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Abdelghaffar M, Hwang E, Damsky W. Cutaneous Sarcoidosis. Clin Chest Med 2024; 45:71-89. [PMID: 38245372 DOI: 10.1016/j.ccm.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a multisystem disease that most commonly affects the lungs, lymphatic system, eyes, and skin but any organ may be involved. Cutaneous sarcoidosis most commonly presents as pink-red to red-brown papules and plaques that commonly affect the head and neck. With the skin being readily accessible for evaluation and biopsy, when sarcoidosis is suspected, dermatologic evaluation may be helpful for establishing a definitive diagnosis. Treatment strategy depends on the severity and distribution of skin lesions and should incorporate patient preference and treatment considerations for other organs that may be involved.
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Affiliation(s)
- Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Erica Hwang
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LCI 501 PO Box 208059, New Haven, CT 06520, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LCI 501 PO Box 208059, New Haven, CT 06520, USA; Department of Pathology, Yale School of Medicine, 310 Cedar Street, LH 108, PO Box 208023, New Haven, CT 06520, USA.
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Meienberger N, Maul JT, Fröhlich F, Maul LV, Kündig T, Nordmann T, Anzengruber F. Atypical and Typical Presentation of Erythema Nodosum: Clinical Differences in Treatment and Outcome. Dermatology 2024; 240:226-232. [PMID: 38185114 PMCID: PMC10997255 DOI: 10.1159/000535617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Erythema nodosum (EN) is the most common form of panniculitis that predominantly affects the shins. While EN in atypical sites has been described by many authors, there are currently only case studies published on this topic. This study aimed to evaluate clinical differences between patients suffering from EN on the shins, compared to patients with EN in atypical locations. METHODS We analyzed 105 patients in a retrospective, single-center study at a university hospital in Switzerland. Typical EN was defined as lesions, found only on the lower legs, while atypical EN as lesions on the upper legs, trunk, arms, or face, only or in addition to lesions on the lower legs. The patients were assessed for age, gender, dermatologic history, time until first medical consultation, time to diagnosis, and time until remission. Further, etiology, symptoms, and applied therapies were investigated. Findings were then compared between the typical and atypical EN cohorts. RESULTS Overall, we included 70 patients (37.99 ± 15.67 [3-81] years) with EN solely on the shins and 35 patients (41.27 ± 16.85 [9-76] years) with EN on other locations. Interestingly, time until diagnosis was significantly shorter in atypical EN (p = 0.034, 1.14 ± 4.68 vs. 0.46 ± 1.14 months). Time to remission was similar in both groups (3.61 ± 2.73 vs. 3.05 ± 2.86 months, respectively). Sarcoidosis was the only etiologic factor significantly more frequent in atypical EN compared to typical EN (23% vs. 9%, p = 0.042). Besides that, solely subtle differences were seen regarding etiology, gender, age at onset, course of the disease, and symptoms. CONCLUSIONS Our study suggests that only minor alterations between both study populations exist. Significant differences were found in time to diagnosis (shorter for atypical EN), as well as in sarcoidosis as an etiologic factor (more frequent in atypical EN). While adalimumab was only prescribed in atypical EN cases, prognosis seems to be similar for typical and atypical EN (similar time to remission, similar amount of reoccurring cases). Due to the limited sample size, however, our study population may have been too small to detect the relevant differences, and bigger studies may be needed.
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Affiliation(s)
- Nina Meienberger
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland,
- Faculty of Medicine, University of Zurich, Zurich, Switzerland,
| | - Julia-Tatjana Maul
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Fabienne Fröhlich
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lara Valeska Maul
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Thomas Kündig
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Thierry Nordmann
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florian Anzengruber
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, Cantonal Hospital of Chur, Chur, Switzerland
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Krkic-Dautovic S, Salihbegovic A, Dervisevic E, Gojak R, Hadzovic-Cengic M, Duratbegovic D, Mostarac N, Begic J, Ahmed H. Clinical Manifestations of European Borreliosis on the Skin in Acute, Subacute and Chronic Disease. Mater Sociomed 2024; 36:33-39. [PMID: 38590600 PMCID: PMC10999147 DOI: 10.5455/msm.2024.36.33-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 04/10/2024] Open
Abstract
Background Lyme borreliosis is a multisystemic infection caused by the spirochete Borrelia burgdorferi. Erythema migras is the main clinical marker of the disease. Objective This study aimed was to investigate the frequency and clinical manifestations of European borreliosis on the skin, and to determine the significance of these findings for diagnosis and therapy. Methods A retrospective-prospective clinical study of outpatients treated and monitored in a private clinic of an infectologist was conducted over nine years from to 2013-2021. The study was clinical, descriptive and analytical in nature. Results In the investigated period, 509 (30.8%) patients with borreliosis symptoms were treated. EM in our patients occurred under the following conditions: a) ringed redness, b) redness of target cels and d) continuous round or oval redness of different sizes of individual redness, or multiple occurrences with primary dissemination. Skin changes with multiorgan chronic symptoms of borreliosis occurred in 67.7% of cases the including: walking redness of different shapes and sizes, pink borreliosis stretch marks, white borreliosis stretch marks, borreliosis palms and soles, psoriatic changes, Acrodermatitis chronica atrophicans, Scleroderma circumscripta-morphae, Erythema nodosum, Granuloma anulare and Lichen striatus et atrophicans. Of the 509 patients treated for borreliosis, 32.3% with multi-organ symptomatology had no skin changes. Conclusion The skin manifestations of European borreliosis are multi-layered and Erythema migrans are basic, but not the only markers of the disease. 'Pink borreliose stretch marks, "white borreliosis striae", "borreliosis palms or soles", and intermittent redness accompanied by itching are unique markers for the diagnosis of chronic borreliosis, if they are manifested.
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Affiliation(s)
| | - Adis Salihbegovic
- Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emina Dervisevic
- Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Refet Gojak
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Meliha Hadzovic-Cengic
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Duratbegovic
- Faculty of Dental Medicine, University of Sarajevo, Bosnia and Herzegovina
| | - Nermin Mostarac
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jasmina Begic
- Department of Dermatology, General Hospital “Prim. Dr Abdulah Nakas,” Sarajevo, Bosnia and Herzegovina
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chakh Shahzad, Islamabad, Pakistan
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Santos LSD, Drummond MR, Goulart IMB, França AFEDC, Souza EMD, Ferreira Velho PEN. Bartonella henselae as a putative trigger for chronic type 2 leprosy reactions. Braz J Infect Dis 2023; 27:103701. [PMID: 37980941 PMCID: PMC10709108 DOI: 10.1016/j.bjid.2023.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 11/21/2023] Open
Abstract
Leprosy reactions are an acute inflammatory phenomenon that can arise before diagnosis, during treatment, or after cure of leprosy. These reactions are considered one of the main diseases that cause physical disabilities. Immunosuppressive treatment for these immune responses makes these patients susceptible to coinfections, which can trigger new leprosy reactions. The main objective of this study was to evaluate the occurrence of infection by Bartonella sp. in blood samples from 47 patients who had untreatable episodes of type 2 leprosy reactions for more than six months, comparing them with a control group. Cultures and molecular methods (PCR) were used. Amplicons from species-specific reactions and sequencing showed a higher prevalence of Bartonella henselae infection in patients, 19/47 (40.4 %), compared to control, 9/50 (18.0 %), p = 0.0149. Five patients accepted treatment for coinfection, and all showed improvement in leprosy reactions with treatment for B. henselae infection. We conclude that these bacteria can trigger chronic reactions of type 2 leprosy and should be investigated in these patients. SUMMARY LINE: Patients who have chronic type 2 leprosy reactions are more susceptible to Bartonella henselae infection than controls: 19/47 (40.4 %) compared 9/50 (18.0 %), p = 0.0149.
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Affiliation(s)
- Luciene Silva Dos Santos
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil.
| | - Marina Rovani Drummond
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil
| | - Isabela Maria Bernardes Goulart
- Universidade Federal de Uberlândia, Centro Nacional de Referência em Dermatologia Sanitária e Hanseníase, Uberlândia, MG, Brazil
| | | | - Elemir Macedo de Souza
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Medicina, Divisão de Dermatologia, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Medicina, Divisão de Dermatologia, Campinas, SP, Brazil
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D'Onghia M, Cinotti E, Cartocci A, Vitale A, Caggiano V, Tognetti L, La Marca F, Sota J, Gentileschi S, Rubegni G, Lopalco G, Guerriero S, Govoni M, Monti S, Ruscitti P, Angeli F, Carubbi F, Giacomelli R, Ciccia F, Piga M, Emmi G, Costi S, Sebastiani GD, Iannone F, Spedicato V, Alessio G, Ruffilli F, Milanesi A, Gentile M, Crisafulli F, Alunno A, Navarini L, Iacono D, Cauli A, Ricci F, Gaggiano C, Tarsia M, Bartoloni E, Conti G, Viapiana O, Gobbi FL, de Paulis A, Parronchi P, Del Giudice E, Barone P, Olivieri AN, Bizzi E, Maggio MC, Balistreri A, Frediani B, Tosi GM, Fabiani C, Rubegni P, Cantarini L. Unfolding dermatologic spectrum of Behçet's disease in Italy: real-life data from the International AIDA Network Behçet's disease Registry. Intern Emerg Med 2023; 18:2245-2252. [PMID: 37803193 PMCID: PMC10635974 DOI: 10.1007/s11739-023-03410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/23/2023] [Indexed: 10/08/2023]
Abstract
Behçet's disease (BD) is a heterogeneous multifactorial autoinflammatory disease characterized by a plethora of clinical manifestations. Cutaneous lesions are considered hallmarks of the disease. However, their evolution over time and a thorough description are scarcely reported in non-endemic regions. The aim of this study was to detail BD skin manifestations and their evolution over time in Italy, as well as the dermatological prognostic impact of specific cutaneous features in long-standing disease. Data were collected in a double fashion, both retrospectively and prospectively, from the AutoInflammatory Disease Alliance (AIDA) international registry dedicated to BD, between January 2022 and December 2022. A total of 458 Italian patients were included. When assessing skin manifestations course, the constant or sporadic presence or absence of cutaneous involvement between onset and follow-up was considered. Oral ulcers (OU) (88.4%) and genital ulcers (GU) (52.6%), followed by skin involvement (53.7%) represented the most common presenting mucocutaneous manifestations at disease onset. Up to the time of enrolment into the AIDA registry, 411 (93.8%) patients had suffered from OU and 252 (57.9%) from GU; pseudofolliculitis (PF) accounted for the most common skin manifestation (170 patients, 37.1%), followed by erythema nodosum (EN) (102 patients, 22.3%), skin ulcers (9 patients, 2%) and pyoderma gangrenosum (4 patients, 0.9%). A prospective follow-up visit was reported in 261/458 patients; 24/148 (16.2%) subjects with skin involvement as early as BD onset maintained cutaneous lesions for the entire period of observation, while 120 (44.1%) patients suffered from sporadic skin involvement. Conversely, 94/113 (83.2%) with no skin involvement at disease onset did not develop skin lesions thereafter. At follow-up visits, cutaneous involvement was observed in 52 (20%) patients, with a statistically significant association between PF and constant skin involvement (p = 0.031). BD in Italy is characterized by a wide spectrum of clinical presentations and skin manifestations in line with what is described in endemic countries. Patients with skin disease at the onset are likely to present persistent cutaneous involvement thereafter; mucocutaneous lesions observed at the onset, especially PF, could represent a warning sign for future persistent skin involvement requiring closer dermatological care.
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Affiliation(s)
- Martina D'Onghia
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Alessandra Cartocci
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Linda Tognetti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Francesca La Marca
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Giovanni Rubegni
- Department of Ophthalmology, University of Catania, 9298, Catania, Italy
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Policlinic Hospital, University of Bari, Bari, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Ferrara, Italy
| | - Sara Monti
- Rheumatology Department, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabrizio Angeli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences and Internal Medicine and Nephrology Unit, Department of Medicine, University of L'Aquila and ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Roberto Giacomelli
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Via Álvaro del Portillo 200, 00128, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Biomedico", Rome, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Medicine, Centre for Inflammatory Diseases, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Florenzo Iannone
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Policlinic Hospital, University of Bari, Bari, Italy
| | - Veronica Spedicato
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Policlinic Hospital, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Ferrara, Italy
| | - Alessandra Milanesi
- Rheumatology Department, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Martina Gentile
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences and Internal Medicine and Nephrology Unit, Department of Medicine, University of L'Aquila and ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Luca Navarini
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Via Álvaro del Portillo 200, 00128, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Biomedico", Rome, Italy
| | - Daniela Iacono
- Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Francesca Ricci
- Pediatric Clinic, University of Brescia and Spedali Civili Di Brescia, Brescia, Italy
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Maria Tarsia
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, Messina, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | | | - Amato de Paulis
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO) Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Emanuela Del Giudice
- Department of Maternal Infantile and Urological Sciences, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Patrizia Barone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alma Nunzia Olivieri
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Bizzi
- Medicina Interna, Ospedale Fatebenefratelli, Milan, Italy
| | - Maria Cristina Maggio
- University Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Alberto Balistreri
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy.
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy.
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Pesce KA, Caro Peralta KL, Chico MJ, Wernicke A, Binder F. Granulomatous mastitis with erythema nodosum: A breast cancer mimicking entity. Radiol Case Rep 2023; 18:3809-3814. [PMID: 37663565 PMCID: PMC10474357 DOI: 10.1016/j.radcr.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/19/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
We present the case of a 42-year-old Hispanic patient who consulted with a left breast mass that showed clinical and imaging signs of breast cancer. During preprocedural examination before needle biopsy, the patient was found to have bilateral, purplish-brown skin lesions on her lower legs, suggestive of erythema nodosum. This clinical finding raised the diagnostic suspicion of granulomatous mastitis, which was later confirmed by histopathology. Granulomatous mastitis is a rare, nonmalignant entity that should be considered in patients of childbearing age who present with a breast mass. The coexistence with erythema nodosum contributes to the clinical suspicion of granulomatous mastitis; the mechanism of this association and the optimal treatment approach remain unknown.
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Affiliation(s)
- Karina A. Pesce
- Breast Imaging and Intervention, Department of Medical Imaging, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Karen L. Caro Peralta
- Breast Imaging and Intervention, Department of Medical Imaging, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maria Jose Chico
- Breast Imaging and Intervention, Department of Medical Imaging, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alejandra Wernicke
- Anatomical Pathology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Binder
- Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
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Abu-Rumeileh S, Barbati F, Indolfi G, Trapani S. Erythema nodosum in children: a cohort study from a tertiary pediatric hospital in Italy. Eur J Pediatr 2023; 182:1803-1810. [PMID: 36790486 DOI: 10.1007/s00431-023-04872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
Erythema nodosum (EN), although relatively uncommon in the pediatric population, is the most frequent type of panniculitis in children. The present study aimed to report all the cases of children admitted to our tertiary pediatric hospital with the diagnosis of EN to evaluate the epidemiology, clinical manifestations, etiology, treatment, and the course of this disease in the pediatric age. This observational study retrospectively considered all children evaluated to the emergency room (ER) of Meyer Children's University Hospital, Florence, Italy, discharged with a diagnosis of EN over a 12-year period (from January 2009 to December 2021). Clinical and laboratory data were recorded using a standardized report form. Sixty-eight patients with EN were included. The etiologic diagnosis of EN was made in 38 children (55.9%): 29 (42.6%) had infection-related EN (in particular EBV and β-hemolytic streptococcus), 6 (8.8%) had Crohn's disease, 1 celiac disease, 1 Sjogren syndrome, and 1 Hodgkin lymphoma. In 30 patients (45%), no definitive diagnosis was reached, and they were defined as having idiopathic EN. Most of the laboratory tests were nonspecific. No statistical differences were found in the demographic and clinical data, and the main diagnostic laboratory parameters between patients with idiopathic EN versus those with secondary EN. Conclusion: Since EN can be isolated or the first manifestation of heterogeneous underlying pathologies, some of which can be severe and life-threatening, it is important to recognize it and carry out all the necessary etiological diagnostic investigations to understand its etiology and start the specific treatment. What is Known: • Erythema nodosum (EN) is the most frequent type of panniculitis in children. • It has been associated with a wide spectrum of disorders, such as different types of infection, malignancies, chronic inflammations, and drugs. What is New: • No statistical differences can be found in clinical features as well as laboratory data, between patients with idiopathic EN versus those with secondary EN. • A broad spectrum of investigations and a proper follow-up should be taken into account in order to prevent a delayed or missed secondary EN diagnosis.
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Affiliation(s)
- Sarah Abu-Rumeileh
- Postgraduate School of Pediatrics, University of Florence, Florence, Italy
- Pediatric Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Federica Barbati
- Postgraduate School of Pediatrics, University of Florence, Florence, Italy.
- Pediatric Unit, Meyer Children's Hospital, IRCCS, Florence, Italy.
| | - Giuseppe Indolfi
- Pediatric Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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8
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Lee YS, Lee JH, Han TY, Choi JE. A Rare Case of Localized Hypertrichosis in Conjunction with Erythema Nodosum. Int J Trichology 2023; 15:74-76. [PMID: 37701553 PMCID: PMC10495067 DOI: 10.4103/ijt.ijt_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 09/14/2023] Open
Abstract
Acquired hypertrichosis can occur in local inflammation. Erythema nodosum (EN) is a hypersensitivity reaction to various underlying antigenic stimuli including Mycobacterium tuberculosis, which causes inflammation in the septa of subcutaneous fat. There were several case reports that describe the association of localized hypertrichosis (LH) with traumatic panniculitis and lupus panniculitis. To our knowledge, this is the first reported case of acquired LH associated with EN. Thus, EN can be added to the list of causes of localized hypertrichosis.
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Affiliation(s)
- Yeon Seok Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - June Hyunkyung Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Tae Young Han
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Eun Choi
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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9
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Pu J, Miranda V, Minior D, Reynolds S, Rayhorn B, Ellingson KD, Galgiani JN. Improving Early Recognition of Coccidioidomycosis in Urgent Care Clinics: Analysis of an Implemented Education Program. Open Forum Infect Dis 2023; 10:ofac654. [PMID: 36733697 PMCID: PMC9887936 DOI: 10.1093/ofid/ofac654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/05/2022] [Indexed: 02/03/2023] Open
Abstract
Background Only 0.2% of coccidioidomycosis (CM) diagnoses were made in patients (pts) with pneumonia (PNA) in urgent care (UC), because they were not being tested for CM. Our objective in this study was to improve CM testing rates. Methods This was a time series of clinician practice before and after an intervention that occurred at UC clinics in Phoenix and Tucson Arizona. All patients in UC were >18 years old. We included information about CM in periodic educational activities for clinicians. Coccidioidal serologic testing (CST), CST results, and their relation to International Classification of Diseases, Tenth Revision (ICD-10) codes were extracted from medical records. Results Urgent care received 2.1 million visits from 1.5 million patients. The CST orders per 104 visits increased from 5.5 to 19.8 (P < .0001). Percentage positive CSTs were highest for August, November, and December (17.0%) versus other months (10.6%). Positive CSTs were associated with PNA ICD-10 codes, and, independently, for Erythema nodosum (EN) which had the highest positivity rate (61.4%). Testing of PNA pts increased on first visits and on second visits when the first CST was negative. Yearly rates of PNA due to CM ranged from 17.3% to 26.0%. Despite this improvement, CST was still not done for over three quarters of pts with PNA. This was a noncomparative study. Conclusions Routine quality improvement activities have significantly but only partially improved rates of testing pts with PNA for CM in UC clinics located in a highly endemic area. Innovative strategies may be needed to improve current practice. Also in our region, EN, independent of PNA, is a strong predictor of CM.
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Affiliation(s)
- Jie Pu
- Banner Health Corporation, Phoenix, Arizona, USA
| | | | - Devin Minior
- Banner Urgent Care Services, Phoenix, Arizona, USA
| | | | | | - Katherine D Ellingson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - John N Galgiani
- Correspondence: John N. Galgiani, MD, University of Arizona, PO Box 245215, Tucson, AZ 85724 ()
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10
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de Souza PK, Amorim RO, Sousa LS, Batista MD. Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases. An Bras Dermatol 2023; 98:141-58. [PMID: 36682966 DOI: 10.1016/j.abd.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.
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11
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Takeda T, Asaoka D, Ogiya S, Akashi K, Abe D, Suzuki M, Akazawa Y, Ueda K, Ueyama H, Shibuya T, Osada T, Hojo M, Hirai S, Ueki R, Nagahara A. A Case of Yersinia enterocolitica Enteritis Diagnosed with Erythema Nodosum. Intern Med 2022; 62:1479-1485. [PMID: 36198596 DOI: 10.2169/internalmedicine.0489-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
We herein report a rare case of Yersinia enterocolitica enteritis with a fever and abdominal pain followed by erythema nodosum (EN) a few days later. The diagnosis was confirmed based on characteristic colonoscopy and computed tomography findings, pathology, and mucosal culture. Yersinia enteritis is a curable disease provided a proper diagnosis and treatment are performed. Although EN is a rare clinical course, it should still be considered as a differential diagnosis.
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Affiliation(s)
- Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Sakiko Ogiya
- Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Ken Akashi
- Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Maiko Suzuki
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Taro Osada
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Shu Hirai
- Department of Human Pathology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Rie Ueki
- Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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12
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Serpa Pinto L, Xavier Pires S, Silva B, Farinha F, Vasconcelos C, Araújo Correia J. Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020. Reumatol Clin (Engl Ed) 2022; 18:410-415. [PMID: 35940675 DOI: 10.1016/j.reumae.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. OBJECTIVES To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. METHODS A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. RESULTS We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DISCUSSION Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.
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Affiliation(s)
- Luísa Serpa Pinto
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.
| | - Sara Xavier Pires
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Berta Silva
- Imunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - João Araújo Correia
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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13
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Afacan Yıldırım E, Aladağ Öztürk P, Adışen E, Köktürk N. The relationship between erythema nodosum and prognosis in systemic sarcoidosis: a retrospective cohort study. An Bras Dermatol 2022; 97:606-611. [PMID: 35811196 PMCID: PMC9453497 DOI: 10.1016/j.abd.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/22/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Erythema Nodosum (EN) is the most common skin manifestation in sarcoidosis and has often been associated with a good prognosis. Objectives To compare the clinical characteristics and treatment-related features in patients with sarcoidosis according to whether or not EN was seen as a presenting symptom at the time of diagnosis. Methods A 20-year single-center retrospective study was performed. The following two groups were identified: one group with EN as one of the presenting symptoms at the time of diagnosis of sarcoidosis (EN group) and a second group without EN as a presenting symptom at diagnosis (non-EN group). The clinical characteristics and treatment modalities were collected from the medical records. Results A total of 122 patients (31 in the EN group, 91 in the non-EN group) were included. Radiological stages of pulmonary disease were significantly lower in the EN group. Articular involvement was more common in the EN group (p = 0.001), whereas other systemic organ involvements (p = 0.025), especially neurological involvement (p = 0.036), were significantly more common in the non-EN group. In the EN group, a higher percentage of patients were managed without systemic therapy (71.0% vs. 54.9%) and spontaneous remission was more frequent (25.0% vs. 14.1%), however, this wasn’t statistically significant. Study limitations Retrospective design. Conclusions The lower radiological stage of pulmonary sarcoidosis and lower frequency of systemic organ involvement in patients with EN augment the prognostic value of EN highlighted in the literature. However, this study couldn’t confirm that the patients with EN would need less systemic therapy in the course of their disease.
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Affiliation(s)
- Elif Afacan Yıldırım
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | | | - Esra Adışen
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nurdan Köktürk
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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14
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Dzhus MB, Karasevska TA, Tsaralunga VM, Yurchenko AV, Ivashkivsky OI. Behçet's disease with intestinal involvement: case-based review. Rheumatol Int 2022; 42:1653-1660. [PMID: 35661907 DOI: 10.1007/s00296-022-05152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Behçet's disease (BD) is a rare (especially in East Europe, Ukraine) systemic vasculitis of blood vessels of varying calibers throughout the body that affects various organs. The variability of the clinical features requires the involvement of doctors of different specialties in the management of such patients. The work was aimed to conduct a literature review of the intestine involvement and skin lesions in BD based on the clinical case with bloody diarrhea at the onset, and to assess the frequency of development of various clinical syndromes in intestinal BD. This is an attempt at describing a manifestation of BD with colitis and to emphasize the necessary revision of BD diagnostic criteria with special attention to early manifestations of BD with gastrointestinal tract involvement.
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Affiliation(s)
- Marta B Dzhus
- Internal Medicine Department No 2, O. Bohomolets National Medical University, Kyiv, Ukraine. .,Rheumatology department, Alexander Clinical Hospital of Kyiv (Municipal Non-Profit Enterprise), Kyiv, Ukraine.
| | - Tetiana A Karasevska
- Internal Medicine Department No 2, O. Bohomolets National Medical University, Kyiv, Ukraine
| | - Vira M Tsaralunga
- Internal Medicine Department No 2, O. Bohomolets National Medical University, Kyiv, Ukraine
| | | | - Olexiy I Ivashkivsky
- Rheumatology department, Alexander Clinical Hospital of Kyiv (Municipal Non-Profit Enterprise), Kyiv, Ukraine
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15
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Affiliation(s)
- Vanessa Juddoo
- Department of Endocrinology and Diabetology, Lariboisière Hospital, Paris, France
| | - Sonia Juddoo
- Department of Geriatrics, Avicenne Hospital, Bobigny, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, INSERM UMRS-1144 Paris, France.
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16
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Laor L, Ganguli S, Fakioglu E. Granulomatous mastitis, erythema nodosum, and polyarthritis: a case report. J Med Case Rep 2022; 16:146. [PMID: 35382864 PMCID: PMC8985372 DOI: 10.1186/s13256-022-03327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Granulomatous mastitis is a rare inflammatory disease of the breast, typically seen in woman of child-bearing age. No definitive etiology has been described. In rare instances, this condition has been reported to be associated with extramammary manifestations such as erythema nodosum and arthritis. We describe this rare condition in an adolescent female. CASE PRESENTATION A 16-year-old, Hispanic female presented with right-sided painful breast swelling, polyarthritis, and erythema nodosum on bilateral shins and lower thighs. Physical examination was negative for lymphadenopathy and pulmonary, gastrointestinal, and cardiovascular findings. Ophthalmologic examination for uveitis and serologic tests for autoimmune diseases were negative. Diagnosis of idiopathic granulomatous mastitis was made by exclusion of other etiologies and conditions. Confirmation was made by histopathologic examination demonstrating noncaseating granuloma within breast lobules with neutrophils and microabscess formation. After wide local excision and a short course of trimethoprim-sulfamethoxazole, our patient was placed on naproxen and prednisone, the latter being tapered off over 3 months, with steady and complete resolution of all symptoms. CONCLUSION This is the first reported case of idiopathic granulomatous mastitis in a pediatric patient who also had extramammary manifestations, including erythema nodosum and polyarthritis. In this case-based review, we summarize the phenotype, risk factors, prognosis, and treatment options of this rare condition, chiefly to make the readers cognizant of such a diagnostic possibility in similar clinical presentation in the future.
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Affiliation(s)
- Leanna Laor
- Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, NY, 11355, USA.
| | - Suhas Ganguli
- Pediatric Rheumatology Marshfield Clinic, 1000 North Oak Ave, Suite 1A1,, Marshfield, WI, 5449, USA
| | - Esra Fakioglu
- Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, NY, 11355, USA
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Damevska K, Simeonovski V. Covid-19 Vaccine Associated Erythema Nodosum: factors to consider. Dermatol Ther 2022; 35:e15410. [PMID: 35218272 PMCID: PMC9111800 DOI: 10.1111/dth.15410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Katerina Damevska
- University Clinic for Dermatology, Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, Skopje, Republic of Macedonia
| | - Viktor Simeonovski
- University Clinic for Dermatology, Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, Skopje, Republic of Macedonia
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18
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Goulart IMB, Santana MADO, Costa WVTD, Pavelka MM, Dornelas BDC. Type 2 leprosy reaction presenting as a monoarthritis post multidrug therapy. IDCases 2022; 27:e01386. [PMID: 35036324 PMCID: PMC8749206 DOI: 10.1016/j.idcr.2022.e01386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Type 2 leprosy reaction, or erythema nodosum leprosum (ENL), involves a complex interaction between the host's immune system and Mycobacterium leprae. It may occur before, during, or after treatment and have a variable clinical presentation involving different body systems, such as skin, osteoarticular, kidneys, and others. Thus, the differential diagnosis, depending on its clinical presentation, can be broad and challenging. The authors report a case of a severe monoarthritis during a type 2 reaction after the multidrug therapy (MDT) was discharged and the investigation of the differential diagnoses.
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Affiliation(s)
- Isabela Maria Bernardes Goulart
- School of Medicine, Federal University of Uberlândia (UFU), 1720, Pará avenue, Uberlândia, MG, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 94, Capricórnio Street, Uberlândia, MG, Brazil.,National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 94, Capricórnio Street, Uberlândia, MG, Brazil
| | - Marcela Araujo de Oliveira Santana
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 94, Capricórnio Street, Uberlândia, MG, Brazil
| | | | - Matthew Martin Pavelka
- Indiana University School of Medicine, 620 N. Chestnut Street Holmstedt Hall 135, Terre Haute, IN 47809, USA
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Gupta SK, Kumari S. Chronic recalcitrant erythema nodosum leprosum: therapeutic dilemma and role of mycobacterium indicus pranii vaccine. An Bras Dermatol 2021; 97:49-53. [PMID: 34848113 PMCID: PMC8799866 DOI: 10.1016/j.abd.2020.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022] Open
Abstract
Erythema nodosum leprosum is a severe immune reaction that complicates the usual course of multibacillary leprosy. There is increased activation of T-cells in erythema nodosum leprosum. Treatment modalities available to date for the management are systemic steroids, thalidomide, methotrexate, cyclophosphamide, azathioprine, minocycline, and apremilast but none of them is promising and safe. Mycobacterium indicus pranii is an atypical mycobacterium possessing strong immunomodulatory properties. The vaccine for this mycobacterium has been shown to have both immunotherapeutic and immunoprophylactic effects in multibacillary leprosy patients. We report a case of chronic recalcitrant erythema nodosum Leprosum which responded to Mycobacterium indicus pranii vaccine without any adverse effects, thereby suggesting its role as a novel therapeutic option in this reaction.
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Affiliation(s)
- Sunil Kumar Gupta
- Department of Dermatology, All India Institute of Medical Sciences, Gorakhpur, India.
| | - Sushantika Kumari
- Department of Dermatology, All India Institute of Medical Sciences, Gorakhpur, India
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Moreno-Vílchez C, Llobera-Ris C, Penin RM, Pla MJ, Mitjavila F, Marcoval J. Granulomatous mastitis associated with erythema nodosum: A case series of 42 patients. Med Clin (Barc) 2021; 158:229-232. [PMID: 34839941 DOI: 10.1016/j.medcli.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Granulomatous mastitis (GM) is defined by the formation of granulomatous inflammation in breast tissue. Erythema nodosum (EN) is a reactive inflammatory panniculitis characterized by erythematous subcutaneous nodules in the lower limbs. The association of GM with EN has been rarely reported. Our aim was to retrospectively review our series of patients with GM to better characterize their features and their association with EN. METHODS Cases histologically diagnosed as granulomatous inflammation in breast tissue between 1995 and 2020 were retrospectively reviewed. RESULTS Forty-two women were diagnosed with GM. The average age at diagnosis was 41.619years, and 59.5% were of South-American ethnicity. EN was associated with GM in 11.9% of the patients. Patients with EN were diagnosed earlier than isolated GM (0.4months vs 6.81months; P<.05). Ulceration in the GM was more prevalent in patients with associated EN (60% vs 14.7%; P<.05). CONCLUSION EN in patients with GM may reduce the evolution time and may help to diagnose this rare condition that mimics breast carcinoma.
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Affiliation(s)
- Carlos Moreno-Vílchez
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España.
| | - Clàudia Llobera-Ris
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España
| | - Rosa María Penin
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España
| | - María Jesús Pla
- Servicio de Ginecología, Hospital Universitari de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España
| | - Francesca Mitjavila
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España
| | - Joaquim Marcoval
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España
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21
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Mzabi A, Benzarti W, Romdhane W, Baya W, Aissa S, Gargouri I, Laouani C. Erythema Nodosum Revealing Metastatic Lung Cancer. Eur J Case Rep Intern Med 2021; 8:002539. [PMID: 34377687 DOI: 10.12890/2021_002539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
Erythema nodosum (EN) is an inflammatory condition of the subcutaneous fat and has been reported in patients with haematological malignancies (lymphomas) or solid tumours. Lung cancer is the most common cause of paraneoplastic syndrome. We report a case of EN occurring as a paraneoplastic disease. A 48-year-old Tunisian woman, a non-smoker with no relevant medical history, presented with painful, erythematous, firm nodules on her legs with ankle swelling. The patient did not report any other symptoms. There were no abnormalities on examination except for moderate fever. An extensive infectious and immunological investigation was negative. Antistreptolysin antibodies were undetectable. Chest radiography showed a focal opacity in the right lung and a CT scan revealed a mass in the lower right pulmonary lobe with hilar and mediastinal lymphadenopathies, a nodule in the right adrenal gland, condensation in the iliac bone and multiple bilateral nodular cerebral expansive processes. Bronchial biopsies revealed a primitive and moderately differentiated adenocarcinoma. No argument for tuberculosis or sarcoidosis was found. LEARNING POINTS Erythema nodosum (EN) can be idiopathic.EN has rarely been associated with lung cancer and so the association may be coincidental in our patient.The lung cancer was easily identified by chest x-ray in this case and in cases described in the literature.
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Affiliation(s)
- Anis Mzabi
- Internal Medicine Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wafa Benzarti
- Pneumology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Wiem Romdhane
- Internal Medicine Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wafa Baya
- Internal Medicine Department, Sahloul University Hospital, Sousse, Tunisia
| | - Sana Aissa
- Pneumology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imen Gargouri
- Pneumology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Chedia Laouani
- Internal Medicine Department, Sahloul University Hospital, Sousse, Tunisia
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22
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Serpa Pinto L, Xavier Pires S, Silva B, Farinha F, Vasconcelos C, Araújo Correia J. Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(21)00121-2. [PMID: 34023233 DOI: 10.1016/j.reuma.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. OBJECTIVES To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. METHODS A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. RESULTS We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DISCUSSION Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.
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Affiliation(s)
- Luísa Serpa Pinto
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.
| | - Sara Xavier Pires
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Berta Silva
- Imunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - João Araújo Correia
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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23
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Koutra E, Lusmöller E, Stadler R. [Calprotectin-a key for diagnosing chronic inflammatory bowel disease in inflammatory dermatoses? : Three case reports]. Hautarzt 2021; 73:303-307. [PMID: 33884437 DOI: 10.1007/s00105-021-04821-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
We report on three patients with inflammatory dermatoses as a result of a chronic inflammatory bowel disease (IBD). The diagnosis of IBD was based on the initial determination of the fecal calprotectin value. Although the patients did not report any intestinal complaints, the increased calprotectin value in the stool was the reason for further gastroenterological evaluation. This article highlights the importance of determining the fecal calprotectin value as another parameter in the diagnosis of inflammatory dermatoses.
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Affiliation(s)
- E Koutra
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - E Lusmöller
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum, Hans-Nolte-Str. 1, 32429, Minden, Deutschland
| | - R Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum, Hans-Nolte-Str. 1, 32429, Minden, Deutschland
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24
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Abstract
Erythema nodosum (EN) is the commonest inflammation of the subcutaneous fat tissue (panniculitis). Erythema nodosum (EN) requires an interdisciplinary approach and exclusion of all underlying causes. We present a case of an 18-year-old female with a history of recurrent streptococcal infections over the years, who developed pain and swelling in the left ankle. To evaluate the persistent ankle swelling, the physician ordered a magnetic resonance imaging (MRI) of the left lower extremity. The MRI appearance of EN has not been described in detail in the literature so far.
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Affiliation(s)
- Ankita Chauhan
- University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Richard Thomas
- Department of Radiology, John R. Oishei Children's Hospital, Buffalo, USA
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25
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Parperis K, Achilleos S, Costi E, Vardas M. Granulomatous mastitis, erythema nodosum and arthritis syndrome: case-based review. Rheumatol Int 2021; 41:1175-81. [PMID: 33649961 DOI: 10.1007/s00296-021-04820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
Granulomatous mastitis (GM) is a rare form of inflammatory breast condition associated with unilateral or bilateral breast pain, swelling and mass formation. Although the disease pathogenesis remains unknown, several reports have associated GM with manifestations such as erythema nodosum and occasionally with arthritis, suggesting that GM might have an autoimmune disease component. We aim to describe two cases of coexistence of GM, erythema nodosum, and arthritis. We also conducted a literature review to comprehensively assess and describe the characteristics of patients with GM, erythema nodosum, and arthritis, and identify effective treatment options. A literature review was conducted using PubMed and EMBASE, and 14 case reports/series were retrieved, with a total number of 29 patients. All patients are women and unilateral breast involvement was evident in the majority of patients. Nine patients (31%) presented with arthritis, 6 patients (20.7%) had a fever, and 6 patients (20.7%) developed the symptoms during pregnancy. All patients had normal chest radiograph and tissue cultures were negative. In most of the cases (n = 25, 86.2%), symptom improvement was observed with glucocorticoids and four patients (13.8%) underwent surgical treatment for the GM. Given the clinical characteristics of patients with GM, with erythema nodosum, with or without arthritis, and the positive response to glucocorticoids, we propose that the described phenotype represents an underrecognized systemic autoimmune disease that could be designated by the acronym "GMENA" (granulomatous mastitis, erythema nodosum, arthritis) syndrome. Further studies are needed to elucidate the pathogenesis of the syndrome.
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26
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Abstract
Coronavirus 2019 (COVID-19) is a viral disease first described in Wuhan, China, which has quickly emerged as a global pandemic with a myriad of manifestations including dermatologic (Li My et al., n.d.; Gottlieb and Long, 2020 [1,2]). A variety of cutaneous symptoms have presented throughout various stages of the disease (Marzano, 2020; Recalcati, n.d.; Henry et al., n.d.; Fernandez-Nieto et al., n.d.; Quintana-Castanedo et al., n.d. [3-5,7,8]). We describe a case of a female patient who presented with an Erythema Nodosum-like exanthema likely secondary to COVID-19. The patient described tested positive for COVID-19 three days prior to presentation for the rash with minimal other symptoms of COVID-19. Given the high infectivity rate as well as multisystem presentation, it is important to continue to report on novel presentations of the virus for early identification and treatment of complications.
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Affiliation(s)
- Nicole Sipfle DO
- Department of Emergency Medicine, San Antonio, Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Rachel E Bridwell Md
- Department of Emergency Medicine, San Antonio, Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Jamie Roper DO
- Department of Emergency Medicine, San Antonio, Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
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27
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Abstract
Sporothrix spp. infection can occur through the inoculation of the organism in the skin through direct contact with the soil (sapronotic infection), through contact with animals, such as infected cats and dogs (zoonotic infection), or less frequently via inhalation. With a subacute or chronic evolution, approximately 80% of patients affected by the disease present with the lymphocutaneous form; episodes associated with a hypersensitivity reaction are rare. The authors report the case of a 12-year-old child with immunoreactive sporotrichosis manifested clinically as erythema nodosum lesions in the lower limbs, associated with an ulcerated lesion in the left arm.
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Affiliation(s)
| | - John Verrinder Veasey
- Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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28
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Darshani AGS, Sathischandra DHHL, Perera MNSK. A case of extra pulmonary tuberculosis misdiagnosed as granulomatosis with polyangitis: Presenting with occipital condylar syndrome. Indian J Tuberc 2020; 67:393-396. [PMID: 32825877 DOI: 10.1016/j.ijtb.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 06/11/2023]
Abstract
Sri Lanka is a tuberculosis (TB) prevalent country with an incidence of 8886 cases in 2016 of which 30% were extra pulmonary tuberculosis (EPTB). These figures may be an underestimation, considering the diagnostic challenge of EPTB due to its diverse presentations and difficulty in microbiological confirmation. Here we describe a case of EPTB which was first diagnosed as granulomatosis with polyangitis when he presented with fever, anorexia, wasting, large joint pains, cervical pain, erythema nodosum, high inflammatory markers with strongly positive Mantoux reaction and, necrotizing granulomatous lymphadenitis in the cervical region. Immunosuppression with methotrexate 15 mg weekly and prednisolone 30 mg daily, achieved resolution of symptoms and the inflammatory markers. After about 4 months on tailing off prednisolone, he developed fever, anorexia, wasting and worsening occipital pain which evolved in to occipital condylar syndrome causing hypoglossal nerve palsy. With the aid of serial radiological, histopathological and bacteriological investigations, he was eventually diagnosed to have EPTB involving the left base of the skull with upper mediastinal lymphadenitis. This case highlights the importance to have a high index of suspicion to diagnose EPTB, especially in a country with a high prevalence of TB and to revise the diagnosis with a close follow up to avoid disastrous consequences associated with misdiagnosis.
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Affiliation(s)
- A G S Darshani
- Medical Unit, National Hospitals of Sri Lanka, Colombo 10, Sri Lanka.
| | | | - M N S K Perera
- Medical Unit, National Hospitals of Sri Lanka, Colombo 10, Sri Lanka.
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29
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Su C, Cowper SE, Ramachandran S, Little AJ. Erythema nodosum due to Mycobacterium abscessus infection complicating autologous fat transfer. Int J Womens Dermatol 2020; 6:340-341. [PMID: 33015302 PMCID: PMC7522915 DOI: 10.1016/j.ijwd.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chang Su
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Shawn E Cowper
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States.,Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Sarika Ramachandran
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Alicia J Little
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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30
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De Luigi G, Zgraggen L, Kottanattu L, Simonetti GD, Terraneo L, Vanoni F, Terrani I, Bianchetti MG, Lava SAG, Milani GP. Skin and Mucous Membrane Eruptions Associated with Chlamydophila Pneumoniae Respiratory Infections: Literature Review. Dermatology 2020; 237:230-235. [PMID: 32222707 DOI: 10.1159/000506460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia is sometimes associated with skin or mucous membrane eruptions. Available reviews do not address the association of Chlamydophila pneumoniae pneumonia with skin eruptions. We therefore conducted a systematic review of the literature addressing this issue. The National Library of Medicine, Excerpta Medica, and Web of Science databases were employed. SUMMARY In two reports, skin lesions and especially urticaria were more common (p < 0.05) in atypical pneumonia caused by C. pneumoniae as compared with M. pneumoniae. We found 47 patients (<18 years, n = 16; ≥18 years, n = 31) affected by a C. pneumoniae atypical pneumonia, which was associated with erythema nodosum, erythema multiforme minus, erythema multiforme majus, isolated mucositis, or cutaneous vasculitis. We also found the case of a boy with C. pneumoniae pneumonia and acute generalized exanthematous pustulosis. We did not find any case of C. pneumoniae respiratory infection associated with either Gianotti-Crosti syndrome, pityriasis lichenoides et varioliformis acuta Mucha-Habermann, or varicella-like skin eruptions.
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Affiliation(s)
| | - Lorenzo Zgraggen
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Università della Svizzera Italiana, Lugano, Switzerland.,Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Luisa Terraneo
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Federica Vanoni
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Isabella Terrani
- Department of Dermatology Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Mario G Bianchetti
- Università della Svizzera Italiana, Lugano, Switzerland.,Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland,
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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31
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Jacquin-Porretaz C, Devalland C, Delapparent T, Nardin C, Dupond AS. [Idiopathic granulomatous mastitis associated with erythema nodosum]. Ann Dermatol Venereol 2019; 146:571-6. [PMID: 31151772 DOI: 10.1016/j.annder.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic, granulomatous, inflammatory disorder with potentially misleading clinical and radiological features. IGM is diagnosed after exclusion of infectious or tumoral diseases. Herein we report a case of erythema nodosum associated with IGM, which serves as a reminder that erythema nodosum may constitute an extra-mammary sign of IGM. PATIENTS AND METHODS A 36-year-old nulliparous woman presented with fever and skin rash at our dermatology clinic at the North Franche-Comté hospital in July 2017. Symptoms had occurred 2 days previously. The patient had a fever of 38.8°C and typical erythema nodosum on the limbs. Physical examination showed an irregular, inflammatory, abscessed mass measuring 20cm with multiple shrinkage zones that had been developing for 4 weeks and for which breast examinations were being performed. Laboratory tests showed an inflammatory state (CRP 155mg/mL, WBC 14.6×109/L), other tests (serum electrolytes and calcium, hepatic and renal tests, Streptotest, T-spot, HIV, HBV, HCV serology, anti-streptolysin, anti-streptodornase, local microbiology samples, antinuclear antibodies, soluble antigens antibodies, hemocultures, angiotensin-converting-enzyme and chest x-rays) were normal. Microbiology investigations were negative. Mammography revealed invasive mastitis. Breast sample biopsies showed giant cell granulomas without caseous necrosis or tumor cells, and histochemical staining (PAS, Ziehl, Grocott, Gram) was negative. The final diagnosis was of IGM associated with erythema nodosum. Symptoms rapidly improved with oral steroids. DISCUSSION As reported herein, erythema nodosum may be associated with IGM and support the diagnosis thereof. This association is rare, with fewer than 30 case reports described in the literature. IGM is an uncommon benign disorder of the breast that can mimic two frequent breast disorders: breast carcinoma and breast abscess. It usually occurs in young sexually active women. It appears as a tumor with an inflammatory solid painful mass, with nipple and skin retraction, occasionally with abscesses and accompanied by homolateral axillary lymphadenopathies. Radiologic findings are usually not specific for or suggestive of cancer. The histopathological picture of IGM is characterized by the presence of multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Minor ductal and periductal inflammation is usually present. IGM is rarely associated with autoimmune system manifestations, especially erythema nodosum, arthritis, episcleritis or hidradenitis suppurativa. Although the physiopathology of IGM remains unclear, this case serves as additional evidence that the etiology of IGM is of autoimmune origin. While there is no recommendation for the treatment of IGM, oral steroids remain the cornerstone of therapy. CONCLUSION We report a case of IGM associated with erythema nodosum. Dermatologists must be aware of this association.
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32
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Marzolf G, Lenormand C, Schissler C, Mitcov M, Cribier B, Lipsker D. [Acute generalized pustular bacterid followed by Sweet's syndrome and erythema nodosum]. Ann Dermatol Venereol 2020; 147:298-302. [PMID: 31812362 DOI: 10.1016/j.annder.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/31/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Streptococcal infections can cause various skin manifestations related to the direct action of the offending organism itself or to a reactional mechanism. Reactional manifestations are less well known and understood, and they include generalized acute pustulosis belonging to the spectrum of neutrophilic dermatoses. We report a case of generalized acute pustulosis followed by Sweet syndrome and erythema nodosum occurring after a streptococcal infection. PATIENTS AND METHODS A 60-year-old woman was consulting for a diffuse pustular rash after a throat infection, with high levels of anti-streptolysin (337 U/L) and anti-streptodornase (2560 U/L). The biopsy showed folliculitis and a neutrophilic infiltrator of the dermis, and bacteriological and mycological cultures were sterile. The patient then developed papules evoking Sweet syndrome followed by nodules typical of erythema nodosum after 20 days. A favourable outcome was achieved under colchicine. DISCUSSION Generalized acute pustulosis is a form of neutrophilic dermatosis whose mechanisms, area predilection and treatment are poorly known. The clinical presentation of this patient was initially typical and the secondary progression to lesions like those in Sweet syndrome is consistent with the pathophysiological continuity and overlap of these entities.
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33
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Hassan A, Alsaihati A, Al Shammari M, Sharroufna M, Alaithan H, Aljubran S. Erythema Nodosum: A Manifestation of Salmonella Infection. Case Rep Gastroenterol 2019; 13:456-461. [PMID: 31762735 PMCID: PMC6873087 DOI: 10.1159/000503894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022] Open
Abstract
Erythema nodosum is a delayed-type hypersensitivity reaction with an unknown trigger in the majority of cases. It is characterized by the development of erythematous tender nodules on the shins. Septal panniculitis without vasculitis is a characteristic histopathological finding. We report the case of a 26-year-old woman who presented with a four-day history of an erythematous swollen left lower limb. She was treated with intravenous clindamycin for suspected cellulitis. However, her symptoms persisted. Punch biopsy revealed findings consistent with erythema nodosum. Two days later, she developed colicky abdominal pain associated with non-bloody diarrhea. Stool culture yielded Salmonella enterica serotype enteritidis. Two days after discharge, she presented again with a right breast abscess for which she underwent incision and drainage along with antibiotic therapy. After discharge, she was symptom-free with complete resolution of the cutaneous lesions. The presented case is unique as it had multiple clinical manifestations of Salmonella infection including erythema nodosum, diarrhea, and presumably a breast abscess. It should be kept in mind that gastrointestinal symptoms are not necessarily the initial presentations of Salmonella infection.
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Affiliation(s)
- Ali Hassan
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Amna Alsaihati
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak Al Shammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Sharroufna
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Haitham Alaithan
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Salman Aljubran
- Department of Allergy and Immunology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
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Rubio-Rivas M, Franco J, Corbella X. Sarcoidosis presenting with and without Löfgren's syndrome: Clinical, radiological and behavioral differences observed in a group of 691patients. Joint Bone Spine 2020; 87:141-7. [PMID: 31606494 DOI: 10.1016/j.jbspin.2019.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Just a few series of Löfgren's syndrome have been reported. Our aim was to describe the epidemiology and clinical profile of sarcoidosis patients presenting with Löfgren's syndrome vs. non-Löfgren's syndrome. METHODS Retrospective cohort study of 691consecutive patients with sarcoidosis diagnosed at the Bellvitge University Hospital in Barcelona, Spain, between 1976 and 2018. RESULTS Three hundred and nine patients (44.7%) were diagnosed with Löfgren's syndrome and 382with non-Löfgren's syndrome (55.3%). The mean age at diagnosis was 39.8years-old (SD 11.7) vs. 46.6 (SD 14.5) (P<0.001). 249 patients (80.6%) vs. 218 (57.1%) were female (P<0.001), and mostly Caucasians (304, 98.4% vs. 351, 91.9%, P=0.002). Out of the total 309, Löfgren's syndrome patients developed more frequently fever and articular involvement, and 45 (14.6%) presented with isolated periarticular ankle inflammation. When compared, radiological stages at diagnosis were more advanced in non-Löfgren's syndrome patients: stage 0 (2.9% vs. 14.7%), stage I (82.5% vs. 41.4%), stage II (14.6% vs. 29.3%), and stage III/IV (0 vs. 14.7%) (P<0.001). Chronic trend>2years was more prevalent in non-Löfgren's syndrome (66, 22.6% vs. 233, 67.4%; P<0.001), as well as the proportion of patients in whom treatment was needed (58, 18.8% vs. 224, 58.6%; P<0.001). Risk factors related to chronic trend>2 years were older age, stage II at diagnosis and the need of treatment. CONCLUSIONS Löfgren's syndrome is a well-differentiated form of sarcoidosis with persuasive different epidemiological, clinical, radiological and prognostic features.
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HAYRAN Y, ÖKTEM A, ŞAHİN B, İNCEL UYSAL P, ALLI N, YALÇIN B. Elevated neutrophil to lymphocyte ratio as an indicator of secondary erythema nodosum, a retrospective observational study. Turk J Med Sci 2019; 49:624-634. [PMID: 30997978 PMCID: PMC7018376 DOI: 10.3906/sag-1810-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Erythema nodosum (EN) is an inflammatory disorder of subcutaneous tissue. Although etiopathogenesis of the disease is unknown, many predisposing factors such as infections, systemic disease, and drugs have been identified. Neutrophil to lymphocyte ratio (NLR) has been shown to be a novel inflammatory marker in many dermatological diseases. The aim of our study is to investigate NLR in EN patients and evaluate its relation to the underlying cause of the disease. Materials and methods Between 2014 and 2018, clinical and laboratory data of 395 patients diagnosed with EN and 395 controls were extracted from patient files. EN patients were grouped as idiopathic EN and secondary EN (EN with an identified underlying cause). Clinical and laboratory characteristics of the two groups were compared Results NLR was elevated in EN patients compared to controls (median of 2.38 vs. 1.55, P < 0.001). Among EN patients, NLR was also elevated in patients with secondary EN. In multivariate logistic regression model NLR (> 2.11), RDW-CV (> 13.65), and CRP (> 5.5) were identified as risk factors for secondary EN (relative risks were 17.16, 2.69, and 2, respectively). Conclusion Elevated NLR (> 2.11) may be used as a parameter to discriminate secondary EN from idiopathic EN.
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Affiliation(s)
- Yıldız HAYRAN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Ayşe ÖKTEM
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Buket ŞAHİN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Pınar İNCEL UYSAL
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Nuran ALLI
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Başak YALÇIN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
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Algahtani H, Shirah B, Marghalani S, Algarni A. Erythema nodosum in a patient with multiple sclerosis on dimethyl fumarate. Mult Scler Relat Disord 2019; 28:155-158. [PMID: 30597324 DOI: 10.1016/j.msard.2018.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 11/26/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Abstract
Erythema nodosum is an uncommon cutaneous hypersensitivity reaction characterized by tender round slightly raised red nodules that become bruise-like and then resolve without scarring. It may be caused by infections, pregnancy, malignancy, systemic illnesses, or idiopathic. Several drugs have been reported in association with erythema nodosum including oral contraceptive pills, penicillin, and sulphonamides. Glatiramer acetate is the only medication used in the treatment of multiple sclerosis that has been reported as a possible cause of erythema nodosum. The association between erythema nodosum and multiple sclerosis or dimethyl fumarate has not been reported in the literature. In this article, we aim to report the first case of a possible association between erythema nodosum and dimethyl fumarate in a multiple sclerosis patient. We hypothesize that dimethyl fumarate may be the cause for the development of erythema nodosum in our patient. The underlying mechanism a possibly related to a delayed hypersensitivity reaction.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Siham Marghalani
- Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ayed Algarni
- Department of Pathology & Lab Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Anzengruber F, Mergenthaler C, Murer C, Dummer R. Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study. Dermatology 2018; 235:137-143. [PMID: 30463069 DOI: 10.1159/000494614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients. METHODS The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study. RESULTS KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1-26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases. CONCLUSIONS Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) were observed.
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Affiliation(s)
- Florian Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland,
| | - Caroline Mergenthaler
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carla Murer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Muñoz C, Restrepo-Escobar M, Martínez-Muñoz M, Echeverri A, Márquez J, Pinto LF. Differences between patients with sarcoidosis with and without joint involvement treated for fifteen years in a third level hospital. ACTA ACUST UNITED AC 2018; 16:45-48. [PMID: 29456153 DOI: 10.1016/j.reuma.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/21/2017] [Accepted: 01/06/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sarcoidosis is a complex disease of unknown etiology, with a variable course and highly different forms of presentation. Our objective was to characterize all our patients with sarcoidosis with emphasis on their clinical presentation and to establish differences between patients with sarcoidosis with and without joint involvement. METHODS We reviewed the medical records of all patients with a diagnosis of sarcoidosis who were treated at the outpatient or inpatient services of the Pablo Tobón Uribe Hospital in Medellín, Colombia, from January 2002 to April 2017. RESULTS We identified 22 patients with sarcoidosis. There were joint symptoms in 13 of them. All but one of the patients with sarcoidosis affecting the joints had concomitant skin involvement (92%), which was much less frequent in patients without joint involvement (22%) (odds ratio=4.2; P<.001). CONCLUSIONS Patients with sarcoidosis who have joint involvement have a much higher frequency of concomitant skin involvement. The absence of cutaneous findings in a patient with joint symptoms decreases the likelihood of sarcoidosis.
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Affiliation(s)
- Carolina Muñoz
- Sección de Reumatología, Departamento de Medicina Interna, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Mauricio Restrepo-Escobar
- Sección de Reumatología, Departamento de Medicina Interna, Hospital Pablo Tobón Uribe, Medellín, Colombia; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | | | - Andrés Echeverri
- Sección de Reumatología, Departamento de Medicina Interna, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Javier Márquez
- Sección de Reumatología, Departamento de Medicina Interna, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Luis Fernando Pinto
- Sección de Reumatología, Departamento de Medicina Interna, Hospital Pablo Tobón Uribe, Medellín, Colombia
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Rebsamen U, Guenova E, Vallelian F. [Not Available]. Praxis (Bern 1994) 2017; 106:973-979. [PMID: 28875753 DOI: 10.1024/1661-8157/a002775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Erythema nodosum ist die häufigste Form einer akuten Pannikulitis. Klinisch manifestiert es sich als erythematöse bis livide, druckdolente, subkutane Plaques und Knoten. Diese treten meist symmetrisch im Bereich der Unterschenkelstreckseiten auf. Die häufigsten Auslöser sind Infekte und entzündliche Erkrankungen; in etwa der Hälfte der Fälle lässt sich keine Ursache finden. Aufgrund der Heterogenität der Trigger und des meist selbstlimitierenden Verlaufes stellt sich in der Praxis die Frage, was die Ursache ist und inwieweit sie gesucht werden soll. In diesem Artikel möchten wir auf die Abklärungsstrategie und die wichtigsten Auslöser des Erythema nodosum eingehen.
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Affiliation(s)
- Ursina Rebsamen
- 1 Klinik und Poliklinik für Innere Medizin Universitätsspital Zürich
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Abstract
BACKGROUND Acute Q fever is asymptomatic in 60% of the patients, while the reminder may present with fever, pneumoniae, and hepatitis. Skin manifestations are uncommon including transient punctiform rashes, purpuric, or maculopapular eruptions. Erythema nodosum have seldom been reported. CASE PRESENTATION A 37-year-old female presented with fever for 1 month and skin lesions consists of erythematous painful nodule of the legs. Serological testing for Coxiella burnetii was positive. Treatment consisted with doxycycline for 2 weeks. Evolution was favorable. The patient completely recovered and had no evidence of skin lesion 1 month later. CONCLUSION Because of its nonspecific clinical presentation, Q fever with erythema nodosum is probably underestimated. Q fever should be evocated when facing unexplained erythema nodosum even if there is not other typical clinical manifestation of Q fever.
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Affiliation(s)
- E Meriglier
- Department of Internal Medicine, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France. .,Department of infectious diseases, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France.
| | - L Asquier
- Emergency unit, Centre hospitalier de La Rochelle, Rue du Dr Schweitzer, 17000, La Rochelle, France
| | - F Roblot
- Department of infectious diseases, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France
| | - P Roblot
- Department of Internal Medicine, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France
| | - C Landron
- Department of Internal Medicine, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France
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Abstract
Background Nephrogenic systemic fibrosis (NSF) is a complication of the gadolinium-based contrast agent used in imaging studies. It is typically characterised by hard, erythematous and indurated skin plaques with surrounding subcutaneous oedema. Distinct papules and subcutaneous nodules can also be seen. Fibrocytes in NSF are immunohistochemically positive for CD34. Case presentation We present a case of NSF occurred after gadolinium exposure in which the initial presentation mimics an erythema nodosum (EN)-like picture. An initial skin biopsy showed EN. Subsequently the patient developed progressive skin and joints contracture. A repeated skin biopsy done three months later confirmed the diagnosis of NSF. As far as we are aware, this is the second reported case of NSF that mimicked the presentation of EN in the early phase of the disease. Conclusions The appearance of EN-like disease can be one of the early manifestations of NSF. We hope that early recognition of this unusual presentation can alert the physician or nephrologist to the potential diagnosis of NSF.
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Affiliation(s)
- Kar Wah Fuah
- Department of Medicine, Serdang Hospital, Serdang, Malaysia
| | - Christopher Thiam Seong Lim
- Unit of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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42
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Abstract
Erythema nodosum (EN), is the most common variant of septal panniculitis and is possibly a delayed hypersensitivity reaction triggered by a wide range of antigenic stimuli. Hypersensitivity reactions due to medications have been recognized as a cause of 3–10% of EN cases. Case reports of EN associated with the anti-thyroid drugs are quite rarely reported in the literature even if there is a common use of anti-thyroid drugs. We report an EN case due to methimazole. The complaints of patients arose immediately fifteen days after the beginning of methimazole treatment. To the best of our knowledge, this case report is the first of an erythema nodosum induced by methimazole.
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Affiliation(s)
- Selma Emre
- Yildirim Beyazit University, Ataturk Training and Research Hospital, Dermatology Clinic, Ankara, Turkey
| | - Didem Ozdemir
- Yildirim Beyazit University, Ataturk Training and Research Hospital, Endocrinology Clinic, Ankara, Turkey
| | - Sibel Orhun
- Yildirim Beyazit University, Ataturk Training and Research Hospital, Pathology Department, Ankara, Turkey
| | - Goknur Kalkan
- Yildirim Beyazit University, Ataturk Training and Research Hospital, Dermatology Clinic, Ankara, Turkey
| | - Sertac Sener
- Yildirim Beyazit University, Ataturk Training and Research Hospital, Dermatology Clinic, Ankara, Turkey
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Abstract
BACKGROUND Over recent decades, both the incidence and prevalence of chronic inflammatory bowel disease have continued to rise in industrialized countries; the disease is frequently associated with extracutaneous involvement and comorbidity. OBJECTIVES The purpose of this work was to investigate the frequency and specificity of mucocutaneous manifestations in Crohn's disease (CD) and ulcerative colitis (UC). MATERIALS AND METHODS An extensive search in peer-reviewed journals via PubMed was performed; presented is a summary and analysis of various studies and data, including data of patients treated at our department. RESULTS CD and UC are frequently associated with mucocutaneous symptoms; however, primary/specific disease-associations are exclusively seen in CD patients. These include peri-anal and -stomal fistulas and ulcerations, "metastatic" Crohn's disease as well as oral granulomatous disease. Moreover, in both CD and UC, there occur several other inflammatory skin conditions such as erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa, chronic oral aphthous disease, Sweet syndrome, pyostomatitis vegetans, and bowel-associated dermatosis-arthritis syndrome. Malnutrition syndromes (zinc and vitamin deficiencies) are only rarely observed. CONCLUSION On skin and oral/genital mucous membranes various different inflammatory manifestations may be observed during the course of CD or UC. However, most data about a direct pathogenic relationship of the gastrointestinal and dermatologic disorders are quite heterogeneous or even contradictory. Nevertheless, knowledge of these conditions and their possible association with CD and UC could be crucial for early diagnosis and initiation of an appropriate therapy and thus be essential to prevent secondary tissue damage.
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Affiliation(s)
- L Richter
- Abteilung für Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich. .,Abteilung für Dermatologie und Venerologie, Sigmund Freud Privatuniversität, Sigmund Freud Platz 1, 1020, Wien, Österreich.
| | - K Rappersberger
- Abteilung für Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich.,Abteilung für Dermatologie und Venerologie, Sigmund Freud Privatuniversität, Sigmund Freud Platz 1, 1020, Wien, Österreich
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Abstract
Recently, a few case reports and clinical studies have been published that explore the association of Behçet’s Disease (BD) and vitiligo, with conflicting results. Genetic and immunological properties of BD and presence of autoantibodies support autoimmunity, but clinical features suggest autoinflammatory diseases. BD is thought to be a cornerstone between autoimmune and autoinflammatory diseases. On the other hand, vitiligo has been accepted as an autoimmune disease with associations of other autoimmune disorders and there is a possible role of autoimmunity in pathogenesis of the disease. Significant advances have been made understanding the pathogenesis and genetics of BD. However, it is worth presenting rare clinical variants for improving the clinical understanding of BD. Herein, we are presenting a case with diagnosis of both Behçet’s disease and vitiligo in same patient, which is a rare occurrence. Discussion and demonstrating the association of these two diseases may give rise to understanding similar and different aspects of autoimmunity and autoinflammatory pathogenesis of both diseases.
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Affiliation(s)
- Ragıp Ertaş
- Dermatology Department, Kayseri Training and Research Hospital, Kayseri, 38050, Turkey
| | - Kemal Özyurt
- Dermatology Department, Kayseri Training and Research Hospital, Kayseri, 38050, Turkey
| | - Atıl Avcı
- Dermatology Department, Kayseri Training and Research Hospital, Kayseri, 38050, Turkey
| | - Sule Ketenci Ertas
- Department of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, 38039, Turkey
| | - Mustafa Atasoy
- Dermatology Department, Kayseri Training and Research Hospital, Kayseri, 38050, Turkey
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Abstract
Panniculitides are diseases of the subcutaneous tissue with heterogeneous etiology. They may develop consequent to infections, as a reaction to drugs, after thermal injury, as part of autoimmune diseases, in metabolic disorders or due to infectious organisms. The clinical presentation with subcutaneous nodules is often nonspecific. Moreover, the differentiation from vasculitides of medium-sized vessels can be clinically challenging. Microscopic examination of biopsy specimens is of high importance in the differential diagnosis of panniculitides. Histopathologically, panniculitides can be classified according to the predominantly infiltrated area in septal and lobular panniculitides and they can be separated from vasculitides of medium-sized vessels. Diagnostic difficulties arise from inadequate biopsy specimens and from lack of clinicopathological correlation. This article summarizes diagnostic criteria of frequent and clinically important panniculitides.
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Affiliation(s)
- A Böer-Auer
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland.
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46
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Abstract
The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Polyarteritis nodosa and Behçet's disease are the conditions that are based in the subcutaneous septa with vasculitis. Predominantly-lobular panniculitides with no vasculitis include pancreatogenic panniculitis, the panniculitis of alpha-1-antitrypsin deficiency, panniculitis associated with lupus erythematosus and dermatomyositis, subcutaneous Sweet syndrome, eosinophilic panniculitis, factitial panniculitis, cold panniculitis, panniculitis following injections of corticosteroids, lipomembranous (ischemic) panniculitis; sclerema neonatorum and subcutaneous fat necrosis of the newborn, and Rosai-Dorfman disease of the subcutis. Erythema induratum and infectious panniculitis are vasculitic and lobulocentric conditions. This article reviews the histological features of these diseases.
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Affiliation(s)
- Mark R Wick
- Section of Dermatopathology,Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, USA.
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47
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Abstract
We report a Caucasian female who presented with simultaneous erythema nodosum and pyoderma gangrenosum due to underlying Takayasu's arteritis. Takayasu's arteritis is a chronic large vessel vasculitis of unknown cause. The disease has a worldwide distribution but is most commonly seen in Asian populations. There is a strong predilection for young females. The clinical presentation is variable, but mostly derives from stenosis or occlusion of affected arteries, resulting in claudication and ischemia. Skin manifestations are observed in up to 28% of patients with Takayasu's arteritis, with erythema nodosum reported more frequently in Caucasians. Pyoderma gangrenosum is more common in Asian patients. This report demonstrates the importance to exclude Takayasu's arteritis in patients with such skin lesions.
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Affiliation(s)
- Jonas Loetscher
- University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | - Ulrich A Walker
- University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
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48
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Arita Y, Taguchi H, Hanada R, Tono T, Ohsone Y, Okata U, Irie R, Okano Y. Acute generalized pustular bacterid concomitant with erythema nodosum, polyarthritis, and Achilles tendinitis. Mod Rheumatol 2016; 29:203-206. [PMID: 27435120 DOI: 10.1080/14397595.2016.1208899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report a case of acute generalized pustular bacterid (AGPB) concomitant with erythema nodosum (EN), polyarthritis, and Achilles tendinitis. The patient was admitted with a complaint of fever, widespread plural pustules, erythema, and polyarthralgia. Histopathological examination of the skin lesions demonstrated features of AGBP and EN. Although arthralgia and AGPB can be recognized together, EN and Achilles tendinitis are rare manifestations seen in patients with AGPB. In this case report, we suggest arthralgia, EN, and Achilles tendinitis could coexist with AGPB.
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Affiliation(s)
| | | | | | | | | | | | - Rie Irie
- d Department of Pathology , Kawasaki Municipal Kawasaki Hospital , Kawasaki-Ku , Kawasaki , Japan
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49
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Abstract
Panniculitis is an inflammation of the subcutaneous fat. Skin biopsy plays a critical role in the differential diagnosis of panniculitis. The most common approach to diagnosis relies on the differentiation between predominantly septal or lobular panniculitis, followed by the distinction between lesions with and without vasculitis. It is also very important to submit a part of the skin biopsy for microbiological analysis and for T-cell clonal expansion if T-cell lymphoma is suspected. Erythema nodosum, the most frequent septal panniculitis, has many causes and in its typical clinical presentation, does not require skin biopsy. In other panniculitis, diagnosis is based on the integration of the clinical and histological data, which renders a deep cutaneous biopsy necessary. Periarteritis nodosa, a septal panniculitis with vasculitis characterized by subcutaneous nodules and livedo racemosa, can be associated with systemic involvement. Nodular thrombophlebitis needs search for associated coagulopathy, Behçet's disease, periarteritis nodosa or Buerger's disease. Lobular panniculitis are classified according to the nature of cells present in the inflammatory infiltrate. If there is a lymphocytic infiltration, lupus panniculitis is difficult to differentiate from subcutaneous panniculitis-like T-cell lymphoma. If there are histiocytes, it can be a sarcoidosis, a cytophagic histiocytic panniculitis or, in newborn, a subcutaneous fat necrosis. Neutrophilic panniculitis needs careful clinic-pathologic correlation. Treatment of panniculitis can be challenging and is based on the histopathological findings. Frequently, the precise cause of panniculitis cannot be established from the outset, so it is important to follow-up patients and not hesitate to repeat the skin biopsy.
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Affiliation(s)
- C Velter
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - D Lipsker
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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50
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Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown aetiology. Its dermatological manifestations are extremely polymorphous. They are normally classed as either specific lesions, comprising granulomas, which are generally chronic, or non-specific lesions, principally acute erythema nodosum. These signs are seen in around 25% of sarcoidosis patients. The disease may be heralded by a skin disorder. Diagnosis of cutaneous sarcoidosis provides the clinician with three problems: screening for a visceral site of the disease, determination of the prognosis, and long-term management with regular monitoring coupled with suitable therapy in the event of cosmetic or functional impairment.
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Affiliation(s)
- V Descamps
- Service de dermatologie, Hôpitaux universitaires Paris-Nord Val-de-Seine, Hôpital Bichat-Claude-Bernard, Université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France.
| | - F Bouscarat
- Service de dermatologie, Hôpitaux universitaires Paris-Nord Val-de-Seine, Hôpital Bichat-Claude-Bernard, Université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
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