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Alhawsawi W, Al Hawsawi K, Almahdi B, Alkidaiwi S, Alzubaidy K, Alhuthayli R, Algethami A, Alshareef A. A Diagnostically Challenging Case of De Novo Febrile Ulceronecrotic Mucha-Habermann Disease with Fatal Pulmonary Involvement: A Case Report. Case Rep Dermatol 2023; 15:17-21. [PMID: 36686043 PMCID: PMC9850257 DOI: 10.1159/000528500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/09/2022] [Indexed: 01/19/2023] Open
Abstract
The febrile ulceronecrotic Mucha-Habermann disease is a rare and potentially lethal variant of pityriasis lichenoides et varioliformis acuta (PLEVA). It is characterized by a sudden onset of ulceronecrotic skin lesions associated with high fever and systemic symptoms. Herein, we report a 23-year-old male, not known to have any medical illnesses, presented with a month-long history of persistent fever of unknown origin associated with a sudden onset of progressive diffuse necrotic ulcers and widespread papulosquamous lesions. Pan CT showed enlarged lymph nodes in the cervix, chest, and abdomen. Unfortunately, a skin biopsy was done late, showing features consistent with PLEVA. Few days after admission, despite being on intravenous methylprednisolone, our patient rapidly deteriorated by showing severe acute respiratory symptoms and consequently died. In spite of the continuous addition of new case reports to the literature, no definite diagnostic criteria have been established, leading to late or missed cases, and an optimum treatment is still waiting.
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Affiliation(s)
- Waseem Alhawsawi
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Khalid Al Hawsawi
- Dermatology Consultant, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Bashaer Almahdi
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | | | | | | | - Alhusain Alshareef
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Cutaneous Lymphoproliferative Disorders: What's New in the Revised 4th Edition of the World Health Organization (WHO) Classification of Lymphoid Neoplasms. Adv Anat Pathol 2019; 26:93-113. [PMID: 30199396 DOI: 10.1097/pap.0000000000000208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cutaneous lymphoproliferative disorders remain a challenging aspect of dermatopathology, in part due to the rarity of the entities and extreme variability in clinical outcomes. Although many of the entities remain unchanged, the approach to some of them has changed in the new 2016 classification scheme of the World Health Organization. Chief among these are Epstein-Barr virus-associated lymphoproliferative disorders such as Epstein-Barr virus-associated mucocutaneous ulcer and hydroa vacciniforme-like lymphoproliferative disorder, primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma, primary cutaneous acral CD8+ T-cell lymphoma, primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder, and breast implant-associated anaplastic large cell lymphoma. In addition, translocations and gene rearrangements such as those involving the 6p25.3 locus have started to inform diagnosis and classification of anaplastic large cell lymphoma and lymphomatoid papulosis. In this review, we will examine what is new in the diagnostic toolbox of cutaneous lymphoproliferative disorders.
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Xing C, Shen H, Xu J, Liu Z, Zhu J, Xu A. A Fatal Case of Febrile Ulceronecrotic Mucha-Habermann Disease which Presenting as Toxic Epidermal Necrolysis. Indian J Dermatol 2017; 62:675. [PMID: 29263553 PMCID: PMC5724328 DOI: 10.4103/ijd.ijd_631_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a severe form of pityriasis lichenoides et varioliformis acuta, is an inflammatory dermatosis of unknown etiology manifested by ulcerative and necrotic lesions accompanied by systemic manifestations. The mortality rate of FUMHD is about 15%. It is reported here a case of FUMHD presenting as toxic epidermal necrolysis that resulted in multiple organ failure and death.
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Affiliation(s)
- Chenjing Xing
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Hong Shen
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Junzhu Xu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Zehu Liu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Jun Zhu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Aie Xu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
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Liu ZH, Shen H. Young Male With Painful Skin Necrosis. Ann Emerg Med 2016; 68:276-311. [PMID: 27568417 DOI: 10.1016/j.annemergmed.2016.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ze-Hu Liu
- Department of Dermatology, Affiliated Third Hospital of Hangzhou, Anhui Medical University, Hangzhou, China
| | - Hong Shen
- Department of Dermatology, Affiliated Third Hospital of Hangzhou, Anhui Medical University, Hangzhou, China
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Nofal A, Alakad R, Assaf M, Nofal E. A fatal case of febrile ulceronecrotic Mucha-Habermann disease in a child. JAAD Case Rep 2016; 2:181-5. [PMID: 27222883 PMCID: PMC4864117 DOI: 10.1016/j.jdcr.2016.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Alakad
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Magda Assaf
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Nofal A, Assaf M, Alakad R, Amer H, Nofal E, Yosef A. Febrile ulceronecrotic Mucha-Habermann disease: proposed diagnostic criteria and therapeutic evaluation. Int J Dermatol 2015; 55:729-38. [DOI: 10.1111/ijd.13195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/13/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Magda Assaf
- Department of Pathology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Rania Alakad
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
| | - Eman Nofal
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Yosef
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
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Lode HN, Döring P, Lauenstein P, Hoeger P, Dombrowski F, Bruns R. Febrile ulceronecrotic Mucha–Habermann disease following suspected hemorrhagic chickenpox infection in a 20-month-old boy. Infection 2015; 43:583-8. [DOI: 10.1007/s15010-015-0726-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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Lejuste FX, Michaux C, Lehners C, Calteux N. Febrile ulceronecrotic Mucha-Habermann disease. BMJ Case Rep 2013; 2013:bcr2013009739. [PMID: 24127370 PMCID: PMC3822268 DOI: 10.1136/bcr-2013-009739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The Mucha-Habermann disease is an inflammatory disease of the skin and is a variant of pityriasis lichenoides et varioliformis acuta. We describe the case of a 64-years-old woman who was admitted for erysipelas of the face. Despite treatment, evolution was marked by the appearance of a necrotising ulcerative area in the centre of the erysipelas associated with local oedema and headache. A skin biopsy revealed a pityriasis lichenoides et varioliformis acuta. Corticosteroids led to a rapid stabilisation of lesions, and after 6 months the patient shows only a small area of frontal hypopigmentation. The aetiology remains uncertain. There is no established standard treatment. We would like to draw attention of the medical and surgical specialists to this rare disease. The diagnosis should be considered in a necrotic lesion associated with rapid expansion of systemic and peripheral cutaneous signs. Diagnosis must be considered to avoid unnecessary debridement and extensive scars.
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Affiliation(s)
- F-X Lejuste
- Service de Chirurgie Plastique Reconstructrice et Esthétique, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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Febrile Ulceronecrotic Mucha-Habermann Disease (Pityriasis Lichenoides et Varioliformis Acuta Fulminans) Associated With Parvovirus Infection. Am J Dermatopathol 2013; 35:503-6. [DOI: 10.1097/dad.0b013e3182770626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gomes Bica BER, Reis Monteiro de Barros MDGC, Junior CS. Doença de Mucha-Habermann. REVISTA BRASILEIRA DE REUMATOLOGIA 2013; 53:314-7. [DOI: 10.1590/s0482-50042013000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
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Kaufman WS, McNamara EK, Curtis AR, Kosari P, Jorizzo JL, Krowchuk DP. Febrile ulceronecrotic Mucha-Habermann disease (pityriasis lichenoides et varioliformis acuta fulminans) presenting as Stevens-Johnson syndrome. Pediatr Dermatol 2012; 29:135-40. [PMID: 22084981 DOI: 10.1111/j.1525-1470.2011.01608.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present two pediatric patients with pityriasis lichenoides et varioliformis acuta fulminans whose admitting diagnosis was Stevens Johnson Syndrome. The patients were successfully treated with methotrexate and prednisone. These cases highlight the importance of early recognition and treatment of this disease to prevent further morbidity and a potentially fatal prognosis.
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Affiliation(s)
- William S Kaufman
- Department of Dermatology, Wake Forest Baptist Health, Winston-Salem, NC 27104, USA
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Meziane L, Caudron A, Dhaille F, Jourdan M, Dadban A, Lok C, Chaby G. Febrile Ulceronecrotic Mucha-Habermann Disease: Treatment with Infliximab and Intravenous Immunoglobulins and Review of the Literature. Dermatology 2012; 225:344-8. [PMID: 23391565 DOI: 10.1159/000346245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- L Meziane
- Department of Dermatology, Amiens University Medical Centre, South Hospital, and University Picardie Jules Verne, Amiens, France.
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Perrin BS, Yan AC, Treat JR. Febrile ulceronecrotic Mucha-Habermann disease in a 34-month-old boy: a case report and review of the literature. Pediatr Dermatol 2012; 29:53-8. [PMID: 21906156 DOI: 10.1111/j.1525-1470.2011.01531.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) in a 34-month-old boy. Our patient had a history of biopsy-proven pityriasis lichenoides et varioliformis acuta (PLEVA) since age 2. At 34 months, his skin lesions rapidly progressed to ulceration and necrosis in the setting of high fever. Skin biopsy revealed an intense lichenoid infiltrate with parakeratosis at the edges of areas of epidermal necrosis consistent with FUMHD, which is the severe variant of PLEVA. Despite initial treatment with prednisolone, his disease progressed to involve more than 50% of his body surface area. In addition to corticosteroids, he was treated with intravenous immunoglobulin, dapsone, and acyclovir, without complete resolution of disease. Methotrexate successfully cleared his skin disease and systemic symptoms. This patient highlights the exceptional response of FUMHD to methotrexate. Based on our review of the literature, this also represents the youngest reported case of FUMHD.
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Affiliation(s)
- Bridget S Perrin
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Lin CY, Cook J, Purvis D. Febrile ulceronecrotic Mucha-Habermann disease: A case with systemic symptoms managed with subcutaneous methotrexate. Australas J Dermatol 2011; 53:e83-6. [PMID: 23157793 DOI: 10.1111/j.1440-0960.2011.00812.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chin-Yun Lin
- Department of Dermatology, Auckland City Hospital, Auckland, New Zealand.
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Nassif PW, Godoy DAS, Nakandakari S, Alves CJM, Soares CT. Febrile ulceronecrotic Mucha-Habermann disease in adult patient successfully treated with systemic corticosteroid. An Bras Dermatol 2011; 85:891-4. [PMID: 21308316 DOI: 10.1590/s0365-05962010000600018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 08/28/2009] [Indexed: 11/21/2022] Open
Abstract
The Febrile Ulceronecrotic Mucha-Habermann (FUMHD) disease is a rare variant of pityriasis lichenoides et varioliformis acuta (PLEVA). Its etiology still remains unknown and it is characterized by a sudden onset of ulceronecrotic skin lesions associated with systemic symptoms. It is reported here the case of a male patient with a sudden and acute evolution of macules and papules, ulceronecrotic and vesicle-bullous lesions associated with systemic symptoms. The patient was treated with prednisone 0.5 mg/kg/day with a dramatic response. The FUMHD is a severe variant of PLEVA and its diagnosis is clinical and histopathological. Many treatments such as methotrexate, corticosteroids and PUVA have been described. However, none of them has been settled.
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Marenco F, Fava P, Fierro MT, Quaglino P, Bernengo MG. High-dose immunoglobulines and extracorporeal photochemotherapy in the treatment of febrile ulceronecrotic Mucha-Habermann disease. Dermatol Ther 2010; 23:419-22. [DOI: 10.1111/j.1529-8019.2010.01343.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Federica Marenco
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Turin, Turin, Italy
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Harenberg PS, Hrabowski M, Ryssel H, Gazyakan E, Germann G, Engel H, Reichenberger MA. CASE REPORT Febrile Ulceronecrotic Mucha-Habermann Disease. EPLASTY 2010; 10:e53. [PMID: 20697454 PMCID: PMC2905190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Case report and review of the current literature about febrile ulceronecrotic Mucha-Habermann disease (FUMHD). METHODS Review of our patient's medical records and of the current literature. RESULTS The FUMHD is a rare and potentially lethal type of pityriasis lichenoides et varioliformis acuta. It is characterized by the sudden onset of ulceronecrotic skin lesions associated with high fever and systemic symptoms. Because of a high case-fatality rate it requires quick and decisive action. Only 40 cases of this severe form of the disease have been reported in the literature to date. We present the case of a 30-year-old male patient with severe FUMHD who was successfully treated in our burn intensive care unit after failed treatment at a dermatological hospital. The patient was treated with topical antiseptics, moisturizers, and artificial skin substitutes, as well as systemic immunosuppressive therapy (glucocorticoids) with which we were able to control the disease activity so that healing of the patient's skin lesions could be achieved. CONCLUSION Patients with FUMHD should be treated in a specialized center for severely burned patients. Only such centers can provide the structural and logistical capacities necessary for the treatment of such extensive superficial wounds.
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Affiliation(s)
- Patrick S. Harenberg
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany,Correspondence:
| | - Manuel Hrabowski
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany
| | - Henning Ryssel
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany
| | - Günter Germann
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany
| | - Holger Engel
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany
| | - Matthias A. Reichenberger
- Department of Hand, Plastic, and Reconstructive Surgery Burn Center; BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttmann, Ludwigshafen, Germany
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Cumming MM, Salathiel AS, Paino MAS, Delort S, Roselino AM. [Febrile ulceronecrotic Mucha-Habermann disease with exuberant mucosal involvement: case report]. An Bras Dermatol 2010; 84:655-8. [PMID: 20191178 DOI: 10.1590/s0365-05962009000600012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 11/06/2009] [Indexed: 11/22/2022] Open
Abstract
Pityriasis lichenoides is a rare idiopathic cutaneous disorder, with a clinical-histopathological spectrum comprising the acute varioliform form (Mucha-Habermann's disease), its febrile ulceronecrotic variant, and its chronic form. Systemic manifestations may occur in the febrile ulceronecrotic variant, with reports of adult mortality. The case of a young male patient with clinical and histopathological diagnosis of Mucha-Habermann's disease, febrile ulceronecrotic variant, with severe mucosal involvement - an occasional incidence even in the most severe forms of pityriasis lichenoides - is presented. In addition to the atypical clinical aspect, an excellent therapeutic result is shown with the association of prednisone and methotrexate.
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Fernandes NF, Rozdeba PJ, Schwartz RA, Kihiczak G, Lambert WC. Pityriasis lichenoides et varioliformis acuta: a disease spectrum. Int J Dermatol 2010; 49:257-61. [DOI: 10.1111/j.1365-4632.2008.03915.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Febrile ulceronecrotic Mucha–Habermann disease associated with herpes simplex virus type 2. J Am Acad Dermatol 2009; 60:149-52. [PMID: 19103367 DOI: 10.1016/j.jaad.2008.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 07/13/2008] [Accepted: 07/21/2008] [Indexed: 11/22/2022]
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Doffoël-Hantz V, Fauchais AL, Sparsa A, Roux C, Ly K, Loustaud-Ratti V, Bonnetblanc JM, Vidal E, Bédane C. Éruptions varioliformes aiguës: aspects diagnostiques et évolutifs. Rev Med Interne 2007; 28:127-30. [PMID: 17150282 DOI: 10.1016/j.revmed.2006.10.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 09/07/2006] [Accepted: 10/09/2006] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Abrupt onset of papular lesions, with ulcero necrotic evolution could refers to many dermatitis. Febrile ulceronecrotic Mucha-Habermann disease is an unusual severe form of pityriasis lichenoides and varioliform acuta (PLEVA) characterized with ulceronecrotic eruption potentially associated with high fever and systemic symptoms leading to death. Lymphomatoid papulosis is a recurrent papulonodular eruption with an initial presentation close to PLEVA. While this disorder usually has a benign course, about 10% of the patients develop lymphoproliferative disorders such as CD30+ lymphoma. EXEGESIS The authors reported an acute form of PLEVA in a young man hospitalized in internal medicine unit with fever and ulcero-necrotic papulo-vesicular lesions. Treatment with tetracycline was successful. They also report a case of lymphomatoïd pustulosis that occurred in a 34 years old woman with an extensive nodulo-pustular eruption characterized by central necrosis and ulceration. Histopathological examination revealed CD30 lymphocytic infiltration leading to diagnosis. CONCLUSION Theses two dermatosis, uncommon and clinically similar, are both characterized with an unpredictable evolution that to be known by internist.
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Affiliation(s)
- V Doffoël-Hantz
- Service de dermatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 cedex Limoges, France
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Abstract
Pityriasis lichenoides (PL) is an uncommon, acquired spectrum of skin conditions that poses various challenges to patients as well as clinicians. It is a difficult and debatable disorder to diagnose, categorize, and treat. Besides these inherent obstacles, PL merits awareness because of its potential to progress to cutaneous lymphoma or an ulceronecrotic presentation, both of which carry a significant risk of mortality. The scope of PL presentations is delineated along a continuum of multiple variants including pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis lichenoides chronica (PLC), and febrile ulceronecrotic Mucha-Habermann disease (FUMHD). Classification of these presentations as separate subsets is debatable in view of their overlapping clinical, histopathologic, and etiologic features. PLEVA generally presents as an acute-to-subacute skin eruption of multiple, small, red papules that develops into polymorphic lesions and vacillates with periods of varying remissions as well as possible sequelae of hyper/hypopigmentation and varicella-like scars. PLC has a more gradual manifestation of very small red-to-brown flat maculopapules with mica-like scale; it also follows a relapsing course but with long periods of remission. FUMHD is an acute and severe generalized eruption of purpuric and ulceronecrotic plaques with associated systemic involvement and a mortality rate of up to 25%; hence, it should be approached as a dermatologic emergency.Histopathological evaluation of PL usually reveals dermal, wedge-shaped, lymphocytic infiltrate, epidermal spongiosis, parakeratosis, and variable necrosis of keratinocytes. PLC demonstrates more subtle histology whereas, at the other end of the spectrum, febrile ulceronecrotic FUMHD exhibits the most exaggerated histological features. The pathogenic mechanism behind PL is unclear although infectious or drug-related hypersensitivity reactions versus premycotic lymphoproliferative disorder are the mainstay theories. The foremost therapies for PLEVA and PLC are phototherapy, systemic antibacterials, and topical corticosteroids. Aggressive treatment with immunosuppressant and/or immunomodulating agents as well as intensive supportive care are recommended for FUMHD. We first describe a representative case of a 14-year-old boy with PLC who was successfully treated with narrow-band UVB. We then review the pathophysiology, classification, and treatment of PL.
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Affiliation(s)
- Amor Khachemoune
- Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
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Bowers S, Warshaw EM. Pityriasis lichenoides and its subtypes. J Am Acad Dermatol 2006; 55:557-72; quiz 573-6. [PMID: 17010734 DOI: 10.1016/j.jaad.2005.07.058] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 07/05/2005] [Accepted: 07/23/2005] [Indexed: 11/18/2022]
Abstract
Pityriasis lichenoides represents a unique group of inflammatory skin disorders that include pityriasis lichenoides et varioliformis acuta (PLEVA), febrile ulceronecrotic Mucha-Habermann disease (a subtype of PLEVA), and pityriasis lichenoides chronica. The history, epidemiology, clinical features, pathophysiology, and treatment of this group of conditions are reviewed in this manuscript.
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Malnar T, Milavec-Puretic V, Rados J, Zarkovic K, Dobric I. Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with fatal outcome. J Eur Acad Dermatol Venereol 2006; 20:303-7. [PMID: 16503892 DOI: 10.1111/j.1468-3083.2006.01389.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Ulceronecrotic Mucha-Habermann disease is a severe, febrile form of pityriasis lichenoides et varioliformis acuta. The condition may sometimes have a fatal outcome, especially in elderly patients. In this paper, we are reporting on a 60-year-old male patient who suffered from the eruption of erythematous, haemorrhagic, ulceronecrotic papules accompanied by high temperature. Erosions and ulceronecrotic papules covered over 80% of his body. Three weeks after his admittance to our hospital, clinical signs resembling ileus together with the leucocytosis occurred. The patient was transferred to the department of internal medicine and later to the surgery department. The fulminant course of the disease could not be stopped, and the patient died of severe intestinal and colon gangrene caused by the massive thrombosis of superior mesenteric artery. Up to date, only 23 cases of this severe form of the disease have been reported, and even with the early recognition, fulminant course may lead to death.
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Affiliation(s)
- T Malnar
- Dermatovenereology Unit, Cakovec General Hospital, Cakovec, Croatia (Hrvatska).
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Tsianakas A, Hoeger PH. Transition of pityriasis lichenoides et varioliformis acuta to febrile ulceronecrotic Mucha-Habermann disease is associated with elevated serum tumour necrosis factor-alpha. Br J Dermatol 2005; 152:794-9. [PMID: 15840118 DOI: 10.1111/j.1365-2133.2005.06485.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) represents a fulminant and potentially lethal variant of pityriasis lichenoides. Only 24 cases have been described so far. We report a 9-year-old boy who initially presented with classical pityriasis lichenoides et varioliformis acuta (PLEVA) following a mild enteritis. Three weeks later, his skin lesions started to ulcerate progressively, involving > 90% of his body surface, accompanied by high fever, normal C-reactive protein, but highly elevated serum levels of tumour necrosis factor (TNF)-alpha. Methotrexate 10 mg m(-2) weekly was required to halt disease progression, while oral steroids (initial dose 2.8 mg kg(-1) daily) alone proved insufficient. Sequential histology revealed progressively dense perivascular and intramural lymphocytic inflammation as well as keratinocyte necrosis. Our case demonstrates the clinical and histological continuum between 'classical' PLEVA and FUMHD and points to the potentially pathogenic significance of TNF-alpha. We hypothesize that in future cases, treatment with TNF-alpha antagonists might represent a reasonable alternative to high-dose immunosuppressive therapy.
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Affiliation(s)
- A Tsianakas
- Division of Paediatric Dermatology, Department of Dermatology, University of Hamburg, Martinistr. 52, D-20246 Hamburg, Germany
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Cozzio A, Hafner J, Kempf W, Häffner A, Palmedo G, Michaelis S, Gilliet M, Zimmermann D, Burg G. Febrile ulceronecrotic Mucha-Habermann disease with clonality: A cutaneous T-cell lymphoma entity? J Am Acad Dermatol 2004; 51:1014-7. [PMID: 15583604 DOI: 10.1016/j.jaad.2004.06.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a severe variant of pityriasis lichenoides et varioliformis acuta (PLEVA). PLEVA patients only very rarely have systemic signs; the cutaneous lesions are usually asymptomatic, but may be pruritic and may heal with scarring. FUMHD often starts out as classic PLEVA, but goes on to develop widespread ulceronecrotic lesions and is associated with a high mortality rate. Whether Pityriasis lichenoides chronica (PLC) and PLEVA form a spectrum rather than single entities of clonal lymphoproliferative diseases has been discussed. Recently, it has been proposed that FUMHD, too, is a clonal lymphoproliferative disorder. Here, we report two cases of FUMHD with monoclonal T-cell population, as detected by Southern blot analysis. We propose that clonal FUMHD represents a cutaneous T-cell lymphoma entity.
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Affiliation(s)
- Antonio Cozzio
- Department of Dermatology, University Hospital of Zurich, Switzerland.
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