Kaposi varicelliform eruption: an unusual presentation caused by varicella zoster virus in a healthy adult patient - a case report

BACKGROUND

Kaposi Varicelliform Eruptions (KVE), also known as eczema herpeticum, is a rare and potentially life-threatening dermatological condition primarily attributed to herpes simplex virus (HSV) infection, with less frequent involvement of Coxsackie A16, vaccinia, Varicella Zoster, and smallpox viruses. Typically associated with pre-existing skin diseases, especially atopic dermatitis, KVE predominantly affects children but can manifest in healthy adults. Characterized by painful clusters of vesicles and sores on the skin and mucous membranes, it often masquerades as other dermatological disorders. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain relief and inflammation, though their potential role as KVE triggers remains uncertain.

CASE REPORT

Here, we present a case of an 18-year-old female with KVE attributed to Varicella Zoster virus (VZV) and successfully treated with oral acyclovir within a week, underscoring the significance of early recognition and intervention. KVE can manifest with systemic symptoms like fever, fatigue, and lymphadenopathy and may involve multiple organ systems, necessitating possible antibiotic use for complications.

CONCLUSION

This case underscores the importance of prompt KVE identification and consideration of antiviral therapy to enhance patient outcomes. Further research is warranted to elucidate predisposing factors for this rare condition.

Overexpression of hypoxia-inducible factor-1α in hidradenitis suppurativa: the link between deviated immunity and metabolism

Hypoxia-inducible factor-1α (HIF-1α) is the master transcription factor of glycolysis, Th17 cell differentiation and suppression of regulatory T cells. In the skin and serum of patients with psoriasis vulgaris, increased expression of HIF-1α has been reported, whereas HIF-1α expression in the skin and serum of patients with hidradenitis suppurativa (HS) has not yet been studied. The objective of the study is to demonstrate is there a role for HIF-1α in the pathogenesis of hidradenitis suppurativa, and its relation to HS severity. Twenty patients suffering from hidradenitis suppurativa were included in the study. Punch biopsies were taken from lesional skin for the determination of HIF-1α expression by immunohistochemical staining, and HIF-1α gene expression by quantitative reverse transcription real time PCR. Quantification of HIF-1α protein concentration was done by enzyme-linked immunosorbent assay. Twenty socio-demographically cross-matched healthy volunteers served as controls. We found increased serum levels of HIF-1α. Literature-derived evidence indicates that the major clinical triggering factors of HS, obesity, and smoking are associated with hypoxia and enhanced HIF-1α expression. Pro-inflammatory cytokines such as tumor necrosis factor-[Formula: see text] via upregulation of nuclear factor [Formula: see text]B enhance HIF-1α expression. HIF-1α plays an important role for keratinocyte proliferation, especially for keratinocytes of the anagen hair follicle, which requires abundant glycolysis providing sufficient precursors molecules for biosynthetic pathways. Metformin via inhibition of mTORC1 as well as adalimumab attenuate HIF-1α expression, the key mediator between Th17-driven deviated immunity and keratinocyte hyperproliferation. In accordance with psoriasis, our study identifies HS as an HIF-1α-driven inflammatory skin disease and offers a new rationale for the prevention and treatment of HS by targeting HIF-1[Formula: see text] overexpression.

Marrow biopsy and survival in multiple myeloma

Pretreatment posterior iliac crest bone marrow biopsies were obtained from 26 multiple myeloma patients. Biopsies were processed in methacrylate. The percentage of myeloma tissue, myeloid tissue, and fat was estimated in each biopsy. In 20 patients who died there was a positive correlation between the percent of myeloid tissue in posterior iliac crest biopsies and survival time (r = 0.47, P less than 0.025), but no correlation could be demonstrated between percentage of myeloma tissue and survival time. The ratio of percentage of myeloid tissue to percentage of myeloma tissue also was related to survival. Six deceased patients with ratios greater than one had a median survival of 4.4 years, compared with 1.8 years in 12 deceased patients with ratios less than one. These medians differ significantly (P less than 0.05). Seven patients also had simultaneous biopsies of the posterior iliac crest and either or both the greater trochanter and the proximal tibia. All five greater trochanter biopsies showed extension of both myeloma tissue and myeloid tissue into the proximal appendicular skeleton.

A study of the gross, microscopic and functional anatomy of the thoracic duct and the lympho-venous junction

The thoracic duct was dissected in 30 fresh cadavers, and the anatomy and histology of the duct, at various levels, described. The lymph flow mechanism is correlated with the anatomical findings. The abdominal and lower two-thirds of the thoracic part are more muscular and probably have active peristalsis. The cervical part is less muscular and functions like a vein, passively conveying the lymph it receives. The ostial valve at the lympho-venous junction is bicuspid and has special characteristics and functions. The flow of lymph through the lympho-venous junction, although continuous, mainly occurs during expiration. The ostial valve functions when there is a sudden rise in venous tension causing stretching of the venous wall and the ostial cusps.