Mycoplasma pneumoniae-Induced Mucocutaneous Rash: A New Syndrome Distinct from Erythema Multiforme? Report of a New Case and Review of the Literature. / Exantema mucocutáneo inducido por Mycoplasma pneumoniae: ¿un nuevo síndrome separado del eritema multiforme? Un nuevo caso y revisión de la literatura.

Respiratory tract infection due to Mycoplasma pneumoniae can provoke cutaneous and mucosal rashes, which have been classified within the spectrum of erythema multiforme or Stevens-Johnson syndrome. This classification is of therapeutic and prognostic importance and has generated intense debate in the literature. A recent systematic review of 202 cases of mucocutaneous rashes associated with M. pneumoniae infection concluded that these rashes might constitute a distinct entity, for which the term Mycoplasma-induced rash and mucositis was proposed. We describe a patient with acute M pneumoniae respiratory tract infection who presented mucosal and cutaneous lesions that were difficult to classify as erythema multiforme or Stevens-Johnson syndrome; the lesions were compatible with the proposed new disease.

Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer.

OBJECTIVES: Although concurrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer. DESIGN: Retrospective review. SETTING: Tertiary care center. PARTICIPANTS: Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66-72 Gy at 2-2.12 Gy/fraction to >95% of the gross tumor volume in the definitive setting or for positive margins and 60-66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0-94.4 months). MAIN OUTCOMES MEASURES: Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0. RESULTS: Eight patients (20%) required a radiation treatment break of ≥ 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4+ skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at >1 year. One patient developed non-healing mandibular osteoradionecrosis >3 years following chemoradiation. The 2-year Kaplan-Meier estimate of overall survival was 55%. CONCLUSION: Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.

Prognosis in implant dentistry: a system for classifying the degree of peri-implant mucosal inflammation.

Disease related to peri-implant mucosal inflammation (PIMI) has been reported as one of the major factors leading to failure of dental implants. Many authors have suggested options for treatment of these lesions, ranging from simple mechanical debridement and regenerative surgical techniques to removal of the implant. Prognostic classification systems have become an integral part of dental practice because they provide direct guidance in planning treatment. However, there is limited evidence to support the appropriate classification of PIMI and the corresponding treatments, and a more specific prognostic system is required. Because the number of patients with implants is increasing, clinicians must be aware of PIMI as an entity with specific management requirements. This report describes a simple prognostic system to help clinicians to foresee the outcomes of PIMI treatment.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy.

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck tumors treated with intensity-modulated radiation therapy.

BACKGROUND: This retrospective study evaluates the efficacy of gabapentin for the treatment of pain syndrome related to radiation-induced mucositis in patients with head and neck tumors. METHODS: Thirty cases of head and neck malignancies treated with radiotherapy were analyzed. RESULTS: By using a median dose of 2700 mg/day of gabapentin, only 10% of patients required additional narcotic pain medications for adequate pain relief during the third and fourth week of treatment, despite grade 2 or higher mucositis present in 56% and 73% of the patients, respectively. Likewise, during the last weeks of intensity-modulated radiation therapy (IMRT), only 35% of patients required additional narcotics for pain control, despite the presence of grade 2 or higher mucositis in 80% of cases. CONCLUSIONS: Gabapentin appears promising in reducing the need for narcotic pain medication for patients with head and neck malignancies treated with IMRT and should be further evaluated prospectively in controlled clinical trials.

Mucositis bucal en trabajadores rurales de Misiones, Argentina, expuestos a agroquímicos: reporte de 3 casos / Oral mucositis in rural workers from Misiones, Argentina, exposed to agrochemicals: report of three cases

Se reportan tres casos de mucositis bucal luego de la exposición ocupacional a agrotóxicos en individuos provenientes de zonas rurales de Misiones, Argentina, los que presentaron inflamación inespecífica y atrofia luego de aplicar pesticidas con difusores.