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Diri E, Espinoza CG, Espinoza LR. Spinal cord granulomatous vasculitis: an unusual clinical presentation of sarcoidosis. J Rheumatol 1999; 26:1408-10. [PMID: 10381066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
A 52-year-old Caucasian man presented with isolated manifestations of myelopathy. Cervical magnetic resonance imaging showed a focus of increased signal intensity at the posterolateral left half of C5 and C6. Biopsy of spinal cord revealed the presence of active vasculitis associated with noncaseating granulomas. The patient responded to the combination of methotrexate (MTX) and corticosteroid treatment. Low-dose MTX was an effective, steroid-sparing regimen. This is a rare condition of isolated spinal cord involvement associated with sarcoid vasculitis.
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Affiliation(s)
- E Diri
- Department of Medicine, Louisiana State University School of Medicine at New Orleans, USA
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2
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Wallach PM, Adelman HM, Seleznick MJ, Kanik KS, Espinoza CG, Espinoza LR. Scurvy is not a rare cause of pseudovasculitis: comment on the concise communication by Mehta et al. Arthritis Rheum 1997; 40:589. [PMID: 9082952 DOI: 10.1002/art.1780400331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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3
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Abstract
BACKGROUND Widespread hypopigmented macules are rarely seen in heavily pigmented patients with Darier's disease. Previous hypotheses concerning the cause of decreased pigmentation suggest it is a postinflammatory phenomenon or that the hypomelanosis is evidence of subclinical acantholysis. PATIENTS This report presents 2 patients: a new case of disseminated guttate leukoderma in a black patient with Darier's disease and the first such case in a patient with transient acantholytic dermatosis (Grover's disease). Direct immunofluorescence and electron-microscopic studies were carried out on lesional biopsies. OBSERVATIONS Numerous small hypopigmented macules were observed in two black patients followed for acantholytic disorders. Three biopsies of the hypopigmented macules revealed acantholysis, while one showed only decreased melanin. Direct immunofluorescence studies were negative. Electron-microscopic studies of the leukodermic macules showed sparse melanocytes and melanosomes that were mostly pigmented stage IV melanosomes. CONCLUSIONS Disseminated guttate leukoderma can occur in transient acantholytic dermatosis, as well as in Darier's disease. It is readily apparent on darkly pigmented skin because of contrast. The etiology of this phenomenon is still unknown.
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Affiliation(s)
- M J Rowley
- Department of Dermatology, Louisiana State University School of Medicine, New Orleans 70112-2822, USA
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4
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Rodriguez JA, Torbati D, Washington T, Espinoza CG, Heneghan JB, O'Leary JP. Jejunoileal bypass-induced liver dysfunction and bacterial translocation: effect of intraluminal glutamine-infusion. Am Surg 1995; 61:397-402. [PMID: 7733542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We tested the effect of long-term intraluminal administration of glutamine on jejunoileal bypass (JIB) induced abnormalities in the plasma-liver profile in rats. Male Sprague Dawley rats (200-250 g) were subjected to an end to side JIB followed by daily intraluminal infusions of either 8 ml saline (n = 5), infused over a 4-hour period, or 8 ml saline containing 1g/Kg body weight glutamine (n = 7) for 3 weeks. Thirteen unoperated rats and four JIB rats without infusions served as controls. At the conclusion of the experiment, a cardiac blood sample was removed and analyzed for plasma cholesterol, albumin, total protein, gamma glutaril transferase, lactic dehydrogenase, glutamic-oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, and bilirubin. Tissue samples from various segments of bowel, liver, mesenteric lymph nodes, and spleen underwent histopathologic examination. Bacteriological cultures were prepared from jejunum, ileum, mesenteric lymph nodes, liver, and spleen. Bacterial translocation occurred in both JIB-saline and JIB-glutamine infused rats. Glutamine-infused rats developed a significant decrease in the plasma cholesterol levels. However, glutamine did not prevent the JIB-induced alterations in the plasma-liver profile and bowel histopathology. It is suggested that experimental JIB procedure can be used as a model of bacterial translocation consequent to mucosal permeability and intestinal inflammatory diseases.
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Affiliation(s)
- J A Rodriguez
- Department of Surgery, Louisiana State University Medical Center, New Orleans, USA
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5
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Awad R, Faba Beaumont G, García Espinoza C, Lezana Fernández MA, Loría A, Oropeza C, Pacheco Pena L, Lourdes Rovalo M, Venteño Jaramillo G, Villanueva I. [Evaluation of Mexican biomedical journals]. GAC MED MEX 1995; 131:205-11. [PMID: 8549908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We present the evaluation procedures of Biomedical Journals, performed by the Journal Committee of the Centro Nacional de Información y Documentación sobre Salud (CENIDS) for the preparation of CR-ROM ARTEMISA 2 (Edited health information articles in Mexico), which contains a database of the complete text of articles appearing in the journals of the highest quality published in Mexico.
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Affiliation(s)
- R Awad
- Revista Médica del Hospital General
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6
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Martinez-Osuna P, Espinoza CG, Cuellar ML, Cabrera GE, Silveira LH, Espinoza LR. Eosinophilic hepatitis: a new feature of the clinical spectrum of the eosinophilia-myalgia syndrome. Clin Rheumatol 1994; 13:528-32. [PMID: 7835024 DOI: 10.1007/bf02242958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The eosinophilia-myalgia syndrome associated with L-tryptophan-containing products is highlighted by eosinophilia, incapacitating myalgias, and diverse multisystemic manifestations. In addition to involvement of the skin, skeletal muscle, and peripheral nerves, visceral damage has been quite prominent, particularly affecting the lungs, the heart, and the liver. Hepatic involvement has been manifested by altered liver tests but is clinically silent. We report the unique case of a woman with this syndrome who developed abdominal pain, a clinical picture of hepatitis and chronically abnormal liver tests. Histologic examination of the liver disclosed eosinophilic hepatitis with piecemeal necrosis. The occurrence of clinically overt hepatic involvement has not been reported previously. Potential mechanisms of liver damage in eosinophilia-myalgia syndromes are discussed.
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Affiliation(s)
- P Martinez-Osuna
- Department of Medicine, Louisiana State University School of Medicine, New Orleans
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7
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Espinoza LR, Aguilar JL, Espinoza CG, Cuéllar ML, Scopelitis E, Silveira LH. Fibroblast function in psoriatic arthritis. I. Alteration of cell kinetics and growth factor responses. J Rheumatol Suppl 1994; 21:1502-6. [PMID: 7983654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore the potential role of fibroblasts in the pathogenesis of psoriasis and its related arthritis. Specifically, we analyzed the cell cycle of psoriatic fibroblasts obtained from skin and synovium by flow cytometry, and we also studied their response to several growth factors. METHODS Fibroblast cultures were established from normal and psoriatic skin, uninvolved and involved, and synovium. NIH-3T3 cells were also used as indicator cells in some of the experiments. Fibroblasts DNA cell cycle analysis was performed by flow cytometry, and the data was analyzed by using the "Cytologic DNA applications software version 2." In addition, fibroblasts were stimulated with growth factors including epidermal growth factor, transforming growth factor-beta, and platelet derived growth factor. RESULTS A significant increase of S and G2-M phase values in confluent cultures of psoriatic fibroblasts in both skin and synovium compared to normal fibroblasts was found. Psoriatic fibroblasts also exhibited a greater proliferative response to growth factors compared to normal fibroblasts. CONCLUSION Data obtained clearly showed a significant intrinsic in vitro alteration in skin and synovium fibroblasts from patients with psoriasis.
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Affiliation(s)
- L R Espinoza
- Department of Medicine, Louisiana State University School of Medicine in New Orleans
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Espinoza LR, Espinoza CG, Cuéllar ML, Scopelitis E, Silveira LH, Grotendorst GR. Fibroblast function in psoriatic arthritis. II. Increased expression of beta platelet derived growth factor receptors and increased production of growth factor and cytokines. J Rheumatol Suppl 1994; 21:1507-11. [PMID: 7983655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The main objective was to investigate the expression of platelet derived growth factor (PDGF) receptors, and production of growth factors and cytokines from psoriatic skin and synovium derived fibroblasts. METHODS Fibroblast cultures were established from normal and psoriatic skin and synovium. Confluent cultures of fibroblasts were used for a receptor binding assay for PDGF, and then extracts were run on Western blot. The amount of immunoreactive A and B chain peptides present was determined with specific A or B chain antisera. Production of interleukin 1 beta and PDGF-beta was accomplished by neutralization with the use of commercially available antisera. A functional assay was used to measure transforming growth factor-beta (TGF-beta). RESULTS There was an increased expression of the beta PDGF receptor in the psoriatic fibroblasts. Interleukin 1 beta and PDGF-beta production by psoriatic fibroblasts was also increased. However, TGF-beta production was similar in normal and psoriatic fibroblasts. CONCLUSION Our data demonstrate an increased expression of beta PDGF receptor, and production of IL-1 beta and PDGF by psoriatic fibroblasts. The findings provide further support for an active role of this cell line in the pathogenesis of psoriasis and psoriatic arthritis.
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Affiliation(s)
- L R Espinoza
- Department of Medicine, Louisiana State University Medical Center, New Orleans 70112-2822
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9
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Adelman HM, Wallach PM, Gutierrez F, Kreitzer SM, Seleznick MJ, Espinoza CG, Espinoza LR. Scurvy resembling cutaneous vasculitis. Cutis 1994; 54:111-4. [PMID: 7956334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Various conditions can imitate cutaneous vasculitis. Scurvy is a less appreciated cause of rash that can resemble vasculitis. Three patients were referred to our rheumatology service for "vasculitis," who subsequently were found to have scurvy. Findings included a purpuric skin rash, myalgias, and malaise. The patients had low vitamin C levels and findings on skin biopsy specimens indicative of scurvy. The three patients were on idiosyncratic diets deficient in vitamin C, and the two patients who allowed us to administer vitamin C therapy improved clinically. We emphasize the importance of a careful dietary history. Early recognition of scurvy is important because it can be treated specifically, and toxic treatment of vasculitis can be avoided.
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Affiliation(s)
- H M Adelman
- Department of Internal Medicine, University of South Florida Health Sciences Center, Tampa
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10
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Abstract
The extracranial spread of a primary intracranial tumor is an infrequent occurrence. The most common metastatic sites in order of frequency are bone, lymph nodes, and soft tissue. Analysis of the literature uncovered only two case reports of medulloblastoma that had metastasized to the breast. Both of these cases were diagnosed by open surgical biopsies. We present a case of medulloblastoma metastatic to the breast which was diagnosed by fine-needle aspiration biopsy. This diagnosis was subsequently confirmed by a tru-cut surgical biopsy and was further supported by immunohistochemical studies.
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Affiliation(s)
- M Baliga
- Department of Pathology, Louisiana State University Medical Center, New Orleans
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Lynn A, Brozena SJ, Espinoza CG, Fenske NA. Nevus of Ota acquisita of late onset. Cutis 1993; 51:194-6. [PMID: 8444053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Nevus of Ota is a melanotic pigmentary disorder characterized by its distinctive cutaneous distribution involving skin innervated by the trigeminal nerve. Most cases are clinically manifest at birth or around puberty; however, acquired lesions in adults have been reported. We report a case of nevus of Ota acquisita that occurred in an eighty-one-year-old man.
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Affiliation(s)
- A Lynn
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa
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12
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Espinoza LR, Zakraoui L, Espinoza CG, Gutiérrez F, Jara LJ, Silveira LH, Cuéllar ML, Martínez-Osuna P. Psoriatic arthritis: clinical response and side effects to methotrexate therapy. J Rheumatol 1992; 19:872-7. [PMID: 1404123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the last decade, methotrexate (MTX) has emerged as a useful second line agent for a variety of arthritides. However, there still exists some reluctance for its wider use mainly because of concerns about its liver side effects. We describe our clinical experience with this drug in psoriatic arthritis (PsA). The study group included 24 men and 16 women, with a mean age of 47 years (16-75), with oligoarticular (13) or polyarticular (27) involvement, with a mean disease duration of 12 years (1-36). Patients received a mean dose of 11.2 mg of MTX orally/week during a mean period of 34 months (6-132). Seven had been previously treated with other second line agents. Thirty-eight patients had an excellent or good response. In them, the erythrocyte sedimentation rate dropped in a mean of 38 mm/h. Only 2 patients had a rather poor response. Two patients discontinued the medication because of side effects: leukopenia in one and stomatitis in the other. Eleven patients presented with liver test abnormalities: 3 mild, 6 moderate and 2 severe. Seven patients had 11 liver biopsies. Except for one, none had evidence of cirrhosis or inflammation. Indeed, no changes were observed in the histopathology in those with repeated biopsies. The case reported as cirrhosis occurred very early in the course of MTX therapy. He continued taking MTX treatment without further deterioration of liver chemistry and/or histology. It is concluded that MTX is an effective and safe agent in PsA. Results also indicate that it is not necessary to perform liver biopsies on a routine basis.
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Affiliation(s)
- L R Espinoza
- Department of Medicine, Louisiana State University School of Medicine, New Orleans
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Espinoza LR, Jara LJ, Espinoza CG, Silveira LH, Martinez-Osuna P, Seleznick M. There is an association between human immunodeficiency virus infection and spondyloarthropathies. Rheum Dis Clin North Am 1992; 18:257-66. [PMID: 1561406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The presence of inflammatory musculoskeletal manifestations during the course of human immunodeficiency virus (HIV) infection is well established. A wide spectrum of rheumatic disorders have been reported since the first reports of Reiter's syndrome with HIV infection. Other reported associations include forms of arthropathies, psoriatic arthritis, Sjögren's syndrome, polymyositis-dermatomyositis, vasculitis, and septic arthritis.
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Affiliation(s)
- L R Espinoza
- Department of Medicine, Louisiana State University School of Medicine, New Orleans
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14
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Morgan MB, Kouseff BG, Silver A, Shenefelt PC, Fenske NA, Espinoza CG. Eruptive vellus hair cysts and neurologic abnormalities: two related conditions? Cutis 1991; 47:413-5. [PMID: 1879179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A fifteen-year-old white boy with a history of seizure disorder, borderline cognitive function, academic difficulty, and explosive temper outbursts was evaluated for asymptomatic flesh-colored papules appearing on his chest, abdomen, and axillae. Examination of a biopsy specimen showed eruptive vellus hair cysts; results of genetic, endocrinologic, and neuropsychiatric evaluation revealed abnormalities suggestive of a previously undescribed neurocutaneous syndrome.
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Affiliation(s)
- M B Morgan
- University of South Florida, College of Medicine, Tampa
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15
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Fenske NA, Groover CE, Lober CW, Espinoza CG. Dowling-Degos disease, hidradenitis suppurativa, and multiple keratoacanthomas. A disorder that may be caused by a single underlying defect in pilosebaceous epithelial proliferation. J Am Acad Dermatol 1991; 24:888-92. [PMID: 2050858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case in which one patient had Dowling-Degos disease (reticulate pigmented anomaly of the flexures), hidradenitis suppurativa, and multiple keratoacanthomas. Abnormal epithelial proliferation involving mainly the pilosebaceous apparatus has been recognized in all three conditions. We speculate that a single underlying defect in follicular epithelial proliferation, characterized by variable expressivity, accounts for the coexistence of these clinically distinct disorders of follicular derivation.
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Affiliation(s)
- N A Fenske
- Division of Dermatology, USF College of Medicine, Tampa 33612
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16
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Espinoza LR, Aguilar JL, Espinoza CG, Gresh J, Jara J, Silveira LH, Martinez-Osuna P, Seleznick M. Characteristics and pathogenesis of myositis in human immunodeficiency virus infection--distinction from azidothymidine-induced myopathy. Rheum Dis Clin North Am 1991; 17:117-29. [PMID: 2041882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Inflammatory muscle involvement during the course of human immunodeficiency virus (HIV) infection is described and guidelines are suggested for its differentiation from the myopathy associated with azidothymidine (AZT) therapy. Six patients infected with HIV presented with proximal muscle weakness, biochemical and electromyographic abnormalities consistent with myositis. One patient had a skin rash characteristic of dermatomyositis. Muscle biopsy findings demonstrated the presence of an inflammatory cell infiltrate and HIV-p24 antigen. All patients developed their clinical picture prior to AZT therapy and responded to steroids with or without coadministration of AZT.
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Affiliation(s)
- L R Espinoza
- Department of Internal Medicine, College of Medicine, University of South Florida, Tampa
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Espinoza LR, Aguilar JL, Espinoza CG, Berman A, Gutierrez F, Vasey FB, Germain BF. HIV associated arthropathy: HIV antigen demonstration in the synovial membrane. J Rheumatol Suppl 1990; 17:1195-201. [PMID: 2290161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Light and electron microscopic studies were performed on the synovial membranes of 5 patients with HIV associated arthropathy. An immunoperoxidase technique with the use of monoclonal antibodies against CD4, CD8, B and DR lymphocytes, and HIV p24 antigen was also used. Mild to moderate nonspecific proliferative changes and increased vascularity of the subsynovial space were seen. Electron dense deposits and viral-like particles were not observed. Immunohistochemical staining revealed HIV p24 positive staining in cells of the synovial lining layer and in the mononuclear cells of the subsynovial space. CD4, CD8, with predominance of CD8, and B and DR cells were also present. The presence of HIV p24 antigen may be indicative of a role, yet to be defined, in the pathogenesis of HIV associated rheumatic disorders.
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Affiliation(s)
- L R Espinoza
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa
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18
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Abstract
A 61-year-old white man was found to have granulomatous myocarditis associated with a carcinoid tumor in the ileum with local lymphatic metastasis, a mixed papillary and follicular carcinoma of the thyroid with regional lymph node metastasis, benign tubular cell adenomas of the kidneys, and chronic pancreatitis.
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Affiliation(s)
- S J Agosti
- Department of Pathology, University of South Florida College of Medicine, Tampa
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Abstract
Male golden Syrian hamsters were evaluated as a model for the pathogenesis of human infection with Mycobacterium avium complex. Intratracheal inoculation produced a chronic, nonfatal, pulmonary and disseminated infection (overall rate, 86%). The frequency of infection in hamsters that received 5 x 10(8) versus 1 x 10(8) colony forming units (cfu) was not significantly different (87% and 92%, respectively), but 1 x 10(7) cfu produced infection in only 78% of inoculated animals (P = .034). The percentage of animals developing pulmonary infection with M. avium complex did not differ between inoculum groups (77%-80%). Disseminated infection occurred significantly less frequently in the 1 x 10(7) group (46%) compared with the 5 x 10(8) (79%) and 1 x 10(8) (68%) groups (P = .001 and .056, respectively). After seven weeks, partial clearance of M. avium complex from the lungs coincided with an increased number of animals with splenic involvement. The hamster may be a useful model for human infection with M. avium complex.
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Affiliation(s)
- B G Yangco
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612
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Brozena SJ, Fenske NA, Cruse CW, Espinoza CG, Vasey FB, Germain BF, Espinoza LR. Human adjuvant disease following augmentation mammoplasty. Arch Dermatol 1988; 124:1383-6. [PMID: 3415282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two patients are described in whom a progressive systemic sclerosis-like illness developed several years after silicone augmentation mammoplasty. Both had removal of breast implants, followed by marked-to-complete recovery from clinical abnormalities. This entity is increasingly recognized and has become known as human adjuvant disease.
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Affiliation(s)
- S J Brozena
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612
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Espinoza CG, Fenske NA. Dermatological manifestations of toxic agents. Ann Clin Lab Sci 1988; 18:148-54. [PMID: 3289469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A great variety of cutaneous disorders can be seen as reactions to toxic substances. To limit the extent of this review, cutaneous manifestations known to have an immunological mechanism are simply listed with pertinent references. The report has been focused to cover the cutaneous manifestations of toxic agents of non-immunological and unknown mechanisms. Entities discussed include acne, alopecia, dermatitis caused by spider bites, pityriasis rosea, and chemically-induced scleroderma.
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Affiliation(s)
- C G Espinoza
- Department of Pathology, University of South Florida College of Medicine, Tampa
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22
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Spencer SA, Fenske NA, Espinoza CG, Hamill JR, Cohen LE, Espinoza LR. Granuloma annulare-like eruption due to chronic Epstein-Barr virus infection. Arch Dermatol 1988; 124:250-5. [PMID: 2829748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 32-year-old woman afflicted with a severe, chronic Epstein-Barr virus (CEBV) infection of 12 months' duration developed an unusual, granuloma annulare-like eruption. The cutaneous disorder, which paralleled the clinical course of her disease, was characterized by slightly raised, erythematous, annular lesions predominantly involving the face and arms, with sporadic involvement elsewhere. Histopathologic examination of biopsy material obtained from affected skin disclosed a granulomatous dermatitis. The patient's symptoms and cutaneous eruption resolved after systemic corticosteroid therapy. This eruption may represent a distinct cutaneous component of CEBV infection with clinically granuloma annulare-like features or the mere serendipitous association of CEBV infection and an unusual granulomatous dermatitis. Because of the unusual clinical appearance of the eruption and its clear correlation with disease activity, we speculate that it likely represents a distinct cutaneous condition, heretofore unreported, caused by CEBV infection.
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Affiliation(s)
- S A Spencer
- Division of Dermatology, University of South Florida College of Medicine, Tampa 33612
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23
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Medenica-Mojsilović L, Fenske NA, Espinoza CG. Epidermolysis bullosa acquisita. Direct immunofluorescence and ultrastructural studies. Am J Dermatopathol 1987; 9:324-33. [PMID: 3307479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of epidermolysis bullosa acquisita (EBA), associated with inflammatory bowel disease in which cicatricial alopecia was present, was studied by electron microscopy and direct immunofluorescence microscopy. Direct immunofluorescence studies were performed on both clinically normal and perilesional skin, with and without previous separation of the epidermis from the dermis by incubation with 1 M sodium chloride. We propose the use of this separation technique to identify the level of antibody deposition in patients with EBA in whom circulating antibodies are lacking. This technique may be particularly beneficial in delineating between EBA and the clinically similar scarring localized forms of bullous pemphigoid in which circulating antibodies are often absent.
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Abstract
Eight patients with long-standing rheumatoid arthritis and cutaneous vasculitis ulcerations resistant to conventional therapy were treated successfully with a low-dose intermittent regimen of oral methotrexate. Objective clinical response was prompt and complete resolution was observed at about 12 weeks of therapy. The drug was well tolerated. Mild gastrointestinal side effects were the most common untoward reaction. We conclude that methotrexate therapy is an effective agent for some of the extraarticular manifestations of rheumatoid arthritis including vasculitis, and further clinical evaluation should be a consideration.
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Medenica-Mojsilović L, Fenske NA, Espinoza CG. Epidermolysis bullosa herpetiformis with mottled pigmentation and an unusual punctate keratoderma. Arch Dermatol 1986; 122:900-8. [PMID: 2943231 DOI: 10.1001/archderm.1986.01660200072019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report the clinical and pathological features of an epidermolytic form of epidermolysis bullosa (EB) present in a family with six affected members that was transmitted in an autosomal dominant manner in four generations. The essential clinical features included generalized herpetiform blistering of the skin, mottled pigmentation and palmo-plantar hyperkeratosis, both punctate and diffuse. Biopsy material obtained from fresh blisters, clinically intact preblistering skin, hyperkeratotic areas, and skin with mottled pigmentation was examined by light and/or electron microscopy. In addition to reporting a heretofore undescribed association of EB herpetiformis with mottled pigmentation and punctate keratoderma, we report previously undescribed histologic changes in the areas of punctate hyperkeratosis. Specifically, the unique histologic findings consisted of the presence of dyskeratotic cells with clear cytoplasm at the cellular periphery, parakeratosis, and involvement of the intradermal portion of the sweat duct. The possibility that these findings represent a new type of epidermolytic EB, rather than a variant of other types of epidermolytic EB, particularly EB herpetiformis or EB with mottled pigmentation, is discussed.
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Abstract
In an attempt to better define the process of lymphomatoid papulosis, two cases were studied by means of light and electron microscopy, immunohistochemistry studies, including the use of monoclonal antibodies, and cytogenetic technics. About 90% of the dermal lymphoid infiltrate, including the atypical cells, reacted with antibodies that define helper-inducer T cells. Only a few cells, about 5%, reacted with antibodies that define cytotoxic-suppressor T cells. Langerhans cells were increased mostly within the epidermis, and in the dermis they were in close proximity to lymphoid cells. Cytogenetic studies disclosed an abnormal hypertetraploid karyotype in dividing cells from the skin lesion, whereas skin fibroblast and phytohemagglutinin-stimulated cells from peripheral blood cultures had a diploid karyotype. The results support the concept that lymphomatoid papulosis is a disorder characterized by a predominance of helper-inducer T cells, including the atypical cells bearing an abnormal karyotype.
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Ling NS, Fenske NA, Julius RL, Espinoza CG, Drake LA. Dyskeratosis congenita in a girl simulating chronic graft-vs-host disease. Arch Dermatol 1985; 121:1424-8. [PMID: 3901930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dyskeratosis congenita (DCG) is a rare genodermatosis characterized primarily by reticular hyperpigmentation of the skin, dystrophy of the nails, and leukoplakia. It is frequently associated with Fanconi-type pancytopenia. Although DCG has a male predisposition, it has been reported in several female patients. We encountered a case of DCG occurring in a girl whose clinical features simulated chronic graft-vs-host disease (GVHD). Because DCG and chronic GVHD share several clinical and histologic features, physicians should always examine a patient for possible DCG whenever a diagnosis of chronic GVHD is considered. In addition, the similar manifestations of the two disorders suggest a similar pathogenesis on a cellular level in the immunologic system.
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Abstract
A detailed ultrastructural study was made of seven cases of bronchiolo-alveolar carcinoma, and the findings were correlated with histochemical and immunohistochemical data. By electron microscopic examination all seven tumors displayed glandular differentiation, manifested by the presence of microvilli and intercellular junctions, with or without mucin production. Variable proportions of tumor cells retained ultrastructural characteristics of alveolar type II cells and Clara cells. In addition, some tumor cells revealed desmosomes and tonofilaments consistent with squamous differentiation. Immunohistochemical evaluation was carried out using a peroxidase-antiperoxidase technique and specific antibodies against surfactant high molecular weight glycoproteins, keratin proteins, IgA + secretory piece, carcinoembryonic antigen (CEA), human chorionic gonadotropin (HCG), and alpha-fetoprotein (AFP). Four tumors with type II cell-like differentiation stained with anti-surfactant glycoprotein sera. All seven tumors stained focally with anti-keratin and IgA + anti-secretory piece antibodies, and diffusely with CEA. These tumors failed to stain with antisera against HCG and AFP. It is concluded that bronciolo-alveolar carcinomas are primarily composed of cells with alveolar and bronchiolar cell differentiation. Adequate criteria were established for ultrastructural identification of tumor cells with differentiation to type II alveolar cell or Clara cell. Moreover, the findings of this study indicate that the surfactant glycoprotein marker, when present in a given tumor either diffusely or focally, is diagnostic of bronchiolo-alveolar carcinoma.
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Espinoza CG, Pillarisetti SG, Azar HA. Immunohistochemistry of hepatocellular carcinoma associated with cirrhosis. Ann Clin Lab Sci 1984; 14:467-73. [PMID: 6210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Tumor cell marker antibodies were used to analyze ten cases of hepatocellular carcinoma associated with cirrhosis. Clinically, eight of these cases gave a history of chronic alcoholism and the other two of hepatitis B virus infection. Formalin-fixed, paraffin-embedded sections from these cases were screened with antibodies against alpha fetoprotein (AFP), hepatitis B surface antigen (HBsAg) and carcinoembryonic antigen (CEA) using the peroxidase antiperoxidase and avidin-biotin immunoperoxidase procedures. Three cases were positive for AFP, four for HBsAg, and three for CEA; two cases had both HBsAg and CEA. Alpha fetoprotein was present only in the cytoplasm of tumor cells in three cases. Hepatitis B surface antigen, on the other hand, was present in the cytoplasm of hepatocytes in cirrhotic areas and, in one out of the four cases, was also present in hepatocellular carcinoma cells. Carcinoembryonic antigen was seen in three cases; it was present on the surface and in the cytoplasm of proliferating ducts within the cirrhotic areas and between cell surfaces of individual tumor cells in two cases. The presence of different markers was not related to the microscopic appearance of the tumors. In one case, positivity for AFP was of diagnostic help in a tissue sample obtained by needle biopsy. The avidin-biotin immunoperoxidase procedure was more sensitive than the peroxidase antiperoxidase (PAP technique in the pathological assessment of autopsy specimens. Our findings are in agreement with those of other reports and indicate that AFP and HBsAg are the most commonly found markers in hepatoma associated with cirrhosis, and that CEA staining is variable and hepatoma associated with cirrhosis, and that CEA staining is variable and probably non-contributory.
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Abstract
Mucormycosis is an often-fatal opportunistic fungal infection caused by members of the class Zygomycetes (Phycomycetes), order Mucorales. Most cases are diagnosed by histologic examination, through the identification of mucormycotic hyphae in infected tissues. Chronic debilitating conditions accompanied by acidosis such as diabetes mellitus, as well as leukemia, lymphoma, and immunodeficient states, predispose to the development of this type of opportunistic infection. This report describes a hitherto undescribed finding, the presence of structures consistent with sporangia in tissue sections, in a case of pulmonary mucormycosis occurring in a nondiabetic patient with metabolic acidosis secondary to chronic salicylate poisoning.
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Abstract
Fifty-two primary carcinomas of the lung were studied by electron microscopy and by an immunoperoxidase method, using an anti-human keratin antiserum. The results were compared with light microscopic observations. One-third of the carcinomas of the lung showed ultrastructural evidence of both glandular and squamous differentiation. The group of small cell carcinomas was found to be particularly heterogenous ultrastructurally with only three out of eight tumors showing neurosecretory-type granules. Indirect immunoperoxidase staining revealed presence of a keratin-type protein in the vast majority of carcinomas, including foci of small cell carcinomas. Our studies emphasize the heterogeneity and frequent intermixing of the four major categories of lung carcinomas: squamous cell carcinomas, adenocarcinomas, small cell carcinomas, and large cell carcinomas. It is suggested that all these tumors might be derived from pluripotential "reserve" bronchial or bronchioalveolar cells. The segregation of small cell carcinomas from other groups continues to be justified on pragmatic grounds because these carcinomas constitute a group of predominantly small fast-replicating cells amenable to chemotherapy.
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Fenske NA, Waisman M, Espinoza CG. Bowen's disease of the palm. Cutis 1983; 31:673-7. [PMID: 6861519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bowen's disease is a squamous cell carcinoma characterized by isolated, grouped or confluent nodules, either flat, scaling, or crusted, with an arcuate or serpiginous configuration. Malignant dyskeratosis throughout the epidermis, the bowenoid hallmark, is not sufficient by itself to identify a lesion as Bowen's disease. It has been suggested, but not proven, that arsenic has a role in the etiology of Bowen's disease. A case of Bowen's disease affecting the palm, an unusual location, is reported.
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Espinoza CG, Pillarisetti SG, Azar HA. Selected applications of immunoperoxidase techniques in surgical pathology. Ann Clin Lab Sci 1983; 13:240-8. [PMID: 6307109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Immunoperoxidase methods are currently used as an important adjunct to the histologic diagnosis of neoplasms, particularly when these lesions appear undifferentiated or when their histologic presentation, on routine staining, presents a confusing or difficult diagnostic problem. Immunoperoxidase techniques, as used in this laboratory, have been described in detail. Specific case studies have been provided to illustrate the application of immunocytochemical techniques in the demonstration of diverse tissue antigens in tumor cells, including keratin-type proteins, prostatic specific antigen, calcitonin, chorionic gonadotropin, alpha-fetoprotein, immunoglobulins, Ia-like antigen, Factor VIII antigen, and glial fibrillary acidic protein.
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Espinoza CG, Azar HA. Immunohistochemical localization of keratin-type proteins in epithelial neoplasms. Correlation with electron microscopic findings. Am J Clin Pathol 1982; 78:500-7. [PMID: 6182789 DOI: 10.1093/ajcp/78.4.500] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A rabbit antiserum prepared against human keratins isolated from calluses was applied to sections of 108 neoplasms using indirect immunofluorescence and immunoperoxidase technics. The vast majority of epithelial neoplasms were strongly positive for keratin-type proteins, even in the absence of obvious keratinization or squamous differentiation as revealed by light microscopy. This keratin-positivity was invariably correlated with the identification of intermediate-sized filaments arranged in loose or dense bundles in the cytoplasm of neoplastic epithelial cells. Keratin-negative neoplasms included nevi, malignant melanomas, carcinoid tumors, malignant lymphomas, and a variety of connective-tissue tumors. Immunologic identification of keratin-type proteins was particularly helpful in establishing the epithelial nature of "undifferentiated" malignant tumors, including oat cell carcinomas.
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Espinoza LR, Vasey FB, Espinoza CG, Bocanegra TS, Germain BF. Vascular changes in psoriatic synovium. A light and electron microscopic study. Arthritis Rheum 1982; 25:677-84. [PMID: 7092966 DOI: 10.1002/art.1780250611] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Light and electron microscopic studies were performed on the synovial membranes from the large joints of 12 patients with psoriatic arthritis. The most significant histopathologic findings were vascular changes that were characterized by endothelial cell swelling accompanied by inflammatory cell infiltration and marked thickening of the vessel wall. Fibrosis of the subsynoviocyte tissue was also prominent, especially in patients with chronic disease. Villi were not prominent, and the lining layer was not thickened. Both type A and B cells were seen; none had significant abnormalities. No electrondense deposits were observed. These findings lend further support to the theory that microvascular changes play a significant role in the pathogenesis of psoriasis and its related arthritis.
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Abstract
One of the most difficult areas of surgical pathology is the classification of "undifferentiated" or "anaplastic" large cell malignant tumors. The differential diagnosis of these tumors includes poorly differentiated carcinomas, large cell malignant lymphomas, and amelanotic malignant melanomas. In this study of 56 such cases, the application of electron microscopy and, in selected instances, of indirect immunofluorescence and immunoperoxidase staining methods have helped us reach a precise histopathologic diagnosis in the majority of neoplasms that were considered to be "undifferentiated" by light microscopy.
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Abstract
Tuberculosis involvement of the larynx is uncommon. However, it is a highly infectious disease and a hazard to both community and hospital staff. It should be considered in the differential diagnosis of patients presenting with chronic hoarseness. Two patients with laryngeal tuberculosis are the objective of the present report. The diagnosis was established by biopsy followed by isolation and identification of Mycobacterium tuberculosis from sputum.
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Espinoza LR, Espinoza CG. Temporal arteritis with normal ESR. Arch Intern Med 1980; 140:281-2. [PMID: 7352827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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