Doença de Hashimoto/complicações , Cirrose Hepática Biliar/complicações , Dermatopatias/complicações , Artrite Reumatoide/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Dermatopatias/patologiaRESUMO
Intravascular lymphoma, also known as malignant angioendotheliomatosis or angiotropic lymphoma, is a rare non-Hodgkin lymphoma that is usually fatal. It often presents with cutaneous and/or nervous system involvement, but the disease can involve any organ system. Clinical symptoms result from the occlusion of small vessels by tumor cells and fibrin. We present a case of cutaneous intravascular lymphoma successfully treated with rituximab, a recombinant antibody to CD20 antigen found on B lymphocytes.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Hemangioendotelioma/tratamento farmacológico , Linfoma de Células B/tratamento farmacológico , Linfoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos , Humanos , Masculino , RituximabAssuntos
Doença de Darier/complicações , Doença de Darier/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Isotretinoína/uso terapêutico , Transtornos de Enxaqueca/complicações , Adulto , Cálcio/metabolismo , Doença de Darier/metabolismo , Feminino , Humanos , Transtornos de Enxaqueca/metabolismoAssuntos
Ceratodermia Palmar e Plantar/diagnóstico , Líquen Plano/diagnóstico , Administração Cutânea , Idoso , Diagnóstico Diferencial , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Ceratodermia Palmar e Plantar/tratamento farmacológico , Ceratodermia Palmar e Plantar/patologia , Líquen Plano/tratamento farmacológico , Líquen Plano/patologia , Masculino , Tacrolimo/administração & dosagem , Tacrolimo/uso terapêuticoRESUMO
BACKGROUND: Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea. The most common phyma is rhinophyma, yet similar swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). OBJECTIVE: Unlike rhinophyma, otophyma is rarely seen. We report two rare phymas: a case of gnatophyma and a case of otophyma. METHODS: A 56-year-old African American man presented with a history of bumps on his chin that had begun about 7 years earlier. Physical examination was remarkable for lobulated plaques on the chin, coalescing into hypertrophic nodules and dilated pores. A 73-year-old African American male presented with bilateral cauliflower-like earlobe growths for the past 17 years. RESULTS: A skin biopsy was performed for each patient demonstrating cystic follicular dilatation with keratin plugging, dermal scarring, psoriasiform epidermal hyperplasia, and chronic inflammation of some of the follicles. CONCLUSION: This case report describes a relatively rare gnatophyma and otophyma. Surgical management is well accepted as the best mode of therapy to treat rhinophyma and is becoming a first-line treatment for all phymas.
Assuntos
Otopatias/diagnóstico , Rosácea/diagnóstico , Pele/patologia , Idoso , Biópsia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Non-tuberculous mycobacteria are becoming increasingly important pathogens among transplant recipients. We report a case of disseminated Mycobacterium haemophilum infection in a heart transplant recipient, manifesting as cellulitis, subcutaneous nodules, septic arthritis, and pneumonitis. Our case illustrates diverse challenges in the identification and treatment of this pathogen, such as its unique culture requirements and variable antimicrobial susceptibilities. Heightened clinical suspicion is necessary to establish a timely diagnosis so that optimal treatment can be administered.