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Sample records for pruritic maculopapular rash

  1. Management of Early Congenital Syphilis in a Newborn Case with Maculopapular Rash

    Directory of Open Access Journals (Sweden)

    Özgün Uygur

    2017-09-01

    Full Text Available Congenital syphilis is preventable with proper antenatal follow-up and treatment of the pregnant woman infected with Treponema pallidum, and the rapid evaluation and early treatment of the newborns. Here we report a newborn with early congenital syphilis presenting with maculopapular rash and positive treponemal test born to an inadequately treated syphilitic mother.

  2. Ibrutinib-Associated Skin Toxicity: A Case of Maculopapular Rash in a 79-Year Old Caucasian Male Patient with Relapsed Waldenstrom's Macroglobulinemia and Review of the Literature.

    Science.gov (United States)

    Jensen, Anders Bisgaard; Stausbøl-Grøn, Birgitte; Riber-Hansen, Rikke; d'Amore, Francesco

    2017-03-13

    Waldenstrom's macroglobulinamia (WM) is a rare malignant lymphoproliferative disorder, characterized by monoclonal IgM paraproteinemia and neoplastic proliferation of malignant lymphoplasmacytoid cells in the bone marrow. Traditionally, WM has been treated with modalities similar to those used in the management of other indolent lymphomas. Just recently, based on impressive clinical trial results in heavily pretreated WM patients, a new Bruton Tyrosine Kinase-inhibitor, Ibrutinib, has been approved for the treatment of this disorder. As the use of Ibrutinib in WM outside clinical trials is still limited, only few clinical reports illustrating treatment side effects are currently available. Here we review the current literature specific on Ibrutinib-associated rash in hematologic patients, and report on an elderly patient with WM, who developed a red maculopapular non-pruritic rash 12 weeks after starting Ibrutinib therapy. Without modifications of the ongoing Ibrutinib schedule, the rash regressed within two weeks of treatment with topical steroid-containing dermatological compounds.

  3. Ibrutinib-Associated Skin Toxicity: A Case of Maculopapular Rash in a 79-Year Old Caucasian Male Patient with Relapsed Waldenstrom’s Macroglobulinemia and Review of the Literature

    Science.gov (United States)

    Jensen, Anders Bisgaard; Stausbøl-Grøn, Birgitte; Riber-Hansen, Rikke; d’Amore, Francesco

    2017-01-01

    Waldenstrom's macroglobulinamia (WM) is a rare malignant lymphoproliferative disorder, characterized by monoclonal IgM paraproteinemia and neoplastic proliferation of malignant lymphoplasmacytoid cells in the bone marrow. Traditionally, WM has been treated with modalities similar to those used in the management of other indolent lymphomas. Just recently, based on impressive clinical trial results in heavily pretreated WM patients, a new Bruton Tyrosine Kinase-inhibitor, Ibrutinib, has been approved for the treatment of this disorder. As the use of Ibrutinib in WM outside clinical trials is still limited, only few clinical reports illustrating treatment side effects are currently available. Here we review the current literature specific on Ibrutinib-associated rash in hematologic patients, and report on an elderly patient with WM, who developed a red maculopapular non-pruritic rash 12 weeks after starting Ibrutinib therapy. Without modifications of the ongoing Ibrutinib schedule, the rash regressed within two weeks of treatment with topical steroid-containing dermatological compounds. PMID:28469834

  4. Etiology of maculopapular rash in measles and rubella suspected patients from Belarus.

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    Marina A Yermalovich

    Full Text Available As a result of successful implementation of the measles/rubella elimination program, the etiology of more and more double negative cases remains elusive. The present study determined the role of different viruses as causative agents in measles or rubella suspected cases in Belarus. A total of 856 sera sent to the WHO National Laboratory between 2009 and 2011 were tested for specific IgM antibodies to measles virus (MV, rubella virus (RV and human parvovirus B19 (B19V. The negatives were further investigated for antibodies to enterovirus (EV and adenovirus (AdV. Children of up to 3 years were tested for IgM antibodies to human herpesvirus 6 (HHV6. A viral etiology was identified in 451 (52.7% cases, with 6.1% of the samples being positive for MV; 2.6% for RV; 26.2% for B19V; 9.7% for EV; 4.6% for AdV; and 3.6% for HHV6. Almost all measles and rubella cases occurred during limited outbreaks in 2011 and nearly all patients were at least 15 years old. B19V, EV and AdV infections were prevalent both in children and adults and were found throughout the 3 years. B19V occurred mainly in 3-10 years old children and 20-29 years old adults. EV infection was most common in children up to 6 years of age and AdV was confirmed mainly in 3-6 years old children. HHV6 infection was mostly detected in 6-11 months old infants. Laboratory investigation of measles/rubella suspected cases also for B19V, EV, AdV and HHV6 allows diagnosing more than half of all cases, thus strengthening rash/fever disease surveillance in Belarus.

  5. Pruritic nodular secondary syphilis in a 61-year-old man with HIV infection.

    Science.gov (United States)

    Rovira-López, Roger; Bertolín-Colilla, Marta; Martín-Ezquerra, Gemma; Pujol, Ramon M

    2017-06-01

    The typical finding in secondary syphilis stage is a generalized non-pruritic maculopapular eruption. We report a case of secondary syphilis in an HIV-infected patient presenting with pruritic crusted nodules showing numerous eosinophils on the histopathological examination.

  6. Smelly foot rash.

    Science.gov (United States)

    Morais, Paulo; Peralta, Ligia

    2011-03-01

    A previously healthy Caucasian girl, 6 years of age, presented with pruritic rash on both heels of 6 months duration. The lesions appeared as multiple depressions 1-2 mm in diameter that progressively increased in size. There was no history of trauma or insect bite. She reported local pain when walking, worse with moisture and wearing sneakers. On examination, multiple small craterlike depressions were present, some coalescing into a larger lesion on both heels (Figure 1). There was an unpleasant 'cheesy' odour and a moist appearance. Wood lamp examination and potassium hydroxide testing for fungal hyphae were negative.

  7. A Desert Rash

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    Ross P. Berkeley

    2011-05-01

    Full Text Available A 29-year-old man presented to the emergency department (ED with a rash across his chest and abdomen. The rash began 2 hours before his arrival and was initially pruritic, but subsequently became painful. The patient also complained of acute onset of aching pain in both hips and his left arm. He denied associated chest pain or dyspnea, and had no paresthesias or disequilibrium. Routine laboratory studies and chest radiograph were normal. Earlier in the day, the patient had completed a dive to 235 feet in depth in Lake Mead, Nevada, but reported a very controlled ascent with appropriate decompression stops. Two days earlier, he had completed a dive to 315 feet in Lake Mead without any problems. [West J Emerg Med. 2011;12(4:563–564.

  8. Rash in a foreign worker

    OpenAIRE

    Nurjahan, MI; Tevaraj, P

    2016-01-01

    Hookworm-related cutaneous larva migrans (HrCLM) is a zoonosis which is endemic in many sub-tropic and tropical countries including Malaysia. We report a case of a 40-year old plantation worker who presented with a pruritic rash on his abdomen. It is important for clinicians to diagnose and treat HrCLM promptly as this condition results in considerable morbidity when treatment is delayed.

  9. Rash in a foreign worker.

    Science.gov (United States)

    Nurjahan, M I; Tevaraj, P

    2016-01-01

    Hookworm-related cutaneous larva migrans (HrCLM) is a zoonosis which is endemic in many sub-tropic and tropical countries including Malaysia. We report a case of a 40-year old plantation worker who presented with a pruritic rash on his abdomen. It is important for clinicians to diagnose and treat HrCLM promptly as this condition results in considerable morbidity when treatment is delayed.

  10. Breast Rash

    Science.gov (United States)

    ... rashes/rash-in-adults. Accessed Dec. 29, 2016. Papadakis MA, et al., eds. Breast disorders. In: Current ... http://www.accessmedicine.com. Accessed Dec. 28, 2016. Papadakis MA, et al., eds. Dermatologic disorders. In: Current ...

  11. Diaper Rash

    Science.gov (United States)

    ... the diapering routine, might be caused by a yeast called Candida albicans (a type of fungus). This ... off the "good" bacteria that keep Candida from growing. continue Prevention To prevent diaper rash, keep your ...

  12. Diaper Rash

    Science.gov (United States)

    ... of newborns: Human breast milk or barrier cream. Journal of Clinical Nursing. 2014;23:515. www.clinicalkey.com. Accessed March 18, 2015. Hajbaghery AM, et al. Shampoo-clay heals diaper rash faster than calendula officinalis. Nurse ...

  13. Diaper Rash

    Science.gov (United States)

    ... al. Shampoo-clay heals diaper rash faster than calendula officinalis. Nurse Midwifery Studies. 2014;3:e14180. Calendula. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. ...

  14. Diaper Rash

    Science.gov (United States)

    ... But sometimes it can’t be avoided. Home treatment often clears up diaper rash in a few days. If that does not work, call your family doctor.If you use cloth diapers, you should also keep these tips in mind.Wash diapers in hot water with bleach to kill germs. You can also ...

  15. What can you learn from rashes? An approach for children.

    African Journals Online (AJOL)

    can be diagnosed with a reasonable degree of certainty and appropriate therapy rapidly instituted. For example,. Kawasaki disease often ... of physical signs such as maculopapular rash, bulbar conjunctivitis, swollen dig~ .... Other: Kawasaki disease, juvenile chronic arthritis. Diffuse erythroderma (red skin). Bacterial: Group ...

  16. Isotretinoin induced rash, urticaria, and angioedema: a case report

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    Zonunsanga

    2015-10-01

    Full Text Available Isotretinoin is a vitamin A analogue, which is readily isomerized to tretinoin. It causes normalization of abnormal keratinisation. It also reduces sebum secretion. It also has anti-inflammatory as well as antibacterial properties. It has some adverse effects like teratogenecity, hypertriglyceridemia, pancreatitis, dryness of skin, cheilitis, altered liver functions etc. A 25 years old unmarried lady presented with acne vulgaris, who did not showed improvements with conventional (antibiotics therapy was given isotretinoin. She developed maculopapular rash, urticaria and angioedema Isotretinoin induced urticarial rashes and angioedema is rarely reported as far as our knowledge is concerned.

  17. First Aid: Rashes

    Science.gov (United States)

    ... to the Gynecologist? Blood Test: Thyroid Peroxidase Antibodies First Aid: Rashes KidsHealth > For Parents > First Aid: Rashes Print A A A Rashes can be ... For Kids For Parents MORE ON THIS TOPIC First Aid: Skin Infections Poison Ivy Erythema Multiforme Hives (Urticaria) ...

  18. Cutaneous form of maculopapular mastocytosis in a foal.

    Science.gov (United States)

    Junginger, Johannes; Geburek, Florian; Khan, Muhammad Akram; Müller, Gundi; Gruber, Achim D; Hewicker-Trautwein, Marion

    2016-06-01

    Cutaneous mastocytosis is a rare benign disease occurring in domestic animals and humans. In previous reports, dermal findings in foals were accompanied by systemic mast cell infiltrations, whereas lesions in human cutaneous mastocytosis, including urticaria pigmentosa and solitary mastocytoma, are usually restricted to the skin. To describe a new variant of equine cutaneous maculopapular mastocytosis lacking systemic involvement. A 2.5-month-old warmblood foal with multiple skin nodules since birth. Clinical examination (including haematology, fine needle biopsy and thoracic radiographs), postmortem examination, histopathology and immunohistochemistry. Clinical examination showed 41 skin nodules that contained numerous mast cells as detected by cytology. Macroscopic examination at postmortem examination revealed intradermal circumscribed lesions ranging from 2 to 5 cm in diameter. Histologically, they were composed of well differentiated mast cells with metachromatic granules stained with toluidine blue accompanied by many eosinophils. Immunohistochemically, mast cells had mast cell growth factor receptor c-KIT predominating at the cell surface and intracytoplasmic expression of tryptase. In other organs similar mast cell infiltrations were not detected. The case presented here fulfils the criteria of equine cutaneous maculopapular mastocytosis (ECMM), representing a rare entity in foals that is reported to be associated with spontaneous regression, although the long-term prognosis is not known. Unlike in previous reports, lesions described here were restricted to the skin. This may imply that ECMM is primarily a dermal disease sharing similarities with urticaria pigmentosa in young children. © 2016 ESVD and ACVD.

  19. A Case Report of Rash at Peritoneal Dialysis Exit Site

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    Elvira O. Gosmanova MD, FASN

    2015-11-01

    Full Text Available The International Society for Peritoneal Dialysis recommends the regular application of topical antibiotic-containing preparations in addition to a routine exit site care to reduce the risk of exit site infection (ESI. Among these prophylactic antimicrobial preparations, topical gentamicin is one of the widely used and effective antibiotics for prevention of ESI and peritonitis in peritoneal dialysis (PD patients. Overall, topical gentamicin is well tolerated; however, its use can be associated with the development of allergic contact dermatitis (ACD. We describe a first reported case of PD catheter exit site contact ACD due to topical gentamicin mimicking ESI. The patient in this report developed worsening violaceous in color and pruritic rash surrounding the PD catheter exit site that appeared 3 weeks after the initiation of gentamicin cream. The association between development of rash and initiation of topical gentamicin led to a suspicion of local reaction to gentamicin rather than ESI. Skin biopsy confirmed ACD. Discontinuation of the provoking agent and subsequent treatment with topical hydrocortisone application led to a resolution of the exit site rash. Any rash at a PD catheter exit site should be considered infectious until proven otherwise. However, it is important to be aware of noninfectious etiologies of exit site rashes as the treatment of these 2 conditions differs.

  20. Drug-mediated rash: erythema multiforme versus Stevens-Johnson syndrome.

    Science.gov (United States)

    Hidajat, Cassandra; Loi, Duncan

    2014-09-22

    A 92-year-old woman presented with an acute onset generalised maculopapular rash with associated mucosal involvement, on a background of recent start of griseofulvin. The rash progressed rapidly over 2 days to involve most of her body, however, mucosal involvement was limited to her oral mucosa. Characteristic target lesions appeared at 72 h, and a diagnosis of erythema multiforme secondary to griseofulvin was made after further investigation and skin biopsy. The patient was monitored closely for progression of the rash and other indicators of more severe dermatological conditions such as Stevens-Johnson syndrome. She was managed symptomatically, with resolution of the rash in 4 weeks and full recovery to her premorbid level of functioning. This case details the diagnostic and management approach to erythema multiforme, a condition that warrants thorough consideration for the differential of Stevens-Johnson syndrome. 2014 BMJ Publishing Group Ltd.

  1. Poison Ivy Rash

    Science.gov (United States)

    ... leaves and can grow as a bush or tree. Unlike poison ivy and poison oak, it doesn't grow in a three-leaf-per-stem pattern. Poison ivy rash is a type of allergic contact dermatitis caused by an oily resin called urushiol. It's found in the leaves, stems ...

  2. Clinical significance of skin rash in dengue fever: A focus on discomfort, complications, and disease outcome.

    Science.gov (United States)

    Huang, Hsin-Wei; Tseng, Han-Chi; Lee, Chih-Hung; Chuang, Hung-Yi; Lin, Shang-Hung

    2016-07-01

    To assess whether the cutaneous features in patients with dengue fever are associated with abnormal blood biochemistry, complications, and poor disease outcome. Forty five patients with dengue fever were identified at a medical center in Kaohsiung, Taiwan, from September to November 2014. All cases were exclusively caused by type 1 dengue virus. Patients were classified into two groups, based on the presence or absence of skin rash, and their rash was subclassified into maculopapular, morbilliform, and petechial types. Clinical symptoms, laboratory data, disease outcome, and complications were compared between the two groups. Thirty two patients with dengue fever developed skin rash (SP group, n = 32) while the rest of 13 did not (SN group, n = 13). The patient numbers in the maculopapular, morbilliform, and petechial group were 4, 21, and 7, respectively. The SP group was younger (P = 0.001), experienced more pruritus (P = 0.008) and more swollen palms/soles (P = 0.015) than the SN group. However, the SN group had greater genital mucosa involvement (P = 0.008), higher platelet transfusion rate (P = 0.003), and lower hemoglobin and hematocrit levels (P = 0.030) than the SP group. Patients with morbilliform lesions had a higher incidence of palm/sole swelling, less genital mucosal involvement, and a lower platelet transfusion rate than did patients with maculopapular or petechial lesions. Cutaneous manifestations provide an important clue to dengue fever. In patients with dengue fever, those with skin rash tend to have itching and swelling of the palms/soles, however, those without skin rash tend to have more complications and poor disease outcomes. Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

  3. Rash - child under 2 years

    Science.gov (United States)

    ... outer edges of the rash. This rash requires treatment with medicine. Heat rash, or prickly heat, is caused by the ... away by itself, but some cases may require treatment with medicine. ... areas are dry, scaly, red (or darker than normal skin color), ...

  4. Adult with morbilliform rash and tattoo bullae.

    Science.gov (United States)

    Borok, Jenna; Hau, Jennifer; Worswick, Scott

    2016-03-16

    A 34-year-old woman was diagnosed with Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), most likelyrelated to a reaction to allopurinol.The patient presented with a 2-week history of a painful pruritic rash that started on her back and progressed to the rest of her body over a five-day period. The eruption started after several new drugs were started, including allopurinol for hyperuricemia. On physical examination, the patient had a diffuse morbilliform eruption and geometric intact bullae limited to the boundaries of tattoos.Most presentations of DRESS include a morbilliform eruption.  However, DRESS does not commonly present with bullae. There have been no known reported cases of bullae forming in the area of tattoos in cases of DRESS. This unique presentation suggests that a component of the tattoo or tattooing process alters the cutaneous immune response, creating an immunocompromiseddistrict. This alteration may promote a greater localized reaction in the setting of widespread skin involvement in DRESS.

  5. An unusual presentation of pruritic urticarial Papules and Plaques of Pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Ehsani AH

    2011-03-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP is a specific dermatosis of the third trimester of pregnancy, commonly seen in primigravid women."n"nCase presentation: A 24-year-old primigravida woman who had developed a rash immediately after delivery was admitted to Razi Hospital in Tehran, Iran. She had an erythematous eruption, particularly concentrated on the abdominal striae with umbilical sparing and involvement of limbs and extremities. Skin biopsy of the lesions on the lower abdomen, showed superficial perivascular infiltrates with occasional neutrophils and eosinophils. Both direct and indirect immunofloresence assays were negative. The patient was ultimately treated with topical clobetasol butyrate and oral chlorpheniramine for pruritus. Within a week, the lesions and the itchings had disappeared completely."n"nConclusion: Pruritic urticarial papules and plaques of pregnancy are often, but not always, seen during the third trimester of pregnancy, but sometimes they present in postpartum period without any prior manifestations during pregnancy.

  6. Late-onset rash in patients with group A beta-hemolytic streptococcal pharyngitis treated with amoxicillin

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    Masahiko Kimura

    2015-12-01

    Full Text Available We observed late-onset rashes in patients with group A beta-hemolytic streptococcal (GAS pharyngitis. Of 1028 patients with GAS pharyngitis, which was principally treated with amoxicillin, we evaluated those who developed a late-onset rash and excluded those with scarlet fever alone. Twenty-one patients developed a rash (2.0%, 95% confidence interval, 1.3- 3.1%, 7 to 20 days (median, 8 days after GAS pharyngitis onset. The rashes were characterized by maculopapules, which increased in size with coalescence and some developing into plaques, with a symmetrical distribution with a propensity for the extremities, including the palms and soles. The clinical courses of the patients were good, and the rashes subsided within 14 days. A non-immediate reaction to β-lactams, which usually manifests as a maculopapular rash, is a possible cause in our patients, however, repeated courses of amoxicillin in 3 patients did not induce the rash. The underlying mechanism of the late-onset rash after GAS pharyngitis with amoxicillin treatment remains unclear.

  7. Delayed hypersensitivity reaction resulting in maculopapular-type eruption due to entecavir in the treatment of chronic hepatitis B.

    Science.gov (United States)

    Kim, Jeong Tae; Jeong, Hye Won; Choi, Ki Hwa; Yoon, Tae Young; Sung, Nohyun; Choi, Young Ki; Kim, Eun Ha; Chae, Hee Bok

    2014-11-14

    Several clinical trials have demonstrated the potent antiviral efficacy of entecavir (ETV), and this relatively new nucleoside analogue drug has rapidly become a frequently prescribed therapy for chronic hepatitis B (CHB) worldwide. While the studies have also shown a good overall safety profile for ETV, adverse drug reactions (ADRs) in patients with advanced cirrhosis have been reported and represent a broad spectrum of drug-induced injuries, including lactic acidosis, myalgia, neuropathy, azotemia, hypophosphatemia, muscular weakness, and pancreatitis, as well as immune-mediated responses (i.e., allergic reactions). Cutaneous ADRs associated with ETV are very rare, with only two case reports in the publicly available literature; both of these cases were classified as unspecified hypersensitivity allergic (type I) ADR, but neither were reported as pathologically proven or as evaluated by cytokine release analysis. Here, we report the case of a 45-year-old woman who presented with a generalized maculopapular rash after one week of ETV treatment for lamivudine-resistant CHB. The patient reported having experienced a similar skin eruption during a previous three-month regimen of ETV, for which she had self-discontinued the medication. Histopathological analysis of a skin biopsy showed acanthotic epidermis with focal parakeratosis and a perivascular lymphocytic infiltrate admixed with interstitial eosinophils in the papillary and reticular dermis, consistent with a diagnosis of drug sensitivity. A lymphocyte stimulation test showed significantly enhanced IL-4, indicating a classification of type IVb delayed hypersensitivity. The patient was switched to an adefovir-lamivudine combination regimen and the skin eruption resolved two weeks after the ETV withdrawal. This case represents the first pathologically and immunologically evidenced ETV-induced delayed type hypersensitivity skin reaction reported to date. Physicians should be aware of the potential, although rare

  8. A Chinese New Year rash

    Directory of Open Access Journals (Sweden)

    Keah SH

    2013-10-01

    Full Text Available A 28-year-old man presented with a chief complaint of rashes all over his body. He had a history of a trip to Langkawi Island, a famous island resort off the west coast of Malaysia, over the Chinese New Year’s weekend. According to him, he had a lot of fun with a group of friends at the sunny beach and the beautiful sea. There were no untoward incidents and they were perfectly well when they returned home after a 2-day trip. On the evening of the second day after his return, he noticed rashes appearing over his body, notably on shoulders and trunk. These rashes were little painful in nature.

  9. Pediatric Patient with a Rash

    Science.gov (United States)

    Sutton, Jared; Walsh, Ryan; Franklin, Jillian

    2014-01-01

    A 2 year old fully immunized male with no personal history of chicken pox presented to the emergency department with a chief complaint of a rash for one week after returning from a hiking trip in a remote island in Canada. After initially being diagnosed with contact dermatitis, a diagnosis of herpes zoster was made by confirmatory viral polymerase chain reaction testing. The purpose of this case report is to examine the literature for the incidence and etiology of shingles in children without a prior history of a primary varicella rash outbreak. PMID:25035735

  10. Pediatric Patient with a Rash

    Directory of Open Access Journals (Sweden)

    Jared Sutton

    2014-07-01

    Full Text Available A 2 year old fully immunized male with no personal history of chicken pox presented to the emergency department with a chief complaint of a rash for one week after returning from a hiking trip in a remote island in Canada. After initially being diagnosed with contact dermatitis, a diagnosis of herpes zoster was made by confirmatory viral polymerase chain reaction testing. The purpose of this case report is to examine the literature for the incidence and etiology of shingles in children without a prior history of a primary varicella rash outbreak.

  11. Rash diagnostics: an update on the diagnosis of allergic rashes.

    Science.gov (United States)

    Happel, Corinne Savides

    2017-06-01

    The purpose of this review is to summarize recent research regarding the diagnosis of allergic rashes and to suggest future directions for the promotion of accurate diagnosis and endotype specification. Multiple cohort studies demonstrate that with appropriate clinical evaluation, drug allergy labels can be removed in up to 90% of cases. Genetic tests can predict severe adverse cutaneous drug reactions in some cases and in vitro tests are being sought to identify causative drugs in others. Biomarkers to define endotypes of atopic dermatitis are needed to predict which patients will benefit from evolving targeted therapies. Hyperspectral imaging is a rapidly evolving technology in medical diagnostics; additional research is needed to demonstrate whether this promising technology can be used to distinguish allergic rashes and/or endotypes in atopic dermatitis. Diagnostic tools for the assessment of allergic rashes are primitive in that they frequently rely on challenges to ascertain whether suspected allergens were causative. Validated in vitro tests with high sensitivity and specificity for drug allergies would benefit the field, particularly in delayed type reactions, as would identification of any hyperspectral signatures that could identify endotypes in atopic dermatitis.

  12. Heat Rash (Prickly Heat or Miliaria)

    Science.gov (United States)

    ... Baby rashes Heat rash Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  13. Rashes

    Science.gov (United States)

    ... lesions - hands Erythema multiforme, target lesions on the palm Erythema multiforme on the leg References James WD, ... Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. ...

  14. Butterfly rash with periodontitis: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Manvi Aggarwal

    2012-01-01

    Full Text Available Rashes can occur in any part of the body. But rash which appears on face has got both psychological and cosmetic effect on the patient. Rashes on face can sometimes be very challenging to physicians and dermatologists and those associated with oral manifestations pose a challenge to dentists. Butterfly rash is a red flat facial rash involving the malar region bilaterally and the bridge of the nose. The presence of a butterfly rash is generally a sign of lupus erythematosus (LE, but it can also include a plethora of conditions. The case presented here is of a female with butterfly rash along with typical bright red discoloration of gingiva. The clinical, histopathological and biochemical investigations suggested the presence of rosacea.

  15. Chikungunya Fever Presenting as a Systemic Disease with Fever. Arthritis and Rash: Our Experience in Israel.

    Science.gov (United States)

    Tanay, Amir

    2016-01-01

    Chikungunya fever (CHIK-F) has been increasingly documented among Western travelers returning from areas with chikungunya virus transmission, which are also popular tourist sites. We present three Israeli travelers who developed fever, maculopapular rash and long-standing arthralgias while visiting northern Indian states not known to be involved in the chikungunya fever epidemic. We also present an epidemiological review of the chikungunya epidemic over the past decades. Rare systemic manifestations of this disorder, like catastrophic antiphospholipid syndrome (CAPS) and adult-onset Still's syndrome, are discussed. The present era of international travel poses a new diagnostic and epidemiologic challenge that demands increased awareness to the possibility of an exotic tropical infectious disease.

  16. Ron Rash: One Foot in Eden

    DEFF Research Database (Denmark)

    Bjerre, Thomas Ærvold

    2010-01-01

    An analysis of Ron Rash's novel One Foot in Eden, focusing on his attachment to place and his depiction of the internal conflicts between farmers and townspeople in a small Appalachian community. Rash depicts the contemporary Southerner’s struggle to maintain his or her roots in a time of rapid h...

  17. A cutaneous rash with mixed gell coombs allergic A cutaneous rash with mixed gell coombs allergic features, sclerodermoid changes and status post features, sclerodermoid changes and status post previous therapy

    Directory of Open Access Journals (Sweden)

    Ana Maria Abreu Velez

    2017-10-01

    Full Text Available Allergies and autoimmune diseases may both be considered hyper-immune responses, where the body’s immune system becomes supercharged and attacks or responds to inappropriate antigens. We describe a skin rash with a mixed allergic and autoimmune host response. A 65 year old female consulted her dermatologist for a pruritic rash. The patient had taken many medications without improvement of the rash, and lived in an area affected by environmental spills; other patients had presented with similar rashes concurrently. A clinical evaluation was performed, and skin biopsies were obtained for hematoxylin and eosin (H&E examination, as well as for immunohistochemical (IHC and direct immunofluorescence (DIF studies. The H&E review revealed a mild, superficial, perivascular dermal infiltrate of lymphocytes, histiocytes, mast cells and eosinophils. Dermal sclerodermoid alterations were also noted. A mild peripheral blood eosinophilia was found; cutaneous IHC staining revealed staining for anti-HLA-DP, DQ, DR antigen and Complement/C5b-9/MAC, in the areas of the perivascular infiltrate and the sclerodermoid changes. The DIF confirmed these findings. Our case is characterized by a mixed allergic/autoimmune reaction, which did not fit exclusively into any single Gell Coombs immune response category.

  18. Anti-allergic, anti-pruritic, and anti-inflammatory activities of Centella asiatica extracts.

    Science.gov (United States)

    George, Mathew; Joseph, Lincy; Ramaswamy

    2009-07-03

    This study investigated antipruritic and anti-inflammatory effect of Centella asiatica extract in rats and anti-allergic in vitro using sheep (Capra hircus) serum method and compound 48/80 induced mast cell degranulation method, compared with standard drug ketotifen fumarate. In rats, extract of Centella asiatica administered orally was examined for anti-pruritic study and chlorpheniramine maleate was used as standard drug while carageenan paw induced inflammatory method was used for the antiinfammatory study. The results show that the extracts of Centella asiatica exhibited antiallergic, anti-pruritic and anti-inflammatory activities.

  19. Drug rash with eosinophilia and systemic symptoms syndrome due to anti-TB medication

    Directory of Open Access Journals (Sweden)

    Dharmesh H Kaswala

    2013-01-01

    Full Text Available Drug rash with eosinophilia and systemic symptoms (DRESS syndrome is a severe, idiosyncratic, multi-system reaction characterized by the clinical triad of fever, rash, and internal organ involvement. The mortality rate is estimated to be 8%, especially among patients with liver involvement, so early recognition is imperative. Drugs commonly associated with the development of DRESS syndrome include anticonvulsants, long-acting sulfonamides, and anti-inflammatory medications; however, there are no reported cases implicating anti-tuberculosis (anti-TB medications. We report a case of DRESS syndrome from anti-TB therapy. A 68-year-old male with pulmonary TB presented with pruritic skin eruption and sore throat, 8 weeks after starting Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE therapy. He takes metformin and glyburide for diabetes. Physical exam was significant for diffuse, exfoliative erythematous macules with target lesions involving the entire skin surface, without mucosal involvement. Laboratory data was significant for mild transaminitis and new onset eosinophilia. Given suspicion of drug eruption, RIPE therapy was discontinued. Skin biopsy confirmed erythema multiforme. Despite discontinuation of the implicated medications, eosinophilia and transaminitis continued to worsen, and so systemic corticosteroids were started. After 4 weeks of discontinuation of RIPE therapy, the cutaneous eruption resolved and laboratory data returned to normal. The patient is finishing course of anti-TB with cycloserine and moxifloxacin. Upon follow up as outpatient, the rash was resolving and disappeared in 1 month. DRESS syndrome is always considered when there is high eosinophil counts and multisystem involvement with skin eruptions. It can be potentially life threatening with certain drugs and infectious agents in predisposed individuals. It is imperative to discontinue the causative medication and avoid re-exposure.

  20. Up-regulation of CCL17, CCL22 and CCR4 in drug-induced maculopapular exanthema.

    Science.gov (United States)

    Tapia, B; Morel, E; Martín-Díaz, M-A; Díaz, R; Alves-Ferreira, J; Rubio, P; Padial, A; Bellón, T

    2007-05-01

    Maculopapular exanthema has been reported to be the most frequently drug-induced cutaneous reaction. Although T lymphocytes are involved in the pathomechanism of this disease, little is know about the recruitment of these cells to the skin. The aim of this work is to study the role of the chemokines TARC/CCL17 and MDC/CCL22 in the lymphocyte trafficking to affected skin in drug-induced exanthemas. Real-time PCR was performed to quantify gene expression levels of CCL17, CCL22 and their receptor CCR4 in lesional skin biopsies and in peripheral blood mononuclear cells from patients. CCL27 and CCL22 proteins were detected in the skin by immunochemistry. Protein expression of CCR4 was determined by flow cytometry in peripheral blood lymphocytes. Functional migration assays to CCL17 and CCL22 were assessed to compare the migratory responses of peripheral blood lymphocytes from patients and healthy subjects. CCL17 and CCL22 were up-regulated in maculopapular exanthema-affected skin. CCR4 mRNA levels and protein expression were increased in peripheral blood mononuclear cells during the acute phase of the disease. The increased expression of the receptor was consistent with a higher response of peripheral blood lymphocytes to CCL17 and CCL22 compared with the migratory response in healthy donors. TARC/CCL17 and MDC/CCL22 might cooperate in attracting T lymphocytes to skin in drug-induced maculopapular exanthemas.

  1. Hot Tub Rash (Pseudomonas Dermatitis/Folliculitis)

    Science.gov (United States)

    ... name=”commit” type=”submit” value=”Submit” /> Healthy Water Home Rashes Language: English (US) Español (Spanish) Recommend on ... scrubbing and cleaning? Replacement of the hot tub water filter according to manufacturer’s recommendations? Replacement of hot tub ...

  2. "Hot Tub Rash" and "Swimmer's Ear" (Pseudomonas)

    Science.gov (United States)

    ... Hot Tub Rash > Remove swimsuits and shower with soap after getting out of the water. > Clean swimsuits after getting out of the water. ... in locations that have been closed because of pollution. Pseudomonas can multiply quickly when water disinfectant levels drop, so testing your pool or ...

  3. Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization.

    Science.gov (United States)

    Ónodi-Nagy, Katinka; Kinyó, Ágnes; Meszes, Angéla; Garaczi, Edina; Kemény, Lajos; Bata-Csörgő, Zsuzsanna

    2015-01-01

    It hasn't been clearly understood yet whether sensitization to antibiotics, the virus itself or transient loss of drug tolerance due to the virus, is responsible for the development of maculopapular exanthems following amoxicillin intake in patients with infectious mononucleosis. We aimed to examine whether sensitization to penicillin developed among patients with skin rash following amoxicillin treatment within infectious mononucleosis. Ten patients were investigated for drug sensitization by lymphocyte transformation test and six patients were further tested by prick-, intradermal and patch tests employing the penicillin's main antigens. Lymphocyte transformation test showed negative results with amoxicillin, while one patient had positive reaction to cefixime. Six patients with suspected sensitization to amoxicillin were then investigated by in vivo tests. Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients. Our data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin. In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.

  4. Methylenetetrahydrofolate reductase (MTHFR) deficiency presenting as a rash.

    LENUS (Irish Health Repository)

    Crushell, Ellen

    2012-09-01

    We report on the case of a 2-year-old girl recently diagnosed with Methylenetetrahydrofolate reductase (MTHFR) deficiency who originally presented in the neonatal period with a distinctive rash. At 11 weeks of age she developed seizures, she had acquired microcephaly and developmental delay. The rash deteriorated dramatically following commencement of phenobarbitone; both rash and seizures abated following empiric introduction of pyridoxine and folinic acid as treatment of possible vitamin responsive seizures. We postulate that phenobarbitone in combination with MTHFR deficiency may have caused her rash to deteriorate and subsequent folinic acid was helpful in treating the rash and preventing further acute neurological decline as commonly associated with this condition.

  5. Demodex gatoi -associated contagious pruritic dermatosis in cats - a report from six households in Finland

    Directory of Open Access Journals (Sweden)

    Rajaniemi Riitta-Liisa

    2009-10-01

    Full Text Available Abstract Background Demodex gatoi is unique among demodectic mites. It possesses a distinct stubby appearance, and, instead of residing in the hair follicles, it dwells in the keratin layer of the epidermis, causing a pruritic and contagious skin disease in cats. Little is known of the occurrence of D. gatoi in Europe or control of D. gatoi infestation. Case presentation We describe D. gatoi in 10 cats, including five Cornish Rex, two Burmese, one Exotic, one Persian and one Siamese, living in six multi-cat households in different locations in Finland containing 21 cats in total. Intense pruritus was the main clinical sign. Scaling, broken hairs, alopecia and self-inflicted excoriations were also observed. Diagnosis was based on finding typical short-bodied demodectic mites in skin scrapings, skin biopsies or on tape strips. Other pruritic skin diseases, such as allergies and dermatophytoses, were ruled out. In one household, despite finding several mites on one cat, all six cats of the household remained symptomless. Amitraz used weekly at a concentration of 125-250 ppm for 2-3 months, proved successful in three households, 2% lime sulphur weekly dips applied for six weeks in one household and peroral ivermectin (1 mg every other day for 10 weeks in one household. Previous trials in four households with imidacloprid-moxidectin, selamectin or injected ivermectin given once or twice a month appeared ineffective. Conclusion D. gatoi-associated dermatitis is an emerging contagious skin disease in cats in Finland. Although pruritus is common, some cats may harbour the mites without clinical signs. In addition, due to translucency of the mites and fastidious feline grooming habits, the diagnosis may be challenging. An effective and convenient way to treat D. gatoi infestations has yet to emerge.

  6. [Amoxicillin-induced skin rash sparing a plaque of erythema migrans: Renbök phenomenon: Case report and literature review].

    Science.gov (United States)

    Dumas, M; Blum, L; Begon, E

    2017-08-02

    Renbök phenomenon describes the inhibition of a lesion when a different one appears. We describe the first case of Renbök phenomenon occurring in a context of erythema migrans (EM) spared by an amoxicillin-induced skin rash and we also present a literature review. A 60-year-old patient was treated with amoxicillin for EM on the right knee and subsequently developed generalized erythema as a result of an antibiotic-induced skin rash, with sparing of the area previously affected by EM. Renbök phenomenon was diagnosed. In 1981, Cochran et al. first described a maculopapular drug reaction, which spared the sites of previous X irradiation for a tumor. Since then, nearly 40 cases have been reported, mostly describing patient with alopecia areata of the scalp with hair growth within plaques of psoriasis. One of the mechanisms suggested is a role played by cytokine cross-regulation in competition among distinct immune responses. We report the first case of Renbök phenomenon involving EM spared by a drug reaction. This phenomenon provides an insight into inflammatory response competition within a single patient. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Setting the Record Straight on Diaper Rash and Disposable Diapers.

    Science.gov (United States)

    Clark-Greuel, Jocelyn N; Helmes, C Tucker; Lawrence, Ann; Odio, Mauricio; White, Jeffrey C

    2014-08-01

    Skin in the diapered area is continuously threatened by exposure to changes in pH levels, overhydration, mechanical friction, and fecal enzymes, making diaper rash a common occurrence among babies. Up to one third of infants may exhibit clinical symptoms of diaper rash at any time, and more than half of babies between the ages of 4 and 15 months develop diaper rash at least once in a 2-month period. Despite misperceptions that disposable diapers are related to an increase in diaper rash, the incidence of diaper dermatitis is on the decline, largely due to significant improvements in disposable diaper construction and materials. Modern-day disposable diapers are specifically designed to limit exposure to irritants in the diaper area, reduce overhydration, inhibit skin barrier compromise, and help maintain normal skin pH levels and have been thoroughly evaluated for safety and skin compatibility. © The Author(s) 2014.

  8. DRUG REACTION WITH HERBAL SUPPLEMENT: A POSSIBLE CASE OF DRUG INDUCED LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    AZIZ NA

    2010-01-01

    Full Text Available A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE and subsequently symptoms subsided rapidly on withholding the herbal medication.

  9. Clinical and laboratory diagnosis of Zika fever: an update

    OpenAIRE

    Xavier,Analúcia R.; Kanaan,Salim; Bozzi,Ronielly P.; Amaral,Luiza V.

    2017-01-01

    ABSTRACT Zika fever can be defined as an acute febrile viral illness, mainly transmitted by the mosquito of the genus Aedes. It makes a differential diagnosis from diseases caused by other flaviviruses, such as chikungunya and dengue fever. Many people with Zika virus (ZIKV) infection will not have symptoms or will only have mild clinical symptoms. The clinical conditions are nonspecific and characterized by low-grade fever, pruritic erythematous maculopapular rash, non-purulent conjunctival ...

  10. Comparison of carbamazepine rash in multiple sclerosis and epilepsy.

    Science.gov (United States)

    Shirzadi, M; Alvestad, S; Hovdal, H; Espeset, K; Lydersen, S; Brodtkorb, E

    2012-01-01

    Studies on the comorbidity of multiple sclerosis (MS) and allergic disorders have shown conflicting results. Carbamazepine (CBZ) is widely used in MS to control pain. We have compared the incidence of rash from CBZ use in MS and epilepsy. Consecutive adult patients with MS and epilepsy were studied retrospectively. A detailed survey of medical records concerning CBZ treatment was performed. A total of 495 patients with epilepsy and 442 patients with MS were included. Sixty-five per cent of patients with epilepsy and 20% of patients with MS had used CBZ. In CBZ-exposed patients, rash occurred in 15/89 (17%) in MS and in 43/323 (13%) in epilepsy, a difference which was not significant. Women below 50 years experienced more skin reactions than older women and men. The unadjusted odds ratio (OR) for rash in the MS vs epilepsy group was 1.32 (CI 0.70-2.51, P = 0.40). Adjusting groups for gender and age reduced the OR to 1.11 (CI 0.56-2.19, P = 0.76). Compared with epilepsy, which is only rarely caused by immunological mechanisms, the autoimmune disorder MS was not associated with a different occurrence of CBZ skin reactions. The trend towards an increased occurrence of rashes in MS can partly be explained by a higher predisposition to CBZ rash in women of fertile age. © 2011 John Wiley & Sons A/S.

  11. Pemetrexed-Induced Rash May Be Prevented by Supplementary Corticosteroids.

    Science.gov (United States)

    Sakurada, Takumi; Kakiuchi, Soji; Tajima, Soichiro; Horinouchi, Yuya; Konaka, Ken; Okada, Naoto; Nishisako, Hirotaka; Nakamura, Toshimi; Teraoka, Kazuhiko; Kawazoe, Kazuyoshi; Yanagawa, Hiroaki; Nishioka, Yasuhiko; Ishizawa, Keisuke

    2015-01-01

    Pemetrexed, a chemotherapeutic drug, is highly active in non-small cell lung cancer and malignant pleural mesothelioma. Unfortunately, rashes are more commonly associated with pemetrexed than other chemotherapies, and it is recommended that patients receive corticosteroids (8 mg/d of dexamethasone) for 3 d, including the day of pemetrexed administration (day 1). However, the efficacy of corticosteroids in this context has not been fully verified. In this retrospective study, we evaluated the medical records of 78 patients who received pemetrexed between April 2009 and March 2014, to confirm whether supplementary corticosteroids prevented rash development. The incidence of rash was lower in the 47 patients who received supplementary corticosteroids (after day 1) compared with the incidence among the 31 patients who did not receive supplementary corticosteroids (19.1% vs. 38.7%). The average cutoff dosage of supplementary corticosteroids on day 2 and day 3 was 1.5 mg/d of dexamethasone, as calculated using the receiver operating characteristic curve, and the odds ratio was 0.33 (95% confidence interval: 0.12-0.94). Administration of ≥1.5 mg of corticosteroids on day 2 and day 3 significantly reduced the severity of the rash compared to no supplementary treatment (grades 2/3, 13.3% vs. 33.3%, pcorticosteroids had no additional effect on rash development. These results suggest that ≥1.5 mg of supplementary dexamethasone on day 2 and day 3 (in addition to day 1) may be necessary for preventing pemetrexed-induced rash, but high doses of dexamethasone (e.g., 8 mg/d) are unnecessary.

  12. An adult male with abdominal pain and skin rash

    Directory of Open Access Journals (Sweden)

    Jay Patel

    2014-12-01

    Full Text Available Henoch-Schönlein purpura is generally a disease of children and uncommon in adults, especially after the age of 40. It is characterized by leukocytoclastic vasculitis skin rash, arthralgia, and gastrointestinal symptoms. In adults, glomerulonephritis may occur and the long-term prognosis is poor. We present the case of a 65-year-old man with complaints of abdomen pain and skin rash who subsequently developed renal failure. He was diagnosed with adult onset Henoch-Schönlein purpura and survived after treatment with glucocorticoids and hemodialysis.

  13. Use of Accelerometer Activity Monitors to Detect Changes in Pruritic Behaviors: Interim Clinical Data on 6 Dogs

    Directory of Open Access Journals (Sweden)

    Susan M. Wernimont

    2018-01-01

    Full Text Available Veterinarians and pet owners have limited ability to assess pruritic behaviors in dogs. This pilot study assessed the capacity of the Vetrax® triaxial accelerometer to measure these behaviors in six dogs with pruritus likely due to environmental allergens. Dogs wore the activity monitor for two weeks while consuming their usual pet food (baseline, then for eight weeks while consuming a veterinary-exclusive pet food for dogs with suspected non-food-related skin conditions (Hill’s Prescription Diet® Derm DefenseTM Canine dry food. Veterinarians and owners completed questionnaires during baseline, phase 1 (days 1–28 and phase 2 (days 29–56 without knowledge of the activity data. Continuous 3-axis accelerometer data was processed using proprietary behavior recognition algorithms and analyzed using general linear mixed models with false discovery rate-adjusted p values. Veterinarian-assessed overall clinical signs of pruritus were significantly predicted by scratching (β 0.176, p = 0.008, head shaking (β 0.197, p < 0.001 and sleep quality (β −0.154, p < 0.001, while owner-assessed quality of life was significantly predicted by scratching (β −0.103, p = 0.013 and head shaking (β −0.146, p < 0.001. Among dogs exhibiting pruritus signs eating the veterinary-exclusive food, the Vetrax® sensor provided an objective assessment of clinically relevant pruritic behaviors that agreed with owner and veterinarian reports.

  14. A non-travel related rash in a traveler

    Directory of Open Access Journals (Sweden)

    Keith A. Sacco

    2017-01-01

    Full Text Available A 45-year-old man was admitted for investigation of a symmetric lower limb rash associated with recurrent fever for two weeks following a hiking trip in Italy and Greece. He was treated for sepsis secondary to lower limb cellulitis with no clinical improvement and subsequently diagnosed with Streptococcus gallolyticus endocarditis mediating an infectious vasculitis.

  15. Biphasic Zika Illness With Rash and Joint Pain.

    Science.gov (United States)

    Edupuganti, Srilatha; Natrajan, Muktha S; Rouphael, Nadine; Lai, Lilin; Xu, Yongxian; Feldhammer, Matthew; Hill, Charles; Patel, Shital M; Johnson, Sara Jo; Bower, Mary; Gorchakov, Rodion; Berry, Rebecca; Murray, Kristy O; Mulligan, Mark J

    2017-01-01

    During the current Zika virus (ZIKV) outbreak, acute symptomatic ZIKV infection in adults appears to be a mild-to-moderate, self-limited illness. We present a case of ZIKV rash illness that improved and then relapsed without repeat exposure to ZIKV. Clinicians should be alert for relapses in patients with ZIKV infection.

  16. Biphasic Zika Illness With Rash and Joint Pain

    OpenAIRE

    Edupuganti, Srilatha; Natrajan, Muktha S; Rouphael, Nadine; Lai, Lilin; Xu, Yongxian; Feldhammer, Matthew; Hill, Charles; Patel, Shital M.; Johnson, Sara Jo; Bower, Mary; Gorchakov, Rodion; Berry, Rebecca; Murray, Kristy O.; Mulligan, Mark J

    2017-01-01

    Abstract During the current Zika virus (ZIKV) outbreak, acute symptomatic ZIKV infection in adults appears to be a mild-to-moderate, self-limited illness. We present a case of ZIKV rash illness that improved and then relapsed without repeat exposure to ZIKV. Clinicians should be alert for relapses in patients with ZIKV infection.

  17. Congenital candidiasis presenting as septic shock without rash

    Science.gov (United States)

    Carmo, Kathryn Browning; Evans, Nick; Isaacs, David

    2009-01-01

    Congenital candidiasis is rare and often benign. This report describes the case of twins born at 32 weeks of gestation with different manifestations of congenital candidiasis. One twin was born well though neutropenic, and died from overwhelming sepsis with septic shock at 22 h. The other twin presented with a delayed onset of rash at 2 days, remained well and survived. PMID:21686407

  18. Shampoo-clay heals diaper rash faster than calendula officinalis.

    Science.gov (United States)

    Adib-Hajbaghery, Mohsen; Mahmoudi, Mansoreh; Mashaiekhi, Mahdi

    2014-06-01

    Diaper rash is one of the most common skin disorders of infancy and childhood. Some studies have shown that Shampoo-clay was effective to treat chronic dermatitis. Then, it is supposed that it may be effective in diaper rash; however, no published studies were found in this regard. This study aimed to compare the effects of Shampoo-clay (S.C) and Calendula officinalis (C.O) to improve infantile diaper rash. A randomized, double blind, parallel controlled, non-inferiority trial was conducted on 60 outpatient infants referred to health care centers or pediatric clinics in Khomein city and diagnosed with diaper rash. Patients were randomly assigned into two treatment groups including S.C group (n = 30) and C.O group (n = 30) by using one to one allocation ratio. The rate of complete recovery in three days was the primary outcome. Data was collected using a checklist and analyzed using t-test, Chi-square and Fisher's exact tests and risk ratio. Totally, 93.3% of lesions in the S.C group healed in the first 6 hours, while this rate was 40% in C.O group (P < 0.001). The healing ratio for improvement in the first 6 hours was 7 times more in the S.C group. In addition, 90% of infants in the SC group and 36.7% in the C.O group were improved completely in the first 3 days (P < 0.001). S.C was effective to heal diaper rash, and also had faster effects compared to C.O.

  19. Pruritic porokeratotic peno-scrotal plaques: Porokeratosis or porokeratotic epidermal reaction pattern? A report of 10 cases

    Directory of Open Access Journals (Sweden)

    Rajiv Joshi

    2014-01-01

    Full Text Available Background: Porokeratosis restricted to the genital region is rare with few cases described in the literature. Cases of porokeratosis restricted to the genital region are similar to plaque type of porokeratosis of Mibelli seen elsewhere on the body. We encountered 10 young males with pruritic plaques restricted to the peno-scrotal region, which clinically were not diagnosed as porokeratosis, but on biopsy revealed multiple cornoid lamellae, some of which were seen to arise from eccrine and follicular structures. Aims: The aim of this study is to study lesions restricted to the peno-scrotal region in males, which on biopsy showed cornoid lamellae suggestive of porokeratosis. Methods: Retrospective analysis of available data of patients who were rendered a histological diagnosis of genital porokeratosis. The database consisted of biopsies received in private consultation by the first author in the period January 2000 to March 2013. Results: Ten young men, 8 in their third decade, presented with pruritic plaques restricted to the peno-scrotal region of variable duration. The lesions were well-demarcated on the penis, but ill-defined with a rough granular surface on the scrotum. None of patients were diagnosed clinically as porokeratosis. The lesions were poorly responsive to topical steroid/antifungal treatment, but two patients showed partial improvement with oral isotretinoin. Biopsy in nine patients revealed multiple cornoid lamellae involving epidermis (6 and adnexal structures (3. One patient had a single cornoid lamella. Conclusion: The clinical and histological presentation of these patients is different from typical genital porokeratosis described in the literature and we postulate that these patients have an unusual porokeratotic reaction pattern of the epidermis with multiple cornoid lamellae.

  20. Nomenclature of drug-induced pityriasis rosea-like rashes

    Directory of Open Access Journals (Sweden)

    Chuh AAT

    2015-10-01

    Full Text Available Antonio AT Chuh1Prince of Wales Hospital, Hospital Authority, 2The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong KongI read with admiration an article published in your prestigious journal on the rare adverse effects of clozapine (CLZ.1I write to address a specific issue in this article. In the second paragraph of the section “Dermatological adverse effects”, it was stated that a 54-year-old patient with schizophrenia treated for 28 days with CLZ developed a generalized rash compatible with pityriasis rosea (skin rash that usually begins as one large circular or oval spot on your chest, abdomen, or back.I wish to point out certain problems for coining pityriasis rosea (PR as the diagnostic label in the patient concerned.View original paper by De Fazio and colleagues.

  1. Antibiotic-Induced Rash in Patients With Infectious Mononucleosis.

    Science.gov (United States)

    Thompson, Dennis F; Ramos, Carroll L

    2017-02-01

    To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM). A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms anti-bacterial agents and infectious mononucleosis. EMBASE (1980 to June 2016) was searched using the terms mononucleosis and antibiotic agent and drug eruption. References of all relevant articles were reviewed for additional citations and information. We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years. We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic. A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.

  2. Hydroxyzine induced pancytopenia and petechial rashes: a rare complication

    Directory of Open Access Journals (Sweden)

    Ihsan Ates

    2016-09-01

    Full Text Available Hydroxyzine is used as an additional treatment both in symptomatic treatment of anxiety and stress caused by psychoneurosis and in organic diseases which anxiety appeared. It is used to treat pruritis caused by histamine and such allergic cases like chronic urticaria because of antihistaminic effect, atopic and contact dermatitis. In this case report, that widespread milimetric petechial rashes in all body and deep pancytopnia development is seen in a patient using hydroxyzine tablet because of pruritis at joints is disscussed. [J Contemp Med 2016; 6(3.000: 234-234

  3. Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood

    Directory of Open Access Journals (Sweden)

    En Hyung Kim

    2017-04-01

    Full Text Available Pruritic urticarial papules and plaques of pregnancy (PUPPP is one of the most common diseases associated with pregnancy. In most cases, the skin lesions develop in the third trimester of primigravidas. There are no systemic alterations seen in PUPPP; however, most patients report severe pruritus. A 34-year-old woman presented 1 week postpartum with typical clinical features of PUPPP. The patient showed good response to intramuscular injection of autologous whole blood with no adverse effects to the patient or her baby. Presentation of PUPPP in the postpartum period is rare. Conservative management with topical corticosteroids and oral antihistamines is commonly used to relieve pruritus. In severe cases, skin lesions and symptoms are controlled with a brief course of systemic corticosteroids. Investigation of new treatment options has been limited by patient concerns about the negative effects of medication on the fetus or breastfeeding. Intramuscular injection of autologous whole blood could be an alternative treatment option for PUPPP, especially for women who worry about the use of medications during pregnancy or breastfeeding.

  4. Challenges in investigating transient rash illness in nursery children.

    Science.gov (United States)

    Paranthaman, K; Pooransingh, S; McCarthy, N; Saunders, P; Haworth, E

    2010-06-01

    In October 2007, the Thames Valley Health Protection Unit (TVHPU) was notified by a parent that her child developed a transient rash after eating lunch at a nursery in Oxfordshire. An initial investigation undertaken by TVHPU was escalated when similar incidents were reported in nurseries in other parts of England. A detailed epidemiological and food tracing investigation was conducted to ascertain the aetiology. Investigations revealed 11 incidents affecting 164 children between July and November 2007 in six nurseries operated by two companies. The symptoms included a transient rash around the mouth and hands of children who ate meals prepared on site by the nurseries. Consumption of the lunch main course appeared to be a strong aetiological factor. Expert opinion pointed to biogenic amines (e.g. histamine) as a possible cause for the symptoms displayed, but there was insufficient evidence to support testing of food samples. The incident highlighted significant gaps in reporting of unexplained symptoms among children in nurseries, indicating that such incidents do not always come to the attention of public health authorities. Timely notification to HPUs will enable prompt investigation, increase the likelihood of identifying the cause and inform appropriate responses to prevent future incidents.

  5. A rash and a rare cause of unilateral diaphragmatic paralysis.

    Science.gov (United States)

    Ashkir, Zakariye M; Tsaknis, George

    2017-03-01

    A 61-year-old man who was an ex-heavy smoker presented to our ambulatory care centre with a 4-week history of dyspnoea on mild exertion. 2 weeks prior to his symptoms, he had developed right-sided cervical herpes zoster for which he was prescribed oral acyclovir by his general practitioner. On examination, a rash over the right C4-5 dermatomes was noted and dullness on percussion of the right mid and lower zones with markedly reduced air entry. His chest radiograph showed a raised right hemi-diaphragm with associated right middle and lower lobe collapse. Further investigation with CT and bronchoscopy did not identify a cause and showed no evidence of underlying malignancy or endobronchial obstruction. An ultrasound 'sniff test' was performed to confirm diaphragmatic paralysis. We present a rare case of cervical herpes-induced diaphragmatic paralysis, and summarise our approach and the current understanding of this interesting condition. 2017 BMJ Publishing Group Ltd.

  6. Mononucleosis-like drug rash: An interesting case presentation

    Directory of Open Access Journals (Sweden)

    Reshma T Vishnani

    2014-01-01

    Full Text Available Dapsone hypersensitivity syndrome (DHS is a rare adverse effect of the commonly prescribed drug dapsone. We present a case of a 35-year-old male who was referred to us from the gastroenterologist with complaints of rash, nausea, vomiting, and jaundice since 2 days with a provisional differential diagnosis of infectious mononucleosis or viral exanthema. On enquiry patient gave history of taking dapsone a week prior for refractory urticaria. After thorough investigations we diagnosed him with DHS. This syndrome occurs in a relatively small proportion of patients, but it is associated with considerable morbidity and mortality. The reason for presenting this case is to remind physicians of the unpredictability and potential severity of this reaction which makes it a major concern in clinical practice.

  7. Incidence and determinants of nevirapine and efavirenz-related skin rashes in West Africans: nevirapine's epitaph?

    Directory of Open Access Journals (Sweden)

    Fred Stephen Sarfo

    Full Text Available Non-nucleoside reverse transcriptase inhibitor (NNRTI associated rash is common and frequently leads to discontinuation of NNRTIs. This study assessed the risk of developing rashes and discontinuing NNRTIs and associated factors in a large clinic in central Ghana. In this retrospective cohort study, clinical data were obtained in patients starting efavirenz or nevirapine between 2004-2010. Factors associated with rashes were explored using a multivariate Cox proportional hazards regression model. Of 3,999 patients who started NNRTI-based ART, 281 (7.0% experienced at least one episode of NNRTI-related rash with an incidence of 2.63 events/100 person-years, occurring in 10.2% and 5.6% of patients taking nevirapine and efavirenz respectively. Most rashes (94% were grade 1 or 2 and were reported a median of 2 months following initiation of ART. In multivariate analysis developing a rash was associated with nevirapine use (aHR 1.67, 95% CI 1.28-2.10, female gender (aHR of 1.39, 95% CI 1.01-1.92 and lower baseline CD4 counts (aHR 0.88, 95% CI 0.82-0.95 per 50 cells/mm³ increment. Patients with nevirapine-associated rash were 11 times more likely to discontinue treatment as patients with efavirenz-associated rash. In contrast to findings in other studies, NNRTI-associated rashes in Ghanaians appear more common in patients with lower baseline CD4 counts. Given the increased frequency of rashes with nevirapine and subsequent discontinuations in many patients, along with other treatment-limiting toxicities, this provides further impetus for the replacement of nevirapine by efavirenz as the first-line NNRTI treatment of choice in Africa.

  8. Brain structure correlates of emotion-based rash impulsivity.

    Science.gov (United States)

    Muhlert, N; Lawrence, A D

    2015-07-15

    Negative urgency (the tendency to engage in rash, ill-considered action in response to intense negative emotions), is a personality trait that has been linked to problematic involvement in several risky and impulsive behaviours, and to various forms of disinhibitory psychopathology, but its neurobiological correlates are poorly understood. Here, we explored whether inter-individual variation in levels of trait negative urgency was associated with inter-individual variation in regional grey matter volumes. Using voxel-based morphometry (VBM) in a sample (n=152) of healthy participants, we found that smaller volumes of the dorsomedial prefrontal cortex and right temporal pole, regions previously linked to emotion appraisal, emotion regulation and emotion-based decision-making, were associated with higher levels of trait negative urgency. When controlling for other impulsivity linked personality traits (sensation seeking, lack of planning/perseverance) and negative emotionality per se (neuroticism), these associations remained, and an additional relationship was found between higher levels of trait negative urgency and smaller volumes of the left ventral striatum. This latter finding mirrors recent VBM findings in an animal model of impulsivity. Our findings offer novel insight into the brain structure correlates of one key source of inter-individual differences in impulsivity. Copyright © 2015. Published by Elsevier Inc.

  9. The Emerging Zika Virus Threat: A Guide for Dermatologists.

    Science.gov (United States)

    He, Alice; Brasil, Patrícia; Siqueira, Andre M; Calvet, Guilherme A; Kwatra, Shawn G

    2017-04-01

    We provide a guide for dermatologists to follow if they encounter patients with a rash and clinical history suspicious of Zika virus infection, including diagnostic testing and management options. We also provide an illustrative case report of a patient from Brazil who was diagnosed with Zika virus infection after presenting with a generalized pruritic rash. One of the most prominent symptoms of Zika virus infection is a cutaneous eruption. As such, it is especially necessary for dermatologists to understand this virus so that they may appropriately recognize this entity as a diagnostic consideration in the clinic. The rash associated with Zika virus infection is most commonly an erythematous maculopapular eruption that presents after an initial 3-4 days of fever, headache, and arthralgia or myalgia. The rash typically lasts for an average of 6 days, and can spread to involve any part of the body, including the face, torso, extremities, palms, and soles.

  10. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis.

    Science.gov (United States)

    Chovel-Sella, Aluma; Ben Tov, Amir; Lahav, Einat; Mor, Orna; Rudich, Hagit; Paret, Gideon; Reif, Shimon

    2013-05-01

    "Ampicillin rash," a phenomenon unique to patients with Epstein-Barr virus acute infectious mononucleosis (AIM) treated with ampicillin, was first reported in the 1960s. The incidence was estimated as being between 80% and 100%, and the figures have not been reviewed since those first accounts. We sought to establish the current incidence of rash associated with antibiotic treatment among children with AIM. A retrospective study of all hospitalized children diagnosed as having AIM based upon positive Epstein-Barr virus serology in 2 pediatric tertiary medical centers in Israel. Of the 238 children who met the study entry criteria during the study period, 173 were treated with antibiotics. Fifty-seven (32.9%) of the subjects treated with antibiotics had a rash during their illness compared with 15 (23.1%) in untreated patients (P = .156; not significant). Amoxicillin was associated with the highest incidence of antibiotic-induced rash occurrence (29.5%, 95% confidence interval: 18.52-42.57), but significantly lower than the 90% rate reported for ampicillin in past studies. Age, gender, ethnicity, and atopic or allergic history were not associated with the development of rash after antibiotic exposure. Among the laboratory data, only increased white blood cell counts were more prevalent among subjects who did not develop an antibiotic-induced rash. The incidence of rash in pediatric patients with AIM after treatment with the current oral aminopenicillin (amoxicillin) is much lower than originally reported.

  11. Spontaneous pneumomediastinum in a patient with facial rash.

    Science.gov (United States)

    Machuca, Jenny S; Cos, Jorge; Niazi, Masooma; Fuentes, Gilda-Diaz

    2010-01-01

    A 38-year-old male nonsmoker presented with constitutional symptoms, polyarthritis, facial rash, and progressive dyspnea of more than 1-year duration. Chest radiology revealed bilateral reticular and ground glass infiltrates. Connective tissue disease investigation was unrevealing. Pulmonary function test was consistent with restrictive lung disease and decreased diffusion capacity. The patient was treated with corticosteroids for amyopathic dermatomyositis with no improvement of dyspnea. Flexible bronchoscopy was noncontributory. Four and 6 months after initial presentation, he developed spontaneous pneumomediastinum and extensive subcutaneous emphysema that resolved with conservative therapy. Surgical lung biopsy revealed cellular-fibrotic nonspecific interstitial pneumonia for which he was started on cytotoxic medication, with no improvement in respiratory symptoms. The frequency of interstitial lung disease (ILD)-related polymyositis/dermatomyositis (DM) has been reported to range between 5% and 30% and nonspecific interstitial pneumonia is seen in up to 80% of DM-related ILD and in almost all the reported patients with amyopathic DM. On account of the increased morbidity and mortality of ILD-related DM, investigations for the early detection of ILD should be performed during initial evaluation and during follow-up of patients with polymyositis/DM. Serum levels of anti-Jo-1 antibodies, chest roentgenogram, high-resolution computed tomography of the lungs, and pulmonary function tests, including diffusing capacity of the lung for carbon monoxide, should be routinely included. In those patients with evidence of DM-related ILD, a lung tissue biopsy should be considered for better prognostic stratification. Conversely, the presence of spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema should prompt a search for underlying connective tissue diseases.

  12. Drug Rash with Eosinophilia and Systemic Symptoms: Two Emergency Department Cases

    Directory of Open Access Journals (Sweden)

    Adam Landman

    2011-05-01

    Full Text Available Drug rash with eosinophilia and systemic symptoms (DRESS is a rare, severe adverse drug event that appears with a generalized rash, fevers, and dysfunction of 1 or more organ systems. We describe 2 patients (1 adult and 1 pediatric seen in the emergency department with DRESS, and review the clinical presentations, potential complications, and management of DRESS. Although rare, it can be associated with significant morbidity, including liver failure and death, and should be considered in the differential diagnosis of patients with diffuse rash and systemic symptoms. [West J Emerg Med. 2011;12(4:559–562.

  13. Correlation between Propionibacterium acnes biotypes, lipase activity and rash degree in acne patients.

    Science.gov (United States)

    Higaki, S; Kitagawa, T; Kagoura, M; Morohashi, M; Yamagishi, T

    2000-08-01

    We examined the possible correlation between biotypes of Propionibacterium acnes, lipase activity, and rash degree in acne patients. Among 5 P. acnes biotypes, P. acnes biotype 3 (B3) was the most common, followed by P. acnes biotypes 1, 2 and 4; P. acnes biotype 5 was not found. P. acnes B3 was isolated from more severe skin rashes than those of the other biotypes. Production of propionic acid (PA) and butyric acid (BA) by P. acnes B3 was higher than those by the other P. acnes biotypes. As the rash degree in acne patients was more severe, the production of PA and BA elevated. Although only a few P. acnes strains were examined in the present study, P. acnes B3 had the highest lipase activity and might have the greatest influence on skin rash in acne patients.

  14. Azithromycin-induced rash in a patient of infectious mononucleosis - a case report with review of literature.

    Science.gov (United States)

    Banerjee, Indranil; Mondal, Somnath; Sen, Sukanta; Tripathi, Santanu Kumar; Banerjee, Gautam

    2014-08-01

    Antibiotic induced skin rash in setting of infectious mononucleosis is often encountered in clinical practice. However, macrolides like azithromycin are considered relatively safe and till date only two cases of azithromycin induced rash in setting of infectious mononucleosis have been reported. The following report illustrates the case of a 23-year-old man suffering from infectious mononucleosis who exhibited a generalized cutaneous rash following treatment with azithromycin. Using the Naranjo ADR probability scale, this case of acute onset rash following azithromycin administration was found to be in 'probable' category. The mechanism of antibiotic-induced rash in patients suffering from infectious mononucleosis is incompletely understood. It has been suggested that the rash could result from virus mediated immunomodulation or due to altered drug metabolism. The report calls for cautious use of antibiotics in the setting of suspected viral infections like infectious mononucleosis as injudicious use might increase the risk of deleterious skin reactions and increase the cost of healthcare.

  15. MRI diagnosis of muscle denervation from herpes zoster with discordant distribution of the skin rash

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Amit; Sundaram, Murali [Cleveland Clinic, Section of Musculoskeletal Radiology, Imaging Institute, Cleveland, OH (United States); Winalski, Carl S. [Cleveland Clinic, Section of Musculoskeletal Radiology, Imaging Institute, Cleveland, OH (United States); Cleveland Clinic, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)

    2014-10-15

    Herpes zoster is a common disorder characterized by a painful rash along a dermatome caused by reactivation of the varicella zoster virus (VZV). Muscle denervation injury from motor involvement is an uncommon phenomenon. Discordant distribution of the skin rash and motor nerve involvement, presenting as a skin rash in one body part and muscle weakness or pain from nerve involvement in another body part is an even more uncommonly reported finding. We present an unusual case of muscle denervation injury resulting from motor involvement of a peripheral nerve by VZV diagnosed by magnetic resonance imaging with cutaneous manifestations in a different dermatomal distribution. To the best of our knowledge, there has been no similar case reported in the English radiology literature. We suggest that whenever a radiologist notices MRI findings suggesting denervation injury and a cause not readily identified, VZV-related denervation injury should be included in the differential diagnosis, especially in an older immunocompromised patient. (orig.)

  16. Getting to the bottom of nappy rash. ALSPAC Survey Team. Avon Longitudinal Study of Pregnancy and Childhood.

    OpenAIRE

    Philipp, R; Hughes, A; Golding, J

    1997-01-01

    BACKGROUND: Nappy rash accounts for 20% of dermatology consultations in childhood, but its causes are poorly understood. AIM: To determine the incidence of nappy rash during the first four weeks of life in a geographically defined United Kingdom (UK) population, and to study the factors associated with developing the rash. METHOD: The data are derived from self-completed questionnaires of parents in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). The response rate to a questi...

  17. Rash, disseminated intravascular coagulation and legionella: Episode 10 and a rewind into the past

    Directory of Open Access Journals (Sweden)

    Prashanth M. Thalanayar

    2015-01-01

    Full Text Available Legionella pneumophila is the most common cause of legionellosis and is one of the organisms causing atypical pneumonia. We report the presentation of disseminated intravascular coagulation (DIC and skin rash in a single case of severe Legionella pneumonia. The unique clinical presentation of a diffuse rash diagnosed as purpura fulminans and the unpredictable variations encountered during the diagnostic work-up of the case make this write-up crucial. This article synthesizes all reported cases of L. pneumonia associated with cutaneous manifestations as well as cases presenting with DIC. Furthermore, this manuscript illustrates the correlation between cutaneous and coagulopathic manifestations, and morbidity and mortality from L. pneumonia.

  18. Sulfasalazine-induced DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms

    Directory of Open Access Journals (Sweden)

    Renata Telles Rudge de Aquino

    Full Text Available CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by sulfasalazine have been reported in the literature. CASE REPORT: The case of a 47-year-old white Brazilian woman who developed DRESS syndrome eight weeks after starting a course of sulfasalazine for treatment of seronegative arthritis is reported. She presented a skin rash, fever, hepatitis, lymphadenopathy, eosinophilia and atypical lymphocytes. The causative drug was discontinued immediately, but she only improved after treatment with prednisone.

  19. The “Pearls” of Multidisciplinary Team: Conquering the Uncommon Rosette Rash

    Directory of Open Access Journals (Sweden)

    Nitin Verma

    2016-01-01

    Full Text Available Linear IgA disease of childhood (LAD also known as chronic bullous disease of childhood is an autoimmune disease with IgA deposition at the basement membrane zone leading to a vesiculobullous rash. It has a clinical appearance which frequently is described as resembling “strings of pearls” or rosette-like. Diagnosis is usually clinical but sometimes biopsy is required. Dapsone is widely considered to be the first line therapy in the treatment of LAD. A 5-year-old girl presented with 4-day history of a widespread painful rash and pyrexia. The rash transformed into painful blisters. A recent contact with chickenpox was present. She remained apyrexial but hemodynamically stable and was treated as chickenpox patient with secondary infection. Due to persistent symptoms after repeated attendance she was reviewed by Dermatology team and diagnosed with linear IgA disease also known as chronic bullous disease of childhood. This was based on the presence of blistering rash with rosette appearance and string of pearl lesions. The clinical features of LAD can be difficult to distinguish from more common skin infections. Benefiting from the experience of other multidisciplinary teams can sometimes be a game changer and can lead to the correct diagnosis and treatment.

  20. Assessment of demodex presence in acne-like rash associated with cetuximab.

    Science.gov (United States)

    Aksu Arıca, Deniz; Ozturk Topcu, Turkan; Baykal Selçuk, Leyla; Yaylı, Savas; Seyman, Unzile; Fidan, Evren; Bahadır, Sevgi; Kavgacı, Halil

    2017-09-01

    Cetuximab is an epidermal growth factor receptor inhibitor. It is frequently used in the treatment of solid tumors. However, it has a high potential to cause acne-like rash. Demodex mites, which are known to increase in number in immunosuppressive circumstances, are closely related to the acneiform lesions. The aim of this study is to evaluate the presence of demodex mites in acne-like rash that appears under the treatment of Cetuximab. We reviewed the medical records of patients who applied to our clinic with cetuximab induced papulopustular rashes between November 2014 and March 2016. Demodex sampling was performed by standardized skin surface biopsy (SSSB) in a total of 11 patients (eight males and three females). Infestation was defined as at least 5 living parasites/cm2 of skin. Upon the SSSB examination in 10 out of the 11 patients, no demodex mites were detected. Demodex mites were found in only one of the patients. This patient, in whom two dead Demodex folliculorums were found through facial sampling, was also regarded as negative since his demodex density was under the threshold limit value. In this study, it has been concluded that acne-like rash that develops under the treatment of cetuximab is not related to the presence of demodex mites. Papulopustular eruptions that develop under cetuximab treatment should not be directly correlated with the presence of demodex; first SSSB and demodex presence should be evaluated.

  1. Mothers Knowledge and Home Management ofNappy Rash in Port ...

    African Journals Online (AJOL)

    Background Nappy rash is thought to affect up to a third of nappy-wearing babies at any given time. It is not a disease but just an irritation of the skin which when severe, becomes painful and distressing for the infant, and a source of great anxiety for caregivers. This study evaluated the knowledge and home management of ...

  2. Mothers Knowledge and Home Management ofNappy Rash in Port ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    2006-10-10

    Oct 10, 2006 ... Level of education significantly affected type of diaper used. (P=0.002). Baby's diaper was changed 3 ... skin rashes in the diaper area that are caused by various skin disorders and/or irritants[1,2]. It is the most ... surfaces in close contact with the diaper, including the buttocks, genitalia, lower abdomen, and ...

  3. Risk of severe rash in cancer patients treated with EGFR tyrosine kinase inhibitors: a systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Xi; Ran, Yu-Ge; Wang, Kun-Jie

    2016-12-01

    We performed a meta-analysis to evaluate the incidence and risk factors of severe rash associated with the use of EGFR tyrosine kinase inhibitors (TKIs). PubMed, EMBASE and oncology conference proceedings were searched for articles published till March 2016. A total of 18,309 patients from 37 randomized controlled trials were available for the meta-analysis. The overall incidence for severe rash was 6.6% (95% CI: 5.2-8.3%) among patients receiving EGFR-TKIs. The use of EGFR-TKIs significantly increased the risk of developing severe rash (risk ratio: 7.70; 95% CI: 5.79-10.23) in cancer patients. On subgroup analysis, the increased risk of severe rash was driven predominantly by drug type (p = 0.002). EGFR-TKIs significantly increase the risk of developing severe rash in cancer patients.

  4. HLA-Cw*04 allele associated with nevirapine-induced rash in HIV-infected Thai patients

    Directory of Open Access Journals (Sweden)

    Tunthanathip Preecha

    2009-10-01

    Full Text Available Abstract Background A high incidence of rash has been reported in HIV-1 patients who received the anti-retroviral drug nevirapine. In addition, several studies have suggested that polymorphisms of human leukocyte antigen (HLA genes may play important roles in nevirapine-induced rash. The aim of the present study was to evaluate the effects of different HLA-C alleles on rash associated with nevirapine in patients who started highly active anti-retroviral therapy (HAART containing nevirapine in Thailand. Results A case-control study was carried out involving HIV-1 patients under treatment at Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand between March 2007 and March 2008. The study included all HIV/AIDS patients being treated with nevirapine-containing regimens. The study population comprised 287 HIV/AIDS patients of whom 248 were nevirapine-tolerant and 39 developed rash after nevirapine treatment. From the nevirapine-tolerant patients, 60 were selected as the control group on the basis of age, sex, and therapy history matched for nevirapine-induced rash cases. We observed significantly more HLA-Cw*04 alleles in nevirapine-induced rash cases than in nevirapine-tolerant group, with frequencies of 20.51% and 7.50%, respectively (P = 0.009. There were no significant differences between the rash and tolerant groups for other HLA-C alleles except for HLA-Cw*03 (P = 0.015. Conclusion This study suggests that HLA-Cw*04 is associated with rash in nevirapine treated Thais. Future screening of patients' HLA may reduce the number of nevirapine-induced rash cases, and patients with alleles associated with nevirapine-induced rash should be started on anti-retroviral therapy without nevirapine.

  5. Serum autoantibodies against the dermal-epidermal junction in patients with chronic pruritic disorders, elderly individuals and blood donors prospectively recruited.

    Science.gov (United States)

    van Beek, N; Dohse, A; Riechert, F; Krull, V; Recke, A; Zillikens, D; Schmidt, E

    2014-04-01

    Bullous pemphigoid (BP) is a subepidermal blistering autoimmune disease characterized by autoantibodies against two structural proteins of the epidermal basal membrane zone (BMZ), BP180 (type XVII collagen) and BP230. Patients are usually old and suffer from severe pruritus. Advanced age and severe pruritus have been hypothesized as potential risk factors for the development of autoantibodies in BP. To prospectively determine anti-BMZ antibodies in sera from patients with advanced age and/or pruritus compared with regular blood donors. Sera from (i) patients with chronic pruritic skin disorders (PSD, n = 78; mean age 62 years), (ii) patients with noninflammatory skin disease aged ≥ 70 years (n = 93; mean age 78 years), and (iii) blood donors (n = 50; mean age 41 years) were included. A large panel of validated test systems used for routine diagnosis were employed comprising indirect immunofluorescence (IF) microscopy on monkey oesophagus and human salt-split skin, BP180 NC16A- and BP230-specific enzyme-linked immunosorbent assay (ELISA) systems, and immunoblotting with various substrates, including LAD-1 (the soluble ectodomain of BP180), BP180, BP230, laminin 332, p200 antigen, laminin γ1 and type VII collagen. No statistically significant difference was seen between the three study groups. The same result was obtained when data for IF microscopy, ELISA and immunoblotting were analysed separately. Neither advanced age nor chronic pruritus have been verified as risk factors for autoantibodies against the epidermal BMZ. © 2014 British Association of Dermatologists.

  6. Getting to the bottom of nappy rash. ALSPAC Survey Team. Avon Longitudinal Study of Pregnancy and Childhood.

    Science.gov (United States)

    Philipp, R; Hughes, A; Golding, J

    1997-08-01

    Nappy rash accounts for 20% of dermatology consultations in childhood, but its causes are poorly understood. To determine the incidence of nappy rash during the first four weeks of life in a geographically defined United Kingdom (UK) population, and to study the factors associated with developing the rash. The data are derived from self-completed questionnaires of parents in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). The response rate to a questionnaire about the child administered four weeks after delivery among parents of singleton infants was 87% (12103/13902). The incidence of nappy rash was 25%. Fourteen highly significant possible causal factors emerged, of which 10 were retained in a logistic regression model: dirtying of nappy, contact with doctor about other problems, history of rashes in joints or skin creases, type of nappy worn, being fed cereal, taken to mother's bed when waking at night, history of cradle cap, general state of health, previous stomach upset, and being only breast-fed. However, the relative risks were generally small. The likelihood of nappy rash increases with intercurrent illness and early introduction of cereals. Disposable nappies give little protection, and this finding helps to endorse a recently introduced hospital scheme arising from environmental concerns that encourages parents to use cotton nappies instead of disposables. For many babies, however, the causes of nappy rash remain unknown.

  7. Mucositis Secondary to Chlamydia pneumoniae Infection: Expanding the Mycoplasma pneumoniae-Induced Rash and Mucositis Concept.

    Science.gov (United States)

    Mayor-Ibarguren, Ander; Feito-Rodriguez, Marta; González-Ramos, Jéssica; Del Rosal-Rabes, Teresa; González-Sainz, Francisco Javier; Sánchez-Orta, Alba; de Lucas-Laguna, Raul

    2017-07-01

    The term Mycoplasma pneumoniae-induced rash and mucositis (MIRM) was recently proposed to identify the mucocutaneous condition secondary to M. pneumoniae infection that had historically been regarded among the more confusing pathologies of erythema multiforme and Stevens-Johnson syndrome. Based on a number of previous reports, these syndromes require differentiation since they have different prognoses and specific treatment requirements. We report a case of oral and genital erosions that strongly resembled MIRM without rash but were found to be secondary to a Chlamydia pneumoniae infection. After a thorough review of the literature on this subject, we propose that C. pneumoniae should also be considered a potential causative agent of MIRM and that this term should be amended to include C. pneumoniae infection. © 2017 Wiley Periodicals, Inc.

  8. Drug rash with eosinophilia and systemic symptoms syndrome following cholestatic hepatitis A: a case report.

    Science.gov (United States)

    An, Jihyun; Lee, Joo Ho; Lee, Hyojeong; Yu, Eunsil; Lee, Dan Bi; Shim, Ju Hyun; Yoon, Sunyoung; Lee, Yumi; Park, Soeun; Lee, Han Chu

    2012-03-01

    Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.

  9. Carcinogenicity evaluation for the application of carbon nanotubes as biomaterials in rasH2 mice.

    Science.gov (United States)

    Takanashi, Seiji; Hara, Kazuo; Aoki, Kaoru; Usui, Yuki; Shimizu, Masayuki; Haniu, Hisao; Ogihara, Nobuhide; Ishigaki, Norio; Nakamura, Koichi; Okamoto, Masanori; Kobayashi, Shinsuke; Kato, Hiroyuki; Sano, Kenji; Nishimura, Naoyuki; Tsutsumi, Hideki; Machida, Kazuhiko; Saito, Naoto

    2012-01-01

    The application of carbon nanotubes (CNTs) as biomaterials is of wide interest, and studies examining their application in medicine have had considerable significance. Biological safety is the most important factor when considering the clinical application of CNTs as biomaterials, and various toxicity evaluations are required. Among these evaluations, carcinogenicity should be examined with the highest priority; however, no report using transgenic mice to evaluate the carcinogenicity of CNTs has been published to date. Here, we performed a carcinogenicity test by implanting multi-walled CNTs (MWCNTs) into the subcutaneous tissue of rasH2 mice, using the carbon black present in black tattoo ink as a reference material for safety. The rasH2 mice did not develop neoplasms after being injected with MWCNTs; instead, MWCNTs showed lower carcinogenicity than carbon black. Such evaluations should facilitate the clinical application and development of CNTs for use in important medical fields.

  10. Herpes Zoster Ophthalmicus Presenting as Acute Orbital Myositis Preceding a Skin Rash: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Ha Yeun; Cho, Seong Whi [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of); Kim, Sung Hun [Dept. of Neurology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2012-03-15

    Herpes zoster ophthalmicus, in which orbital symptoms and signs appear before the onset of a skin rash, is very rare. We experienced such a case and therefore report on it via magnetic resonance imaging. A 48-year-old man with pain and swelling of left eye and headache presented 2 days before onset of a zoster skin rash. On orbit-al MRI, edematous thickening of the left lateral rectus muscle with high signal intensity was revealed. After contrast injection, the lateral rectus muscle demonstrated heterogenous enhancement. Also, diffuse contrast enhancement was noted at left preseptal space, lacrimal gland and periorbital soft tissue. The man was treated with antiviral agents and prednisolone. Two weeks later, he recovered from the skin manifestations and most of the orbital manifestations except for the diplopia and restricted lateral movement.

  11. Metabolic alkalosis secondary to baking soda treatment of a diaper rash.

    Science.gov (United States)

    Gonzalez, J; Hogg, R J

    1981-06-01

    A 4-month-old infant was seen with hypokalemic metabolic alkalosis that was associated with prior application of liberal amounts of sodium bicarbonate (baking soda) to a diaper rash. After exclusion of other etiologies of the infant's acid-base disturbance, a complete resolution occurred following discontinuation of the baking soda applications. This case report provides a reminder of the significant side effects that may result from the excessive use of a seemingly harmless household substance.

  12. Breast Rash

    Science.gov (United States)

    ... 2017. 56th ed. New York, N.Y.: The McGraw-Hill Companies; 2017. http://www.accessmedicine.com. Accessed ... Guide. 7th ed. New York, N.Y.: The McGraw Hill Companies; 2011. http://www.accessmedicine.com. Accessed ...

  13. Heat Rash

    Science.gov (United States)

    ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth ...

  14. Diaper rash

    Science.gov (United States)

    ... sores filled with pus Smaller red patches (called satellite lesions) that grow and blend in with the ... important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy , ...

  15. Comparison of the Effects of Chamomile and Calendula Ointments on Diaper Rash

    Directory of Open Access Journals (Sweden)

    Zahra Afshari

    2015-06-01

    Full Text Available Background: Diaper Rash is a common skin disorder in the infancy that makes infants and their parents anxious and nervous. Due to the high prevalence of dermatitis and its complications in addition to adverse effects of chemical drugs, herbal therapy is an appropriate solution. Aim: Comparison of the effects of Chamomile and Calendula ointments on severity of Diaper Rash. Methods: This double-blind randomized controlled trial was conducted on 90 infants under one year who were hospitalized in Sabalan Hospital of Ardebil. The infants were treated by Chamomile and Calendula ointments for one week. The severity of dermatitis was evaluated on days one, 3 and 7.  In order to assess the severity of dermatitis, the checklist of Diaper Rash five-point scale was used. Data were analyzed by software SPSS version 14 using chi-square, ANOVA, T-Test. Results: The age in the Chamomile group was (8. 8 ± 2.3 and in Calendula group was (9.0± 2.4 months. The severity of dermatitis in Chamomile group before treatment was 1.6 ± 0.5, on the third day 0.8 ± 0.4, and on the seventh day zero (p

  16. An approach for children.

    African Journals Online (AJOL)

    Rodents Leptospirosis Rare - Maculopapular rash. Livestock Biucella Rare - Maculopapular, crythema nodosum, petechiae,. ' vasculitic lesions. Foodstuffs Unpasteurised milk or Listeriosis Exposure to the mother — maculopapular rash part cheese of neonatal listeriosis. Recent contact with an 7 days South African tick bite ...

  17. Rash related to use of scented products. A questionnaire study in the Danish population. Is the problem increasing?

    DEFF Research Database (Denmark)

    Johansen, J D; Andersen, T F; Thomsen, L K

    2000-01-01

    Fragrances are used in many types of cosmetic and household products, which are an important part of everyday life in modern society. The aim of the current investigation was to describe the frequency of self-reported rash due to scented products in a random sample of the adult Danish population...... that women had a significantly increased risk of reporting rash from scented products compared to men (odds ratio: 1.56, p

  18. Azithromycin-Induced Rash in a Patient of Infectious Mononucleosis – A Case Report with Review of Literature

    Science.gov (United States)

    Mondal, Somnath; Sen, Sukanta; Tripathi, Santanu Kumar; Banerjee, Gautam

    2014-01-01

    Antibiotic induced skin rash in setting of infectious mononucleosis is often encountered in clinical practice. However, macrolides like azithromycin are considered relatively safe and till date only two cases of azithromycin induced rash in setting of infectious mononucleosis have been reported. The following report illustrates the case of a 23-year-old man suffering from infectious mononucleosis who exhibited a generalized cutaneous rash following treatment with azithromycin. Using the Naranjo ADR probability scale, this case of acute onset rash following azithromycin administration was found to be in ‘probable’ category. The mechanism of antibiotic-induced rash in patients suffering from infectious mononucleosis is incompletely understood. It has been suggested that the rash could result from virus mediated immunomodulation or due to altered drug metabolism. The report calls for cautious use of antibiotics in the setting of suspected viral infections like infectious mononucleosis as injudicious use might increase the risk of deleterious skin reactions and increase the cost of healthcare. PMID:25302218

  19. Evaluation of patch test in identification of causative agent in drug rashes due to antiepileptics

    Directory of Open Access Journals (Sweden)

    Vatve Maneesha

    2000-01-01

    Full Text Available Patch test was evaluated for the identification of causative agent in cutaneous eruptions due to antiepileptics. Patch tests were carried out in twenty patients and ten controls with carbamazepine, phenytoin sodium, phenobarbitone and sodium valproate. Sodium valproate was found tobe irritant in 1 and 5% concentration and further dilution is recommended for patch testing. Patch test was positive in 14 (70% patients and in 7 with suspected drug alone, and remaining 7 were positive with more than one antiepileptic drug. We recommended patch test for identification of causative drug in rashes due to antiepileptics.

  20. Iatrogenic Cushing's syndrome in children presenting at Children's Hospital Lahore using nappy rash ointments.

    Science.gov (United States)

    Sattar, Hina; Manzoor, Jaida; Mirza, Liaqat; Sheikh, Abdul Malik; Butt, Taeed Ahmad

    2015-05-01

    To study the characteristics of infants and children presenting with iatrogenic Cushing's Syndrome due to nappy rash ointments. The descriptive study was conducted at the Children's Hospital, Lahore, from April to September 2013, and comprised patients presenting with cushingoid features and history of using nappy rash ointments. Patients having Cushing's Syndrome due to causes other than iatrogenic were excluded and so were those taking oral or parenteral steroids due to skin allergy, renal or respiratory disease. Demographic data, history and examination of all patients were recorded on a proforma and results were analysed using SPSS 16. Of the total 18 patients, 13(72%) were girls and 5(27%) were boys. Eight (44.4%) patients were younger than 6 months, 6(33.3%) were between 6 months to 1 year, while 4(22.2%) were between 12 and 18 months of age. Clobetasol alone was the most frequently used agent responsible in 13(72%) cases. Duration of use of steroid ointment was as short as 3 weeks to as much as 1 year. All the patients were using disposable diapers. Ointment was prescribed by a doctor in 5(27%) cases and self-prescribed (relative or neighbour) in 13(72%). Self-medication and prolonged use of potent steroid ointments are major contributors in development of iatrogenic Cushing's Syndrome in infants and children. Younger age, female gender and use of disposable diapers were other important predisposing factors.

  1. Skin rash, eosinophilia, and renal impairment in a patient recently started on allopurinol

    Directory of Open Access Journals (Sweden)

    Ashraf Jmeian

    2016-01-01

    Full Text Available Allopurinol is a hypoxanthine analog which inhibits xanthine oxidase, it is a widely used medication for the treatment of hyperuricemia and gout. Allopurinol-induced drug-induced rash with eosinophilia and systemic symptoms syndrome is an infrequent, life-threatening adverse reaction of allopurinol therapy that is remarkable for the higher mortality rate with the use of allopurinol than with the use of another agent. We present a case of a 62-year-old male with a history of chronic kidney disease stage 3, hypertension and gout who developed skin rash, eosinophilia, and renal impairment 2 weeks after he was started on allopurinol therapy for gout. Allopurinol was stopped, and the patient was started on steroids. This case emphasizes that although allopurinol is commonly used the drug for the treatment of gout. However, it can be associated with serious life-threatening complications. Therefore, care should be taken when prescribing allopurinol, and it should be prescribed only for the appropriate indications.

  2. Dermatoscopy in diagnosing maculopapular cutaneous mastocytosis

    Directory of Open Access Journals (Sweden)

    Popadić Mirjana

    2016-01-01

    Full Text Available The diagnosis of cutaneous mastocytosis is based on the clinical finding of the pigmented macules or papules, positive Darier's sign and a dermal infiltrate composed of mast cells that can be better visualized by the use of special stains (Giemsa or Toluidine blue. Clinical, dermatoscopic and histopathological presentations of new appearing pigmented lesions in a female patient were presented. Dermatoscopic findings of pigment network-like structure combined with parallel pigmented lines and central reddish background in a adult patient with new appearing pigmented lesions should led us to searching for cutaneous mastocytosis.

  3. Hepatitis, rash and eosinophilia following trichloroethylene exposure: a case report and speculation on mechanistic similarity to halothane induced hepatitis.

    Science.gov (United States)

    Bond, G R

    1996-01-01

    A previously healthy 30-year-old male began work as a degreaser. The solvent used in the degreasing operation was trichloroethylene. Over the next month he experienced symptoms of weakness, dizziness, decreased appetite, nausea, abdominal pain, diarrhea, fever, chills, dry skin, red rash with bumps, peeling face, and itching. At that time he had marked liver enzyme elevation without evidence of cholestasis. CBC was remarkable for a significant number of atypical lymphocytes. Two weeks later his liver enzymes showed a marked reduction in ALT from a peak of 1250 IU to 717 IU. Tests for Hepatitis A, B, and C, CMV, HIV1 were all negative. The night following his first day back at work he had a recurrence of a red, diffuse rash without any consumption of alcohol. The rash caused tremendous itching. Over the next few days off work the rash continued and peeled. Physical examination one week after re-exposure was remarkable for diffuse, erythematous rash; some peeling skin and pitting edema to the knees. ALT was 517 IU/L. White blood cell count was 10,100/mm3 with 27% eosinophilia. This patient had possibly experienced sensitization to trichloroethylene, or more likely, to one of its metabolites. Similar symptoms attributed to trichloroethylene have been reported in only a few other patients. Patch testing with trichloroethylene and its metabolites may better clarify a causal relationship in future patients. If an immune mechanism is involved it may be similar to one postulated for halothane induced hepatitis.

  4. Fever, rash, and leukopenia in a 32-year-old man · Dx?

    Science.gov (United States)

    Gauer, Robert; Hu, Collin; Beaman, Lindsey

    2017-10-01

    A 32-year-old man was admitted to our hospital with fever, chills, malaise, leukopenia, and a rash. About 3 weeks earlier, he'd had oral maxillofacial surgery and started a 10-day course of prophylactic amoxicillin/clavulanic acid. Fifteen days after the surgery, he developed a fever (temperature, 103° F), chills, arthralgia, myalgia, cough, diarrhea, and malaise. He was seen by his physician, who obtained a chest x-ray showing a lingular infiltrate. The physician diagnosed influenza and pneumonia in this patient, and prescribed oseltamivir, azithromycin, and an additional course of amoxicillin/clavulanic acid. Upon admission to the hospital, laboratory tests revealed a white blood cell count (WBC) of 3.1 k/mcL (normal: 3.2-10.8 k/mcL). The patient's physical examination was notable for lip edema, white mucous membrane plaques, submandibular and inguinal lymphadenopathy, and a morbilliform rash across his chest. Broad-spectrum antibiotics were initiated for presumed sepsis. On hospital day (HD) 1, tests revealed a WBC count of 1.8 k/mcL, an erythrocyte sedimentation rate of 53 mm/hr (normal: 20-30 mm/hr for women, 15-20 mm/hr for men), and a C-reactive protein level of 6.7 mg/dL (normal: <0.5 mg/dL). A repeat chest x-ray and orofacial computerized tomography scan were normal. By HD 3, all bacterial cultures were negative, but the patient was positive for human herpesvirus-6 on viral cultures. His leukopenia persisted and he had elevated levels of alanine transaminase ranging from 40 to 73 U/L (normal: 6-43 U/L) and aspartate aminotransferase ranging from 66 to 108 U/L (normal range: 10-40 U/L), both downtrending during his hospitalization. He also had elevated levels of antinuclear antibodies and anti-Smith antibody titers. A posterior-auricular biopsy was consistent with lymphocytic perivasculitis. The rash continued to progress, involving his chest, abdomen, and face. Bacterial and viral cultures remained negative and on HD 4, broad-spectrum antibiotics were

  5. Rash related to use of scented products. A questionnaire study in the Danish population. Is the problem increasing?

    DEFF Research Database (Denmark)

    Johansen, J D; Andersen, T F; Thomsen, L K

    2000-01-01

    Fragrances are used in many types of cosmetic and household products, which are an important part of everyday life in modern society. The aim of the current investigation was to describe the frequency of self-reported rash due to scented products in a random sample of the adult Danish population....... Further, it was determined whether risk of self-reported 1st-time rash from scented products had increased during the past 15 years compared to the preceding period. The sample consisted of 1537 persons, 801 female and 736 male, above the age of 15 years. The participants were interviewed person....... The risk of reporting 1st-time rash occurring after 1978 was significantly increased (odds ratio: 2.34, pproblem with scented products, involving potentially severe public health implications....

  6. Focal encephalitis following varicella-zoster virus reactivation without rash in a healthy immunized young adult.

    Science.gov (United States)

    Halling, Geoffrey; Giannini, Caterina; Britton, Jeffrey W; Lee, Ricky W; Watson, Robert E; Terrell, Christine L; Parney, Ian F; Buckingham, Erin M; Carpenter, John E; Grose, Charles

    2014-09-01

    Herein we describe an episode of focal varicella-zoster virus (VZV) encephalitis in a healthy young man with neither rash nor radicular pain. The symptoms began with headaches and seizures, after which magnetic resonance imaging detected a single hyperintense lesion in the left temporal lobe. Because of the provisional diagnosis of a brain tumor, the lesion was excised and submitted for pathological examination. No tumor was found. But the tissue immunostained positively for VZV antigens, and wild-type VZV sequences were detected. In short, this case represents VZV reactivation, most likely in the trigeminal ganglion, in the absence of clinical herpes zoster. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  7. A 25-Year-Old Male with Orogenital Ulcers, Rash, and Difficulty Swallowing

    Directory of Open Access Journals (Sweden)

    Lauren N. Ko

    2017-11-01

    Full Text Available A 25-year-old otherwise healthy male presented with new-onset odynophagia, rash, and orogenital ulcers. Despite treatment with antibiotics for presumed bacterial pharyngitis, the patient remained symptomatic, with abnormal vital signs and laboratory values. Upon dermatology consultation and histopathologic correlation, he was diagnosed with Behçet disease. Behçet disease is a rare rheumatologic condition that presents with recurrent oral ulcers and varying degrees of ophthalmic, neurologic, cardiac, and vascular disease. Given its protean nature, the treatment of Behçet disease is tailored to the patient's presentation and severity of organ involvement. Following treatment with colchicine and prednisone, the patient's symptoms improved rapidly.

  8. Psoriasiform Diaper Rash Possibly Induced by Oral Propranolol in an 18-Month-Old Girl with Infantile Hemangioma

    Directory of Open Access Journals (Sweden)

    Raphaëlle Baggio

    2016-12-01

    Full Text Available Propranolol, a nonselective blocker of β-adrenergic receptors, has become the first-line treatment for complicated infantile hemangiomas. Therefore, its use in the pediatric population has expanded in recent years. In adults, β-blockers have been reported to be the most common causative agents for drug-induced psoriasis. In infants treated with propranolol for infantile hemangioma, the onset of psoriasiform diaper rash has not yet been reported. Here, to the best of our knowledge, we report the first case of psoriasiform diaper rash possibly induced by oral propranolol in an 18-month-old girl with no family history of psoriasis.

  9. Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

    Directory of Open Access Journals (Sweden)

    R. W. Knackstedt

    2015-01-01

    Full Text Available Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may

  10. Identification of thymus and activation-regulated chemokine (TARC/CCL17) as a potential marker for early indication of disease and prediction of disease activity in drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS).

    Science.gov (United States)

    Ogawa, Kohei; Morito, Hironori; Hasegawa, Ayako; Daikoku, Natsuko; Miyagawa, Fumi; Okazaki, Aiko; Fukumoto, Takaya; Kobayashi, Nobuhiko; Kasai, Takahiko; Watanabe, Hideaki; Sueki, Hirohiko; Iijima, Masafumi; Tohyama, Mikiko; Hashimoto, Koji; Asada, Hideo

    2013-01-01

    Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a serious acute drug reaction with fever, cutaneous eruption, lymphadenopathy, and several visceral dysfunctions. Eosinophilia is a common hematological abnormality in DIHS/DRESS suggesting that the Th2-type immune response is involved. Thymus and activation-regulated chemokine (TARC/CCL17) is a family of CC chemokines known to play an important role in Th2-mediated immune-inflammatory processes. We investigated the pathogenic role of TARC in patients with DIHS. Sera were obtained from 8 patients with DIHS, 7 patients with Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN), and 14 patients with drug-induced maculopapular exanthema (MPE). Serum TARC levels were measured by ELISA. TARC levels were then compared with clinical symptoms and various hematological parameters. In addition, a biopsy was taken from the lesional skin of patients with DIHS and stained with anti-TARC Ab and anti-CD11c Ab. Serum TARC levels in patients with DIHS were significantly higher than those in patients with SJS/TEN and MPE during the acute phase. Serum TARC levels in DIHS patients correlated with skin eruptions, serum sIL-2R levels, eosinophil counts, and serum IL-5 levels. Immunohistochemical staining revealed that TARC was mainly expressed on CD11c+ dermal dendritic cells in patients with DIHS. Serum TARC levels may be associated with the initial presentation of DIHS as well as disease activity during the course. Thus, they could be useful as an indicator for early diagnosis and assessment of disease activity in DIHS. CD11c+ dendritic cells may be the main source of TARC in patients with DIHS. Copyright © 2012 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Validity of genito-urinary discharges, genital ulcers and genital rashes as indicators of seroincident HSV-2 infection

    Directory of Open Access Journals (Sweden)

    Eziyi Iche Kalu

    2015-06-01

    Full Text Available Objective: To evaluate the validity of vaginal discharges, urethral discharges, genital rashes, and painful genital ulcers as indicators of early detection of incident herpes simplex virus type 2 (HSV-2 infection among pregnant women in Benin metropolis. Methods: Participants were antenatal clinic attendees of University of Benin Teaching Hospital and Central Hospital, Benin. Baseline sociodemographic, obstetric and HSV-2 serological data were collected. The HSV-2-seronegative returned for a repeat HSV-2 antibody assay before delivery date. Data on incidence of genital rashes, abnormal vaginal discharges, painful genital ulcers and urethral discharges were collected. Results: The sensitivities of abnormal vaginal discharges, genital rashes, urethral discharges and painful genital ulcers were 82.3%, 70.6%, 41.2% and 28.6% respectively; while their positive-predictive values were 53.8%, 60.0%, 58.3% and 66.7% respective. All the symptoms had >95% specificities and 95% negative-predictive values for seroincident HSV-2 infection. Conclusions: Abnormal vaginal discharge, genital rashes, urethral discharges and genital ulcers are valid indicators of seroincident HSV-2 infection and could be useful in formulation of screening tools in resource-limited settings.

  12. Dispositions to rash action moderate the associations between concurrent drinking, depressive symptoms, and alcohol problems during emerging adulthood.

    Science.gov (United States)

    King, Kevin M; Karyadi, Kenny A; Luk, Jeremy W; Patock-Peckham, Julie A

    2011-09-01

    "Impulsivity" has been consistently identified as a key personality predictor of alcohol-related problems and subsequent alcohol use disorder. Multiple prior studies have demonstrated impulsivity is an individual difference factor that strengthens the effects of some risk factors, such as alcohol consumption and depressive symptoms, on alcohol problems. However, recent research indicated common measures of impulsivity actually reflect multiple dispositions toward rash action, and that alcohol problems were most consistently related to one of those dispositions, negative urgency. Little research has examined how specific dispositions to rash action may act as putative moderators of other risk factors for alcohol problems. The goal of the current study was to test which dispositions to rash action moderated the effects of concurrent alcohol use or depressive symptoms on alcohol problems. Using a large cross-sectional sample of college students (n = 573), the current study utilized semicontinuous regression models, which allow prediction of both the likelihood and level of alcohol problems. Negative urgency was found to be the main predictor of alcohol problems, above and beyond other dispositions to rash action, which replicates prior research. However, each of the other dispositions exhibited risk-enhancing effects on the relations between either depressive symptoms or alcohol use and concurrent alcohol problems. Specifically, lower levels of premeditation enhanced the association between depressive symptoms and alcohol problems, while lower perseverance and higher sensation seeking were related to more alcohol problems at higher levels of alcohol use. Results suggest that multiple dispositions to rash action were related to problematic alcohol use both directly and via their interaction with other risk factors. (c) 2011 APA, all rights reserved.

  13. Smart Rash Driver System via Internet of Things (IoT

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    Sheau Tong Kong

    2017-01-01

    Full Text Available Nearly half a million accidents on Malaysians road occur in 2015. The aim of this research is to detect car speed, capture the photo of the speeding car and then transfer the data like car speed, date and time, location and lane number to an online database. A distance sensor is used to measure the distance range between two points on the road. The ESP8266 NodeMCU will be the control unit to process the data and calculate the speed with the formula of speed equal to distance over time. The ESP8266 NodeMCU is also a Wi-Fi module to help in transferring data via IoT to an online database. The Google spreadsheet acted as an online database and will receive all the data if detected a speeding car. In conclusion, the Smart Rash Driver System is successfully invented and able to detect vehicle speed, capture the photo of over speed vehicle and save it to the SD card and lastly transfer all data via IoT to the Google Spreadsheet. This invention will be able to help to decrease the road accident rate efficiently.

  14. Genetic linkage of familial granulomatous inflammatory arthritis, skin rash, and uveitis to chromosome 16

    Energy Technology Data Exchange (ETDEWEB)

    Tromp, G.; Kuivaniemi, H.; Ala-Kokko, L. [Thomas Jefferson Univ., Philadelphia, PA (United States)] [and others

    1996-11-01

    Blau syndrome (MIM 186580), first described in a large, three-generation kindred, is an autosomal, dominantly inherited disease characterized by multiorgan, tissue-specific inflammation. Its clinical phenotype includes granulomatous arthritis, skin rash, and uveitis and probably represents a subtype of a group of clinical entities referred to as {open_quotes}familial granulomatosis.{close_quotes} It is the sole human model with recognizably Mendelian inheritance for a variety of multisystem inflammatory diseases affecting a significant percentage of the population. A genomewide search for the Blau susceptibility locus was undertaken after karyotypic analysis revealed no abnormalities. Sixty-two of the 74-member pedigree were genotyped with dinucleotide-repeat markers. Linkage analysis was performed under dominant model of inheritance with reduced penetrance. The marker D16S298 gave a maximum LOD score of 3.75 at {theta} = .04, with two-point analysis. LOD scores for flanking markers were consistent and placed the Blau susceptibility locus within the 16p12-q21 interval. 46 refs., 3 figs., 3 tabs.

  15. An Unrecognized Rash Progressing to Lyme Carditis: Important Features and Recommendations Regarding Lyme Disease.

    Science.gov (United States)

    Lee, Shawn; Singla, Montish

    2016-01-01

    We present a case report of 46-year-old man with no medical history, who complained of extreme fatigue, near-syncope, and palpitations. He initially presented in complete heart block. A transvenous pacemaker was placed in the emergency department, and he was started empirically on Ceftriaxone for Lyme disease. He was admitted and over the course of the next few days, his rhythm regressed to Mobitz type I first-degree atrioventricular block and then to normal sinus rhythm. This case report highlights some important features regarding Lyme carditis, a rare presentation of early disseminated Lyme disease (seen in a few weeks to months after the initial tick bite). In 25%-30% of patients, the characteristic targetoid rash may not be seen, a likely culprit of the disease not being detected early and progressing to disseminated disease. The most common cardiac complaint of Lyme disease is palpitations, occurring in 6.6% of patients, which may not accurately reflect progression into disseminated Lyme disease because it is a nonspecific finding. Conduction abnormality, occurring in 1.8% of patients, is a more specific finding of Borrelia invading cardiac tissue. Finally, this case report highlights a recommendation that patients with confirmed Lyme disease or those presenting with cardiac abnormalities or symptoms who have an atypical profile for a cardiac event should be screened with a 12-lead electrocardiogram, Lyme serology, and be considered for antibiotic therapy with the possibility of temporary pacing.

  16. Nakajo-Nishimura Syndrome: An Autoinflammatory Disorder Showing Pernio-Like Rashes and Progressive Partial Lipodystrophy

    Directory of Open Access Journals (Sweden)

    Nobuo Kanazawa

    2012-01-01

    Full Text Available Nakajo-Nishimura syndrome (ORPHA2615; also registered as Nakajo syndrome in OMIM#256040 is a distinct inherited inflammatory and wasting disease, originally reported from Japan. This disease usually begins in early infancy with a pernio-like rash, especially in winter. The patients develop periodic high fever and nodular erythema-like eruptions, and gradually progress lipomuscular atrophy in the upper body, mainly the face and the upper extremities, to show the characteristic thin facial appearance and long clubbed fingers with joint contractures. So far about 30 cases have been reported from Kansai, especially Wakayama and Osaka, Tohoku and Kanto areas. At present, about 10 cases are confirmed to be alive only in the Kansai area, including one infant case in Wakayama. However, more cases are expected to be added in the near future. Although cause of the disease has long been undefined, a homozygous mutation of the PSMB8 gene, which encodes the β35i subunit of immunoproteasome, has been identified to be responsible in 2011. By analyses of the patients-derived cells and tissues, it has been suggested that accumulation of ubiquitinated and oxidated proteins due to immunoproteasome dysfunction causes hyperactivation of p38 mitogen-activated protein kinase and interleukin-6 overproduction. Since similar diseases with PSMB8 mutations have recently been reported from Europe and the United States, it is becoming clear that Nakajo-Nishimura syndrome and related disorders form proteasome disability syndromes, a new category of autoinflammatory diseases distributed globally.

  17. Hand-foot-and-mouth disease: a new look at a classic viral rash.

    Science.gov (United States)

    Nassef, Christopher; Ziemer, Carolyn; Morrell, Dean S

    2015-08-01

    Hand-foot-and-mouth disease (HFMD) is a common cause of viral rash in children with classic skin findings which are easily recognized by pediatricians. Recently, several atypical cutaneous manifestations of HFMD have been described. Awareness of these patterns may lead providers to appropriate diagnosis and management. This review also highlights the epidemiological patterns of more virulent strains and emerging research in disease prevention. Classic HFMD presents with tender lesions on the hands, feet, and oral mucosa. Atypical skin findings in HFMD may be seen in children with atopic dermatitis. These include 'eczema coxsackium', in which eczematous skin is superinfected with coxsackie virus, resembling herpes infection. Nail changes, such as shedding, may follow HFMD after a latency period. Enterovirus 71 is responsible for epidemic outbreaks of HFMD in Asia, with systemic manifestations and occasionally neurological sequelae. Research is underway to develop a vaccine which could curb epidemics, but for the present, supportive care and hygiene measures are the standard of care. Atypical manifestations of HFMD in children with atopic dermatitis may mimic herpetic superinfection. In a child presenting with nail changes, consider antecedent HFMD in the differential diagnosis. The mainstay of treatment for HMFD remains supportive care.

  18. [Drug rash with eosinophilia and systemic symptoms syndrome induced by carbamazepine: Case report].

    Science.gov (United States)

    Marín, Jorge Alonso; Ortega, Mayra Alexandra; Sánchez, Isaura Pilar; Pacheco, José Armando

    2017-06-01

    Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction associated with a variety of drugs, mainly anticonvulsants, which is characterized by systemic symptoms and erythematous lesions, common to other toxicodermas. It is an uncommon clinical entity that requires a high suspicion by clinical staff given its varied initial presentation, and the fact that symptoms can overlap with those of other adverse cutaneous reactions to drugs. Without early diagnosis and appropriate treatment, mortality increases.We report the case of a 22-year-old patient with impaired neurodevelopment who received treatment with carbamazepine. Two months later he presented with general symptoms and skin erythematous lesions that began on his trunk. The patient received outpatient care with antihistamines and antipyretics without an appropriate response. His case progressed with increased skin lesions and systemic symptoms that met the diagnostic criteria for DRESS syndrome. He was hospitalized and received medical treatment according to recommended guidelines. The patient's condition improved as his symptoms and associated complications resolved. He was discharged with gradual clearing of the steroid therapy.

  19. Metabolic differentiation of early Lyme disease from southern tick-associated rash illness (STARI).

    Science.gov (United States)

    Molins, Claudia R; Ashton, Laura V; Wormser, Gary P; Andre, Barbara G; Hess, Ann M; Delorey, Mark J; Pilgard, Mark A; Johnson, Barbara J; Webb, Kristofor; Islam, M Nurul; Pegalajar-Jurado, Adoracion; Molla, Irida; Jewett, Mollie W; Belisle, John T

    2017-08-16

    Lyme disease, the most commonly reported vector-borne disease in the United States, results from infection with Borrelia burgdorferi. Early clinical diagnosis of this disease is largely based on the presence of an erythematous skin lesion for individuals in high-risk regions. This, however, can be confused with other illnesses including southern tick-associated rash illness (STARI), an illness that lacks a defined etiological agent or laboratory diagnostic test, and is coprevalent with Lyme disease in portions of the eastern United States. By applying an unbiased metabolomics approach with sera retrospectively obtained from well-characterized patients, we defined biochemical and diagnostic differences between early Lyme disease and STARI. Specifically, a metabolic biosignature consisting of 261 molecular features (MFs) revealed that altered N-acyl ethanolamine and primary fatty acid amide metabolism discriminated early Lyme disease from STARI. Development of classification models with the 261-MF biosignature and testing against validation samples differentiated early Lyme disease from STARI with an accuracy of 85 to 98%. These findings revealed metabolic dissimilarity between early Lyme disease and STARI, and provide a powerful and new approach to inform patient management by objectively distinguishing early Lyme disease from an illness with nearly identical symptoms. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

  20. 263 Clinical Features of Drug Rash with Eosinophilia and Systemic Symptoms Syndrome Caused by Antituberculous Medications

    OpenAIRE

    Kim, Sang-Ha; Lee, Shun Nyung; Lee, Seok Jeong; Kim, Chong Whan; Lee, Won Yeon; Yong, Suk Joong; Chul Shin, Kye

    2012-01-01

    Background Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is one of severe adverse drug reactions. Aromatic anticonvulsants and sulfonamides are the most common causes of DRESS syndrome. However, there have been only 2 case reports of DRESS syndrome induced by antituberculous medication. This study was aimed to observe the clinical features of patients with DRESS syndrome caused by antituberculous medications. Methods We retrospectively revealed the clinical and laboratory...

  1. Itch and skin rash from chocolate during fluoxetine and sertraline treatment: Case report

    Directory of Open Access Journals (Sweden)

    Svenson Svante

    2004-11-01

    Full Text Available Abstract Background The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause pruritus when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects. Case presentation A 46-year-old man consulted his doctor due to symptoms of depression. He did not suffer from any allergy but drinking red wine caused vasomotor rhinitis. Antidepressive treatment with fluoxetine 20 mg daily was initiated which was successful. After three weeks of treatment an itching rash appeared. An adverse drug reaction (ADR induced by fluoxetine was suspected and fluoxetine treatment was discontinued. The symptoms disappeared with clemastine and betametasone treatment. Since the depressive symptoms returned sertraline medication was initiated. After approximately two weeks of sertraline treatment he noted an intense itching sensation in his scalp after eating a piece of chocolate cake. The itch spread to the arms, abdomen and legs and the patient treated himself with clemastine and the itch disappeared. He now realised that he had eaten a chocolate cake before this episode and remembered that before the first episode he had had a chocolate mousse dessert. He had never had any reaction from eating chocolate before and therefore reported this observation to his doctor. Conclusions This case report suggests that there may be individuals that are very sensitive to increases in serotonin concentrations. Dermal side reactions to SSRI-drugs in these patients may be due to high activity in the serotonergic system at the dermal and epidermo-dermal junctional area rather than a hypersensitivity to the drug molecule itself.

  2. Itch and skin rash from chocolate during fluoxetine and sertraline treatment: case report.

    Science.gov (United States)

    Cederberg, Jonas; Knight, Stefan; Svenson, Svante; Melhus, Håkan

    2004-11-02

    The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause pruritus when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects. A 46-year-old man consulted his doctor due to symptoms of depression. He did not suffer from any allergy but drinking red wine caused vasomotor rhinitis. Antidepressive treatment with fluoxetine 20 mg daily was initiated which was successful. After three weeks of treatment an itching rash appeared. An adverse drug reaction (ADR) induced by fluoxetine was suspected and fluoxetine treatment was discontinued. The symptoms disappeared with clemastine and betametasone treatment. Since the depressive symptoms returned sertraline medication was initiated. After approximately two weeks of sertraline treatment he noted an intense itching sensation in his scalp after eating a piece of chocolate cake. The itch spread to the arms, abdomen and legs and the patient treated himself with clemastine and the itch disappeared. He now realised that he had eaten a chocolate cake before this episode and remembered that before the first episode he had had a chocolate mousse dessert. He had never had any reaction from eating chocolate before and therefore reported this observation to his doctor. This case report suggests that there may be individuals that are very sensitive to increases in serotonin concentrations. Dermal side reactions to SSRI-drugs in these patients may be due to high activity in the serotonergic system at the dermal and epidermo-dermal junctional area rather than a hypersensitivity to the drug molecule itself.

  3. "Histopathologic and Immunohistochemical Characterization of Rash to Human Epidermal Growth Factor Receptor 1 (HER1) and HER1/2 Inhibitors in Cancer Patients

    OpenAIRE

    Nardone, Beatrice

    2011-01-01

    Introduction: Human epidermal receptor (HER) 1 inhibitors and HER 1/2 inhibitors have shown benefit against a wide range of solid tumors. However, their use is associated with rash in 40-90% of patients, which impacts quality of life and interrupts antineoplastic therapy. The pathologic characteristics of affected skin remain unclear, precluding development of rational therapies. The aim of this study is to evaluate differences in histologic and immunohistochemical (IHC) alterations in rash c...

  4. Topical vitamin K1 may not be effective in preventing acneiform rash during cetuximab treatment in patients with metastatic colorectal cancer.

    Science.gov (United States)

    Jo, Jae-Cheol; Hong, Yong Sang; Kim, Kyu-pyo; Lee, Jae-Lyun; Kim, Hwa Jung; Lee, Mi-Woo; Lim, Seok-Byung; Yu, Chang Sik; Kim, Jin Cheon; Kim, Jong Hoon; Kim, Tae Won

    2013-01-01

    Several studies have described the efficacy of topical vitamin K1 cream in the prevention and treatment of acneiform rash during cetuximab treatment. An interventional study with a historical control was conducted to investigate the efficacy of vitamin K1 cream for acneiform rash associated with cetuximab. For the historical control, data were collected from 40 patients with metastatic colorectal cancer who had participated in a previous clinical trial of cetuximab plus irinotecan. The experimental group consisted of 61 patients who were instructed to prophylactically apply topical vitamin K1 cream beginning on the first day of cetuximab treatment. The incidence, severity, and time to occurrence of acneiform rash were compared between groups. The incidence of grade≥2 acneiform rash after 4 weeks of cetuximab treatment was 42.5% in the historical control group and 55.5% in the experimental group. The median time to grade≥2 rash in the experimental group was 4 weeks compared to 6 weeks in the historical control group (p=0.340). By multivariate analysis, male gender was the only independent risk factor for grade 2 or worse acneiform rash (HR=2.49; 95% CI, 1.27-4.88; p=0.007). Prophylactic application of topical vitamin K1 cream did not decrease the risk of acneiform rash (HR=1.33; 95% CI, 0.57-3.10; p=0.507). The prophylactic application of topical vitamin K1 cream did not translate into clinically meaningful benefit in terms of reducing acneiform rash in patients with metastatic colorectal cancer treated with cetuximab.

  5. Pseudomembranous colitis in a patient with lamotrigine-induced drug rash with eosinophilia and systemic symptoms syndrome

    Directory of Open Access Journals (Sweden)

    Manuel Soria Orozco

    2016-08-01

    Full Text Available Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome is a hypersensitivity reaction with rash, fever and multiorgan dysfunction potentially lethal in up to 10% of cases. It often affects liver function, but it can also affect kidney, lungs, and heart. Severe gastrointestinal involvement is rare. We present a case of a 31-year-old hispanic woman with pseudomembranous colitis associated with lamotrigine-induced DRESS syndrome. To the best of our knowledge, this is the fourth reported case of severe involvement of the gastrointestinal tract and the first to report pseudomembranous colitis in the setting of DRESS syndrome.

  6. Neisseria lactamica Causing a Lung Cavity and Skin Rash in a Renal Transplant Patient: First Report from India

    Directory of Open Access Journals (Sweden)

    Khalid Hamid Changal

    2016-01-01

    Full Text Available Neisseria lactamica, a commensal, has been very rarely reported to cause diseases in immunocompromised hosts. In medical literature, there is only one report of a cavitatory lung lesion caused by it. The patient was a kidney transplant recipient. Neisseria lactamica was found to be the cause of his pulmonary cavity and a desquamating rash on feet. With the rapidly spreading medical advance, more and more patients are getting organ transplants, so the population of immunocompromised people is on the rise. We expect more sinister and less expected organisms to cause diseases in patients who have organ transplants.

  7. Placebo-controlled phase II study of vitamin K3 cream for the treatment of cetuximab-induced rash

    DEFF Research Database (Denmark)

    Eriksen, Jesper Grau; Kaalund, Inger; Clemmensen, Ole

    2017-01-01

    PURPOSE: Cetuximab inhibits the epidermal growth factor receptor (EGFR), and papulopustular eruptions is a frequent side effect. Vitamin K3 (menadione) has preclinically shown to be a potential activator of the EGFR by phosphorylating the receptor (pEGFR). The present randomised study investigate...... in the skin of the vitamin K3-treated area compared to the placebo area. CONCLUSION: The present data do not support any clinical or immunohistochemical benefit of using vitamin K3 cream for cetuximab-induced rash....... the effect of a vitamin K3 cream on cetuximab-induced rash. MATERIALS AND METHODS: Thirty patients were included in this double-blinded placebo-controlled trial. Patients receiving cetuximab 500 mg/m2 every second week plus chemotherapy for metastatic cancer were included. In each patient, vitamin K3 cream...... and placebo were applied twice daily on two separate areas of the skin of minimum 10 × 10 cm for up to 2 months. Papulopustular eruptions were evaluated clinically and monitored by clinical photos. Skin biopsies, from ten patients taken before and after 1 month of treatment from each treatment area, were...

  8. Detection of human parvovirus B19 in serum samples from children under 5 years of age with rash-fever illnesses in the Democratic Republic of the Congo.

    Science.gov (United States)

    Wawina, Tony Bokalanga; Tshiani, Olivier Mbaya; Ahuka, Steve Mundeke; Pukuta, Elisabeth Simbu; Aloni, Michel Ntetani; Kasanga, Christopher Jacob; Muyembe, Jean-Jacques Tamfum

    2017-12-01

    It has been demonstrated that infection with human parvovirus B19 (B19V) is associated with rash-fever illnesses. The present study aimed to investigate B19V as an aetiological agent of rash-fever syndromes in Congolese children confirmed as measles and rubella IgM-negative. An ELISA IgM test and PCR were performed to screen for B19V. A total of 177 archived serum samples were randomly selected from the measles biobank of the National Institute for Biomedical Research (INRB). Samples were investigated for anti-B19V IgM and B19V DNA. These samples originated from children <5years of age with measles-like rashes, previously confirmed as negative for both measles and rubella IgM. Out of 177 serum samples tested by ELISA and 168 tested by PCR, 109 were positive for B19V IgM antibodies (61.6%) and 87 (51.8%) were positive for B19V DNA. Positive samples in both assays were from all provinces of DRC. B19V plays a role in rash-fever illnesses in children under 5 years of age suspected of having measles or rubella infections in DRC. As an aetiological cause of rash and fever syndromes, the present study demonstrates that B19V should also be considered during the laboratory investigation of rash-fever illnesses in DRC, particularly in the paediatric population. There is a need to conduct further studies in order to gain a better understanding of the spatiotemporal pattern of B19V and to define the genotype(s) of B19V circulating in DRC. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. A 14-year paraneoplastic rash: urticarial vasculitis and dermal binding bullous pemphigoid secondary to chronic lymphocytic leukaemia.

    Science.gov (United States)

    Kassim, J M; Igali, L; Levell, N J

    2015-06-01

    A 72-year-old woman with a 14-year history of urticarial vasculitis (UV) and a 13-year history of bullous pemphigoid (BP) presented with associated progressive chronic lymphocytic leukaemia (CLL). Both skin conditions responded poorly to treatment, until chemotherapy for CLL was commenced. The skin features showed a clear paraneoplastic course, resolving with chemotherapy and recurring when the CLL relapsed and the lymphocyte count rose above 5 × 10(9)/L. No case of UV secondary to CLL, and very few cases of BP related to CLL have been reported, and no paraneoplastic rash of any type lasting 14 years has been reported previously. © 2014 British Association of Dermatologists, North American Clinical Dermatologic Society and St Johns Dermatological Society.

  10. Incidence and risk factors of skin rashes and hepatotoxicity in HIV-infected patients receiving nevirapine-containing combination antiretroviral therapy in Taiwan

    Directory of Open Access Journals (Sweden)

    Yu-Tzu Tseng

    2014-12-01

    Conclusions: Abnormal liver function at baseline was significantly associated with skin rashes, while a higher CD4 count and the concurrent use of trimethoprim/sulfamethoxazole were associated with hepatotoxicity after the initiation of nevirapine-containing cART in HIV-infected Taiwanese patients.

  11. Establishing a laboratory animal model from a transgenic animal: RasH2 mice as a model for carcinogenicity studies in regulatory science.

    Science.gov (United States)

    Urano, K; Tamaoki, N; Nomura, T

    2012-01-01

    Transgenic animal models have been used in small numbers in gene function studies in vivo for a period of time, but more recently, the use of a single transgenic animal model has been approved as a second species, 6-month alternative (to the routine 2-year, 2-animal model) used in short-term carcinogenicity studies for generating regulatory application data of new drugs. This article addresses many of the issues associated with the creation and use of one of these transgenic models, the rasH2 mouse, for regulatory science. The discussion includes strategies for mass producing mice with the same stable phenotype, including constructing the transgene, choosing a founder mouse, and controlling both the transgene and background genes; strategies for developing the model for regulatory science, including measurements of carcinogen susceptibility, stability of a large-scale production system, and monitoring for uniform carcinogenicity responses; and finally, efficient use of the transgenic animal model on study. Approximately 20% of mouse carcinogenicity studies for new drug applications in the United States currently use transgenic models, typically the rasH2 mouse. The rasH2 mouse could contribute to animal welfare by reducing the numbers of animals used as well as reducing the cost of carcinogenicity studies. A better understanding of the advantages and disadvantages of the transgenic rasH2 mouse will result in greater and more efficient use of this animal model in the future.

  12. Correlation Between the Severity of Cetuximab-Induced Skin Rash and Clinical Outcome for Head and Neck Cancer Patients: The RTOG Experience

    Energy Technology Data Exchange (ETDEWEB)

    Bar-Ad, Voichita, E-mail: voichita.bar-ad@jefferson.edu [Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Zhang, Qiang [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Harari, Paul M. [University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States); Axelrod, Rita [Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Rosenthal, David I. [University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Trotti, Andy [H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Jones, Christopher U. [Radiological Associates of Sacramento, Sacramento, California (United States); Garden, Adam S. [University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Song, Guobin [Virginia Mason Medical Center, Seattle, Washington (United States); Foote, Robert L. [Mayo Clinic, Rochester, Minnesota (United States); Raben, David [University of Colorado Comprehensive Cancer Center, Denver, Colorado (United States); Shenouda, George [McGill University, Montreal, Quebec (Canada); Spencer, Sharon A. [University of Alabama at Birmingham, Birmingham, Alabama (United States); Harris, Jonathan [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Le, Quynh-Thu [Stanford University Medical Center, Stanford, California (United States)

    2016-08-01

    Purpose: To evaluate the severity of cetuximab-induced skin rash and its correlation with clinical outcome and late skin toxicity in patients with head and neck squamous cell carcinoma treated with chemoradiation therapy and cetuximab. Methods and Materials: Analysis included patients who received loading dose and ≥1 cetuximab dose concurrent with definitive chemoradiation therapy (70 Gy + cisplatin) or postoperative chemoradiation therapy (60-66 Gy + docetaxel or cisplatin). Results: Six hundred two patients were analyzed; 383 (63.6%) developed grade 2 to 4 cetuximab rash. Patients manifesting grade 2 to 4 rash had younger age (P<.001), fewer pack-years smoking history (P<.001), were more likely to be males (P=.04), and had p16-negative (P=.04) oropharyngeal tumors (P=.003). In univariate analysis, grade 2 to 4 rash was associated with better overall survival (hazard ratio [HR] 0.58, P<.001) and progression-free survival (HR 0.75, P=.02), and reduced distant metastasis rate (HR 0.61, P=.03), but not local-regional failure (HR 0.79, P=.16) relative to grade 0 to 1 rash. In multivariable analysis, HRs for overall survival, progression-free survival, distant metastasis, and local-regional failure were, respectively, 0.68 (P=.008), 0.85 (P=.21), 0.64 (P=.06), and 0.89 (P=.48). Grade ≥2 rash was associated with improved survival in p16-negative patients (HR 0.28 [95% confidence interval 0.11-0.74]) but not in p16-positive patients (HR 1.10 [0.42-2.89]) (P=.05 for interaction). Twenty-five percent of patients with grade 2 to 4 acute in-field radiation dermatitis experienced grade 2 to 4 late skin fibrosis, versus 14% of patients with grade 0 to 1 acute in-field radiation dermatitis (P=.002). Conclusion: Grade 2 to 4 cetuximab rash was associated with better survival, possibly due to reduction of distant metastasis. This observation was noted mainly in p16-negative patients. Grade 2 to 4 acute in-field radiation dermatitis was associated with higher rate of

  13. Simple technique for in field samples collection in the cases of skin rash illness and subsequent PCR detection of orthopoxviruses and varicella zoster virus.

    Science.gov (United States)

    Dumont, Catherine; Irenge, Leonid M; Magazani, Edmond K; Garin, Daniel; Muyembe, Jean-Jacques T; Bentahir, Mostafa; Gala, Jean-Luc

    2014-01-01

    In case of outbreak of rash illness in remote areas, clinically discriminating monkeypox (MPX) from severe form of chickenpox and from smallpox remains a concern for first responders. The goal of the study was therefore to use MPX and chickenpox outbreaks in Democratic Republic of Congo (DRC) as a test case for establishing a rapid and specific diagnosis in affected remote areas. In 2008 and 2009, successive outbreaks of presumed MPX skin rash were reported in Bena Tshiadi, Yangala and Ndesha healthcare districts of the West Kasai province (DRC). Specimens consisting of liquid vesicle dried on filter papers or crusted scabs from healing patients were sampled by first responders. A field analytical facility was deployed nearby in order to carry out a real-time PCR (qPCR) assay using genus consensus primers, consensus orthopoxvirus (OPV) and smallpox-specific probes spanning over the 14 kD fusion protein encoding gene. A PCR-restriction fragment length polymorphism was used on-site as backup method to confirm the presence of monkeypox virus (MPXV) in samples. To complete the differential diagnosis of skin rash, chickenpox was tested in parallel using a commercial qPCR assay. In a post-deployment step, a MPXV-specific pyrosequencing was carried out on all biotinylated amplicons generated on-site in order to confirm the on-site results. Whereas MPXV proved to be the agent causing the rash illness outbreak in the Bena Tshiadi, VZV was the causative agent of the disease in Yangala and Ndesha districts. In addition, each on-site result was later confirmed by MPXV-specific pyrosequencing analysis without any discrepancy. This experience of rapid on-site dual use DNA-based differential diagnosis of rash illnesses demonstrates the potential of combining tests specifically identifying bioterrorism agents and agents causing natural outbreaks. This opens the way to rapid on-site DNA-based identification of a broad spectrum of causative agents in remote areas.

  14. Skin rash in patients treated with neoadjuvant erlotinib (Tarceva in resectable non-small cell lung cancer: Predictor for tumor response and survival?

    Directory of Open Access Journals (Sweden)

    Van Gool MH

    2017-08-01

    Full Text Available Background: Skin rash during treatment with epidermal growth factor receptor (EGFR-tyrosine kinase inhibitors (TKI has been reported to be predictive for response and survival in patients with advanced non-small cell lung cancer (NSCLC. The aim of this analysis was to evaluate whether skin rash during treatment (as a biomarker in a preoperative setting was related to response and survival. Methods: This study was designed as an open-label phase II trial (also known as M06NEL. Patients received preoperative erlotinib (Tarceva 150 mg once daily for 3 weeks. Skin toxicity during treatment was analysed in relation to metabolic and histopathological response, overall survival (OS and progression-free survival (PFS. Results: In total 59 patients (25 male, 34 female were eligible for analysis. In 39 patients (66% skin toxicity occurred. According to National Cancer Institute Common Toxicity Criteria (NCICTC, Grade 1 toxicity was seen in 15 patients (25%, Grade 2 in 19 patients (32% and Grade 3 in five patients (8%. None of the patients showed skin toxicity Grade 4 and 5. The median follow up was 74 months. Thirty-six patients (61% were alive at time of analysis. Twenty-seven patients (46% showed disease progression during follow up. Hazard ratios (HR indicated lower risk of death (HR = 0.66, 95%CI: 0.29 - 1.50 and progression (HR = 0.64, 0.30 - 1.36, although in this small group results were not significant. Skin rash did not adequately predict response. Conclusions: In this neoadjuvant setting with limited treatment time in patients with early stage NSCLC, skin rash was not associated with response and survival and cannot be used as an early biomarker.

  15. Niacin improved rigidity and bradykinesia in a Parkinson's disease patient but also caused unacceptable nightmares and skin rash--a case report.

    Science.gov (United States)

    Alisky, Joseph Martin

    2005-01-01

    A patient with Parkinson's disease taking levodopa/carbidopa, selegiline, buproprion, aspirin and niacin had decreased rigidity and bradykinesia when his niacin dose was steadily escalated for treatment of high triglycerides, but ultimately the patient could not tolerate niacin because of severe nightmares and skin rash. If further research can reproduce this patient's initial beneficial experience while avoiding the adverse effects, niacin could be a useful adjunctive agent for Parkinson's disease, either population-wide or in a pharmacogenomically defined set of responders.

  16. [The sweet Christmas rash].

    Science.gov (United States)

    Gyldenløve, Mette; Nepper-Christensen, Steen; Thyssen, Jacob P; Faurschou, Annesofie

    2013-12-02

    Christmas tree hypersensitivity is a rare condition, which has so far obtained scarce attention in the medical literature. We present two clinical cases of hypersensitivity associated with Christmas tree exposure, a 51-year-old woman with allergic contact dermatitis and a 41-year-old man with allergic rhinitis. The female patient had a positive patch test reaction to colophony, and the male patient had a positive skin prick test reaction to alternaria mould. Both were successfully advised to avoid prolonged exposure to Christmas trees and buy artificial trees for Christmas.

  17. Severe toxicity of skin rash, fever and diarrhea associated with imatinib: case report and review of skin toxicities associated with tyrosine kinase inhibitors

    Directory of Open Access Journals (Sweden)

    Delong Liu

    2008-10-01

    Full Text Available Xuan Huang1, Samir Patel2, Nasir Ahmed2, Karen Seiter2, Delong Liu21Department of Medicine, Richmond University Medical Center, New York, NY, USA; 2Division of Oncology and Hematology, New York Medical College and Westchester Medical Center, New York, NY, USAAbstract: Chronic myeloid leukemia (CML is characterized by a Philadelphia chromosome which contains an oncogene, bcr-abl. This oncogene encodes a tyrosine kinase which is constitutively activated. Imatinib, a tyrosine kinase inhibitor (TKI, has been widely used in the treatment of CML. Dasatinib and nilotinib were recently approved for the treatment of CML. Other TKIs, such as bosutinib, erlotinib, and sunitinib, are under study for the treatment of CML as well as other hematologic and solid malignancies. Skin rash has been reported as one of the most common side effects of the TKIs. Here we present a case of severe skin rash together with unusual symptoms of high fever and diarrhea induced by imatinib in a CML patient. The dermatologic toxicities from a variety of tyrosine kinase inhibitors are reviewed and general principles of management are also discussed.Keywords: chronic myeloid leukemia, skin rash, tyrosine kinase inhibitor, imatinib

  18. Simple technique for in field samples collection in the cases of skin rash illness and subsequent PCR detection of orthopoxviruses and varicella zoster virus.

    Directory of Open Access Journals (Sweden)

    Catherine Dumont

    Full Text Available BACKGROUND: In case of outbreak of rash illness in remote areas, clinically discriminating monkeypox (MPX from severe form of chickenpox and from smallpox remains a concern for first responders. OBJECTIVE: The goal of the study was therefore to use MPX and chickenpox outbreaks in Democratic Republic of Congo (DRC as a test case for establishing a rapid and specific diagnosis in affected remote areas. METHODS: In 2008 and 2009, successive outbreaks of presumed MPX skin rash were reported in Bena Tshiadi, Yangala and Ndesha healthcare districts of the West Kasai province (DRC. Specimens consisting of liquid vesicle dried on filter papers or crusted scabs from healing patients were sampled by first responders. A field analytical facility was deployed nearby in order to carry out a real-time PCR (qPCR assay using genus consensus primers, consensus orthopoxvirus (OPV and smallpox-specific probes spanning over the 14 kD fusion protein encoding gene. A PCR-restriction fragment length polymorphism was used on-site as backup method to confirm the presence of monkeypox virus (MPXV in samples. To complete the differential diagnosis of skin rash, chickenpox was tested in parallel using a commercial qPCR assay. In a post-deployment step, a MPXV-specific pyrosequencing was carried out on all biotinylated amplicons generated on-site in order to confirm the on-site results. RESULTS: Whereas MPXV proved to be the agent causing the rash illness outbreak in the Bena Tshiadi, VZV was the causative agent of the disease in Yangala and Ndesha districts. In addition, each on-site result was later confirmed by MPXV-specific pyrosequencing analysis without any discrepancy. CONCLUSION: This experience of rapid on-site dual use DNA-based differential diagnosis of rash illnesses demonstrates the potential of combining tests specifically identifying bioterrorism agents and agents causing natural outbreaks. This opens the way to rapid on-site DNA-based identification of a

  19. Impact of KRAS, BRAF, PIK3CA mutations, PTEN, AREG, EREG expression and skin rash in ≥ 2 line cetuximab-based therapy of colorectal cancer patients.

    Directory of Open Access Journals (Sweden)

    Zacharenia Saridaki

    2011-01-01

    Full Text Available To investigate the predictive significance of KRAS, BRAF, PIK3CA mutational status, AREG- EREG mRNA expression, PTEN protein expression and skin rash in metastatic colorectal cancer (mCRC patients treated with cetuximab containing salvage chemotherapy.Primary tumors from 112 mCRC patients were analyzed. The worst skin toxicity during treatment was recorded.KRAS, BRAF and PIK3CA mutations were present in 37 (33%, 8 (7.2% and 11 (9.8% cases, respectively, PTEN was lost in 21 (19.8% cases, AREG and EREG were overexpressed in 48 (45% and 51 (49% cases. In the whole study population, time to tumor progression (TTP and overall survival (OS was significantly lower in patients with KRAS (p = 0.001 and p = 0.026, respectively or BRAF (p = 0.001 and p<0.0001, respectively mutant tumors, downregulation of AREG (p = 0.018 and p = 0.013, respectively or EREG (p = 0.002 and p = 0.004, respectively and grade 0-1 skin rash (p<0.0001 and p<0.0001, respectively. In KRAS wt patients TTP and OS was significantly lower in patients with BRAF (p = 0.0001 and p<0.0001, respectively mutant tumors, downregulation of AREG (p = 0.021 and p = 0.004, respectively or EREG (p = 0.0001 and p<0.0001, respectively and grade 0-1 skin rash (p<0.0001 and p<0.0001, respectively. TTP was significantly lower in patients with PIK3CA mutations (p = 0.01 or lost PTEN (p = 0.002. Multivariate analysis revealed KRAS (Hazard Ratio [HR] 4.3, p<0.0001, BRAF mutation (HR: 5.1, p<0.0001, EREG low expression (HR: 1.6, p = 0.021 and absence of severe/moderate skin rash (HR: 4.0, p<0.0001 as independent prognostic factors for decreased TTP. Similarly, KRAS (HR 2.9, p = 0.01, BRAF mutation (HR: 3.0, p = 0.001, EREG low expression (HR: 1.7, p = 0.021, absence of severe/moderate skin rash (HR: 3.7, p<0.0001 and the presence of undifferantited tumours (HR: 2.2, p = 0.001 were revealed as independent prognostic factors for decreased OS.These results underscore that KRAS-BRAF mutations and EREG

  20. Zika Virus Infection in Pregnant Women in Rio de Janeiro.

    Science.gov (United States)

    Brasil, Patrícia; Pereira, José P; Moreira, M Elisabeth; Ribeiro Nogueira, Rita M; Damasceno, Luana; Wakimoto, Mayumi; Rabello, Renata S; Valderramos, Stephanie G; Halai, Umme-Aiman; Salles, Tania S; Zin, Andrea A; Horovitz, Dafne; Daltro, Pedro; Boechat, Marcia; Raja Gabaglia, Claudia; Carvalho de Sequeira, Patrícia; Pilotto, José H; Medialdea-Carrera, Raquel; Cotrim da Cunha, Denise; Abreu de Carvalho, Liege M; Pone, Marcos; Machado Siqueira, André; Calvet, Guilherme A; Rodrigues Baião, Ana E; Neves, Elizabeth S; Nassar de Carvalho, Paulo R; Hasue, Renata H; Marschik, Peter B; Einspieler, Christa; Janzen, Carla; Cherry, James D; Bispo de Filippis, Ana M; Nielsen-Saines, Karin

    2016-12-15

    Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (PBrasil and others.).

  1. Acute Generalized Exanthematous Pustulosis Induced by Cefepime: A Case Report

    Directory of Open Access Journals (Sweden)

    L.F.F. Botelho

    2010-06-01

    Full Text Available Acute generalized exanthematous pustulosis (AGEP is a rare cutaneous rash characterized by widespread sterile nonfollicular pustules. Cefepime is a fourth generation cephalosporin, used to treat severe infections. A 67-year-old man was admitted with acute gastroenterocolitis. On the seventh day, the patient developed a nosocomial pneumonia and cefepime was initiated. On the fourth day of cephalosporin treatment, he presented with a maculopapular, pruritic eruption affecting the face, neck, abdomen and limbs. One day later he developed disseminated pustular lesions and his temperature was 37°C. Laboratory analysis evidenced leukocytosis and skin biopsy showed subcorneal pustule, edema in the papillary dermis, perivascular inflammatory infiltrate consisting of neutrophils, leukocytoclasia and red cell extravasation in the epidermis. Cefepime was suspended and within 4 days the non-follicular pustules cleared following a desquamation. AGEP is a disease attributed to a variety of causes, but in 90% of the cases it is due to an adverse drug reaction. Antibiotics are implicated in 80% of these cases, mostly penicillins and macrolides. There are few cases associated with cephalosporins. It is very important to consider AGEP in cases of acute pustular rashes and drugs should be investigated as causative agents.

  2. Tetracycline to prevent epidermal growth factor receptor inhibitor-induced skin rashes: results of a placebo-controlled trial from the North Central Cancer Treatment Group (N03CB).

    Science.gov (United States)

    Jatoi, Aminah; Rowland, Kendrith; Sloan, Jeff A; Gross, Howard M; Fishkin, Paul A; Kahanic, Stephen P; Novotny, Paul J; Schaefer, Paul L; Johnson, David B; Tschetter, Loren K; Loprinzi, Charles L

    2008-08-15

    Epidermal growth factor receptor (EGFR) inhibitors are effective cancer therapies, but they are reported to cause a rash in >50% of patients. In the current study, the authors examined the use of tetracycline for rash prevention. This placebo-controlled, double-blinded trial enrolled patients who were starting cancer treatment with an EGFR inhibitor. Patients could not have had a rash at the time of enrollment. All patients were randomly assigned to receive either tetracycline at a dose of 500 mg orally twice a day for 28 days versus a placebo. Patients were monitored for rash (through monthly physician assessment and weekly patient-reported questionnaires), quality of life (using the SKINDEX-16, a skin-specific quality of life index), and adverse events. Monitoring occurred during the 4-week intervention and then for an additional 4 weeks. The primary objective of the current study was to compare the incidence of rash between the study arms, and the enrollment of 30 patients per arm provided a 90% probability of detecting a 40% difference in incidence with a P value of .05 (2-sided). A total of 61 evaluable patients were enrolled. The 2 treatment arms were well balanced with regard to baseline characteristics, dropout rates, and rates of discontinuation of the EGFR inhibitor. The incidence of rash was found to be comparable across treatment arms. Physicians reported that 16 patients treated with tetracycline (70%) and 22 patients treated with placebo (76%) developed a rash (P = .61). Tetracycline appears to have lessened the rash severity, although the high dropout rates invite caution when interpreting these findings. By Week 4, physician-reported grade 2 rash (using the National Cancer Institute's Common Terminology Criteria for Adverse Events [version 3.0]) occurred in 17% of tetracycline-treated patients (n = 4 patients) and in 55% of placebo-exposed patients (n = 16 patients) (P = .04). Patients treated with tetracycline reported better scores, as per the

  3. Tetracycline to Prevent Epidermal Growth Factor Receptor Inhibitor-Induced Skin Rashes: Results of a Placebo-Controlled Trial from the North Central Cancer Treatment Group (N03CB)1

    Science.gov (United States)

    Jatoi, Aminah; Rowland, Kendrith; Sloan, Jeff A.; Gross, Howard M.; Fishkin, Paul A.; Kahanic, Stephen P.; Novotny, Paul J.; Schaefer, Paul L.; Johnson, David B.; Tschetter, Loren K.; Loprinzi, Charles L.

    2014-01-01

    PURPOSE Epidermal growth factor receptor inhibitors are effective cancer therapies, but they cause a rash in greater than 50% of patients. This study tested tetracycline for rash prevention. METHODS This placebo-controlled, double-blinded trial enrolled patients who were starting cancer treatment with an epidermal growth factor receptor inhibitor. Patients could not have had a rash at enrollment. All were randomly assigned to either tetracycline 500 milligrams orally twice a day for 28 days versus a placebo. Patients were monitored for rash (monthly physician assessment and weekly patient-reported questionnaires), quality of life (SKINDEX-16), and adverse events. Monitoring occurred during the 4-week intervention and then for an additional 4 weeks. The primary objective was to compare the incidence of rash between study arms, and 30 patients per arm provided a 90% probability of detecting a 40% difference in incidence with a p-value of 0.05 (2-sided). RESULTS Sixty-one evaluable patients were enrolled, and arms were well balanced on baseline characteristics, rates of drop out, and rates of discontinuation of the epidermal growth factor receptor inhibitor. Rash incidence was comparable across arms. Physicians reported that 16 tetracycline-treated patients (70%) and 22 placebo-exposed patients (76%) developed a rash (p=0.61). Tetracycline appears to have lessened rash severity, although high drop out rates invite caution in interpreting findings. By week 4, physician-reported grade 2 rash occurred in 17% of tetracycline-treated patients (n=4) and in 55% of placebo-exposed patients (n=16); (p=0.04). Tetracycline-treated patients reported better scores, as per the SKINDEX-16, on certain quality of life parameters, such as skin burning or stinging, skin irritation, and being bothered by a persistence/recurrence of a skin condition. Adverse events were comparable across arms. CONCLUSION Tetracycline did not prevent epidermal growth factor receptor inhibitor

  4. The strange connection between epidermal growth factor receptor tyrosine kinase inhibitors and dapsone: from rash mitigation to the increase in anti-tumor activity.

    Science.gov (United States)

    Boccellino, Mariarosaria; Quagliuolo, Lucio; Alaia, Concetta; Grimaldi, Anna; Addeo, Raffaele; Nicoletti, Giovanni Francesco; Kast, Richard Eric; Caraglia, Michele

    2016-11-01

    The presence of an aberrantly activated epidermal growth factor receptor (EGFR) in many epithelial tumors, due to its overexpression, activating mutations, gene amplification and/or overexpression of receptor ligands, represent the fundamental basis underlying the use of EGFR tyrosine kinase inhibitors (EGFR-TKIs). Drugs inhibiting the EGFR have different mechanisms of action; while erlotinib and gefitinib inhibit the intracellular tyrosine kinase, monoclonal antibodies like cetuximab and panitumumab bind the extracellular domain of the EGFR both activating immunomediated anti-cancer effect and inhibiting receptor function. On the other hand, interleukin-8 has tumor promoting as well as neo-angiogenesis enhancing effects and several attempts have been made to inhibit its activity. One of these is based on the use of the old sulfone antibiotic dapsone that has demonstrated several interleukin-8 system inhibiting actions. Erlotinib typically gives a rash that has recently been proven to come out via up-regulated keratinocyte interleukin-8 synthesis with histological features reminiscent of typical neutrophilic dermatoses. In this review, we report experimental evidence that shows the use of dapsone to improve quality of life in erlotinib-treated patients by ameliorating rash as well as short-circuiting a growth-enhancing aspect of erlotinib based on increased interleukin-8 secretion.

  5. Impact of KRAS, BRAF, PIK3CA Mutations, PTEN, AREG, EREG Expression and Skin Rash in ≥2nd Line Cetuximab-Based Therapy of Colorectal Cancer Patients

    Science.gov (United States)

    Saridaki, Zacharenia; Tzardi, Maria; Papadaki, Chara; Sfakianaki, Maria; Pega, Fraga; Kalikaki, Aristea; Tsakalaki, Eleftheria; Trypaki, Maria; Messaritakis, Ippokratis; Stathopoulos, Efstathios; Mavroudis, Dimitris; Georgoulias, Vassilis; Souglakos, John

    2011-01-01

    Background To investigate the predictive significance of KRAS, BRAF, PIK3CA mutational status, AREG- EREG mRNA expression, PTEN protein expression and skin rash in metastatic colorectal cancer (mCRC) patients treated with cetuximab containing salvage chemotherapy. Methods Primary tumors from 112 mCRC patients were analyzed. The worst skin toxicity during treatment was recorded. Results KRAS, BRAF and PIK3CA mutations were present in 37 (33%), 8 (7.2%) and 11 (9.8%) cases, respectively, PTEN was lost in 21 (19.8%) cases, AREG and EREG were overexpressed in 48 (45%) and 51 (49%) cases. In the whole study population, time to tumor progression (TTP) and overall survival (OS) was significantly lower in patients with KRAS (p = 0.001 and p = 0.026, respectively) or BRAF (p = 0.001 and p<0.0001, respectively) mutant tumors, downregulation of AREG (p = 0.018 and p = 0.013, respectively) or EREG (p = 0.002 and p = 0.004, respectively) and grade 0-1 skin rash (p<0.0001 and p<0.0001, respectively). In KRAS wt patients TTP and OS was significantly lower in patients with BRAF (p = 0.0001 and p<0.0001, respectively) mutant tumors, downregulation of AREG (p = 0.021 and p = 0.004, respectively) or EREG (p = 0.0001 and p<0.0001, respectively) and grade 0-1 skin rash (p<0.0001 and p<0.0001, respectively). TTP was significantly lower in patients with PIK3CA mutations (p = 0.01) or lost PTEN (p = 0.002). Multivariate analysis revealed KRAS (Hazard Ratio [HR] 4.3, p<0.0001), BRAF mutation (HR: 5.1, p<0.0001), EREG low expression (HR: 1.6, p = 0.021) and absence of severe/moderate skin rash (HR: 4.0, p<0.0001) as independent prognostic factors for decreased TTP. Similarly, KRAS (HR 2.9, p = 0.01), BRAF mutation (HR: 3.0, p = 0.001), EREG low expression (HR: 1.7, p = 0.021), absecence of severe/moderate skin rash (HR: 3.7, p<0.0001) and the presence of undifferantited tumours (HR: 2.2, p = 0.001) were revealed as

  6. Eslicarbazepine acetate as a therapeutic option in a patient with carbamazepine-induced rash and HLA-A*31:01.

    Science.gov (United States)

    Kay, Lara; Willems, Laurent M; Zöllner, Johann Philipp; Reif, Philipp S; Klein, Karl Martin; Rosenow, Felix; Strzelczyk, Adam

    2017-04-01

    Eslicarbazepine acetate (ESL) is an anticonvulsant drug approved for the treatment of focal epilepsies, and related to oxcarbazepine and carbamazepine (CBZ), which are also derivatives of the dibenzazepine family. ESL is contraindicated in patients with hypersensitivity reactions to CBZ.We report a patient with frontal lobe epilepsy responding to treatment with ESL without any serious adverse effects after developing a severe skin rash following treatment with CBZ. HLA testing revealed an HLA-A*31:01 haplotype, that increases the risk of CBZ-induced cutaneous reactions.This case study shows that, in clinical practice, ESL may be considered in a patient with the HLA-A*31:01 haplotype and a hypersensitivity reaction to CBZ. Copyright © 2017. Published by Elsevier Ltd.

  7. Ipilimumab-induced hypophysitis and uveitis in a patient with metastatic melanoma and a history of ipilimumab-induced skin rash.

    Science.gov (United States)

    Nallapaneni, Neelima N; Mourya, Rajesh; Bhatt, Vijaya Raj; Malhotra, Sakshi; Ganti, Apar Kishor; Tendulkar, Ketki K

    2014-08-01

    Ipilimumab, a monoclonal antibody that blocks cytotoxic T-lymphocyte-associated antigen-4, leading to enhanced T-cell activation and proliferation, is associated with improved overall survival in melanoma. Its use can result in immune-related adverse events, the most common of which are skin rash, diarrhea, and colitis. Ipilimumab-induced hypophysitis is uncommon, mostly involves anterior pituitary, and is associated with abnormalities in pituitary MRI, whereas uveitis has been rarely reported. These immune-related adverse events occur during therapy. This report describes a patient who developed uveitis and hypophysitis involving both anterior and posterior pituitary, without MRI findings more than 3 weeks after the fourth dose of ipilimumab. This case illustrates the unusual presentation of and diagnostic challenges associated with ipilimumab-induced immune-related adverse events. Copyright © 2014 by the National Comprehensive Cancer Network.

  8. Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials*

    Science.gov (United States)

    Bloom, Romi; Amber, Kyle T.

    2017-01-01

    Lamotrigine is an antiepileptic drug used for the treatment of epilepsy, bipolar disorder and numerous off-label uses. The development of rash significantly affects its use. The most concerning of these adverse reactions is Stevens-Johnson syndrome/toxic epidermal necrolysis. We performed a systematic review of randomized controlled trials using lamotrigine as a monotherapy to quantify the incidence of cutaneous reactions, particularly Stevens-Johnson syndrome/toxic epidermal necrolysis. Of a total of 4,364 papers regarding lamotrigine, 122 studies met our inclusion and exclusion criteria. In total, 18,698 patients were included with 1,570 (8.3%) of patients experiencing an adverse dermatologic reaction. The incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis was 0.04%. PMID:28225977

  9. Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials.

    Science.gov (United States)

    Bloom, Romi; Amber, Kyle T

    2017-01-01

    Lamotrigine is an antiepileptic drug used for the treatment of epilepsy, bipolar disorder and numerous off-label uses. The development of rash significantly affects its use. The most concerning of these adverse reactions is Stevens-Johnson syndrome/toxic epidermal necrolysis. We performed a systematic review of randomized controlled trials using lamotrigine as a monotherapy to quantify the incidence of cutaneous reactions, particularly Stevens-Johnson syndrome/toxic epidermal necrolysis. Of a total of 4,364 papers regarding lamotrigine, 122 studies met our inclusion and exclusion criteria. In total, 18,698 patients were included with 1,570 (8.3%) of patients experiencing an adverse dermatologic reaction. The incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis was 0.04%.

  10. Levamisole-Induced Leukocytoclastic Vasculitis with Negative Serology in a Cocaine User.

    Science.gov (United States)

    Salehi, Mashal; Morgan, Michael P; Gabriel, Abigail

    2017-06-08

    BACKGROUND Levamisole is a common adulterant of cocaine. It can cause agranulocytosis and cutaneous vasculitis that can possibly lead to cutaneous necrosis. In all reported cases of levamisole-induced vasculitis, it has been described as a clinical syndrome characterized by a constellation of typical clinical features and a positive serum serology for ANCA levels, especially very high-titer p-ANCA levels, in the background of cocaine abuse. However, patients may have a negative serology and here, we present the first such case. CASE REPORT A 58-year-old African American man with a history of polysubstance abuse, 4 days after last cocaine use, presented with sudden onset of painful pruritic rash and polyarthralgias. He was found to have normal vital signs, with bilateral tender knees and erythematous-purplish maculopapular lesions involving the abdomen and the left thigh. Laboratory work-up was significant for elevated CRP, negative c-ANCA, p-ANCA ANA, and RA levels, and a positive urine toxicology for cocaine. Urine analysis by high-performance liquid chromatography was positive for levamisole. Ultimately, a final diagnosis was made by skin biopsy, which revealed findings suggestive of leukocytoclastic vasculitis. CONCLUSIONS Cutaneous leukocytoclastic vasculitis can be caused by levamisole, which is used as an adulterant in cocaine. Most cases are associated with positive ANCA levels; however, a negative serology is also a possibility.

  11. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review.

    Science.gov (United States)

    Canavan, Theresa N; Mathes, Erin F; Frieden, Ilona; Shinkai, Kanade

    2015-02-01

    Mycoplasma pneumoniae infection is associated with extrapulmonary complications, including mucocutaneous eruptions. These eruptions, which have been termed either "Stevens-Johnson syndrome" or "erythema multiforme" in the literature, may differ from drug-induced Stevens-Johnson syndrome or viral-associated erythema multiforme. We sought to review the literature characterizing morphology and disease course of M pneumoniae-associated mucocutaneous disease. A comprehensive literature search identified 95 articles with 202 cases. Patients were often young (mean age: 11.9 years) and male (66%). Cutaneous involvement ranged from absent (34%), to sparse (47%), to moderate (19%). Oral, ocular, and urogenital mucositis was reported in 94%, 82%, and 63% of cases, respectively. Treatments included antibiotics (80%), systemic corticosteroids (35%), supportive care alone (8%), and/or intravenous immunoglobulin (8%). Complications included mucosal damage (10%), cutaneous scarring (5.6%), recurrence (8%), and mortality (3%). Mild cases may not have been published; thus this review may have a bias toward more severe disease. M pneumoniae-associated mucocutaneous disease has prominent mucositis and sparse cutaneous involvement, although cutaneous involvement varies. Because of the distinct morphology, mild disease course, and potentially important clinical implications regarding treatment, we propose a revision of the nomenclature system and suggest the term "Mycoplasma-induced rash and mucositis" for these cases. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Skin rash in the intensive care unit: Stevens-Johnson syndrome, toxic epidermal necrolysis, or a rare manifestation of a hidden cutaneous malignancy: A case report.

    Science.gov (United States)

    Al-Saffar, Farah; Ibrahim, Saif; Patel, Pujan; Jacob, Rafik; Palacio, Carlos; Cury, James

    2016-03-01

    Skin rashes are infrequently encountered in the intensive care units, either as a result or as a cause of admission. The entities of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of desquamating skin diseases that have multiple etiologies, the most common being drug-related reactions; very rarely, the cause may be cutaneous malignancies. We herein present a unique case of a 54-year-old male patient with psoriasis treated with methotrexate, who presented with a cellulitis-like clinical picture, then developed a severe progressive systemic inflammatory response syndrome, and progressed clinically to SJS, then TEN even after discontinuing the antibiotics and methotrexate. A skin biopsy demonstrated an aggressive and rapidly-progressing T-cell lymphoma. The present case highlights the necessity of skin biopsy when encountering SJS and TEN in the ICU in order to identify potentially treatable/controllable causes. Although it appeared reasonable to correlate TEN solely to medications, the skin biopsies clearly demonstrated an aggressive T-cell skin lymphoma. In a patient with a better general condition it may have been helpful to treat this malignancy. TEN is a life-threatening condition and skin biopsy is the cornerstone of diagnosis, despite the presence of multiple risk factors and the typical physical findings of a drug-induced reaction.

  13. Multicenter study of skin rashes and hepatotoxicity in antiretroviral-naïve HIV-positive patients receiving non-nucleoside reverse-transcriptase inhibitor plus nucleoside reverse-transcriptase inhibitors in Taiwan.

    Directory of Open Access Journals (Sweden)

    Pei-Ying Wu

    Full Text Available Two nucleos(tide reverse-transcriptase inhibitors (NRTIs plus 1 non-NRTI (nNRTI remain the preferred or alternative combination antiretroviral therapy (cART for antiretroviral-naive HIV-positive patients in Taiwan. The three most commonly used nNRTIs are nevirapine (NVP, efavirenz (EFV and rilpivirine (RPV. This study aimed to determine the incidences of hepatotoxicity and skin rashes within 4 weeks of initiation of cART containing 1 nNRTI plus 2 NRTIs.Between June, 2012 and November, 2015, all antiretroviral-naive HIV-positive adult patients initiating nNRTI-containing cART at 8 designated hospitals for HIV care were included in this retrospective observational study. According to the national HIV treatment guidelines, patients were assessed at baseline, 2 and 4 weeks of cART initiation, and subsequently every 8 to 12 weeks. Plasma HIV RNA load, CD4 cell count and aminotransferases were determined. The toxicity grading scale of the Division of AIDS (DAIDS 2014 was used for reporting clinical and laboratory adverse events.During the 3.5-year study period, 2,341 patients initiated nNRTI-containing cART: NVP in 629 patients, EFV 1,363 patients, and RPV 349 patients. Rash of any grade occurred in 14.1% (n = 331 of the patients. In multiple logistic regression analysis, baseline CD4 cell counts (per 100-cell/μl increase, adjusted odds ratio [AOR], 1.125; 95% confidence interval [95% CI], 1.031-1.228 and use of NVP (AOR, 2.443; 95% CI, 1.816-3.286 (compared with efavirenz were independently associated with the development of skin rashes. Among the 1,455 patients (62.2% with aminotransferase data both at baseline and week 4, 72 (4.9% developed grade 2 or greater hepatotoxicity. In multiple logistic regression analysis, presence of antibody for hepatitis C virus (HCV (AOR, 2.865; 95% CI, 1.439-5.704 or hepatitis B surface antigen (AOR, 2.397; 95% CI, 1.150-4.997, and development of skin rashes (AOR, 2.811; 95% CI, 1.051-7.521 were independently

  14. Multicenter study of skin rashes and hepatotoxicity in antiretroviral-naïve HIV-positive patients receiving non-nucleoside reverse-transcriptase inhibitor plus nucleoside reverse-transcriptase inhibitors in Taiwan.

    Science.gov (United States)

    Wu, Pei-Ying; Cheng, Chien-Yu; Liu, Chun-Eng; Lee, Yi-Chien; Yang, Chia-Jui; Tsai, Mao-Song; Cheng, Shu-Hsing; Lin, Shih-Ping; Lin, De-Yu; Wang, Ning-Chi; Lee, Yi-Chieh; Sun, Hsin-Yun; Tang, Hung-Jen; Hung, Chien-Ching

    2017-01-01

    Two nucleos(t)ide reverse-transcriptase inhibitors (NRTIs) plus 1 non-NRTI (nNRTI) remain the preferred or alternative combination antiretroviral therapy (cART) for antiretroviral-naive HIV-positive patients in Taiwan. The three most commonly used nNRTIs are nevirapine (NVP), efavirenz (EFV) and rilpivirine (RPV). This study aimed to determine the incidences of hepatotoxicity and skin rashes within 4 weeks of initiation of cART containing 1 nNRTI plus 2 NRTIs. Between June, 2012 and November, 2015, all antiretroviral-naive HIV-positive adult patients initiating nNRTI-containing cART at 8 designated hospitals for HIV care were included in this retrospective observational study. According to the national HIV treatment guidelines, patients were assessed at baseline, 2 and 4 weeks of cART initiation, and subsequently every 8 to 12 weeks. Plasma HIV RNA load, CD4 cell count and aminotransferases were determined. The toxicity grading scale of the Division of AIDS (DAIDS) 2014 was used for reporting clinical and laboratory adverse events. During the 3.5-year study period, 2,341 patients initiated nNRTI-containing cART: NVP in 629 patients, EFV 1,363 patients, and RPV 349 patients. Rash of any grade occurred in 14.1% (n = 331) of the patients. In multiple logistic regression analysis, baseline CD4 cell counts (per 100-cell/μl increase, adjusted odds ratio [AOR], 1.125; 95% confidence interval [95% CI], 1.031-1.228) and use of NVP (AOR, 2.443; 95% CI, 1.816-3.286) (compared with efavirenz) were independently associated with the development of skin rashes. Among the 1,455 patients (62.2%) with aminotransferase data both at baseline and week 4, 72 (4.9%) developed grade 2 or greater hepatotoxicity. In multiple logistic regression analysis, presence of antibody for hepatitis C virus (HCV) (AOR, 2.865; 95% CI, 1.439-5.704) or hepatitis B surface antigen (AOR, 2.397; 95% CI, 1.150-4.997), and development of skin rashes (AOR, 2.811; 95% CI, 1.051-7.521) were independently

  15. Pruritic bluish-black subcutaneous papules on the chest.

    Science.gov (United States)

    Laquer, Vivian T; Wu, Jashin J; Tournas, Joshua A; Murase, Jenny E; Dyson, Senait W

    2008-03-15

    Steatocystoma multiplex (SM) is characterized by multiple dermal cysts involving the pilosebaceous glands. Although most presenting cases are sporadic, there is a rare familial syndrome involving a mutation in keratin 17 (K17) that is inherited in an autosomal dominant fashion. SM often presents concomitantly with eruptive vellus hair cysts (EHVS) and pachyonychia congenital type 2 (PC-2). We report a sporadic case of SM in a 21-year-old man.

  16. La Verbena azul en el tratamiento del niño con salpullido The blue Verbena to treat the child with rash

    Directory of Open Access Journals (Sweden)

    Roberto Galiano Piquet

    2012-03-01

    Full Text Available Introducción: la miliaria es una enfermedad inflamatoria de la piel, usualmente conocida como salpullido, es muy frecuente en niños pequeños sobre todo en los meses de verano. Objetivo: valorar la eficacia de la infusión de Verbena azul en el control de la miliaria común. Métodos: se realizó un ensayo clínico fase II, a partir de la preparación de una infusión de hojas frescas o secas molidas, que se vertieron en 12 litros de agua hirviente, se tapó y se separó del fuego después de añadirle la planta, se dejó reposar y se coló. Fue aplicada tibia en todo el cuerpo durante 21 días, en dos secciones, al levantarse, y en la tarde luego del baño diario. El estudio se realizó en 30 lactantes de raza blanca, que acudieron con esta patología a la consulta de Medicina Natural y Tradicional, en el consultorio 6 del poblado de Altagracia, en el periodo entre junio del 2004 y junio del 2005, los cuales pertenecían al Policlínico Comunitario Docente "Carlos J. Finlay" de la Ciudad de Camagüey. Los datos se recogieron mediante una encuesta, confeccionada de acuerdo con los objetivos planteados en la investigación. Resultados: el grupo más afectado fue el de 3 a 6 meses, todos los pacientes fueron blancos, no se encontraron diferencias significativas en cuanto al sexo. La variedad clínica más frecuente fue la cristalina, y los meses en que más se presentó fueron entre junio y agosto. Conclusiones: este tratamiento presentó una alta eficacia en el control de la sintomatología de la miliaria común; se curaron 9 de cada 10 pacientes.Introduction: miliaria is an skin inflammatory disease known as rash and is very frequent in small children mainly during summer months. Objective: assessing the efficacy of the infusion of blue Verbena in controlling common heat rash. Methods: a phase II clinical trial was conducted from the preparation of an infusion of fresh leaves or dry grinded poured out in 12 liters of boiling water, was covered

  17. Diaper Rash: How to Treat

    Science.gov (United States)

    ... benefits Become a member DermCare Team Professionalism and ethics My account Member directory Publications JAAD JAAD Case ... SkinPAC State societies Scope of practice Truth in advertising Public and patients SPOT Skin Cancer™ Community programs & ...

  18. Skin Rashes and Other Problems

    Science.gov (United States)

    ... area had been hit?YesNoAre there scaly, pink, gray or tan patches or bumps on your face, ... OverDiagnosisThis could be FOLLICULITIS, an infection of the hair follicle.Self CareMost of these will heal on ...

  19. Doxycycline for prevention of erlotinib-induced rash in patients with non-small-cell lung cancer (NSCLC) after failure of first-line chemotherapy: A randomized, open-label trial.

    Science.gov (United States)

    Deplanque, Gaël; Gervais, Radj; Vergnenegre, Alain; Falchero, Lionel; Souquet, Pierre-Jean; Chavaillon, Jean-Michel; Taviot, Bruno; Fraboulet, Ghislaine; Saal, Hakim; Robert, Caroline; Chosidow, Olivier

    2016-06-01

    Rash is a common epidermal growth factor receptor inhibitor-induced toxicity that can impair quality of life and treatment compliance. We sought to evaluate the efficacy of doxycycline in preventing erlotinib-induced rash (folliculitis) in patients with non-small-cell lung cancer. This open-label, randomized, prospective, phase II trial was conducted in 147 patients with locally advanced or metastatic non-small-cell lung cancer progressing after first-line chemotherapy, randomized for 4 months with erlotinib alone 150 mg/d per os (control arm) or combined with doxycycline 100 mg/d (doxycycline arm). Incidence and severity of rash, compliance, survival, and safety were assessed. Baseline characteristics of the 147 patients were well balanced in the intent-to-treat population. Folliculitis occurred in 71% of patients in the doxycycline arm and 81% in the control arm (P = .175). The severity of folliculitis and other skin lesions was lower in the doxycycline arm compared with the control arm. Other adverse events were reported at a similar frequency across arms. There was no significant difference in survival between treatment arms. The open-label design of the study and the duration of the treatment with doxycycline are limitations. Doxycycline did not reduce the incidence of erlotinib-induced folliculitis, but significantly reduced its severity. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Multicenter study of skin rashes and hepatotoxicity in antiretroviral-na?ve HIV-positive patients receiving non-nucleoside reverse-transcriptase inhibitor plus nucleoside reverse-transcriptase inhibitors in Taiwan

    OpenAIRE

    Wu, Pei-Ying; Cheng, Chien-Yu; Liu, Chun-Eng; Lee, Yi-Chien; Yang, Chia-Jui; Tsai, Mao-Song; Cheng, Shu-Hsing; Lin, Shih-Ping; Lin, De-Yu; Wang, Ning-Chi; Lee, Yi-Chieh; Sun, Hsin-Yun; Tang, Hung-Jen; Hung, Chien-Ching

    2017-01-01

    Objectives Two nucleos(t)ide reverse-transcriptase inhibitors (NRTIs) plus 1 non-NRTI (nNRTI) remain the preferred or alternative combination antiretroviral therapy (cART) for antiretroviral-naive HIV-positive patients in Taiwan. The three most commonly used nNRTIs are nevirapine (NVP), efavirenz (EFV) and rilpivirine (RPV). This study aimed to determine the incidences of hepatotoxicity and skin rashes within 4 weeks of initiation of cART containing 1 nNRTI plus 2 NRTIs. Methods Between June,...

  1. Preventive effect of kampo medicine (hangeshashin-to, TJ-14 plus minocycline against afatinib-induced diarrhea and skin rash in patients with non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Ichiki M

    2017-10-01

    Full Text Available Masao Ichiki,1 Hiroshi Wataya,2 Kazuhiko Yamada,3 Nobuko Tsuruta,4 Hiroaki Takeoka,1 Yusuke Okayama,1 Jun Sasaki,1 Tomoaki Hoshino3 1Department of Respiratory Medicine, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 2Division of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka City, 3Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University, Kurume City, 4Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka City, Fukuoka, Japan Purpose: Diarrhea and oral mucositis induced by afatinib can cause devastating quality of life issues for patients undergoing afatinib treatment. Several studies have shown that hangeshashin-to (TJ-14 might be useful for chemotherapy-induced diarrhea and oral mucositis. In this study, we investigated the prophylactic effects of TJ-14 for afatinib-induced diarrhea and oral mucositis and minocycline for afatinib-induced skin rash.Patients and methods: First- and second-generation epidermal growth factor receptor (EGFR-tyrosine kinase inhibitors have become the standard first-line treatment in patients with EGFR-mutated non-small cell lung cancer. The incidence of diarrhea was higher with afatinib than with gefitinib, and we conducted a single-arm Phase II study with afatinib. Patients who had previously undergone treatment with afatinib were ineligible. Both TJ-14 (7.5 g/day and minocycline (100 mg/day were administered simultaneously from the start of afatinib administration. The primary end point was the incidence of ≥ grade 3 (G3 diarrhea (increase of ≥7 stools/day over baseline during the first 4 weeks of treatment. The secondary end points were the incidence of ≥ G3 oral mucositis (severe pain interfering with oral intake and ≥ G3 skin toxicity (severe or medically significant but not immediately life-threatening.Results: A total of 29 patients (nine men and 20 women; median age, 66

  2. Imatinib-induced Stevens-Johnsons syndrome.

    Science.gov (United States)

    Jha, Praveen; Himanshu, D; Jain, Nirdesh; Singh, Ajay Kumar

    2013-01-23

    Imatinib mesylate is a tyrosine kinase inhibitor used widely as the first-line treatment for chronic myeloid leukaemia (CML). The side-effect profile of this drug includes fluid retention, muscle cramps, diarrhoea, myelosuppression and skin rashes. Of these, rashes of the type maculo-papular eruptions and oedema developed most commonly. The cutaneous adverse reactions other than maculo-papular eruptions are rare with imatinib. Severe and life-threatening cutaneous reactions can occur in 5% cases. Here, the author reports a case of newly diagnosed CML that developed Steven-Johnsons syndrome due to imatinib therapy. Patient responded and discharged successfully on withdrawal of the culminating drug.

  3. Type II lepra reaction: an unusual presentation.

    Science.gov (United States)

    Chauhan, S; D'Cruz, S; Mohan, H; Singh, R; Ram, J; Sachdev, A

    2006-01-27

    Ulcers with maculo-papular rash are an unusual presenting feature of leprosy. They occur as result of neuropathy, type-2 lepra reaction or Lucio's phenomenon. The hall mark of type-2 reaction is erythema nodosum. Very rarely it manifests as ulcerative skin lesions. We describe one such unusual case of a young male who presented with multiple ulcers and maculo-papular rash over the legs, chest and abdomen. In addition to this, he had fever, heart murmur, pulmonary infiltrates, neuropathy, and deranged liver function. A clinical differential diagnosis of infective endocarditis and systemic nectrozing vasculitis was made. Skin biopsy showed dense inflammation with lepra bacilli consistent with type-2 lepra reaction.

  4. A 28-day oral gavage toxicity study of 3-monochloropropane-1,2-diol (3-MCPD) in CB6F1-non-Tg rasH2 mice.

    Science.gov (United States)

    Lee, Byoung-Seok; Park, Sang-Jin; Kim, Yong-Bum; Han, Ji-Seok; Jeong, Eun-Ju; Moon, Kyoung-Sik; Son, Hwa-Young

    2015-12-01

    3-Monochloro-1,2-propanediol (3-MCPD) is a well-known contaminant of foods containing hydrolyzed vegetable protein. However, limited toxicity data are available for the risk assessment of 3-MCPD and its carcinogenic potential is controversial. To evaluate the potential toxicity and determine the dose levels for a 26-week carcinogenicity test using Tg rasH2 mice, 3-MCPD was administered once daily by oral gavage at doses of 0, 25, 50, and 100 mg/kg body weight (b.w.)/day for 28 days to male and female CB6F1-non-Tg rasH2 mice (N = 5 males and females per dose). The standard toxicological evaluations were conducted during the in-life and post-mortem phase. In the 100 mg/kg b.w./day group, 3 males and 1 female died during the study and showed clinical signs such as thin appearance and subdued behavior accompanied by significant decreases in mean b.w. Microscopy revealed tubular basophilia in the kidneys, exfoliated degenerative germ cells in the lumen of the seminiferous tubule of the testes, vacuolation in the brain, axonal degeneration of the sciatic nerve, and cardiomyopathy in the 100, ≥25, ≥50, 100, and 100 mg/kg b.w./day groups, respectively. In conclusion, 3-MCPD's target organs were the kidneys, testes, brain, sciatic nerve, and heart. The "no-observed-adverse-effect level" (NOAEL) of 3-MCPD was ≤25 and 25 mg/kg b.w./day in males and females, respectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Netherton′s Syndrome

    Directory of Open Access Journals (Sweden)

    M L Khatri

    1989-01-01

    Full Text Available A 6 year old Libyan boy had diffuse erythema at birth and later developed pruritic, maculo-papular, papular, circinat c, double-edge, scaly lesions, suggestive of ichthyosis linearis circumflexa (ILC.Hisscalp hair were brittle and sparse with partial patchy alopecia, showing change of trichorrhexis invaginata, these -associations being characteristic of Netherton′s syndrome. The boy had slightly stunted growth; a feature which has not been recorded in previously reported cases.

  6. Origin of the Zika virus revealed: a historical journey across the world.

    Science.gov (United States)

    Mlacker, Stephanie; Shafa, Golsa; Aldahan, Adam S; Shah, Vidhi V; Samarkandy, Sahal; Nouri, Keyvan

    2016-12-01

    Zika virus (ZIKV) is an arbovirus within the Flaviviridae family, the recent spread of which has promoted public concern. This study outlines the clinical features, potential for teratogenicity, diagnosis, and treatment of ZIKV infection. Zika virus is transmitted through the bite of an infected Stegomyia (= Aedes) mosquito, blood transfusion, sexual intercourse, and perinatal routes. Infection has been characterized as mildly symptomatic. Symptoms include mild fever, headache, arthralgia, myalgia, non-purulent conjunctivitis, and a pruritic maculopapular rash. It is rarely life-threatening, but both Guillain-Barré syndrome and fetal microcephaly have been reported. ZIKV belongs to the same family as bovine viral diarrhea virus, which causes hydrocephalus and microcephaly in newborn calves, and hepatitis C virus, which can be vertically transmitted in human pregnancies, and hence there remains concern for potential similarities. Diagnostic methods include polymerase chain reaction performed in blood samples during infection, and in urine and saliva. Pregnant women undergo antibody testing for immunoglobulin M. Treatment involves supportive care, and acetaminophen and antihistamines to control symptoms. Although there was no evidence of the circulation of ZIKV in the Western hemisphere prior to 2014, the global spread of Stegomyia aegypti and increases in urban populations and international travel have fostered its evolution. Adherence to current guidelines for the prevention of ZIKV transmission is especially relevant in regions experiencing ongoing outbreaks. Concern for microcephaly in newborns warrants further investigation into the potential long-term effects of ZIKV infection, especially in relation to reproductive health and mother-fetus transmission. © 2016 The International Society of Dermatology.

  7. Serological and virological characterization of clinically diagnosed cases of measles in suburban Khartoum

    NARCIS (Netherlands)

    H.S. el Mubarak; H.G.M. Niesters (Bert); S.A. Ibrahim; R.L. de Swart (Rik); E.E. Zijlstra (Edward); T.F. Wild (Thomas Fabian); O.A. Mustafa; H.W. Vos (Helma); M.M. Mukhtar; J. Groen (Jan); A.M. El-Hassan (Ahmed Mohamed); A.D.M.E. Osterhaus (Albert); M.W.G. van de Bildt (Marco)

    2000-01-01

    textabstractMeasles continues to be a major childhood disease in terms of global morbidity and mortality. In the main areas of its endemicity the only available means of diagnosis are based on clinical criteria: the presence of a maculopapular rash and fever accompanied by cough,

  8. Unusual Presentation Of Dapsone Syndrome

    Directory of Open Access Journals (Sweden)

    Singh Prabhas Chandra

    2001-01-01

    Full Text Available A 15 year old girl presented with a rare association of generalized maculopapular rash with exfoliation, hepatic involvement, nephritis, arthralgia and repeated serum sickness type of reaction after taking depsone. The case is reported because of its unusual presentation.

  9. NEONATES (BIRTH – 1 MONTH)

    African Journals Online (AJOL)

    Chantel

    CANDIDIASIS. Congenital candidiasis. Infection with Candida albicans in the first weeks of life can be congenital, fol- lowing infection from candidal chorioam- nionitis due to ascending infection from the mother's genital tract. This affects the lungs and skin, causing pneumonitis and a maculopapular erythematous rash,.

  10. Skin Rashes Due to Bed-Wetting

    Science.gov (United States)

    ... advanced. But there's good news. Taking steps to live a healthy lifestyle can go a long way towards reducing risk. Read more. Patients NKF Cares Peers Support Ask the Doctor My Food Coach Nutrition Dialysis Patient & Family Resources Emergency Resources A to Z ...

  11. The sweet Christmas rash (case series)

    DEFF Research Database (Denmark)

    Gyldenløve, Mette; Nepper-Christensen, Steen; Thyssen, Jacob P

    2013-01-01

    with allergic rhinitis. The female patient had a positive patch test reaction to colophony, and the male patient had a positive skin prick test reaction to alternaria mould. Both were successfully advised to avoid prolonged exposure to Christmas trees and buy artificial trees for Christmas....

  12. Rashes in infants. Pitfalls and masquerades.

    Science.gov (United States)

    Orchard, D

    2001-11-01

    Physiological and pathological skin eruptions are extremely common in neonates and are often presented to the general practitioner as either a primary or incidental problem at consultation. To discuss the presentation and treatment of common dermatological conditions presenting in the first six months of life. Common conditions such as pityrosporum folliculitis, neonatal acne, cradle cap, eczema and food allergy are discussed. The rarer conditions of zinc deficiency and neonatal lupus are described because they may pose significant potential medical consequences.

  13. [A man with severe skin rash].

    Science.gov (United States)

    Nguyen, T V; van Rooijen, G L; van Doorn, M B A

    2018-01-01

    A 31-year-old man visited the outpatient clinic Dermatology with an exacerbation of his atopic eczema. Since a few day vesicles and crusts had appeared and his eyelids were swollen. He was known to have eczema, for which he was treated with ciclosporin 200 mg 2 times a day (4 mg/kg per day) since four months. Under this treatment the eczema used to be under control. There were no neurological symptoms or vision problems. At physical examination we saw erythematous papules, vesicles, superficial erosions and crusts on all body regions, but especially on the trunk and in the main neck region. The patient was diagnosed with eczema herpeticum and he was treated with intravenous aciclovir 1000 mg 3 times a day (10 mg/kg 3 dd) and flucloxacillin 1000 mg 4 times a day for seven days.

  14. Skin Manifestations of HIV/AIDS in Sudanese Patients | El Nour ...

    African Journals Online (AJOL)

    The non- infectious conditions associated with HIV/AIDS includes Kaposi's sarcoma (10.0%) and skin lymphoma (3.3%), seborrhoeic dermatitis (10.0%), psoriasis (10.0%), papular pruritic rash (10.0%) and vitiligo (3.3%). Conclusions Infectious conditions, such as bacterial, fugal and viral infection are fairly common, ...

  15. Pruritic and vascular responses induced by serotonin in patients with atopic dermatitis and in healthy controls.

    Science.gov (United States)

    Rausl, Aram; Nordlind, Klas; Wahlgren, Carl-Fredrik

    2013-05-01

    Atopic dermatitis (AD) is a chronic inflammatory skin disease with often severe itch. The aim of this study was to determine the pruritogenic and vascular effect of serotonin (5-hydroxytryptamine; 5-HT) in patients with AD and in healthy controls. A 50 µg dose of 5-HT was injected intradermally into non-lesional skin of 25 patients with AD and 25 healthy control individuals, and the effect compared with 0.2 µg histamine as a positive control, and buffer as a negative control. Pruritus was recorded by the subjects, using a computerized visual analogue scale, while flare and wheal were recorded by the investigator. There was no qualitative or quantitative difference in 5-HT-induced itch between patients and control subjects, or between males and females. However, reduced flare and wheal were found in the patient group for 5-HT. There were no correlations between clinical findings (i.e. eczema severity, clinical pruritus) and recorded experimental itch, or flare or wheal responses for 5-HT, in the patients with AD. In both groups a shorter itch latency was found for 5-HT compared with histamine. Through the use of intradermal injections, making it possible to calculate the dose of substance delivered, a lower vascular response to 5-HT was shown in patients with AD compared with healthy controls. In addition to confirming a pruritogenic role of 5-HT in both patients with AD and healthy controls, we found a shorter itch latency for 5-HT compared with histamine in both groups. The short itch latency time may indicate a direct effect of 5-HT on itch receptors.

  16. Anti-allergic, anti-pruritic, and anti-inflammatory activities of Centella ...

    African Journals Online (AJOL)

    This study investigated antipruritic and anti-inflammatory effect of Centella asiatica extract in rats and anti-allergic in vitro using sheep (Capra hircus) serum method and compound 48/80 induced mast cell degranulation method, compared with standard drug ketotifen fumarate. In rats, extract of Centella asiatica administered ...

  17. Primary dermatologic findings with early-onset intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Chao, Tamara T; Sheffield, Jeanne S

    2011-02-01

    Primary dermatologic findings are not thought to be associated with intrahepatic cholestasis of pregnancy. We report on a patient with twins who presented with a pruritic rash and cholestasis. A woman with a twin gestation and two previous term stillbirths developed a pruritic rash at 16 weeks. Scleral icterus and jaundice were observed at 27 weeks. Elevated bile acid levels confirmed a diagnosis of intrahepatic cholestasis of pregnancy, and ursodeoxycholic acid therapy was initiated. Fetal heart rate decelerations were noted at 32 4/7 weeks, prompting delivery of two live male newborns. Declining laboratory values and resolution of rash occurred within a few days of delivery. This case illustrates an unusual presentation of recurrent cholestasis of pregnancy in a twin gestation with primary dermatologic findings.

  18. Phenytoin induced Steven–Johnson syndrome and bronchiolitis obliterans – case report and review of literature

    OpenAIRE

    Pannu, Bibek S.; Egan, Ashley M.; Iyer, Vivek N.

    2016-01-01

    Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both rare but serious idiosyncratic drug reactions characterized by diffuse muco-epidermoid injury and high mortality. Keratinocytes in both skin and mucous membranes (including eyes, mouth and genitalia) are injured resulting in a diffuse maculopapular rash, blistering lesions and epithelial detachment with minimal force (Nikolsky's sign). SJS is typically diagnosed when less than 10% of the skin surface is involved and ...

  19. Syphilitic hepatitis: An uncommon manifestation of a common disease

    Directory of Open Access Journals (Sweden)

    Sukriti Baveja

    2014-01-01

    Full Text Available Hepatitis being first manifestation of secondary syphilis is rare. Here in we report a case of 39 years old male who was being treated for hepatitis and presented to us subsequently with itchy maculopapular rash. Venereal disease research laboratory (VDRL titre was 1:16. Treponema pallidum hemagglutination assay (TPHA was positive. He was treated with intramuscular Benzathine Penicillin. His hepatitis improved rapidly.

  20. Metastatic fungating ulcerative growth on vulva as a presenting feature of carcinoma cervix: A rare case report

    Directory of Open Access Journals (Sweden)

    Smriti Naswa

    2015-01-01

    Full Text Available Carcinoma of the cervix is the second to fourth most common malignancy in women. It metastasizes most often to the lungs, bones, and liver. Skin involvement originating from cervical cancer is rare, even in the terminal stages of the disease. Cutaneous metastasis of cervical cancer usually presents as cutaneous nodules, papules/plaques, maculopapular rash, and diffuse inflammatory rash. We report a rare case (only the second reported case to the best of our knowledge of a 50-year-old woman with cutaneous metastasis in form of fungating ulcerative growth on mons pubis as presenting feature of carcinoma cervix.

  1. Cross-reactivity between voriconazole, fluconazole and itraconazole.

    Science.gov (United States)

    Benjamin Lash, D; Jolliff, J; Munoz, A; Heidari, A

    2016-10-01

    Hypersensitivity to triazoles is a rare occurrence and cross-reactivity between agents is unknown. We present a successful voriconazole challenge in a patient allergic to fluconazole and itraconazole. A 41-year-old immunocompetent male with coccidioidomycosis developed fever, eosinophilia and maculopapular rash from fluconazole. Switching to itraconazole resulted in worsening of the rash and skin sloughing over 25% of his body. He was given an oral-graded challenge of voriconazole which he tolerated without incident. This is the first report of a lack of cross-reactivity between itraconazole and voriconazole. © 2016 John Wiley & Sons Ltd.

  2. Drug reaction with eosinophilia and systemic symptoms syndrome probably induced by a lamotrigine-ginseng drug interaction.

    Science.gov (United States)

    Myers, Amy P; Watson, Troy A; Strock, Steven B

    2015-03-01

    The likelihood of a drug reaction with lamotrigine is increased by dose escalation that is too rapid or drug interactions that increase the concentration of lamotrigine. There is a well-documented interaction between valproic acid and lamotrigine in which lamotrigine levels are increased, subsequently increasing the risk of a drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. This syndrome is characterized by fever, lymphadenopathy, diffuse maculopapular rash, multivisceral involvement, eosinophilia, and atypical lymphocytes and has a mortality rate of 10-40%. We describe the first case, to our knowledge, of DRESS syndrome that was probably induced by a drug interaction between lamotrigine and ginseng. A 44-year-old white man presented to the emergency department after experiencing a possible seizure. His medical history included two other lifetime events concerning for seizures at ages 14 and 29 years old. After referral to the neurology clinic, he was diagnosed with generalized tonic-clonic seizure disorder, and lamotrigine was started with up-titration according to the drug's package insert to a goal dosage of 150 mg twice/day. The patient had also been taking deer antler velvet and ginseng that he continued during his lamotrigine therapy. On day 43 of therapy, the patient presented to the emergency department with a pruritic rash that had started on his extremities and spread to his torso. He was thought to have experienced a drug reaction to lamotrigine, and the drug was discontinued. Thirteen days later, the patient was admitted from the acute care clinic for inpatient observation due to laboratory abnormalities in the setting of continued rash, headache, and myalgias. His admission laboratory results on that day were remarkable for leukocytosis, with a white blood cell count up to 17.6 × 10(3) /mm(3) , with a prominent eosinophilia of 3.04 × 10(3) /mm(3) ; his liver enzyme levels were also elevated, with an aspartate

  3. Neuroendocrine differentiation in a case of cervical cancer | Rashed ...

    African Journals Online (AJOL)

    tumor; that further showed neuroendocrine differentiation, as demonstrated by chromogranin-A positivity. It is important to differentiate small cell carcinoma from other malignant tumors of the uterine cervix. Morphological features play an important role in making a diagnosis and the immunohistochemistry study can offer an ...

  4. Red, Itchy Rash? Get the Skinny on Dermatitis

    Science.gov (United States)

    ... time, wearing nickel earrings can cause an allergic reaction to the metal. Other common causes of allergic dermatitis are poison oak and poison ivy. The stems and leaves of these plants produce a chemical that’s likely to cause allergies. If you touch ...

  5. Blistering rash in a young male child | Sanders | South African ...

    African Journals Online (AJOL)

    ... lower limbs. He had visited three different general practitioners prior to presentation and had been given several drugs and ointments, including three different classes of antibiotics. During his admission, the diagnosis of linear IgA bullous dermatitis was made. Dapsone and prednisone were given and he recovered well.

  6. Spot diagnosis: An ominous rash in a newborn

    Directory of Open Access Journals (Sweden)

    Wong William

    2009-04-01

    Full Text Available Abstract Purpura fulminans (PF is an ominous cutaneous condition usually associated with meningococcemia. PF in the newborn is rarely reported. We report the case of a female preterm infant with extensive PF due to group B streptococcus (GBS septicemia. She developed multi-organ system failure despite neonatal intensive care support and succumbed 9 days later. GBS, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics. PF associated with GBS is a rare cutaneous sign that must not be missed. Mortality remains high despite aggressive treatment and ICU support.

  7. Rash, fever and proteinuria after amoxicillin in a SLE patient.

    Science.gov (United States)

    Couto, M; Duarte, C; Geraldes, A; Medeiros, Colleen; Inês, L; Malcata, A

    2009-01-01

    We report a case of severe type IV hypersensitivity reaction to amoxicillin, which occurred in a person with a 12-year history of SLE. The present case illustrates the wide differential diagnosis in a SLE patient who presents with an allergic drug reaction. The attribution of the presenting symptoms to the underlying SLE and/or to the drugs used to treat SLE and coexisting conditions is a major challenge.

  8. Side Effects of HIV Medicines: HIV and Rash

    Science.gov (United States)

    ... or swallowing, dizziness or lightheadedness, and kidney damage. Stevens-Johnson syndrome (SJS) (also called erythema multiforme major) is a ... multiforme National Center for Advancing Translational Sciences (NCATS): Stevens-Johnson syndrome Print This Fact Sheet Entire Series Related Content ...

  9. Costs and cost-effectiveness of the nursing programme 'Coping with itch' for patients with chronic pruritic skin disease

    NARCIS (Netherlands)

    van Os-Medendorp, H.; Guikers, C. L. H.; Eland-de Kok, P. C. M.; Ros, W. J. G.; Bruijnzeel-Koomen, C. A. F. M.; Buskens, E.

    Background Itch, a major symptom of many skin diseases, has a great impact on quality of life. The nursing programme 'Coping with itch' aims at reducing itch and at helping patients to cope with itch. Objectives To explore costs and cost-effectiveness of the programme. Methods A randomized

  10. DRESS syndrome with autoimmune hepatitis from strontium ranelate.

    Science.gov (United States)

    di Meo, Nicola; Gubertini, Nicoletta; Crocè, Lory; Tiribelli, Claudio; Trevisan, Giusto

    2016-05-01

    Strontium ranelate, which is used for postmenopausal osteoporosis, has been associated with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, a severe, acute, potentially fatal, multisystem adverse drug reaction characterized by skin rash, fever, hematological abnormalities, and lymphadenopathy with involvement of several internal organs. We report the case of a woman who developed DRESS syndrome with a generalized maculopapular rash, eosinophilia, dyspnea, bilateral cervical lymphadenopathy, and reactivation of Epstein-Barr virus (EBV) with liver damage 3 weeks after administration of strontium ranelate for postmenopausal osteoporosis. Approximately 6 months after total remission of cutaneous symptoms, the patient developed autoimmune hepatitis. This case confirms that strontium ranelate should be considered as a possible factor in the etiopathology of DRESS syndrome as well as in the subsequent development of autoimmune hepatitis. The possibility of developing autoimmune hepatitis as a part of DRESS syndrome related to strontium ranelate use can occur months after the acute episode.

  11. Skin toxicity in a patient with ovarian cancer treated with pegylated liposomal doxorubicin: A case report and review of the literature.

    Science.gov (United States)

    Kubicka-Wołkowska, Joanna; Kędzierska, Magdalena; Lisik-Habib, Maja; Potemski, Piotr

    2016-12-01

    Pegylated liposomal doxorubicin (PLD) is a form of doxorubicin enclosed in pegylated liposomes. In contrast to conventional doxorubicin, PLD is characterized by a lower incidence of cardiotoxicity and myelosuppression. However, it induces specific mucocutaneous side effects, particularly palmar-plantar erythrodysesthesia (PPE). Other dermal manifestations, such as intertrigo-like dermatitis, diffuse follicular rash, melanotic macules, maculopapular rash or recall phenomenon are less common. Mechanisms that lead to skin toxicity remain unclear, however, certain reports indicate that drug excretion in sweat, host-vs.-altered-host reactions and local mechanical microtrauma play an important role in the development of cutaneous disorders. Effective preventive and curative management has not yet been established. The current study reports a case of a 55-year-old patient with advanced ovarian cancer who developed an uncommon diffuse maculopapular rash and severe PPE during treatment with PLD. Complete regression of the skin disorder was observed after 4 weeks. At present, palliative chemotherapy provides the opportunity to prolong life and alleviate disease symptoms, nonetheless it produces a number of adverse effects. Dermal complications may affect patient quality of life and cause therapy interruption. In the light of widespread use of PLD, skin toxicity associated with this drug creates a major problem.

  12. Multistages and Reinfection of Syphilis: A Case Report with Jarisch Herxheimer Reaction

    Directory of Open Access Journals (Sweden)

    Pimchaya Udomphan

    2016-09-01

    Full Text Available Multistage and reinfection of syphilis, which developed genital chancre after secondary syphilis is an uncommon manifestation. Among HIV-positive MSM, concurrent primary chancres with secondary syphilis are common. The Jarisch-Herxheimer reaction (JHR is a transient immunological phenomenon and increases in inci- dence among HIV patients. This report demonstrates a case of secondary syphilis and reinfection in a 19-year-old Thai male who presented with multiple erythematous maculopapular rashes on trunk, extremities, palms and soles for 5 days and then had multiple painless genital ulcers 2 days later. He developed Jarisch-Herxheimer reaction after the treatment.

  13. [Hypersensitivity reactions to use of mebeverine].

    Science.gov (United States)

    in 't Veld, B A; van Puyenbroek, E; Stricker, B H

    1997-07-12

    Twenty-one cases of adverse reactions to mebeverine use were reported to the Inspectorate for Health Care in the Netherlands since 1978. In 12 patients (five men and seven women) this was an immunological hypersensitivity reaction. All patients recovered after drug withdrawal. The time between start and onset of symptoms varied from several minutes to 14 days. Most reactions consisted of urticaria or maculopapular rash, sometimes accompanied by fever, polyarthritis, thrombopenia or angioedema. In contradiction to the manufacturer's claims adverse reactions to the use of mebeverine do occur.

  14. An Elderly Long-Term Care Resident with Crusted Scabies

    Directory of Open Access Journals (Sweden)

    Matthew Sandre

    2015-01-01

    Full Text Available Crusted scabies is a highly contagious form of scabies. Altered immune response, nutritional deficiencies and modified host response are all risk factors for crusted scabies. The authors report a case involving a patient found to have a chronic maculopapular, erythematous rash with large hyperkeratotic, white and grey plaques on the soles of both feet. An ultimate diagnosis of crusted scabies was reached after a delay in diagnosis suspected to be caused by the similarity in appearance to more common skin conditions such as psoriasis. After topical permethrin was unsuccessful, intermittent dosing of oral ivermectin resulted in a rapid reduction in cutaneous plaques.

  15. Cutaneous cytomegalovirus infection in a child with hyper IgE and specific defects in antibody response to protein vaccines

    Directory of Open Access Journals (Sweden)

    Shahrzad Fallah

    Full Text Available Cytomegalovirus (CMV infection is a common opportunistic systemic infection in immunocompromised patients, but skin involvement is rare. Herein, we report a 10 year-old girl from consanguineous parents who was referred to our center because of disseminated maculopapular rash. She had history of upper and lower respiratory tract infections. In immunological studies, increased serum IgE level and decreased responses to tetanus and diphtheria were detected. Polymerase chain reaction (PCR examination of bronchoalveolar lavage and serum sample revealed the presence of CMV. Early diagnosis of cutaneous CMV and appropriate treatment are the key actions in management of patients with underlying immunodeficiencies to avoid further complications.

  16. Cutaneous larva migrans

    Directory of Open Access Journals (Sweden)

    Aleksandra Wieczorek

    2016-09-01

    Full Text Available Introduction . Cutaneous larva migrans (CLM is a tropical zoonosis, caused by parasites, usually Ancylostoma braziliense. Humans are an accidental host. Polish patients with CLM are usually tourists visiting tropical and subtropical countries. The first symptoms do not always appear as creeping eruptions, which complicates the diagnosis. Objective. To present the case of a man with CLM after returning from Thailand to Poland and associated diagnostic difficulties. Case report. We present a case of a 28-year-old man who returned to Poland from Thailand. The first symptoms appeared as disseminated pruritic papules. No improvement after treatment with corticosteroids and antihistamines was observed. The diagnosis was established after the appearance of serpentine erythemas and improvement after albendazole therapy. Conclusions. In the case of returnees from exotic countries suffering from raised, pruritic rashes, and no improvement after treatment with corticosteroids and antihistamines, parasitic etiology should be considered.

  17. [83-year-old patient with salmonella bacteremia and infection-associated Sweet's syndrome].

    Science.gov (United States)

    Budniak, L; Schmiegel, W; Pox, C

    2013-01-01

    An 83 year-old man presented with watery diarrhea and a rash. He was hypotensive, febrile and dehydrated. The rash was maculopapular and most pronounced on the dorsal trunk. The lab tests showed an acute renal failure with hypokalemia and hyponatremia. Salmonella typhimurium was isolated from the aerobic blood culture, stool cultures were negative. The rash was consistent with an infection-associated Sweet's syndrome. THERAPY AND COURSE OF DISEASE: The patient was admitted and received iv fluids and potassium. An empiric antibiotic treatment with i. v. ciprofloxacin was started and changed to p. o. after 8 days. Antibiotic therapy was given 11 days total. After the administration of steroids the skin rash resolved. It is important to draw blood cultures in patients presenting with diarrhea if fever is present. Complications associated with non-typhoidal salmonella bacteremia occur most frequently in elderly patients and include pneumonia, infected aneurysms and bone/soft part infections. In rare cases patients can also present with a skin rash. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012

    Science.gov (United States)

    Albariño, César G.; Foltzer, Michael; Towner, Jonathan S.; Rowe, Lory A.; Campbell, Shelley; Jaramillo, Carlos M.; Bird, Brian H.; Reeder, DeeAnn M.; Vodzak, Megan E.; Rota, Paul; Metcalfe, Maureen G.; Spiropoulou, Christina F.; Knust, Barbara; Vincent, Joel P.; Frace, Michael A.; Nichol, Stuart T.; Rollin, Pierre E.

    2014-01-01

    In 2012, a female wildlife biologist experienced fever, malaise, headache, generalized myalgia and arthralgia, neck stiffness, and a sore throat shortly after returning to the United States from a 6-week field expedition to South Sudan and Uganda. She was hospitalized, after which a maculopapular rash developed and became confluent. When the patient was discharged from the hospital on day 14, arthralgia and myalgia had improved, oropharynx ulcerations had healed, the rash had resolved without desquamation, and blood counts and hepatic enzyme levels were returning to reference levels. After several known suspect pathogens were ruled out as the cause of her illness, deep sequencing and metagenomics analysis revealed a novel paramyxovirus related to rubula-like viruses isolated from fruit bats. PMID:24447466

  19. Delayed Stevens-Johnson Syndrome Secondary to the Use of Lamotrigine in Bipolar Mood Disorder.

    Science.gov (United States)

    Jha, Kunal Kishor; Chaudhary, Durgesh Prasad; Rijal, Tshristi; Dahal, Semanta

    2017-01-01

    Lamotrigine is a mood-stabilizing drug used in maintenance treatment of bipolar I disease. There are adverse effects with lamotrigine such as a headache, blurred vision, diplopia, somnolence, ataxia, dizziness, rash, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis. SJS is a life-threatening, blistering mucocutaneous disease. SJS is characterized by the presence of flat, diffuse erythematous maculopapular rashes with the involvement of <10% of the body surface area. Standard trigger is drugs including anticonvulsants, antibiotics, and Mycoplasma pneumoniae infection. We report a case where a patient developed SJS secondary to delayed-type hypersensitivity reaction after 6 months of the use of lamotrigine, while his initial response during the first 6 months did not show any sign of SJS.

  20. Epidermal Growth Factor Receptor Inhibitors: A Review of Cutaneous Adverse Events and Management

    Directory of Open Access Journals (Sweden)

    K. Chanprapaph

    2014-01-01

    Full Text Available Epidermal growth factor inhibitors (EGFRI, the first targeted cancer therapy, are currently an essential treatment for many advance-stage epithelial cancers. These agents have the superior ability to target cancers cells and better safety profile compared to conventional chemotherapies. However, cutaneous adverse events are common due to the interference of epidermal growth factor receptor (EGFR signaling in the skin. Cutaneous toxicities lead to poor compliance, drug cessation, and psychosocial discomfort. This paper summarizes the current knowledge concerning the presentation and management of skin toxicity from EGFRI. The common dermatologic adverse events are papulopustules and xerosis. Less common findings are paronychia, regulatory abnormalities of hair growth, maculopapular rash, mucositis, and postinflammatory hyperpigmentation. Radiation enhances EGFRI rash due to synergistic toxicity. There is a positive correlation between the occurrence and severity of cutaneous adverse effects and tumor response. To date, prophylactic systemic tetracycline and tetracycline class antibiotics have proven to be the most effective treatment regime.

  1. Rocky Mountain spotted fever in Panama: a cluster description.

    Science.gov (United States)

    Tribaldos, Maribel; Zaldivar, Yamitzel; Bermudez, Sergio; Samudio, Franklyn; Mendoza, Yaxelis; Martinez, Alexander A; Villalobos, Rodrigo; Eremeeva, Marina E; Paddock, Christopher D; Page, Kathleen; Smith, Rebecca E; Pascale, Juan Miguel

    2011-10-13

    Rocky Mountain spotted fever (RMSF) is a tick-borne infection caused by Rickettsia rickettsii. We report a cluster of fatal cases of RMSF in 2007 in Panama, involving a pregnant woman and two children from the same family.  The woman presented with a fever followed by respiratory distress, maculopapular rash, and an eschar at the site from which a tick had been removed.  She died four days after disease onset.  This is the second published report of an eschar in a patient confirmed by PCR to be infected with R. rickettsii.  One month later, the children presented within days of one another with fever and rash and died three and four days after disease onset. The diagnosis was confirmed by immunohistochemistry, PCR and sequencing of the genes of R. rickettsii in tissues obtained at autopsy. 

  2. Late adverse reactions to intravascular iodine based contrast media

    DEFF Research Database (Denmark)

    Bellin, Marie-France; Stacul, Fulvio; Webb, Judith A W

    2011-01-01

    DEFINITION: Late adverse reactions (LAR) to contrast media (CM) are defined as reactions occurring 1 h to 1 week after exposure. NEED FOR REVIEW: In view of more prospective studies of LAR and new data about their pathophysiology, the Contrast Medium Safety Committee (CMSC) of the European Society...... of Urogenital Radiology (ESUR) reviewed the literature on LAR and updated their guidelines. CLINICAL FEATURES AND PATHOLOGY: LAR after CM include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. Skin reactions are well-documented LAR to CM with an incidence...... of approximately 2%-4% after nonionic monomers. LAR are commoner by a factor of three to four after nonionic dimers. The commonest skin reactions are maculopapular rashes, erythema and skin swelling. These reactions are T cell-mediated immune reactions, and the diagnosis may be confirmed using skin tests (patch...

  3. Adult-onset Still's disease presenting as myopericarditis.

    Science.gov (United States)

    Gonzalez, Filipe André; Beirão, Pedro; Adrião, Joana; Coelho, Margarida Lopes

    2014-06-04

    A 24-year-old man presented to the emergency department with fever, maculopapular rash, myalgia and polyarthralgia, thoracic pain and dry cough, which had been present for 24 h. At the time of observation he had high fever (39°C), maculopapular rash on the torso, arms and legs proximally, axillary adenopathies and pharyngitis. Laboratorial data showed elevated inflammation markers (leukocytosis, C reactive protein of 44 mg/dL, erythrocyte sedimentation rate of 120 mm), elevated transaminases, lactate dehydrogenase, ferritin levels (>2000 ng/mL) and rising troponin. ECG had sinus rhythm and ST elevation in leads V1-V5. Thoracic radiography revealed bilateral interstitial infiltrate confirmed by CT scan. Echocardiographic findings included diffuse hypokinesia of the left ventricle and impaired systolic function. After the investigation of an infectious or autoimmune aetiology was negative, the diagnosis of adult-onset Still's disease was considered. The patient was put on a 60 mg/day prednisolone regimen with remission of symptoms and normalisation of systolic function and ECG. 2014 BMJ Publishing Group Ltd.

  4. Cutaneous adverse drug reactions: clinical pattern and causative agents--a 6 year series from Chandigarh, India.

    Directory of Open Access Journals (Sweden)

    Sharma V

    2001-04-01

    Full Text Available AIM: To study the different clinical spectrum of cutaneous adverse drug reactions (ADR and to determine the causative drugs. MATERIALS & METHODS: A prospective, hospital based study was carried out over a period of 6 years recording various cutaneous ADR. RESULTS: A total of 500 patients with cutaneous ADR were enrolled in the study. The most common types of cutaneous ADR patterns were maculopapular rash (34.6%, fixed drug eruption (FDE (30% and urticaria (14%. The drugs most often incriminated for the various cutaneous ADR were antimicrobials (42.6%, anticonvulsants (22.2% and NSAIDs (18%. Anticonvulsants were implicated in 41.6% of maculopapular rashes. Sulfonamides accounted for 43.3% and NSAIDs for 30.7% of FDE. Urticaria was caused mainly by NSAIDs(24.3% and penicillins(20%. Anticonvulsants were responsible for 43.8% of life-threatening toxic epidermal necrolysis and Stevens Johnson syndrome. CONCLUSIONS: The clinical pattern and drugs causing cutaneous ADR are similar to those observed in other countries except for minor variations. Cutaneous ADR patterns and the drugs causing various reactions are changing every year, which may be due to the emergence of newer molecules and changing trends in the use of drugs.

  5. [Histopathology of cutaneous drug reactions].

    Science.gov (United States)

    Ortonne, Nicolas

    2018-02-01

    There are many different types of cutaneous adverse reactions. The most classical reactions are driven by T lymphocytes that specifically react towards a drug, with an individual genetic susceptibility linked to certain type I major histocompatibility complex alleles. These reactions are characterized by a wide variety of clinical and histopathological presentations, and a wide range of severity. The most frequent entity is the maculopapular rash, while the most aggressive forms are the Steven-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN). The histopathological alterations associated to each of these syndromes have been better described in the literature during the past 10 years, encompassing non-specific lesions, as in most drug induced maculopapular rashes, to more specific inflammatory patterns. The finding of confluent apoptotic keratinocytes with epidermal detachment is the prototypical aspect of SJS-TEN. There are however numerous pitfalls, and a similar aspect to those observed in each cutaneous drug reactions entities can be found in other diseases. DRESS syndrome can indeed present with dense and epidermotropic T-cell infiltrate, sometimes with nuclear atypias, and thus can be difficult to distinguish from a primary or secondary cutaneous T-cell lymphoma. The diagnosis of cutaneous adverse reactions relies on a clinical-pathological confrontation and requires an accurate evaluation of drug imputability. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. Allergic contact dermatitis induced by zinc pyrithione in shampoo: a case report

    Directory of Open Access Journals (Sweden)

    Chih-Wei Hsieh

    2010-12-01

    Full Text Available Shampoo-induced allergic contact dermatitis is difficult to diagnose clinically because it can involve multiple and variable areas where the shampoo flows. Zinc pyrithione is a common active agent in medicated shampoo that is known to have good anti-dandruff and antifungal effects. Despite its low risk of sensitization, cases of allergic contact dermatitis still occur because of the popularity of such products. We report a 33-year-old man who developed pruritic rash on his scalp, face, neck, and hands after using a new shampoo containing zinc pyrithione. A patch test revealed a positive reaction to zinc pyrithione and personal shampoo containing zinc pyrithione.

  7. Skin manifestations of a case of phenylbutazone-induced serum sickness-like reactions.

    Science.gov (United States)

    Sánchez, G; Vila, L; Pajarón, M; Diéguez, I

    2000-01-01

    Serum sickness consists of a systemic reaction resulting from the formation of soluble circulating immunocomplexes after the introduction of a foreign substance into the body We studied a 38-year-old woman diagnosed with anxiety, depression and right sacroileitis who was treated with phenylbutazone, ranitidine, clomipramine and levomepromazine. After taking this treatment for 1 month, she presented with fever, diarrhea, localized edemas, generalized pruritic papular and erythematous rash and lymphadenopathies. She presented the same symptoms after oral intake of metamizole. The diagnosis was confirmed following a single-blind, placebo-controlled provocation test with phenylbutazone and a biopsy of the affected skin.

  8. Normocomplementaemic Urticarial Vasculitis in a 19-Month-Old Girl

    Science.gov (United States)

    2016-01-01

    Urticaria is common in children. Urticarial vasculitis (UV) is a potentially more serious, rare variant. The youngest reported case was 12 months of age. A systemically well, 19-month-old girl presented with her mother who was concerned about the development of a rash. On presentation, the child had normal vital signs, was alert, and was well and playing with toys. There was a widespread urticarial rash (raised, pruritic, and erythematous) that was most apparent on the trunk with minimal rash on the legs. Overlying this urticarial rash in a similar distribution was a blotchy, palpable purpuric rash and associated hyperpigmentation. Investigations revealed a normal level of haemoglobin, white cells, platelets, and electrolytes. Renal function, international normalised ratio, and activated partial thromboplastin time were all normal. There was no blood or protein in the urine. The erythrocyte sedimentation rate was mildly elevated at 19 mm/hour. Complement results (including C1q) obtained later were normal. This case is striking not only because of the rarity of UV in children but also due to the unique diagnostic and prognostic challenges that it raises. PMID:27818822

  9. Normocomplementaemic Urticarial Vasculitis in a 19-Month-Old Girl

    Directory of Open Access Journals (Sweden)

    Peter Williams

    2016-01-01

    Full Text Available Urticaria is common in children. Urticarial vasculitis (UV is a potentially more serious, rare variant. The youngest reported case was 12 months of age. A systemically well, 19-month-old girl presented with her mother who was concerned about the development of a rash. On presentation, the child had normal vital signs, was alert, and was well and playing with toys. There was a widespread urticarial rash (raised, pruritic, and erythematous that was most apparent on the trunk with minimal rash on the legs. Overlying this urticarial rash in a similar distribution was a blotchy, palpable purpuric rash and associated hyperpigmentation. Investigations revealed a normal level of haemoglobin, white cells, platelets, and electrolytes. Renal function, international normalised ratio, and activated partial thromboplastin time were all normal. There was no blood or protein in the urine. The erythrocyte sedimentation rate was mildly elevated at 19 mm/hour. Complement results (including C1q obtained later were normal. This case is striking not only because of the rarity of UV in children but also due to the unique diagnostic and prognostic challenges that it raises.

  10. Therapeutic Effects of Korean Red Ginseng Extract in a Murine Model of Atopic Dermatitis: Anti-pruritic and Anti-inflammatory Mechanism.

    Science.gov (United States)

    Lee, Hyun Joo; Cho, Sang Hyun

    2017-04-01

    Korean red ginseng (KRG) and ginsenosides exhibit diverse biological effects, including anti-inflammatory and anti-allergic. We aimed to investigate the therapeutic effect of KRG in a murine model of atopic dermatitis (AD) is mediated whether by diminishing the pruritus or by suppressing the inflammation. Thirty NC/Nga mice were randomly divided to 5 groups. AD-like skin lesions were induced by percutaneous challenge with 2,4,6-trinitro-1-chrolobenzene (TNCB) on the ears and backs of NC/Nga mice. KRG extract, evening primrose oil, cyclosporine, and phosphate-buffered saline were administered orally by a gastric tube. Each study group was also divided into scratching-permitted and scratching-restricted subgroups to evaluate the impact of scratching behavior on AD. The effects of KRG and the other agents were assessed by measuring the clinical severity score, ear thickness, extent of transepidermal water loss (TEWL), number of scratching movements, total systemic immunoglobulin E (IgE) and interleukin (IL)-31 levels, histologic changes of cutaneous lesions, and mRNA expression levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, thymic stromal lymphopoietin (TSLP), and IL-31. KRG exerts therapeutic effects against AD by inhibiting the T helper 2 (Th2) mediated inflammation as well as by diminishing the itching sensation. Moreover, restricting scratching behavior suppresses the vicious cycle of itching and scratching, thus reducing clinical and systemic inflammation in our murine model of AD. © 2017 The Korean Academy of Medical Sciences.

  11. Red man syndrome caused by vancomycin powder.

    Science.gov (United States)

    Nagahama, Yasunori; VanBeek, Marta J; Greenlee, Jeremy D W

    2018-02-01

    Red man syndrome (RMS) is a well-known hypersensitivity reaction caused by intravenous administration of vancomycin, with symptoms ranging from flushing, erythematous rash, pruritus, mild to profound hypotension, and even cardiac arrest. RMS has not previously been described from local application of vancomycin powder in a surgical wound, a technique increasingly utilized for infection prophylaxis in many surgical disciplines including neurosurgery. We describe the first reported case of RMS as a result of local intra-wound application of vancomycin powder for infection prophylaxis. A 73-year-old male with a history of Parkinson's disease underwent 2-stage deep brain stimulation implantation surgeries. Vancomycin powder was applied locally in the surgical wounds for infection prophylaxis during both of the surgeries. The patient developed a well-demarcated, geometric erythematous pruritic rash following the second surgery that was clinically diagnosed as RMS and resolved without sequelae. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. A case of localized adrenergic urticaria mimicking an allergic reaction to a sweat chloride test.

    Science.gov (United States)

    Klebanova, Y; LeGrys, V; Cooper, D; Levy, D; Santora, D; Schwindt, C

    2009-09-01

    Adrenergic urticaria (AU) is a rare type of physical urticaria triggered by stress. It is frequently confused with IgE-mediated urticaria or other physical urticarias. This report describes a case of localized adrenergic urticaria triggered by a sweat chloride test in an adolescent male with multiple atopic disorders. A pruritic papular rash at the site of a sweat chloride test prompted an evaluation for allergic and physical urticarias using multiple skin test methods. A positive intradermal skin test to noradrenaline, which reproduced the rash observed during the sweat test, lead to the diagnosis of adrenergic urticaria. This is the first case report describing an immediate adrenergic urticarial reaction to sweat chloride testing in a patient with other atopic disorders. Copyright 2009 Wiley-Liss, Inc.

  13. Perinatal Chicken Pox (Varicella Zoster Virus Infection

    Directory of Open Access Journals (Sweden)

    Ali Annagur

    2013-04-01

    Full Text Available Chickenpox is due to infection with the varicella zoster virus (VZV, a human alphaherpervirus found worldwide. Classically, the cinical disease is a febrile illness with a pruritic vesicular rash. Maternal chickenpox between 5 days before delivery to 2 days after delivery (perinatal varicella can cause severe and even fatal illness in the newborn. A 7-day old girl baby presented on day 4 of postnatal with the complaints of widespread vesicular rash and non-suckling. Mother of the baby also had a similar eruption four day prior to delivery, which was clinically characteristic of varicella. Considering history and clinical presentation, a diagnosis of perinatal chickenpox was considered and the baby was treated with acyclovir which she responded and recovered. Herein, the clinical feasures and treatment of chickenpox infection in the perinatal period have been emphasized with this case report. [Cukurova Med J 2013; 38(2.000: 311-314

  14. Drug eruptions: An 8-year study including 106 inpatients at a dermatology clinic in Turkey

    Directory of Open Access Journals (Sweden)

    Fatma Akpinar

    2012-01-01

    Full Text Available Background: Few clinical studies are found in the literature about patients hospitalized with a diagnosis of cutaneous drug eruption. Aims: To determine the clinical types of drug eruptions and their causative agents in a hospital-based population. Materials and Methods: This retrospective study was performed in the Dermatology Department of Haseki General Hospital. Through 1751 patients hospitalized in this department between 2002 and 2009, inpatients diagnosed as drug eruption were evaluated according to WHO causality definitions. 106 patients composed of probable and possible cases of cutaneous drug eruptions were included in this study. Results: Seventy one females and 35 males were evolved. Mean age was 44.03±15.14. Duration between drug intake and onset of reaction varied from 5 minutes to 3 months. The most common clinical type was urticaria and/or angioedema in 48.1% of the patients, followed by maculopapular rash in 13.2%, and drug rash with eosinophilia and systemic symptoms in 8.5%. Drugs most frequently associated with cutaneous drug eruptions were antimicrobial agents in 40.5% of the patients, followed by antipyretic/anti-inflammatory analgesics in 31.1%, and antiepileptics in 11.3%. Conclusion: Urticaria and/or angioedema and maculopapular rash comprised majority of the drug eruptions. Rare reactions such as acute generalized exanthematous pustulosis, sweet syndrome, oral ulceration were also found. Antimicrobial agents and antipyretic/anti-inflammatory analgesics were the most commonly implicated drugs. Infrequently reported adverse reactions to myorelaxant agents, newer cephalosporins and fluoroquinolones were also detected. We suppose that studies on drug eruptions should continue, because the pattern of consumption of drugs is changing in every country at different periods and many new drugs are introduced on the market continuously.

  15. Clinical features and seasonality of parechovirus infection in an Asian subtropical city, Hong Kong.

    Directory of Open Access Journals (Sweden)

    Grace P K Chiang

    Full Text Available The epidemiology of human parechovirus (HPeV in Asia remains obscure. We elucidated the prevalence, seasonality, type distribution and clinical presentation of HPeV among children in Hong Kong.A 24-month prospective study to detect HPeV in children ≤36 months hospitalized for acute viral illnesses.2.3% of the 3911 children examined had HPeV infection, with most (87.5% concentrated in September-January (autumn-winter. 81.3% were HPeV1 and 12.5% were HPeV4, while HPeV3 was rare (2.5%. HPeV was a probable cause of the disease in 47.7% (42/88, mostly self-limiting including acute gastroenteritis, upper respiratory tract infection and maculopapular rash. A neonate developed severe sepsis-like illness with HPeV3 as the only pathogen detected. A high proportion (60.0% of children coinfected with HPeV and other respiratory virus(es had acute bronchiolitis or pneumonia. Six children with HPeV coinfections developed convulsion / pallid attack. Most rash illnesses exhibited a generalized maculopapular pattern involving the trunk and limbs, and were more likely associated with HPeV4 compared to other syndrome groups (36.4% vs. 3.1%, p = 0.011.In Hong Kong, HPeV exhibits a clear seasonality (autumn-winter and was found in a small proportion (2.3% of young children (≤36 months admitted with features of acute viral illnesses. The clinical presentation ranged from mild gastroenteritis, upper respiratory tract infection and febrile rash to convulsion and severe sepsis-like illness. HPeV3, which is reported to associate with more severe disease in neonates, is rare in Hong Kong. HPeV coinfection might associate with convulsion and aggravate other respiratory tract infections.

  16. A double blind, placebo controlled trial of efficacy and safety of oral acyclovir (Zovirax) in the treatment of chickenpox in adults.

    Science.gov (United States)

    Andreoni, M; Canfarini, M; Grint, P C; Martorelli, M; Di Luzio Paparatti, U; Rocchi, G

    1992-02-01

    A double-blind placebo controlled trial of oral acyclovir in otherwise healthy immune competent young adults with chickenpox was conducted. One hundred males were recruited into the trial, fifty were randomised to receive acyclovir at a dose of 800 mg five times daily for 5 days and fifty to receive matching placebo. Acyclovir recipients experienced itching and required anti-pruritic therapy for a significantly shorter period of time (p less than 0.05); no significant effects of acyclovir therapy on overall rash progression were observed. In patients with a mild rash on entry the maximum daily temperature recorded was significantly lower in the acyclovir group as compared with placebo recipients on day 1 of therapy (p less than 0.01). Acyclovir was extremely well tolerated and no adverse events were reported. Studies with early oral acyclovir therapy in otherwise healthy children with chickenpox has demonstrated significant benefits, particularly in rash progression. It is postulated that the partial benefits shown in this study in adults reflect the high proportion of patients with mild disease and enrollment of the majority of patients more than 24 hours after the rash onset.

  17. Contact urticaria caused by the Apple Watch – A case report

    Directory of Open Access Journals (Sweden)

    Spencer D. Hawkins

    2017-07-01

    Full Text Available Smart watches are an upcoming trend that provide quick access to smartphone notifications on the wearer’s wrist. Metal portions of the Apple Watch contain small amounts of nickel, however, the interchangeable bands can be made of a variety of different materials including methacrylate polymers and fluoroelastomer synthetic rubber. There are multiple reports in non-peer reviewed literature such as social media and blogs of the Apple Watch causing skin irritation. Here we present a case report of a patient presenting to Wake Forest Baptist Dermatology clinic with a skin rash following use of an Apple Watch with a synthetic rubber watch band. The patient presented with a pruritic erythematous rash distributed in a 2 cm band on the medial flexor aspect of the left wrist that developed after weeks of daily use of an Apple Watch. The presence of a rash focally under the band suggest contact urticaria, irritant contact dermatitis secondary to sweat and friction, or an allergic contact dermatitis process related to the metal of the watch or synthetic rubber of the band. The patient’s report that the rash resolves within hours of removal supports contact urticaria over a contact dermatitis process.

  18. Skin rashes and stomatitis due to parenteral treatment of rheumatoid arthritis with sodium aurothiomalate.

    Science.gov (United States)

    Svensson, A; Theander, J

    1992-03-01

    In a prospective study of 45 patients with rheumatoid arthritis mucocutaneous symptoms and signs were evaluated before and during treatment with intramuscular sodium aurothiomalate (Myocrisin). The work, performed in close collaboration between dermatology and rheumatology departments, showed that there was no significant increase in mucocutaneous side effects in patients with pre-existing mucocutaneous disease. It is concluded that pre-existing dermatitis is not a contraindication for treatment with gold salts and that a previous mucocutaneous reaction to gold salts is not an absolute contraindication for a new trial of chrysotherapy.

  19. Skin rashes and stomatitis due to parenteral treatment of rheumatoid arthritis with sodium aurothiomalate.

    OpenAIRE

    Svensson, A; Theander, J

    1992-01-01

    In a prospective study of 45 patients with rheumatoid arthritis mucocutaneous symptoms and signs were evaluated before and during treatment with intramuscular sodium aurothiomalate (Myocrisin). The work, performed in close collaboration between dermatology and rheumatology departments, showed that there was no significant increase in mucocutaneous side effects in patients with pre-existing mucocutaneous disease. It is concluded that pre-existing dermatitis is not a contraindication for treatm...

  20. Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash

    Directory of Open Access Journals (Sweden)

    Guilherme Almeida Rosa da Silva

    2014-01-01

    Full Text Available Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfly of the genus Lutzomyia. There are three main clinical forms of leishmaniasis: visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. The wide spectrum of nonvisceral forms includes: localized cutaneous leishmaniasis, a papular lesion that progresses to ulceration with granular base and a large framed board; diffuse cutaneous leishmaniasis; mucocutaneous leishmaniasis, which can cause disfiguring and mutilating injuries of the nasal cavity, pharynx, and larynx. Leishmaniasis/HIV coinfection is considered an emerging problem in several countries, including Brazil, where, despite the growing number of cases, a problem of late diagnosis occurs. Clinically, the cases of leishmaniasis associated with HIV infection may demonstrate unusual aspects, such as extensive and destructive lesions. This study aims to report a case of mucocutaneous leishmaniasis/HIV coinfection with atypical presentation of diffuse desquamative eruption and nasopharyngeal involvement.

  1. Itch and skin rash from chocolate during fluoxetine and sertraline treatment: Case report

    OpenAIRE

    Svenson Svante; Knight Stefan; Cederberg Jonas; Melhus Håkan

    2004-01-01

    Abstract Background The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause pruritus when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects. Case presentation A 46-year-old man consulted his doctor due to symptoms of depression. He did not suffer from any allergy but drinking red wine caused vasomotor rhinitis. Antidepressive treatment with fluoxetine 20 mg daily...

  2. The “phantom” rash of Still's disease | Koufakis | Pan African Medical ...

    African Journals Online (AJOL)

    Pan African Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 22, No 1 (2015) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your ...

  3. A Woman with Unilateral Rash and Fever: Cellulitis in the Setting of Lymphedema

    Directory of Open Access Journals (Sweden)

    Melissa Joseph

    2015-01-01

    Full Text Available Cellulitis in the setting of lymphedema is an uncommon but clinically important presentation to the emergency department. Stagnant lymph is an ideal medium for bacterial growth and progression can be rapid due to decreased ability to fight infection in the affected area. Infections are commonly caused by gram-positive cocci, though blood cultures are often negative. Treatment should be aimed at rapid initiation of antibiotics targeting these species. There may be a role for antibiotic prophylaxis in recurrent cases.

  4. Simian varicella virus infection of Chinese rhesus macaques produces ganglionic infection in the absence of rash

    NARCIS (Netherlands)

    W.J.D. Ouwendijk (Werner ); R. Mahalingam (Ravi); V. Traina-Dorge (Vicki); G. van Amerongen (Geert); M. Wellish (Mary); A.D.M.E. Osterhaus (Albert); D. Gilden (Don); G.M.G.M. Verjans (George)

    2012-01-01

    textabstractVaricella-zoster virus (VZV) causes varicella (chickenpox), becomes latent in ganglia along the entire neuraxis, and may reactivate to cause herpes zoster (shingles). VZV may infect ganglia via retrograde axonal transport from infected skin or through hematogenous spread. Simian

  5. Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash.

    Science.gov (United States)

    da Silva, Guilherme Almeida Rosa; Sugui, Daniel; Nunes, Rafael Fernandes; de Azevedo, Karime; de Azevedo, Marcelo; Marques, Alexandre; Martins, Carlos; Ferry, Fernando Raphael de Almeida

    2014-01-01

    Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfly of the genus Lutzomyia. There are three main clinical forms of leishmaniasis: visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. The wide spectrum of nonvisceral forms includes: localized cutaneous leishmaniasis, a papular lesion that progresses to ulceration with granular base and a large framed board; diffuse cutaneous leishmaniasis; mucocutaneous leishmaniasis, which can cause disfiguring and mutilating injuries of the nasal cavity, pharynx, and larynx. Leishmaniasis/HIV coinfection is considered an emerging problem in several countries, including Brazil, where, despite the growing number of cases, a problem of late diagnosis occurs. Clinically, the cases of leishmaniasis associated with HIV infection may demonstrate unusual aspects, such as extensive and destructive lesions. This study aims to report a case of mucocutaneous leishmaniasis/HIV coinfection with atypical presentation of diffuse desquamative eruption and nasopharyngeal involvement.

  6. Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash

    OpenAIRE

    Guilherme Almeida Rosa da Silva; Daniel Sugui; Rafael Fernandes Nunes; Karime de Azevedo; Marcelo de Azevedo; Alexandre Marques; Carlos Martins; Fernando Raphael de Almeida Ferry

    2014-01-01

    Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfl...

  7. October 2014 critical care case of the month: a skin rash in the ICU

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2014-10-01

    Full Text Available No abstract available. Abstract truncated after first page. History of Present Illness: A 28 year old man was admitted to an outside hospital with an ethylene glycol overdose in an apparent suicide attempt. At that time the patient was delirious and vomiting. He had a severe metabolic acidosis and a creatinine of 2.1 mg/dL. He was intubated, a nasogastric tube was placed, and he was transferred to the toxicology service. PMH, FH, SH: There was no significant past medical history. Family history was noncontributory. He was a nonsmoker who recently had a fight with his girlfriend prompting the suicide attempt. Physical Examination: Vital signs were stable and he was sedated and nasally intubated receiving mechanical ventilation. There were no other significant findings on physical examination. Which of the following can be used for ethylene glycol poisoning? 1. Ethanol; 2. Fomezipole; 3. Hemodialysis; 4. Pyridoxine; 5. All of the above ...

  8. A Teenager With Sacroileitis, Rash and Fever Caused by Streptobacillus moniliformis Bacteremia.

    Science.gov (United States)

    Gill, Navneet K; Craft, David; Crook, Tonya; Dossett, John

    2016-12-01

    We report a rare case of sacroileitis in a teenager resulting from Streptobacillus moniliformis bacteremia, identified by matrix-assisted laser desorption/ionization-time of flight. We discuss the challenges of making this diagnosis and review the literature on rat bite fever.

  9. May 2015 pulmonary case of the month: pneumonia with a rash

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    Robbins RA

    2015-05-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 77-year-old man underwent a thoracic CT scan for follow up of a known thoracic aneurysm. However, he had been feeling tired for about a week with a cough, night sweats and fever. He had no shortness of breath, wheezing or known history of lung disease. Past Medical History, Social History and Family History: He has a history of hypertension and a known thoracic aortic aneurysm. There was a surgical repair of his right clavicle after a motor vehicle accident. He is single and has lived in Arizona for over 50 years. He just returned from a trip to California where he visited Disneyland. He does not smoke. Family history is noncontributory. Current Medications: dutasteride, levothyroxine, atorvastatin. Physical Examination: His physical examination was reported as unremarkable. SpO2 was 95% on room air. Which of the following is appropriate at this time? 1. Begin empiric antibiotics; 2. ...

  10. Chikungunya: acute fever, rash and debilitating arthralgias in a returning traveler from Haiti.

    Science.gov (United States)

    Anderson, Kathryn B; Pureza, Vincent; Walker, Patricia F

    2014-01-01

    The following case report details a case of chikungunya fever in a returning traveler from Haiti. The report highlights the clinical presentation and natural history of the disease, and emphasizes that chikungunya has become established in the western hemisphere, with a resultant need for heightened provider awareness. © 2014 International Society of Travel Medicine.

  11. Congenital Cutaneous Candidiasis: Prompt Systemic Treatment Is Associated With Improved Outcomes in Neonates.

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    Kaufman, David A; Coggins, Sarah A; Zanelli, Santina A; Weitkamp, Jörn-Hendrik

    2017-05-15

    Congenital cutaneous candidiasis (CCC) is a challenging diagnosis due to various rash presentations. Inadequate early treatment is associated with high rates of dissemination and death. The effects of early diagnosis, dermatologic presentation, and antifungal treatment on outcomes are lacking. CCC cases were reviewed from 2 academic neonatal intensive care units (NICUs) from 2004 to 2015. We defined CCC as a diffuse rash involving the body, extremities, face or scalp, and/or funisitis, presenting in the first week (≤7 days), with identification of Candida species from skin or mucous membrane cultures, and/or by culture or staining of the placenta or umbilical cord. CCC occurred in 0.1% of all NICU admissions (21 of 19 303) and 0.6% of infants <1000 grams birth weight. Median gestational age of CCC infants was 26 3/7 (range, 23 0/7-40 4/7) weeks. Skin findings were commonly present on the day of birth [median (range): 0 (0-6) days], appearing most frequently as a desquamating, maculopapular, papulopustular, and/or erythematous diffuse rash. When systemic antifungal therapy was started empirically at the time of rash presentation and continued for a median (interquartile range) of 14 (14-15) days, all patients survived and none developed dissemination. Delaying systemic treatment, exclusive use of nystatin, and treating for <10 days was associated with Candida bloodstream dissemination. CCC is an invasive infection that presents as a diffuse rash in preterm and term infants. Prompt systemic antifungal treatment at the time of skin presentation for ≥14 days prevents dissemination and Candida-related mortality.

  12. Syphilis gastritis: a case report.

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    Lai, Kuan; Pinto-Sander, Nicolas; Richardson, Daniel; Wei, Shanshan; Zeng, Kang

    2017-01-01

    Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.

  13. Congenital syphilis presenting as Jarisch-Herxheimer reaction at birth.

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    Hori, Hideyuki; Sato, Yoshitake; Shitara, Tosiji

    2015-04-01

    We report a rare case of congenital syphilis (CS) presenting as Jarisch-Herxheimer reaction (JHR) at birth. The mother (primigravida) presented in labor and had not received antenatal care. She was given prophylactic ampicillin 2 g i.v. on admission and delivered shortly thereafter. The male infant (2899 g) had normal vital signs, conjunctival congestion, splenohepatomegaly, and maculopapular rash with small blisters over the entire body. Serological tests on the infant and mother confirmed CS. The infant was given i.v. ampicillin for 14 days (50 mg/kg per day until day 3, 100 mg/kg per day thereafter). One hour after the first injection, the infant developed fever (39°C), tachycardia and tachypnea without worsening of rash. Vital signs improved gradually. The rash reduced markedly at postnatal day 1, and disappeared without pigmentation at day 3. This was considered a JHR following ampicillin injection given to the mother before delivery and to the infant after birth. © 2015 Japan Pediatric Society.

  14. The Immune Response in Measles: Virus Control, Clearance and Protective Immunity.

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    Griffin, Diane E

    2016-10-12

    Measles is an acute systemic viral infection with immune system interactions that play essential roles in multiple stages of infection and disease. Measles virus (MeV) infection does not induce type 1 interferons, but leads to production of cytokines and chemokines associated with nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) signaling and activation of the NACHT, LRR and PYD domains-containing protein (NLRP3) inflammasome. This restricted response allows extensive virus replication and spread during a clinically silent latent period of 10-14 days. The first appearance of the disease is a 2-3 day prodrome of fever, runny nose, cough, and conjunctivitis that is followed by a characteristic maculopapular rash that spreads from the face and trunk to the extremities. The rash is a manifestation of the MeV-specific type 1 CD4⁺ and CD8⁺ T cell adaptive immune response with lymphocyte infiltration into tissue sites of MeV replication and coincides with clearance of infectious virus. However, clearance of viral RNA from blood and tissues occurs over weeks to months after resolution of the rash and is associated with a period of immunosuppression. However, during viral RNA clearance, MeV-specific antibody also matures in type and avidity and T cell functions evolve from type 1 to type 2 and 17 responses that promote B cell development. Recovery is associated with sustained levels of neutralizing antibody and life-long protective immunity.

  15. Cutaneous manifestations of adult-onset Still's disease: a case report and review of literature.

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    Cozzi, Alessandra; Papagrigoraki, Anastasia; Biasi, Domenico; Colato, Chiara; Girolomoni, Giampiero

    2016-05-01

    Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology and pathogenesis characterized by high spiking fever, arthralgia or arthritis, sore throat, lymphadenopathy, hepatosplenomegaly, serositis, and transient cutaneous manifestations. Although more common in children, cases are seen also in adults. Cutaneous involvement is common and may be suggestive for the diagnosis. A case of AOSD in a 35-year-old man is reported here, presenting with urticarial maculopapular rash of trunk, high spiking fever, acute respiratory distress syndrome, and myopericarditis. Skin biopsy showed interstitial and perivascular mature CD15(+) neutrophils. A comprehensive review of literature showed that cutaneous involvement occurs in about 80 % of patients, with various clinical presentations. The most common skin manifestation is an evanescent salmon pink or erythematous maculopapular exanthema, predominantly on the trunk and proximal limbs, with rare involvement of face and distal limbs. Less common manifestations include persistent erythematous plaques and pustular lesions. A constant histopathologic finding is the presence of interstitial dermal neutrophils aligned between the collagen bundles. This pattern may provide an easy accessible clue for the definitive diagnosis of AOSD and exclude other diagnosis such as drug eruptions or infectious diseases.

  16. A neonate with hand, foot, and mouth disease complicated with brainstem encephalitis and pulmonary edema:A complete recovery.

    Science.gov (United States)

    Guo, Shi-Jie; Wang, Dong-Xuan; Dai, Chun-Lai; Wu, Hui

    2014-07-01

    Hand, foot, and mouth disease (HFMD) with serious complications and fatal cases have been reported over the last decade worldwide. The authors report a rare case of HFMD in a neonate complicated with brainstem encephalitis and pulmonary edema. She had fever, lethargy, dyspnea. Physical examination revealed shock signs, fine rales on both lungs, absent Moro reflex. The patient had a rapidly progressive course with seizures, coma, no spontaneous breathing, chemosis. There were some vesicles on left sole and red maculopapular rashes on perianal skin. She had a history of exposure to HFMD. Fecal sample was positive for EV71 RNA by real-time PCR. Chest X-rays showed bilateral pulmonary infiltrates. MRI of the brain showed significant hypointensity in the brainstem on T1WI and hyperintensity on T2WI. She recovered well. This case highlights severe HFMD in neonates is rare. Medical history and physical examination are important in making diagnosis.

  17. A Case of Allopurinol Induced Dress Syndrome

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    İjlal Erturan

    2013-06-01

    Full Text Available Allopurinol induced DRESS syndrome is a life threatening serious drug reaction characterized by eosinophilia and systemic symptoms. We report here a case of a 65-year-old woman who developed maculopapular rash and systemic symptoms after two weeks treatment with allopurinol and was diagnosed as DRESS syndrome. The patient responded to administration of methylprednisolone with complete resolution of symptoms and improvement of laboratory abnormalities. According to the information obtained from the literature, metabolite excretion of allopurinol has slowed down in patients with advanced age and impaired renal functions. This is an important case in terms of caution against toxic drug reaction due to allopurinol treatment in elderly patients with renal dysfunction.

  18. Ofloxacin Induced Cutaneous Reactions in Children.

    Science.gov (United States)

    Ramani, Yerramalli Roja; Mishra, Sailen Kumar; Rath, Bandana; Rath, Saroj Sekhar

    2015-06-01

    Cutaneous adverse effects to antimicrobials are a major health problem. Though majority of them are mild and self-limiting, severe variants like Steven Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) are not uncommon. Ofloxacin, a fluoroquinolone widely used for the treatment of urinary tract infections, acute bacterial diarrheas, enteric fever, STDs and other soft tissue infections either as a single drug or in combination with other drugs. Earlier a case of mucocutaneous maculopapular rash with oral ofloxacin and was reported in an adult. In the present hospital set up there were few reports of such reactions to adults. Here we report three different variants of reactions associated with oral ofloxacin in chlidren. Early detection of cutaneous lesions and immediate withdrawal of the offending drug can prevent progression of such reactions to their severe variants as well as morbidity and mortality.

  19. Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap.

    Science.gov (United States)

    Khawaja, Ali; Shahab, Ahmed; Hussain, Syed Ather

    2012-05-01

    Steven Johnson Syndrome and Toxic Epidermal Necrolysis are rare but severe form of hypersensitivity inflammatory reactions to multiple offending agents including drugs. Acetaminophen is extensively used due to its analgesic and anti-pyretic properties. It is rendered to be relatively safe, with hepatotoxicity considered to be the major adverse effect. However, very few cases of Steven Johnson Syndrome and Toxic Epidermal Necrolysis have been reported with acetaminophen usage in the past. We present the case of a 40 years old lady who developed an overlap of the two condition after taking several doses of acetaminophen for fever. She presented with widespread maculopapular rash, stinging in the eyes, oral mucosal ulcerations and high grade fever. She was successfully treated with corticosteroid therapy along with the supportive treatment. This case addresses the fact, that severe hypersensitivity reactions can occur with acetaminophen which can be potentially life threatening.

  20. OUTBREAK OF ZIKA VIRUS DISEASE AND ITS COMPLICATIONS

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    Gabriela S. Tsankova

    2016-07-01

    Full Text Available Zika virus (ZIKV is an arbovirus from Flaviviridae family, genus Flavivirus. Like most of the viruses which belong to the Flavivirus genus, it replicates in and is transmitted by mosquitoes. Unlike other arbovirus infections including dengue and chikungunya, Zika virus causes a relatively mild disease. The most common symptoms of ZIKV are mild fever, arthralgia, myalgia, headache, asthenia, abdominal pain, oedema, lymphadenopathy, retro-orbital pain, conjunctivitis, and cutaneous maculopapular rash, which last for several days to a week. Although 80% of the cases with ZIKV are asymptomatic, severe complications such as microcephalia and GBS may be observed. This explains why ZIKV is more dangerous that it was thought to be and why it rapidly evolves in unexpected challenge for the international and national public health authorities.

  1. Neurological manifestations of Chikungunya and Zika infections

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    Talys J. Pinheiro

    Full Text Available ABSTRACT The epidemics of Chikungunya virus (CHIKV and Zika virus (ZIKV infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular, fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis. The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

  2. Deferasirox-induced urticarial vasculitis in a patient with myelodysplastic syndrome.

    Science.gov (United States)

    Polat, Asude Kara; Belli, Asli Akin; Karakus, Volkan; Dere, Yelda

    2017-01-01

    Deferasirox is an iron chelator agent used in the treatment of diseases with iron overload, such as thalassemia and myelodysplastic syndrome. Although the majority of adverse reactions of deferasirox involve gastrointestinal symptoms and increase in serum creatinine and transaminases, skin rashes, such as maculopapular and urticarial eruptions, have also been reported. This study reports a case of myelodysplastic syndrome with urticarial vasculitis due to deferasirox therapy. Drug eruption was been confirmed by means of a challenge test, together with histopathological and clinical findings. To the best of our knowledge, we report the first case of deferasirox-induced urticarial vasculitis. Physicians should be aware of the possibility of urticarial vasculitis on deferasirox therapy and the fact that the discontinuation of the drug generally results in improvement.

  3. Acute Generalized Exanthematous Pustulosis (AGEP Induced by Cetirizine in a Child A Case Report

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    Gunseli Pancar

    2014-12-01

    Full Text Available Acute Generalized Exanthematous Pustulosis (AGEP, is a rare cutaneous rash characterized by widespread sterile non-follicular pustules. AGEP is a rare disease in childhood and it is often due to drugs. Antibiotics, sulphanamides and antipyretic-analgesics are the main reasons of this drug reaction . Cetirizine is a second generation antihistamine is often used in the treatment of angioedema, atopic dermatitis and urticaria in children. Cetirizine induced AGEP was not reported in the literature. In this case a twelve year old child was admitted with urticarial plaques located on her trunk. She developed maculopapular lesions and pustular eruption with Cetirizine (once a day treatment. Cetirizine was stopped and the nonfollicular pustules cleared with a desquamation. The result of the oral challenge test was positive. We present this rare case to show that the antihistamines (cetirizine may cause AGEP in childhood.

  4. [Zika virus - ancient virus gets new life in a new ecosystem. Microcephaly and Guillain-Barre syndrome are possible consequences when there is no background herd immunity in the population].

    Science.gov (United States)

    Olsen, Björn; Lundkvist, Åke

    2016-03-10

    Zika virus is a mosquito-borne flavivirus transmitted by Aedes mosquitos. The virus was discovered in 1947 in the Zika forest in Uganda. Symptomatic disease is usually mild and is characterized by maculopapular rash, headache, fever, arthralgia and conjunctivitis. Fatalities are rare. There is neither vaccine nor curative treatment available. In May 2015, the first observation of local virus transmission was reported from Brazil. During the expanding outbreak in the Americas, Zika virus infection has been associated with microcephaly in newborn and fetal losses in women infected with Zika virus during pregnancy. The main reason for the current epidemic in the Americas is the introduction of an Old World virus into a new ecosystem, with no background herd immunity in the population. It is likely that the spread of Zika virus will continue, affecting all countries in the Americas except for Chile and Canada.

  5. Physician approaches to beta-lactam use in patients with penicillin hypersensitivity.

    Science.gov (United States)

    Prematta, Tracy; Shah, Shenil; Ishmael, Faoud T

    2012-01-01

    Beta-lactam antibiotics are widely used, but hypersensitivity reactions are common and difficult to manage. This study was designed to identify lack of knowledge regarding the safe use of alternative beta-lactams in penicillin-allergic patients and assess management differences between allergists and nonallergists. An electronic physician survey was sent to 623 providers in allergy, internal medicine, pediatrics, and family medicine, querying beta-lactam use in patients with a history of penicillin allergy. A total of 110 (17.7%) surveys were completed. For patients with a prior maculopapular rash to penicillin, most providers were uncomfortable prescribing penicillins again, although they would use other beta-lactams. In patients with an exfoliative dermatitis to penicillin, 46% of responders would not prescribe any beta-lactam again. For patients with a positive skin test to penicillin, only 45.1% of nonallergists were comfortable prescribing monobactams versus 62.5% of allergists; 30.3% of all responders would give a carbapenem. In patients with urticaria to penicillin, pediatricians were the most comfortable prescribing third- or fourth-generation cephalosporins. Providers (both allergists and nonallergists) were unfamiliar with the safety of prescribing penicillin in patients with history of maculopapular rash, the safety of monobactams, and low cross-reactivity with carbapenems in penicillin-allergic individuals. Nonallergists were also unfamiliar with the usefulness of penicillin skin testing. Improved education is needed to address these areas. Additionally, we found variability in responses regarding exfoliative dermatitis and comfort prescribing cephalosporins in patients with suspected IgE-mediated drug allergy to penicillin, highlighting the need for additional research in these areas.

  6. The Case of Unilateral Laterothoracic Exanthem

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    Seda Atay

    2016-12-01

    Full Text Available Unilateral laterothoracic exanthem (asymmetric periflexural exanthem of childhood which have a tendency to form plaques in a particular region of the body is characterized by erythematous papules. The lesions usually begin at unilateral axillary or inguinal region. Unilateral laterothoracic exanthem is usually seen in children of 1-5 year-old. Although the etiology is not known very well, viral agents are considered to be the etiologic factor, because in 75% of the patients, prodromal symptoms like fever, diarrhea, fatigue and rhinitis were seen before rash. The histopathologic evidences are nonspecific. The disease is diagnosed clinically. This disease is self-limited and the rash disappears without sequel in 2-6 weeks. In this case, 3 year-old boy was presented with, multiple, erythematous, pruritic millimetric papules which first developed in right axillar region and extended to the same side of abdomen. It was found out that fatigue, loss of appetite, diarrhea before rashes were in the medical history of the patient. The serological examination of the patient’s blood showed that ebstein barr virus, cytomegalovirus, rubella and measles immunoglobulin G were positive, immunoglobulin M were negative, parvovirus B19 immunoglobulin G and M were both negative. The patient was treated with topical moisturizer and oral antihistaminic. This case which was diagnosed with unilateral laterotoracic exanthema due to history of the disease, clinical findings and its rarity found fit to be presented.

  7. [Cutaneous adverse events of telaprevir/peginterferon/ribavirin therapy for chronic hepatitis C: A multicenter prospective cohort study].

    Science.gov (United States)

    Lorcy, S; Gaudy-Marqueste, C; Botta, D; Portal, I; Quiles, N; Oulies, V; Mancini, J; Grob, J-J; Richard, M-A

    2016-05-01

    Telaprevir, sale of which was suspended, has been approved in combination with pegylated interferon and ribavirin (triple therapy) in the treatment of chronic hepatitis C virus (HCV). Skin eruptions and isolated cases of severe cutaneous adverse reactions (SCAR) have been reported. Our aim was to assess the incidence of skin eruption and the clinical characteristics of mucocutaneous adverse events (AE), and to identify potential risk factors for telaprevir-associated skin eruption. A prospective observational multicenter follow-up cohort study with monthly controls by a dermatologist and additional examinations in case of any undercurrent AE. Among the 48 enrolled patients, the incidence of skin eruption was 58.4%, consisting mainly of maculopapular and eczematous lesions and only one case of SCAR. Telaprevir was discontinued in 6% of patients due to severe rash, whereas peginterferon and ribavirin were continued. The median time to onset of rash following telaprevir initiation was 25 days (range: 3-79 days). The rash was preceded by skin dryness and associated with pruritus in 100% and 90% of patients, respectively. Of those presenting with skin eruption, 37.5% also complained of conjunctival or oral lesions, or of anorectal symptoms. Neither a past history of dermatological conditions nor sociodemographic or viral status was predictive factor for skin rash. Telaprevir-related dermatitis has a high incidence but is mostly of mild intensity. In most cases, tri-therapy was continued under close dermatological follow-up allowing rapid detection of rare instances of severe drug eruptions. Ribavirin and Interferon were thus continued even in the event of diffuse eruptions, enabling confirmation of the causative role of telaprevir in these eruptions. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Corrigendum.

    Science.gov (United States)

    2016-01-01

    Jakubowski, T.L., Perron, T.J., and Teixeira, E. (2015). Rashes in school: Can they stay, or should they go? NASN School Nurse, 30(5): 274-282. (Original DOI: 10.1177/1942602X15596815)In the September 2015 issue of NASN School Nurse, the images for Lyme Disease and Spider bites were reversed. The correct order appears below.spnas;31/1/61/TABLE11942602X15621761T1table1-1942602X15621761Table 5.Bites/Stings in ChildrenDiagnosis(Bites, Stings, cutaneous infestations)Rash DescriptionSigns and SymptomsStay in School or Go Home?PhotoLyme Disease (Borrelia burgdorferi)Transmitted by deer tickErythema rash when present, "Bull's eye rash" distinct red borders with central clearing.Rash at site of bite but can have multiple rashesFever, joint pain, malaise, headache, single swollen joint usually knee usually accompany the rash.Not Contagious: Can stay at school.Incubation: 1-32 days median is 11 days. April through October with more than 50% of the cases presenting in June and July.Rocky Mountain Spotted Fever (RMSF) Rickettial infection transmitted by wood ticks.Characteristic spotted rash, maculopapular and sometimes petechial rash.Triad of fever, rash, and history of tick exposure, headache, vomiting, sore throatNot Contagious: Can stay at school.Rash initially appears on wrists and ankles and spreads to trunk within hours. Palms of hands and soles of feet are also involved.Incubation: Average time frame one week. Can range 2-14 days. August through September highest prevalence.Scabies(Mites)Papules and burrows, excoriation secondary to scratching.Intense itching especially at night. Commonly seen between the fingers and toes.Is Contagious: Should go home.Skin-to-skin contact. Mites can remain alive for > 2 days on clothing and bedding.Incubation: 4-6 weeksIf the child had it previously 1-4 days.*Can return to school with medical clearance.Bee stingsLocalized swelling, redness. If allergic can spread rapidly. Raised pink wheel.Pain, redness, swelling, hives if allergic

  9. Is Levamisole-Induced Vasculitis a Relegated Diagnostic Possibility? A Case Report and Review of Literature

    Science.gov (United States)

    Patnaik, Soumya; Balderia, Percy; Vanchhawng, Lisa; Markazi, Peyman; Wykretowicz, Jedrzej; Perloff, Sarah

    2015-01-01

    Patient: Female, 38 Final Diagnosis: Levamisole induced vasculitis Symptoms: Skin and joint Medication: — Clinical Procedure: None Specialty: Toxicology Objective: Unusual clinical course Background: Levamisole, a veterinary anti-helminthic, is a common adulterant in cocaine. Levamisole-induced vasculopathy (LIV) is a relatively new entity, and is being increasingly recognized since it was first reported in 2010. Although cutaneous findings, agranulocytosis, and positive antineutrophil cytoplasmic antibodies (ANCA) are characteristic, the full clinical picture and appropriate management remain unclear. Case Report: A 38-year-old woman presented with malaise and a pruritic, painful rash on all extremities, right ankle pain, and effusion and necrosis of the right 2nd and 3rd finger tips. After extensive work-up, we determined that she had LIV. Conclusions: Arthritis-dermatitis syndrome in cocaine users should raise suspicion for LIV. Although some features are characteristic, the full clinical spectrum is yet to be described. Management is supportive. PMID:26406869

  10. Crescentic membranoproliferative glomerulonephritis and hypocomplementemic urticarial vasculitis.

    Science.gov (United States)

    Enríquez, Ricardo; Sirvent, Ana Esther; Amorós, Francisco; Pérez, Miguel; Matarredona, Jaime; Reyes, Adolfo

    2005-01-01

    We describe the association of crescentic membranoproliferative glomerulonephritis and hypocomplementemic urticarial vasculitis syndrome. A 39-year-old woman presented edema and proteinuria and later a non-pruritic urticarial rash. Laboratory results showed nephrotic syndrome, hypocomplementemia and positive anti-C1q antibodies. Skin biopsy disclosed leukocytoclastic vasculitis. Acute renal failure developed. Renal biopsy revealed crescentic membranoproliferative glomerulonephritis. She was treated with corticosteroids and cyclosphosphamide with improvement of the renal function and partial remission of the nephrotic syndrome. Afterwards the nephrotic syndrome relapsed, mycophenolate mofetil in monotherapy was administered with reduction in proteinuria. As far as we know only 3 cases, 2 in children and one in an adult, of crescentic glomerulonephritis and hypocomplementemic urticarial vasculitis syndrome have been reported. In our patient renal manifestations preceded urticarial lesions. We provide information on the evolution during a 42-month follow-up.

  11. March 2013 critical care case of the month: beware the escargot

    Directory of Open Access Journals (Sweden)

    Thomas AR

    2013-03-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness A 29 year old woman presented to the Phoenix VA Medical Center with complaints of headache and diffuse generalized weakness most pronounced in the lower extremities. She also noted recent fecal and urinary incontinence, abdominal pain, back pain, numbness in the feet and a non pruritic skin rash on the trunk. Onset of symptoms was about 2 weeks prior to her presentation. Since her symptoms began she had seen in multiple local emergency departments for these same complaints as they worsened and was discharged home in each case with suspected viral syndrome. PMH, SH, FH She had no allergies and her past medical history was only significant for post- traumatic stress disorder. She has had no major surgery in her life so far and her family history was not contributory to her current presentation. She smokes marijuana for recreational purposes and drinks alcohol socially. She was …

  12. Miliaria-rash after neutropenic fever and induction chemotherapy for acute myelogenous leukemia Miliária 'rash' após neutropenia febril e quimioterapia de indução para a leucemia mielóide aguda

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    Tuyet A Nguyen

    2011-08-01

    Full Text Available Miliaria is a disorder of the eccrine sweat glands which occurs in conditions of increased heat and humidity. It can be associated with persistent febrile states as well as with certain drugs. We presented a 40 year-old female with myelodysplastic syndrome and progression to acute myelogenous leukemia who was admitted to the hospital for chemotherapy induction. The patient was treated with idarubicin and cytarabine. She became pancytopenic and developed neutropenic fever and was started on vancomycin and cefepime, but was persistently febrile with night sweats. Five days into her fevers, she developed diffuse, nonpruritic and fragile vesicles together with drenching nightsweats. The patient's exanthem was diagnosed as Miliaria crystallina, most probably induced by neutropenic fever and idarubucin exposureMiliária é uma desordem das glândulas sudoríparas écrinas, que ocorre em condições de aumento de calor e umidade. Miliária pode ser associada com estados febris persistentes bem como com certos medicamentos. Apresentamos o caso de uma mulher de 40 anos com síndrome mielodisplásica e progressão para leucemia mielóide aguda que foi admitida no hospital para quimioterapia de indução. A paciente foi tratada com idarrubicina e citarabina. Ela se tornou pancitopênica e desenvolveu neutropenia febril. Iniciou tratamento com vancomicina e cefepime, mas a febre com sudorese noturna continou. Cinco dias depois a paciente desenvolveu vesículas difusas, não pruríticas e frágeis juntamente com a persistência de sudorese noturna. O exantema do paciente foi diagnosticado como Miliária cristalina, provavelmente induzida por neutropenia febril e exposição a idarubucin

  13. Zika emergence in the French Territories of America and description of first confirmed cases of Zika virus infection on Martinique, November 2015 to February 2016.

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    Daudens-Vaysse, Elise; Ledrans, Martine; Gay, Noellie; Ardillon, Vanessa; Cassadou, Sylvie; Najioullah, Fatiha; Leparc-Goffart, Isabelle; Rousset, Dominique; Herrmann, Cécile; Cesaire, Raymond; Maquart, Marianne; Flusin, Olivier; Matheus, Séverine; Huc-Anaïs, Patricia; Jaubert, Josiane; Criquet-Hayot, Anne; Hoen, Bruno; Djossou, Felix; Locatelli-Jouans, Corinne; Blateau, Alain; McKenzie, Anne-Marie; Melin, Mathilde; Saint-Martin, Patrick; Dorléans, Frédérique; Suivant, Claudine; Carvalho, Luisiane; Petit-Sinturel, Marion; Andrieu, Audrey; Noël, Harold; Septfons, Alexandra; Gallay, Anne; Paty, Marie-Claire; Filleul, Laurent; Cabié, André

    2016-07-14

    Following of the emergence of Zika virus in Brazil in 2015, an epidemiological surveillance system was quickly implemented in the French overseas Territories of America (FTA) according to previous experience with dengue and chikungunya and has detected first cases of Zika. General practitioners and medical microbiologists were invited to report all clinically suspected cases of Zika, laboratory investigations were systematically conducted (RT-PCR). On 18 December, the first autochthonous case of Zika virus infection was confirmed by RT-PCR on French Guiana and Martinique, indicating introduction of Zika virus in FTA. The viral circulation of Zika virus was then also confirmed on Guadeloupe and Saint-Martin. We report here early findings on 203 confirmed cases of Zika virus infection identified by RT-PCR or seroneutralisation on Martinique Island between 24 November 2015 and 20 January 2016. All cases were investigated. Common clinical signs were observed (maculopapular rash, arthralgia, fever, myalgia and conjunctival hyperaemia) among these patients, but the rash, the foundation of our case definition, may be absent in a significant proportion of patients (16%). These results are important for the implementation of a suspected case definition, the main tool for epidemiological surveillance, in territories that may be affected by ZIKV emergence, including Europe. This article is copyright of The Authors, 2016.

  14. Erythema Marginatum as an Unusual Presentation for Kawasaki Disease

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    I. Sedighi

    2008-10-01

    Full Text Available Introduction: Kawasaki disease is an acute, systemic vacuity that predominantly manifests in infants and young children. Severe systemic inflammation and vacuities can cause cardiovascular involvement, particularly coronary artery injury that includes dilatation or aneurysm. The final goal of treatment for acute Kawasaki disease، therefore، is to diminish systemic inflammation and vacuities as soon as possible, thereby, preventing progression to coronary artery injury and thrombosis.Case Report: In this report we present a case of Kawasaki disease in a 7-year-old boy with prolonged fever and cervical adenopathy presented with erythema marginatum as a first skin presentation. We treated the patient with intravenous gamma-globulin (IVIG by six day after admission. He developed cardiac and pulmonary involvement two days later.Conclusion: Any skin rash is described in Kawasaki disease except for bullous and vesicular lesions. The common skin manifestation of Kawasaki disease are erythematous and maculopapular rash, although it may appear urticarial, scarlatiniform, erythema multiforme-like, or as erythroderma. Erythema marginatum had a limited differential diagnosis in pediatric patients. The major cause of erythema marginatum is rheumatic fever but there is no report of erythema marginatum in face and cervical region and Kawasaki disease should be considered in differential diagnosis of erythema marginatum in face and neck.

  15. Successful drug desensitization in patients with delayed-type allergic reactions to anti-tuberculosis drugs.

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    Siripassorn, Krittaecho; Ruxrungtham, Kiat; Manosuthi, Weerawat

    2018-02-02

    To evaluate the outcomes of anti-tuberculosis drug desensitization. This was a retrospective study. Inclusion criteria were as follows: age >18years, documented tuberculosis infection, a previous cutaneous allergic reaction to anti-tuberculosis drugs, and having undergone drug desensitization between January 2003 and March 2014. The definition of allergic reaction to anti-tuberculosis drugs included (1) a temporal relationship between drug use and the allergic reaction; (2) improvement in the allergic reaction after drug withdrawal; (3) recurrence of the allergic reaction after reintroduction of only the offending drug; and (4) absence of other causes. A total of 19 desensitization procedures were performed. The drugs used for these procedures were isoniazid (n=7), rifampicin (n=6), or ethambutol (n=6). Of note, severe allergic reactions (Stevens-Johnson syndrome (n=4), erythema multiforme (n=3), and drug rash with eosinophilia and systemic syndrome (n=1)) were included. All patients underwent resolution of the previous allergic reactions before desensitization. The median duration of desensitization was 18 days. The success rate was 78.9%. The allergic reactions following failed desensitization were not severe; most were maculopapular rashes. The desensitization protocol for anti-tuberculosis drugs was associated with a high success rate, and the individuals who failed desensitization experienced mild allergic reactions. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  16. A New Case of DRESS Syndrome Induced by Sulfasalazine and Triggered by Amoxicillin

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    Francesco Girelli

    2013-01-01

    Full Text Available Drug Rash Eosinophilia Systemic Symptoms (DRESS syndrome is a systemic hypersensitivity reaction characterized by exfoliative dermatitis and maculopapular rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and involvement of internal organs as liver, lung, heart, and kidney; the disorder starts within 2–6 weeks after taking a drug with an incidence that ranges from 1/1000 to 1/10000 exposures. Fatal cases are reported. The exact pathogenesis of DRESS syndrome is not completely understood, while it is reported that amoxicillin could trigger it in patients who are taking allopurinol, sulfasalazine, NSAIDs, carbamazepine, strontium ranelate, lisinopril, lansoprazole, and minocycline. Amoxicillin could act directly, inducing the reactivation of a viral infection (HHV 6 and EBV with symptoms similar to DRESS syndrome or by reducing the patients’ ability to detoxify the body from substances chronically taken. We describe a case of a patient admitted to our hospital for a DRESS syndrome flared after amoxicilline intake during treatment with sulfasalazine; this combination can activate severe reactions often with an insidious onset that can mimic an infectious disease.

  17. Fever, rash, and systemic symptoms: understanding the role of virus and HLA in severe cutaneous drug allergy.

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    Pavlos, Rebecca; Mallal, Simon; Ostrov, David; Pompeu, Yuri; Phillips, Elizabeth

    2014-01-01

    Drug hypersensitivity syndromes such as abacavir hypersensitivity and the severe cutaneous adverse drug reactions have been associated with significant short- and long-term morbidity and mortality. More recently, these immunologically mediated and previously unpredictable diseases have been shown to be associated with primarily class I but also class II HLA alleles. The case of the association of HLA-B*57:01 and abacavir hypersensitivity has created a translational roadmap for how this knowledge can be used in the clinic to prevent severe reactions. Although many hurdles exist to the widespread translation of such HLA screening approaches, our understanding of how drugs interact with the major histocompatibility complex has contributed to the discovery of new models that have provided considerable insights into the immunopathogenesis of severe cutaneous adverse drug reactions and other T-cell-mediated drug hypersensitivity syndromes. Future translation of this knowledge will facilitate the development of preclinical toxicity screening to significantly improve efficacy and safety of drug development and design. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. A RASH analysis of National Toxicology Program data: Predictions for 30 compounds to be tested in rodent carcinogenesis experiments

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    Jones, T.D.; Easterly, C.E. [Oak Ridge National Lab., TN (United States)

    1996-10-01

    Relative potencies for 30 compounds scheduled for carcinogenic testing in the 2-year rodent bioassays were estimated based on comparisons with a wide variety of bioassay data for benzo[a]pyrene, nicotine, cisplatin, aflatoxin B1, and cyclophosphamide. Potential for oncogenic transformation of each of the compounds was estimated from short-term bioassays. Promoting strength was assigned on the basis of comparisons of the product of relative potency and test dose with the distribution of similar products obtained for 67 common compounds in the data- base of Gold et al. A potency class for promotion was assigned on the basis of whether the potency-adjusted test dosage was > 2{sigma} below the mean, > 1{sigma} below the mean, within {+-}{sigma} of the mean, >{sigma} above the mean, or > 2{sigma} above the mean, as determined from the 67 compounds. The underlying hypothesis is that a weak test dose may have a low probability of revealing a potential carcinogen, whereas a strong dose may have a high probability of producing false-positive results. Predictions are therefore directed at the central 68% of the log-normal frequency distribution according to the assumption that {+-}{sigma} represents the ideal test dose. 22 refs., 7 tabs.

  19. Vancomycin-Induced Leukocytoclastic Vasculitis and Acute Renal Failure Due to Tubulointerstitial Nephritis.

    Science.gov (United States)

    Pingili, Chandra Shekar; Okon, Emmanuel E

    2017-09-25

    BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and sepsis are commonly treated with intravenous vancomycin. However, vancomycin treatment is associated adverse reactions, including skin rashes and nephrotoxicity. We present a case of acute renal failure due to acute tubulointerstitial nephritis associated with a diffuse leukocytoclastic vasculitic skin eruption following intravenous vancomycin treatment. CASE REPORT A 79-year-old Caucasian male patient was treated with intravenous vancomycin for MRSA bacteremia. Prior to treatment, his creatinine was normal at 0.6 mg/dl. He presented one week later with shortness of breath, lower limb edema, and acute renal failure. He had a diffuse maculopapular rash involving the trunk and both upper and lower extremities. A renal biopsy and left arm skin biopsy were examined histologically. The skin biopsy showed leukocytoclastic vasculitis. Renal biopsy showed some sclerosed glomeruli, some with mesangial proliferation, and tubulointerstitial inflammation with eosinophils and plasma cells and mild interstitial fibrosis. Although there was some renal arteriolosclerosis, no vasculitic changes were seen, and no vascular thrombosis was present. A diagnosis of leukocytoclastic vasculitis and acute tubulointerstitial nephritis secondary to intravenous vancomycin therapy was made. CONCLUSIONS Although skin reactions associated with drug therapy are common, vancomycin-associated dermal vasculitis is rare. Tubulointerstitial nephritis is also a rare association with vancomycin treatment. This case report has highlighted that patients being treated with intravenous vancomycin should be carefully observed for acute skin rashes and deterioration in renal function, which can be managed by ceasing treatment with vancomycin, steroid challenge, and preventing future exposure to similar antimicrobial agents.

  20. Cutaneous Manifestations of Chikungunya Fever: Observations from an Outbreak at a Tertiary Care Hospital in Southeast Rajasthan, India.

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    Kumar, Ramesh; Sharma, Manoj K; Jain, Suresh K; Yadav, Sumit K; Singhal, Anil K

    2017-01-01

    Chikungunya fever is caused by chikungunya virus which is transmitted by the bite of infected Aedes aegypti and A. albopictus mosquitoes. To study the various mucocutaneous manifestations in suspected cases of chikungunya fever. The patients who attended our outpatient department from July 2016 to October 2016 and fulfilled the criteria for "suspect cases" of chikungunya infection stipulated by the National Institute of Communicable Diseases, Directorate General of Health Services, Government of India, were included in the study prospectively. A total of 112 patients (62 males and 50 females) with mucocutaneous manifestations of chikungunya fever were enrolled in the study. Mucocutaneous manifestations were found more in males than females. Serological immunoglobulin M enzyme-linked immunosorbent assay (IgM ELISA) test for chikungunya virus was positive in 62 (55.3%) patients. Generalized erythematous maculopapular rash (53.5%) was the most common finding. Genital pustular rash with aphthae (4.4%), oral and intertriginous aphthae, red lunula, subungual hemorrhage, localized erythema of the ear pinnae, erythema, swelling, and eczematous changes over the preexisting scars and striae (scar phenomenon) were the other interesting findings. Various pattern of pigmentation (37.5%) were observed including striking nose pigmentation in a large number of patients, by looking at which even a retrospective diagnosis of chikungunya fever could be made. There was flare-up of existing dermatoses like psoriasis and dermatophytic infection. Wide varieties of the mucocutaneous manifestations were observed in our study, but the striking nose pigmentation was present irrespective of age and this peculiar pigmentation may be considered as a specific clinical marker of chikungunya fever. Chikungunya fever must be suspected in any patient with painful oro-genital and intertriginous aphthous-like lesions associated with febrile polyarthralgia with rash.

  1. Drug-induced skin reactions: a 2-year study

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    Farshchian M

    2015-02-01

    Full Text Available Mahmood Farshchian,1 Akram Ansar,1 Abbas Zamanian,2 Ghasem Rahmatpour-Rokni,1 Arash Kimyai-Asadi,3 Mehdi Farshchian1,4 1Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran; 2Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran; 3Derm Surgery Associates, Houston, TX, USA; 4Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland Background: The aim of this study was to analyze the clinical characteristics of patients with adverse cutaneous drug reactions, which occur when a medicinal product results in cutaneous morbidity. Methods: The study included 308 patients who were diagnosed as having an adverse cutaneous drug reaction during the study period (2007–2009. In 84 cases, histopathologic examination of skin biopsies were also performed. Results: Patients with drug reactions were found to be more commonly female (63% than male (37%. Beta-lactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%, followed by non-steroidal anti-inflammatory drugs (16.5%. Acute urticaria was the most common clinical presentation (59.2% followed by fixed drug eruptions (18.5%, and maculopapular eruptions (14.9%. Conclusion: Adverse cutaneous drug reactions in our study population were mainly induced by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be acute urticaria, fixed drug eruptions, and maculopapular rashes. Keywords: adverse drug reaction, acute urticaria, exanthematous eruption

  2. Pediculosis and scabies: treatment update.

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    Gunning, Karen; Pippitt, Karly; Kiraly, Bernadette; Sayler, Morgan

    2012-09-15

    Pediculosis and scabies are caused by ectoparasites. Pruritus is the most common presenting symptom. Head and pubic lice infestations are diagnosed by visualization of live lice. Finding nits (louse egg shells) alone indicates a historical infestation. A "no nit" policy for schools and day care centers no longer is recommended because nits can persist after successful treatment with no risk of transmission. First-line pharmacologic treatment of pediculosis is permethrin 1% lotion or shampoo. Multiple novel treatments have shown limited evidence of effectiveness superior to permethrin. Wet combing is an effective nonpharmacologic treatment option. Finding pubic lice should prompt an evaluation for other sexually transmitted infections. Body lice infestation should be suspected when a patient with poor hygiene presents with pruritus. Washing affected clothing and bedding is essential if lice infestation is found, but no other environmental decontamination is necessary. Scabies in adults is recognized as a pruritic, papular rash with excoriations in a typical distribution pattern. In infants, children, and immunocompromised adults, the rash also can be vesicular, pustular, or nodular. First-line treatment of scabies is topical permethrin 5% cream. Clothing and bedding of persons with scabies should be washed in hot water and dried in a hot dryer.

  3. Dermatologic adverse events associated with chemotherapy and targeted anticancer therapy

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    Maria Kowalska

    2016-05-01

    Full Text Available Chemotherapeutic agents and drugs used for targeted tumor therapy often cause undesirable side effects of the skin which typically are toxic cutaneous reactions (toxicity grade 1 to 4. The first group of drugs that cause toxicities affecting the skin are inhibitors of epidermal growth factor receptor (EGFR. They cause a variety of skin changes (PRIDE syndrome, which are mainly manifested by papulopustular rash, also referred to as acneiform rash, occurring in 44–74% of patients. Another drug which causes cutaneous toxicities is inhibitor of CTLA4 (cytotoxic T lymphocyte-associated protein 4, which is represented by ipilimumab, used in the treatment of metastatic melanoma. The most common dermatological adverse event, observed in 40–64% of patients receiving ipilimumab, is generalized maculopapular rash with pruritus and dry skin, and in some cases vitiligo is also observed. BRAF and MEK inhibitors introduced for the treatment of advanced melanoma also cause skin rashes. BRAF inhibitors also affecting the proliferation of keratinocytes stimulate hypertrophic changes and cause the whole spectrum of lesions from benign and keratoacanthoma to squamous cell carcinoma. A hedgehog pathway inhibitor (vismodegib is used for the treatment of metastatic basal cell carcinoma. The most common adverse events it causes are reversible alopecia and dysgeusia, but it can also cause the development of keratoacanthoma and squamous cell carcinoma. Among the most common side effects of chemotherapy and targeted therapy are toxic changes within the hands and feet (hand-foot skin reaction – HFSR that early manifest as a neurological symptoms (numbness, paresthesia, and skin symptoms (erythematous swelling changes, blisters, hyperkeratosis occur later. Anti-cancer drugs can also cause serious skin diseases such as Stevens-Johnson syndrome (SJS, toxic epidermal necrolysis (TEN and DRESS (drug rash with eosinophilia and systemic symptoms, whose course and prognosis

  4. Atopic Dermatitis and Homeopathy

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    Lawrence Chukwudi Nwabudike

    2012-07-01

    Full Text Available Introduction: Atopic dermatitis (AD is a chronic, relapsing disorder of the skin associated with allergen sensitization and impaired barrier function. There is often a family history of pruritic skin disease or asthma.Materials and Methods: Three cases of atopic dermatitis treated with homeopathy are presented. Case 1 is a case of a 22-year-old female, with AD since early childhood, which had not responded to standard topical therapy. She received several homeopathic medicines, with transitory effect until she finally received the medicine Aurum metallicum, at M potency. At present, 1 year after cessation of treatment, she remains lesion-free. Case 2 is a case of a 10-month-old baby with a an 8-month history of itchy rash and poor sleep, that had failed to respond to treatment. The patient was given the homeopathic medicine Lachesis at C30 potency and responded. The rashes receded and the patient was able to sleep better at night. Case 3 is a case of an 11-month-old boy with a 3-month history of itchy rash, diagnosed as having AD and treated with topical steroids. After 3 months of unsuccessful treatment, the patient was brought in for homeopathic therapy. He received the homeopathic medicine Lachesis, at C30 potency. He improved under this treatment and is currently lesion-free, 6 months after cessation of treatment.Conclusions: Three cases of atopic dermatitis that failed to respond to treatment were given homeopathic therapy and responded adequately. The patients remained free of lesions even after cessation of treatment.

  5. Immune reconstitution inflammatory syndrome associated with secondary syphilis.

    Science.gov (United States)

    Frunza-Stefan, Simona; Acharya, Gyanendra; Kazlouskaya, Viktoryia; Vukasinov, Paunel; Chiou, Yushan; Thet, Zeyar

    2017-03-01

    Immune reconstitution inflammatory syndrome (IRIS) is a condition associated with paradoxical worsening and/or new onset of an opportunistic infection in HIV patients following the initiation of anti-retroviral therapy or switching to more potent antiretroviral therapy (ART) regimen. Although IRIS associated with many opportunistic infections (OIs) has been well reported, syphilis has very rarely been mentioned in this regard. A 52-year-old male, diagnosed with AIDS six weeks ago, presented with the disseminated non-pruritic painless skin rash. He denied any fever, cough, shortness of breath, and joint pain or swelling. The patient had no similar symptoms, genital ulcers, or any medical illness in the past. CD4 cell count and viral load were 40 cells/mm 3 and 280,000 copies/ml, respectively, while screening tests for OIs including rapid plasma reagin test, quantiferon, cryptococcal antigen, and toxoplasma tests were negative at the time of HIV diagnosis. After three days of initiation of anti-retroviral therapy, he developed the above-mentioned skin rash. Repeat rapid plasma regain (RPR) test at this time was also negative. Punch biopsy of the skin lesion demonstrated findings suggestive of secondary syphilitic lesions, which was confirmed by immunostain. The repeat RPR, CD4 cell count, and viral load showed a titer of 1:256, 257 cells/mm 3 , and 5000 copies/ml, respectively. His skin rashes faded away, and RPR titer trended down on treatment with benzathine penicillin without discontinuation of ART. The presence of an IRIS response does not predict overall HIV or OI treatment responses, and discontinuation of ART is not generally recommended as the benefits of treating HIV infection outweighs the risk associated with IRIS.

  6. Cutaneous adverse drug reactions in a tertiary care teaching hospital in India: An intensive monitoring study

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    Sejal Thakkar

    2017-01-01

    Full Text Available Background: The epidemiological data based on intensive monitoring studies are limited for the cutaneous adverse drug reactions (CADRs in terms of incidence. Most of earlier Indian studies focused only on types and causative drugs of CADRs. Aim: The aim of this study is to analyze the CADRs with reference to the incidence, its subgroup analysis, causative drugs, and other clinical characteristics in Indian population. Methodology: Intensive monitoring study was carried out over a period of 3 years in the dermatology outpatient and inpatient department. CADRs due to only systematically administered drugs were considered. The WHO definition for CADR, the WHO causality definitions, modified Schumock and Thornton's criteria for preventability, and International Conference on Harmonisation E2A guidelines for seriousness were considered. Incidence was expressed in percentage and its 95% confidence interval. The incidence was analyzed on basis of characteristics of study population and CADRs. Results: A total of 171 CADRs were observed from 37,623 patients. The CADR incidence was 0.45% (95% CI: 0.39–0.53. The incidence did not significantly differ in different age groups and gender. Commonly observed CADRs were maculopapular rash (23.98%, urticaria (21.64%, and fixed drug eruptions (FDEs (18.13%. Antimicrobials (35.18% and nonsteroidal anti-inflammatory drugs (NSAIDs were suspected in all common CADRs. Anti-infective and NSAIDs were most commonly suspected drugs in overall CADRs, maculopapular rash, urticaria, FDEs, and erythema multiforme. The exact nature of drugs remained inaccessible in one-fourth cases due to use of the over-the-counter self-medications. The incidence of preventable and serious and fatal CADRs was 0.08% (95% CI: 0.05–0.11, 0.04% (95% CI: 0.02–0.06, and 0.003% (95% CI: 0.000–0.001, respectively. Conclusion: Ethnic characteristics should be considered while interpreting incidence from the international studies. The

  7. Cutaneous adverse drug reactions in Indian population: A systematic review

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    Tejas K Patel

    2014-01-01

    Full Text Available Background: Epidemiological data is limited for cutaneous adverse drug reactions (CADRs in India. Most of the Indian studies have small sample size and are of limited duration. Aims: The aim of this study is to analyze CADRs with reference to the causative drugs and their clinical characteristics in Indian population. Materials and Methods: As per selection criteria, electronic databases were searched for publications describing CADRs from January-1995 to April-2013 by two independent investigators. Data of the causative drugs and clinical characteristics were extracted and summarized by absolute numbers, percentages, ranges, and means as presented by the authors. The subgroup analysis of causative drugs was performed for causality assessment, severe or nonsevere reactions and occurrence of common CADRs. Studies showing "definite" and "probable" categories of causality analysis were labeled as "definite and probable causality (DPC studies". The other included studies were labeled as "non-DPC studies". Results: Of 8337 retrieved references, 18 prospective studies were selected for analysis. The pooled incidence was 9.22/1000 total among outpatient and inpatient cases. Commonly observed reactions were maculopapular rash (32.39%, fixed drug eruptions (FDEs (20.13%, urticaria (17.49% and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN (6.84%. The major causative drug groups were antimicrobials (45.46%, nonsteroidal anti-inflammatory drugs (NSAIDs (20.87% and anti-epileptic drugs (14.57%. Commonly implicated drugs were sulfa (13.32%, β-lactams (8.96% and carbamazepine (6.65%. High frequency of CADRs is observed with anti-epileptic drugs in DPC studies only. Carbamazepine, phenytoin and fluoroquinolones had higher severe to nonsevere cutaneous reaction ratio than other drugs. Antimicrobials were the main causative drugs for maculopapular rash, FDEs and SJS/TEN, and NSAIDs for the urticaria. The mortality for overall CADRs, SJS/TEN, and

  8. Cutaneous manifestations of systemic lupus erythematosus in a tertiary referral center.

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    Kole, Alakes Kumar; Ghosh, Alakendu

    2009-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan involvement. The skin is the second most commonly affected organ. SLE with skin lesions can produce considerable morbidity resulting from painful skin lesions, alopecia, disfigurement, etc. Skin lesions in patients with lupus may be specific (LE specific) or may be non specific (LE non specific). Acute cutaneous LE (Lupus specific) has a strong association with systemic disease and non-specific skin lesions always indicate disease activity for which patients present to rheumatologists and internists. Therefore, a thorough understanding of the cutaneous manifestations of SLE is essential for most efficient management. The aims of this study were to evaluate the patterns and prevalence of skin lesions in patients with SLE and to assess the relationship between skin lesions and other systemic involvement. At the Department of Rheumatology and Clinical Immunology, IPGME&R in Kolkata, 150 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatology Association (updated 1982) were examined and followed-up for cutaneous manifestations between January 2002 and January 2007. Skin lesions were important clinical features. About 45 patients (30%) presented with skin lesions although all patients had skin lesions during the follow-up period. Skin changes noted were as follows: Lupus specific lesions: malar rash in 120 patients (80%), photosensitive dermatitis in 75 patients (50%), generalized maculopapular rash in 40 patients (26.67%), discoid rash in 30 patients (20%), subacute cutaneous lupus erythematosus (SCLE) in 5 patients (3.34%), lupus profundus in 5 patients (3.34%). The lupus non-specific lesions were non-scarring alopecia in 130 patients (86.67%), oral ulcers in 85 patients (56.67%), vasculitic lesions in 50 patients (33.34%), bullous lesions in 15 patients (10%), Raynaud's phenomenon in 10 patients (6.67%), pyoderma gangrenosum in 2 patients (1

  9. Cutaneous manifestations of systemic lupus erythematosus in a tertiary referral center

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    Kole Alakes

    2009-01-01

    Full Text Available Background : Systemic lupus erythematosus (SLE is an autoimmune disease with multiorgan involvement. The skin is the second most commonly affected organ. SLE with skin lesions can produce considerable morbidity resulting from painful skin lesions, alopecia, disfigurement, etc. Skin lesions in patients with lupus may be specific (LE specific or may be non specific (LE non specific. Acute cutaneous LE (Lupus specific has a strong association with systemic disease and non-specific skin lesions always indicate disease activity for which patients present to rheumatologists and internists. Therefore, a thorough understanding of the cutaneous manifestations of SLE is essential for most efficient management. Aims: The aims of this study were to evaluate the patterns and prevalence of skin lesions in patients with SLE and to assess the relationship between skin lesions and other systemic involvement. Materials and Methods: At the Department of Rheumatology and Clinical Immunology, IPGME&R in Kolkata, 150 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatology Association (updated 1982 were examined and followed-up for cutaneous manifestations between January 2002 and January 2007. Results: Skin lesions were important clinical features. About 45 patients (30% presented with skin lesions although all patients had skin lesions during the follow-up period. Skin changes noted were as follows: Lupus specific lesions: malar rash in 120 patients (80%, photosensitive dermatitis in 75 patients (50%, generalized maculopapular rash in 40 patients (26.67%, discoid rash in 30 patients (20%, subacute cutaneous lupus erythematosus (SCLE in 5 patients (3.34%, lupus profundus in 5 patients (3.34%. The lupus non-specific lesions were non-scarring alopecia in 130 patients (86.67%, oral ulcers in 85 patients (56.67%, vasculitic lesions in 50 patients (33.34%, bullous lesions in 15 patients (10%, Raynaud′s phenomenon in 10 patients (6

  10. Rickettsioses do grupo das febres maculosas em viajantes argentinos Spotted fever group rickettsial disease in argentinean travelers

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    Olindo Martino

    2001-12-01

    Full Text Available Durante o ano de 1996, foram atendidos no ambulatório de medicina de viajantes, quatro pacientes procedentes do sul da África com diagnóstico de rickettsiose. Todos eles apresentaram febre, dor de cabeça e presença de escara cutânea. Às 48 horas de iniciado o quadro, um dos pacientes evidenciou uma erupção máculo-papular, enquanto que os restantes desenvolveram um exantema vesicular e crostoso. A reação de Weil-Felix mostrou-se negativa e a sorologia para Rickettsia conorii por imunofluorescência foi positiva em todos os casos. Nenhum dos pacientes recordava haver sofrido picada de insetos ainda que tenham permanecido ou transitado por pastagens em regiões agrestes. Todos receberam tratamento com doxiciclina com evolução clínica satisfatória.During 1996, four patients that returned from South Africa suffering from rickettsiosis were attended at the Traveler's Medicine practice of our hospital. All of them presented fever, headache and cutaneous scar. One of these presented maculopapular rash, while the rest developed a vesicular rash. The Weil-Felix reaction was negative and the immunofluorescence test for Rickettsia conorii was positive in all cases. None of the patients remembered having been bitten by any insects, however all of them had been staying in or going through a wild environment. All the patients were treated with doxycycline and presented a good outcome.

  11. [A case of secondary syphilis with hepatitis].

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    Tanyel, Esra; Taşdelen Fişgin, Nuriye; Sarikaya Genç, Hanife; Tülek, Necla

    2007-04-01

    Hepatitis is a rare clinical manifestation of syphilis. In this report a 50 years old male patient who was diagnosed as secondary syphilis presenting with hepatitis has been discussed. The patient was admitted to the hospital with high fever and skin rash, and his history revealed a suspected sexual contact. He indicated that he had been admitted to a health center eight months ago because of the presence of a penile wound, however VDRL (Venereal Disease Research Laboratory) test was negative at that time. Fever (39.5 degrees C), jaundice in skin and sclera, generalized macular and maculopapular skin rash including palms and soles, lymphadenopathy and hepatosplenomegaly were detected in physical examination. Laboratory tests yielded elevated erythrocyte sedimantation rate, high CRP levels and elevated liver enzyme levels, however viral hepatitis markers together with VDRL and TPHA (Treponema pallidum hemagglutination) tests were found negative. Ceftriaxone therapy was initiated because of the presence of high fever (40 degrees C) and 30 leukocyte/mm3 in urine, and the absence of bacteria in Gram staining of urine sample. However, the antibiotic therapy was discontinued since fever persisted. As the clinical signs and symptoms strongly indicated syphilis, the serological tests were repeated and VDRL positivity at 1/8 and TPHA positivity at 1/1280 titers were detected. Ceftriaxone therapy was restarted and continued for 14 days with complete cure. Since the spouse of the patient was also found VDRL and TPHA positive, she was treated with penicilin. The presentation of this case emphasized the importance of repeating the serological tests for syphilis since they might be negative in the early stages of infection. The case also indicates that syphilis should be considered in the differential diagnosis of hepatitis.

  12. Rubella outbreak in the union territory of Chandigarh, North India.

    Science.gov (United States)

    Singh, Mini P; Kumar, Archit; Gautam, Neha; Khurana, Jasmine; Gupta, Madhu; Ratho, Radha Kanta

    2015-02-01

    Rubella virus outbreaks usually occur when a large numbers of susceptible individuals accumulate. The disease presents clinically with fever and maculopapular rash. The present study reports the investigation of rubella outbreak in a modern and well-planned village near Chandigarh, North India. The blood samples were collected from 39 cases with febrile rash and from 15 age and sex matched healthy controls residing in the same locality and subjected for the detection of Rubella IgM and IgG antibodies by Enzyme linked immunosorbent assay. The throat swabs, urine and blood samples from acute cases were also collected and subjected to RT-PCR using the primers targeting the E1 region. The genetic characterization of the rubella virus was carried out to identify the circulating genotypes. In the present outbreak, 13 laboratory confirmed cases were reported. Rubella IgM antibodies were detected in 12/39 (30.7%) patients. Rubella RNA could be detected in 83.3% (5/6) of urine, 22.2% (2/9) of throat swabs, and 8.3% (1/12) of blood samples. The rubella genotype responsible for the present outbreak was identified as genotype 1a. This outbreak highlights the need for the introduction of rubella vaccine in the National Immunization Programme of India to prevent outbreaks and to aim towards the eradication of this disease. This study reports the presence of genotype 1a in North India for the first time and stresses the need for further molecular work to identify the circulating strains of the virus. © 2014 Wiley Periodicals, Inc.

  13. Nifurtimox therapy for Chagas disease does not cause hypersensitivity reactions in patients with such previous adverse reactions during benznidazole treatment.

    Science.gov (United States)

    Pérez-Molina, José A; Sojo-Dorado, Jesús; Norman, Francesca; Monge-Maillo, Begoña; Díaz-Menéndez, Marta; Albajar-Viñas, Pedro; López-Vélez, Rogelio

    2013-08-01

    Currently, only two drugs are approved for treating Trypanosoma cruzi infection: benznidazole and nifurtimox. Adverse reactions are frequent with both drugs: they have chemical similarities and common metabolic pathways making cross reactions a possibility. Our objective was to describe the safety/tolerability profile of nifurtimox in patients who had previously discontinued benznidazole due to hypersensitivity reactions. We performed a prospective observational study from September 2009 to December 2011. Patients who discontinued benznidazole therapy due to hypersensitivity reactions (HR) and were later treated with nifurtimox were included. HR to benznidazole were defined as presence of a rash with or without mucosal involvement, fever or laboratory abnormalities (such as eosinophilia, leucopaenia or impaired liver function tests). The drugs were prescribed for 60 days (benznidazole) or 60-90 days (nifurtimox). The National Cancer Institute criteria (CTCAE, 2006, Version 3.0) were used for grading and reporting of adverse reactions (AR). Eighteen patients (16 females, two males, median age 35.5 years, range 15-50 years) with asymptomatic late chronic infection, were included. Median time between benznidazole interruption and start of therapy with nifurtimox was 121.5 days (IQR 72-223 days). Fifteen patients (83.3%) developed an AR to nifurtimox, gastrointestinal complaints and anorexia being the most common, and 13 patients (72%) completed the treatment schedule. Five patients interrupted therapy (27.8%) mainly because of gastrointestinal intolerance and/or nervous system toxicity. Only one patient developed skin lesions, a mild maculopapular rash not requiring specific therapy or treatment withdrawal. There was no severe AR. Nifurtimox as second line therapy in patients who discontinued benznidazole specifically due to HR appears to be safe and does not seem to be associated with a higher incidence of AR. Copyright © 2013 Elsevier B.V. All rights reserved.

  14. Clinical features and phylogenetic analysis of Coxsackievirus A9 in Northern Taiwan in 2011

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    Huang Yi-Chuan

    2013-01-01

    Full Text Available Abstract Background Coxsackievirus A9 (CA9 was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9. Methods We analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree. Results Of the 100 patients with culture-proven CA9 infections, the mean (SD age was 4.6 (3.4 years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96% had fever and the mean (SD duration of fever was 5.9 (3.4 days. Sixty one patients (61% developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%, among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8, bronchopneumonia (n=6, acute cerebellitis (n=1, and polio-like syndrome (n=1. Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar. Conclusions The most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course.

  15. Clinical features and phylogenetic analysis of Coxsackievirus A9 in Northern Taiwan in 2011

    Science.gov (United States)

    2013-01-01

    Background Coxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9. Methods We analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree. Results Of the 100 patients with culture-proven CA9 infections, the mean (SD) age was 4.6 (3.4) years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96%) had fever and the mean (SD) duration of fever was 5.9 (3.4) days. Sixty one patients (61%) developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%), among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8), bronchopneumonia (n=6), acute cerebellitis (n=1), and polio-like syndrome (n=1). Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar. Conclusions The most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course. PMID:23347781

  16. Morphological Pattern of Cutaneous Adverse Drug Reactions due to Antiepileptic Drugs in Eastern India

    Science.gov (United States)

    Singh, Punit Kumar; Kumar, Dharmendra; Kumar, Prashant

    2015-01-01

    Introduction: Cutaneous manifestations of adverse drug reactions are a common occurrence and need to be differentiated from other causes of similar manifestations. Antiepileptic drugs (AED) usually are responsible for severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophillia and systemic symptoms (DRESS). There is paucity of published research regarding morphological pattern of CADR due to various antiepileptic drugs AED. Objective: To study the morphological patterns of CADR due to AED and common anticonvulsant drugs implicated particularly in severe CADR such as SJS/TEN and DRESS in a tertiary care teaching hospital in eastern India. Materials and Methods: A prospective, observational study was conducted over a period of 4 years from August 2009 to July 2013 after the approval of the Institutional Ethics Committee using self-reporting method for selection of cases. Settings: All patients with CADR after AED consumption for various conditions presenting to the Dermatology outpatient department (OPD) and Pediatric OPD and Indoor patients of a tertiary care teaching hospital located in Rohtas district of Bihar were included in this study. Results: During the study period, 64 cases of severe CADRs were included in this study. Out of 64 patients, 28 were male and 36 were female with mean age 36.1 years (range 6 years to 72 years). Most common AED implicated for CADR was Phenytoin. Maculopapular rash was the most common cutaneous manifestation of ADRs (42.85%). Serious CADR like TEN and SSJS were more likely in patients prescribed Phenytoin and Carbemazepine simultaneously. Conclusion: CADRs are a common occurrence and awareness about the same is essential for diagnosis and prevention. This study identified combined use of phenytoin and carbamezepine as a most important risk factor for serious CADR like SJS and TEN. PMID:25738068

  17. Pruritus in female patients

    National Research Council Canada - National Science Library

    Lambert, Julien

    2014-01-01

    Pruritus is a frequent symptom in many dermatological diseases. In this review we want to focus on not only itch problems specific to women, namely, pruritic vulvodermatoses, but also the specific pruritic dermatoses of pregnancy...

  18. Is this a simple drug eruption to be discharged?

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    Mucahit Emet

    2016-12-01

    Full Text Available ‘Erythema Multiforme associated with Phenytoin And Cranial radiation Therapy’ (EMPACT is a very rare clinic situation and classified in EM-like drug reactions. It can be easily misdiagnosed as acute urticaria or drug eruption in ED. Initial symptoms may resemble a simple skin problem, but diagnosing and early hospitalization of the patients can be lifesaving. Here, we present a man with renal cell cancer and brain metastases who admitted to ED due to fever and generalized rash. His skin lesions beginning from his head and spreading through the torso appeared four days after the end of radiotherapy (11 days after the initial dose of both radiation and oral phenytoin. Inspection showed erythematous lesions on the scalp, neck, torso and arms. These lesions had desquomative character on the scalp. Erythematous maculopapular lesions with the tendency of fusion were also visible on the chest, abdomen, back, on the flexor areas of the arm, forearm and femoral region. Laboratory studies showed normal complete blood counts, high creatinine kinase, creatinine kinase-MB, gamma-glutamyl transpeptidase, aspartate aminotransferase, lactate dehydrogenase, albumin and total protein. After discontinuation of phenytoin and giving H1, H2 receptor blockers and steroid intravenously, he was discharged two weeks later with full recovery. Keywords: Erythema multiforme, Phenytoin, Cranial radiation, Skin, Emergency

  19. Rituximab Therapy for Severe Cutaneous Leukocytoclastic Angiitis Refractory to Corticosteroids, Cellcept and Cyclophosphamide

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    Kamel El-Reshaid

    2013-04-01

    Full Text Available We report our clinical experience with rituximab in the treatment of 2 patients with idiopathic cutaneous angiitis who relapsed after treatment with high-dose corticosteroids and cyclophosphamide. A 39-year-old woman and a 51-year-old man presented with ulcerating maculopapular rash in both lower limbs which relapsed 6 months after treatment with a combination of high-dose corticosteroids and cyclophosphamide. After treatment with 2 g of rituximab, the first patient has still been in clinical remission for 32 months while the second has finished 28 months. Interestingly, CD19 which had dropped to 0.5% 8 months later in both patients. Despite that, our patients are still in clinical remission. No significant side effects were noted during infusions and up to the period of follow-up. In conclusion, rituximab is a useful and safe agent in the treatment of idiopathic cutaneous angiitis refractory to conventional therapy. Clinical remission persists years after improvement of B-cell suppression.

  20. Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case

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    Maria Miguel Gomes

    2016-01-01

    Full Text Available A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy’s sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy’s sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6 by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160 for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.

  1. Mucocutaneous findings in pediatric patients with bone marrow transplantation

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    Serap Aksoylar

    2017-03-01

    Full Text Available Background and Design: Bone marrow transplantation (BMT is performed for many malign and non-malign diseases in pediatric patients. Cutaneous signs in transplant patients are usually encountered in the presence of underlying primary diseases or due to the intense conditioning regimens that include chemotherapy and radiotherapy protocols. In this study, it is aimed to define mucocutaneous changes in pediatric patients with BMT. Materials and Methods: A total of 44 patients, in whom BMT was planned between 2010 and 2011, were included in the study. Dermatological examinations were performed at the beginning of the study and were repeated once a week in the first month, once a month in the following 5 months; and once in every 3 months in the last 1.5 years of follow-up. Results: Forty-one patients were completed the study. The mean age of 41 patients was 9.24 years (range: 1-17 years. Of the subjects, 26 (64% were male and 15 (36% were female. Dermatological signs, in order of frequency, were mucositis (75.6%, xeroderma (70.7%, alopecia (46.3%, nail disorders (24.3%, inflammatory skin diseases (24.2%, aphthous stomatitis (22%, cutaneous hyperpigmentation (22%, graft versus host diseases (17.1%, infectious diseases (15.5%, and maculopapular rash (4.8%. Conclusion: Dermatological diseases can be frequently observed in BMT patients. Close monitoring of dermatological signs is important to minimize the complications of the treatment in this patient group.

  2. Cutaneous allergic drug reactions: update on pathophysiology, diagnostic procedures and differential diagnosic.

    Science.gov (United States)

    Balakirski, Galina; Merk, Hans F

    2017-12-01

    Important changes in the understanding and management of drug hypersensitivity reactions during the last years result from the increasing importance of biologics in medical practice, which differ in their spectrum of adverse drug reactions (ADRs) from the classical covalent drugs. With regard to covalent drugs, ampicillin and amoxicillin as well as clavulanic acid play an increasing role among ADRs to betalactam antibiotics. Fluoroquinolones are mainly the cause of anaphylactic and photosensitivity reactions. Especially in allergic reactions to NSAIDs, pseudoallergic reactions should be considered in the differential diagnosis. In opposite to the main cutaneous allergic drug reactions such as urticaria or maculopapular skin rash, in which antibiotics are the main culprits, in severe drug allergic reactions such as SJS (Stevens-Johnson Syndrome), TEN (Toxic Epidermal Necrolysis), or DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) Syndrome, compounds like allopurinol and anticonvulsants are the main causes. Similar mutations in the IL36R gene, which were found in both patients with an AGEP (Acute Generalized Exanthematous Pustulosis) and pustular psoriasis, make the differential diagnosis more difficult and raise the question whether there is a difference between these diseases or whether AGEP is not just a drug induced pustular psoriasis. Finally, some special aspects of side effects of biologics and targeted therapies respectively are discussed.

  3. Direct oral provocation tests in non-immediate mild cutaneous reactions related to beta-lactam antibiotics.

    Science.gov (United States)

    Vezir, Emine; Dibek Misirlioglu, Emine; Civelek, Ersoy; Capanoglu, Murat; Guvenir, Hakan; Ginis, Tayfur; Toyran, Muge; Kocabas, Can N

    2016-02-01

    Skin testing has a limited role in the diagnosis of non-immediate beta-lactam hypersensitivity in children. The aim of this study was to report the results of oral provocation tests performed without skin tests in children with non-immediate mild cutaneous reactions without systemic symptoms caused by beta-lactam antibiotics. Oral provocation tests with suspected antibiotics were performed to patients with non-immediate mild cutaneous reactions without systemic symptoms caused by beta-lactam antibiotics. Skin tests were not performed before provocation tests. A total of five doses were administered with half-an-hour intervals in increasing doses. Provocation was continued for 5 days. A total of 119 patients with a median age of 4.3 (IQR: 2-7.5) years, of whom 58% were males, were included in the study. Amoxicillin-clavulanic acid was the most frequently responsible agent in 87 (73.1%) patients, and most common type of rash was maculopapular in 74 (62.2%) patients. Four patients (3.4%) had an urticarial reaction during the provocation test. We did not experience any severe reactions during oral provocation test without previous skin tests performed to children with non-immediate mild cutaneous reactions without systemic symptoms. Omitting skin tests before oral provocation test in this group of children can help decreasing the burden of allergy clinics and alleviating the discomfort of children. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. A case report of disappearing pigmented skin lesions associated with pembrolizumab treatment for metastatic melanoma.

    Science.gov (United States)

    Wolner, Z J; Marghoob, A A; Pulitzer, M P; Postow, M A; Marchetti, M A

    2017-01-28

    Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death (PD)-1 receptor. Common cutaneous adverse side-effects of PD-1 inhibitors include maculopapular rash, pruritus, vitiligo and lichenoid skin and mucosal reactions. Here we describe a man in his sixties with metastatic melanoma treated with pembrolizumab who subsequently developed fading or disappearance of pigmented skin lesions, lightening of the skin, and poliosis of the eyebrows, eyelashes and scalp and body hair. Compared with baseline high-resolution three-dimensional total-body photography, we observed fading or disappearance of solar lentigines, seborrhoeic keratoses and melanocytic naevi, suggesting that PD-1 inhibitors may affect the evolution of these benign skin lesions. With dermatoscopic follow-up, altered lesions showed either blue-grey peppering/granularity or fading in colour without other identifiable features. No halo lesions or lesions with surrounding inflammation were identified. One changed pigmented lesion that showed blue-grey peppering/granularity on dermoscopy was biopsied and interpreted as a macular seborrhoeic keratosis with melanophages. Further studies are required to elucidate the effects of PD-1 inhibition on benign skin lesions. © 2017 British Association of Dermatologists.

  5. Hypersensitivity Reaction and Tolerance Induction to Ethambutol

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    Josefina Rodrigues Cernadas

    2013-01-01

    Full Text Available Tuberculosis remains the leading cause of death worldwide from any infectious agent and the alarming increase in the annual incidence of new cases has been described as a global emergency. Mycobacterium infection requires simultaneous administration of multiple drugs. Although the majority of treatment courses progress with minor side effects, adverse reactions to antituberculosis drugs occur in about 5% of treated patients and can be responsible for cessation or switching the therapy. Both nonimmediate (mostly maculopapular rash and immediate reactions (urticarial reactions have been described with these drugs. The main problem is the occurrence of reactions while the patient is on treatment with multiple drugs. The diagnosis of the culprit drug is mostly based on stopping all medication, followed by the reintroduction of each drug with a time interval of four to five days. An alternative drug should be the first approach if it is equally effective. Most of the times, none of the alternative drugs are as effective as the culprit. If this is the case, a desensitization procedure should be performed. The authors describe a case of a woman with Mycobacterium avium complex (MAC infection, to whom treatment with ethambutol was crucial to recovery, and present a modified desensitization protocol to this drug.

  6. Phenytoin induced Steven-Johnson syndrome and bronchiolitis obliterans - case report and review of literature.

    Science.gov (United States)

    Pannu, Bibek S; Egan, Ashley M; Iyer, Vivek N

    2016-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both rare but serious idiosyncratic drug reactions characterized by diffuse muco-epidermoid injury and high mortality. Keratinocytes in both skin and mucous membranes (including eyes, mouth and genitalia) are injured resulting in a diffuse maculopapular rash, blistering lesions and epithelial detachment with minimal force (Nikolsky's sign). SJS is typically diagnosed when less than 10% of the skin surface is involved and the term TEN is used in cases with more than 30% involvement. Respiratory involvement in SJS-TEN is common with 30-50% of cases demonstrating respiratory epithelial sloughing with severe short and long term complications. Patients who survive SJS-TEN are often left with impaired respiratory function and bronchiolitis obliterans. Cases of bronchiolitis obliterans with SJS/TEN have been very rarely reported. We report a case of phenytoin induced SJS/TEN followed by severe bronchiolitis obliterans in an adult patient. The presentation, pathophysiology and management of SJS/TEN related bronchiolitis obliterans is also reviewed.

  7. Phenytoin induced Steven–Johnson syndrome and bronchiolitis obliterans – case report and review of literature

    Directory of Open Access Journals (Sweden)

    Bibek S. Pannu

    2016-01-01

    Full Text Available Stevens–Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are both rare but serious idiosyncratic drug reactions characterized by diffuse muco-epidermoid injury and high mortality. Keratinocytes in both skin and mucous membranes (including eyes, mouth and genitalia are injured resulting in a diffuse maculopapular rash, blistering lesions and epithelial detachment with minimal force (Nikolsky's sign. SJS is typically diagnosed when less than 10% of the skin surface is involved and the term TEN is used in cases with more than 30% involvement. Respiratory involvement in SJS-TEN is common with 30–50% of cases demonstrating respiratory epithelial sloughing with severe short and long term complications. Patients who survive SJS-TEN are often left with impaired respiratory function and bronchiolitis obliterans. Cases of bronchiolitis obliterans with SJS/TEN have been very rarely reported. We report a case of phenytoin induced SJS/TEN followed by severe bronchiolitis obliterans in an adult patient. The presentation, pathophysiology and management of SJS/TEN related bronchiolitis obliterans is also reviewed.

  8. Case report: Features of hand, foot and mouth disease in neonates.

    Science.gov (United States)

    Chen, Wen-Wen; Yang, Zhao-Bin; Lian, Lian-Shu; Xu, Li-Ping

    2017-10-01

    Hand, foot and mouth disease (HFMD) is caused by enterovirus. The virus may exist in secretions. Five neonates had symptoms of fever and maculopapular rashes involving face, trunk, breech, arms, and legs, especially scattering on palms and feet. Blood, oropharyngeal fluid, urine, and cerebrospinal fluid (CSF) samples were collected and detected for further diagnoses with the consent of the infants' parents. Some of them suffered aseptic meningitis. They were diagnosed as HFMD with CSF enterovirus positive. All of them continued breastfeed. Water bag was used during the pyrogenic stage. Antibiotics were administrated at first and withdrawn as soon as possible. None of them developed into brainstem encephalitis or pulmonary edema and they all recovered well. HFMD is more common in neonates than it has been thought. Enterovirus may exist in neonatal CSF and cause CSF cell to increase similar to purulent meningitis. Medical history, physical examination, and CSF enterovirus detection are important in making correct diagnosis. Unlike bacterial infection, HFMD is a self-limited disease. Once HFMD is determined and bacterial infection is ruled out, antibiotics should be avoided.

  9. [DRESS syndrome in paediatrics. Clinical case].

    Science.gov (United States)

    Silva-Feistner, Marcos; Ortiz, Elena; Rojas-Lechuga, María Jesús; Muñoz, Daniel

    2016-07-01

    Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, haematological abnormalities, lymphadenopathy, and internal organ involvement. Presenting a rare condition in children, to facilitate a rapid diagnostic suspicion and recognition by doctors CASE REPORT: An 9 months old infant admitted due to a severe viral pneumonia, managed with non-invasive ventilation and ceftriaxone. Five days after stopping antibiotics, a confluent maculopapular rash appeared, which was predominantly in the trunk, face and upper extremities, combined with a fever, eosinophilia, and elevated serum levels of transaminase. She received treatment with oral prednisone and topical corticosteroids for 6 weeks, with a good outcome after 3 months. The diagnosis of DRESS syndrome is made using clinical criteria, laboratory values, and histopathology, if there is any query. Although it is classically caused by anticonvulsants and sulphonamides, many other drugs have been implicated. The offending drug should be immediately discontinued and the patient given supportive treatment, and systemic corticosteroids for long periods of treatment. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Acute localized exanthem due to Coxsackievirus A4.

    Science.gov (United States)

    Drago, Francesco; Ciccarese, Giulia; Gariazzo, Lodovica; Cioni, Margherita; Parodi, Aurora

    2017-09-01

    Enteroviruses are the leading cause of exanthems in children, especially during summer and autumn. Enterovirus infections may occur in epidemics or small outbreaks. A 30-year-old woman presented with a three-day history of an erythematous maculopapular skin rash with petechiae localized exclusively under the nipple of the right breast. The skin eruption was associated with an erythematous-petechial enanthem. The patient complained of low-grade fever, headache, asthenia, sore throat and arthromyalgias. IgM (1:128) and IgG (1:640) antibodies against Coxsackievirus A4 were detected by the virus neutralization test. Reverse transcriptase real time polymerase chain reaction (PCR) assay detected enterovirus RNA in the patient's plasma and faeces. Diagnosis of an acute localized exanthem due to Coxsachievirus A4 was performed. Skin lesions improved in seven days and completely cleared in two weeks without any systemic or topical treatment. Physicians should be aware of the possibility that enteroviruses may determine localized skin eruptions in addition to hand-foot-mouth disease and atypical exanthems. Viral infections should be considered in the differential diagnosis of localized dermatitis especially when the skin eruption is associated with enanthems and with systemic symptoms.

  11. Outbreake of Marburg virus disease in Johannesburg.

    Science.gov (United States)

    Gear, J S; Cassel, G A; Gear, A J; Trappler, B; Clausen, L; Meyers, A M; Kew, M C; Bothwell, T H; Sher, R; Miller, G B; Schneider, J; Koornhof, H J; Gomperts, E D; Isaäcson, M; Gear, J H

    1975-11-29

    The first recognised outbreak of Marburg virus disease in Africa, and the first since the original epidemic in West Germany and Yugoslavia in 1967, occurred in South Africa in February 1975. The primary case was in a young Australian man , who was admitted to the Johannesburg Hospital after having toured Rhodesia. Two secondary cases occurred, one being in the first patient's travelling companion, and the other in a nurse. Features of the illness included high fever, myalgia, vomiting and diarrhoea, hepatitis, a characteristic maculopapular rash, leucopenia, thrombocytopenia, and a bleeding tendency. The first patient died on the seventh day from haemorrhage resulting from a combination of disseminated intravascular coagulation and hepatic failure. The other two patients were given vigorous supportive treatment and prophylactic heparin and recovered after an acute phase lasting about seven days. During this period on developed pancreatitis, the serum amylase remaining raised until the 32nd day after the onset of the illness. The other developed unilateral uveitis after having been asymptomatic for two months. This persisted for several weeks and Marburg virus was cultured from the anterior chamber of the eye.

  12. Evaluation of cutaneous drug reactions in patients visiting out patient departments of Indira Gandhi Government Medical College and Hospital (IGGMC and H, Nagpur

    Directory of Open Access Journals (Sweden)

    Sachin Hiware

    2013-01-01

    Full Text Available Objectives: To detect cutaneous drug reactions through spontaneous reporting system in IGGMCand H, Nagpur and analyze them using standard assessment scales. Materials and Methods: An observational, prospective study was performed in patients attending dermatology OPD of IGGMC and H, Nagpur from 1 st June 05 to 31 st May 09. Patients were examined for cutaneous drug reactions (CDRs by spontaneous Adverse Drug Reaction reporting system. Results: Among 2693 total ADRs reported, 872 (33.04% were CDRs. Antimicrobials (55.5% were the main drugs involved followed by NSAIDs (18.56% and steroids (12.61%. Maculopapular rash (37.73% followed by fixed drug eruption (17.2% and urticaria (14.56% were the most frequently observed CDRs. The common drugs causing CDRs were cotrimoxazole (20.41%, topical steroids (betamethasone, ibuprofen (7.91%, ampicillin (6.54%, diclofenac (4.7% and iron dextran (3.44%. Conclusion : It was observed that commonly used drugs like antibiotics and NSAIDs lead to maximum number of CDRs. Hence strict vigilance is required while using them. This study provides a database of ADRs due to common drugs, which will help clinicians in safe use of these drugs.

  13. Development of an improved RT-LAMP assay for detection of currently circulating rubella viruses.

    Science.gov (United States)

    Abo, H; Okamoto, K; Anraku, M; Otsuki, N; Sakata, M; Icenogle, J; Zheng, Q; Kurata, T; Kase, T; Komase, K; Takeda, M; Mori, Y

    2014-10-01

    Rubella virus is the causative agent of rubella. The symptoms are usually mild, and characterized by a maculopapular rash and fever. However, rubella infection in pregnant women sometimes can result in the birth of infants with congenital rubella syndrome (CRS). Global efforts have been made to reduce and eliminate CRS. Although a reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay for detection of rubella virus has been reported, the primers contained several mismatched nucleotides with the genomes of currently circulating rubella virus strains. In the present study, a new RT-LAMP assay was established. The detection limit of this assay was 100-1000PFU/reaction of viruses for all rubella genotypes, except for genotype 2C, which is not commonly found in the current era. Therefore, the new RT-LAMP assay can successfully detect all current rubella virus genotypes, and does not require sophisticated devices like TaqMan real-time PCR systems. This assay should be a useful assay for laboratory diagnosis of rubella and CRS. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Measles.

    Science.gov (United States)

    Rota, Paul A; Moss, William J; Takeda, Makoto; de Swart, Rik L; Thompson, Kimberly M; Goodson, James L

    2016-07-14

    Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from 5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.

  15. Zika Virus, Congenital Infection, and Neurologic Manifestations in Children: A Narrative Review

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    Narges Karimi

    2017-05-01

    Full Text Available Context Zika virus (ZIKV is an arbovirus of the family Flaviviridae. This virus, which is transmitted by mosquitoes, usually affects children and causes self-limited diseases, associated with fever, maculopapular rash, conjunctivitis, arthralgia, and myalgia. There is a significant relationship between ZIKV infection and central nervous system disorders in infants. In this study, we aimed to review neurologic manifestations of ZIKV infection in infants. Evidence Acquisition We searched the following Mesh terms in scientific databases: “Zika virus”, “infants”, “children”, “neurologic manifestations”, and “congenital infection”. Electronic databases including Google Scholar, Science Direct, PubMed, Web of Science, Scientific Information Database, and Scopus were searched from 2000 to 2016. Results The literature review showed a probable relationship between ZIKV infection and prevalence of microcephaly in newborns. Besides microcephaly, other central nervous system abnormalities included abnormal gyral arrangement, decreased brain parenchymal volume, cortical atrophy and malformation, cerebellar hypoplasia, and delayed myelination of the brain stem. Conclusions Vertical transmission of ZIKV in pregnant women is associated with intrauterine infection and brain malformations in the developing fetus, including microcephaly, calcification, cortical displacement, ventriculomegaly, and white-matter abnormalities.

  16. [Brown recluse bite].

    Science.gov (United States)

    Nehemya, Moshe

    2008-01-01

    Spider bites are not uncommon in our warm climate. The most prevalent species of venomous spiders in Israel are the brown recluse and the black widow. Although the black widow is more notorious than the recluse, for every bite by a black widow there are hundreds of recluse bites reported. Despite the numerous bites, there is little awareness amongst physicians with regard to the clinical signs of recluse bites, and very often the wrong diagnosis is made, resulting in complex and unnecessary treatments. The basis of this error stems from the numerous clinical diagnoses which closely imitate a recluse bite, the relative scarceness of documented recluse bites and the fact that in most cases the spider is not witnessed by the victim. The following article describes three cases of children admitted to our department, presenting with high fever, a necrotic lesion and an extensive maculopapular rash. The children were eventually diagnosed with brown recluse bites. Furthermore, the article summarizes the literature regarding the clinical signs of recluse bites, possible complications and treatment options. The objective of this review is to increase awareness towards recluse bites, thereby preventing misdiagnoses and unnecessary treatments.

  17. Infeção Aguda pelo Vírus da Imunodeficiência Humana 1: uma janela de oportunidade

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    Eunice Oliveira

    2016-03-01

    The diagnosis of acute infection by the Human Immunodeficiency Virus 1 (HIV-1 is a challenge, being essential a high degree of suspicion to achieve the diagnosis, particularly in the absence of an apparent epidemiological context. The authors present a case of a 52 years old woman with a clinical picture suggestive of infectious mononucleosis, associated with nausea, vomiting and diarrhea with one week of evolution. The patient denied sexual activity, injection drug use or blood transfusions. Physical examination pointed out the presence of prostration, ulcerative lesions of the oral cavity, sore throat, maculopapular rash and bilateral cervical lymphadenopathies. Laboratory studies showed bicytopenia, citocolestase pattern, increased lactate dehydrogenase and lipase. After etiological investigation it was assumed the diagnosis of acute HIV-1 infection with acute pancreatitis in this context. After the beginning of the antiretroviral therapy there was complete resolution of symptoms. The authors pretend to show that acute retroviral syndrome should be considered in the differential diagnosis of mononucleosis like syndrome, the relevance of 4th generation tests as well as the role of antiretroviral therapy in the acute infection.

  18. Adverse cutaneous drug reactions: Clinical pattern and causative agents in a tertiary care center in South India

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    Pudukadan David

    2004-01-01

    Full Text Available Background: Adverse cutaneous drug reactions (ACDRs are caused by a wide variety of agents. Aims: Our objective was to ascertain the clinical spectrum of ACDRs and the causative drugs in this part of India and to find any risk factors. Methods: Ninety patients with adverse cutaneous drug reactions were recruited for this study during 2001-2003. Hematological and biochemical investigations were done in all of them. The VDRL and HIV (ELISA tests were performed where the underlying risk factors were present. Patch testing, intradermal testing and oral provocation tests were done wherever feasible. Results: The mean age of the patients with cutaneous drug eruptions was 37.06 years. Most of them (52.2% were in the age group of 20-39 years. The male to female ratio was 0.87: 1. The most common eruptions observed were fixed drug eruption (31.1% and maculopapular rash (12.2%, and the most common causes were co-trimoxazole (22.2% and dapsone (17.7%. Conclusion: The pattern of ACDRs and the drugs causing them is remarkably different in our population. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators is essential for the clinician.

  19. A case of human monocytic ehrlichiosis in Serbia

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    Arsić Bogdan

    2014-01-01

    Full Text Available Introduction. Ehrlichiosis is a bacterial zoonosis transmitted by hematophagous arthropods - ticks. In humans, it occurs as monocytic, granulocytic, and ewingii ehrlichiosis. Pathological process is based on parasitic presence of Ehrlichia organisms within peripheral blood cells - monocytes and granulocytes. Case Outline. Fifty-two year old patient was admitted to hospital due to high fever of over 40°C that lasted two days, accompanied with chills, muscle aches, malaise, loss of appetite, headache, confusion, breathing difficulties, and mild dry cough. The history suggested tick bite that occurred seven days before the onset of disease. Doxycycline was introduced and administered for 14 days, causing the disease to subside. Indirect immunofluorescence assay was used to analyze three serum samples obtained from this patient for Ehrlichia chaffeensis antibodies, and peripheral blood smear was evaluated for the presence of Ehrlichia and Ehrlichia aggregation into morulae. Conclusion. Ehrlichiosis should be considered in each case where there is a history of tick bite together with the clinical picture (high fever, chills, muscle aches, headache, generalized weakness and malaise, and possible maculopapular rash. The presence of Ehrlichia chaffeensis antibodies was confirmed in a patient with the history of tick bite, appropriate clinical picture and indirect immunofluorescence assay. This confirmed the presence of human monocytotropic ehrlichiosis, a disease that is uncommonly identified in our country.

  20. Stevens-Johnson syndrome induced by the cross-reactivity between teicoplanin and vancomycin.

    Science.gov (United States)

    Yang, L-P; Zhang, A-L; Wang, D-D; Ke, H-X; Cheng, Q; Wang, C

    2014-08-01

    The glycopeptide antibiotics, vancomycin and teicoplanin, are the mainstay of therapy for severe gram-positive organisms such as methicillin-resistant Staphylococcus aureus. We report a case of Stevens-Johnson syndrome (SJS) induced by sequential therapy with teicoplanin and vancomycin, in a patient with chronic obstructive pulmonary disease (COPD). A 74-year-old Han Chinese with 1-year history of COPD was admitted for treatment of infective endocarditis. After teicoplanin therapy for 12 days, he developed pruritus and maculopapular over his trunk and limbs. His rash spread rapidly to most parts of the body surface area, 7 days after his anti-infection therapy was switched to vancomycin. This was stopped, but he developed SJS when teicoplanin was re-introduced. This patient recovered from his drug eruptions when both teicoplanin and vancomycin were stopped. Pharmacogenetic analyses revealed he was heterozygous with respect to two variants (rs2844682 of MUC21 and rs750332 of BAG6). Cross-reactivity between vancomycin and teicoplanin is rare. SJS attributable to sequential treatment with these two antibiotics has not been reported previously. Care should be taken when prescribing vancomycin in patients with a previous documented skin eruption to teicoplanin, especially in those who carry any susceptibility alleles to SJS/TEN. © 2014 John Wiley & Sons Ltd.

  1. Infectious mononucleosis-like syndrome probably attributable to Coxsackie A virus infection.

    Science.gov (United States)

    Cunha, Burke A; Mickail, Nardeen; Petelin, Andrew P

    2012-01-01

    Infectious mononucleosis (IM) is a clinical syndrome most often attributable to Epstein-Barr virus (EBV). Characteristic clinical features of EBV IM include bilateral upper lid edema, exudative or nonexudative pharyngitis, bilateral posterior cervical adenopathy, and splenomegaly ± maculopapular rash. Laboratory features of EBV IM include atypical lymphocytes and elevated levels of serum transaminases. Leukopenia and thrombocytopenia are not uncommon. The syndrome of IM may also be attributable to other infectious diseases, eg, cytomegalovirus (CMV), human herpes virus-6 (HHV-6), or Toxoplasma gondii. Less commonly, viral hepatitis, leptospirosis, brucellosis, or parvovirus B(19) may present as an IM-like infection. To the best of our knowledge, only 2 cases of IM-like infections attributable to Coxsackie B viruses (B(3) and B(4)) have been reported. We present the first reported case of an IM-like syndrome with sore throat, fatigue, atypical lymphocytes, and elevated levels of serum transaminases likely due to Coxsackie A in an immunocompetent adult. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Hypersensitivity to antihistamines.

    Science.gov (United States)

    Shakouri, Alireza A; Bahna, Sami L

    2013-01-01

    Antihistamines are the cornerstone of allergy therapy and are not expected to cause hypersensitivity reactions. We describe two cases, one had urticaria to multiple anti-H1-preparations and the other had anaphylaxis to hydroxyzine. We also provide a review of the English literature on reported reactions regarding causative preparations and manifestations. The latter showed a wide range; most commonly urticaria/angioedema, contact dermatitis, anaphylaxis, and fixed drug eruption (FDE). Most reported cases were young to middle age adults, with apparent predilection to female subjects. The onset of reactions varied from a few minutes for anaphylaxis and urticaria/angioedema, several hours for maculopapular rashes, or longer for contact dermatitis and FDE. Almost all antihistamines have been reported as causing reactions; cetirizine was the most common oral preparation followed by its parent drug, hydroxyzine. Doxepin cream was the most commonly implicated topical preparation in causing contact dermatitis. A causal relationship is often difficult to recognize because the reaction may be similar to the disease being treated with that antihistamine preparation. Reactions to one preparation are likely to occur, but not always, to other members of the same class. Diagnosis is based on clinical suspicion and may be verified by challenge testing. Except for patch testing in contact dermatitis or fixed eruption, other tests have not shown optimal reliability. In most cases, challenge testing with multiple preparations would identify one or more preparations that can be tolerated. Although hypersensitivity to antihistamines seems to be very rare, awareness of the problem would reduce its misdiagnosis.

  3. Neonatal Listeriosis

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    Shih-Yu Chen

    2007-01-01

    Full Text Available In Western developed countries, Listeria monocytogenes is not an uncommon pathogen in neonates. However, neonatal listeriosis has rarely been reported in Taiwan. We describe two cases collected from a single medical institute between 1990 and 2005. Case 1 was a male premature baby weighing 1558 g with a gestational age of 31 weeks whose mother had fever with chills 3 days prior to delivery. Generalized maculopapular rash was found after delivery and subtle seizure developed. Both blood and cerebrospinal fluid culture collected on the 1st day yielded L. monocytogenes. In addition, he had ventriculitis complicated with hydrocephalus. Neurologic development was normal over 1 year of follow-up after ventriculoperitoneal shunt operation. Case 2 was a 28-weeks' gestation male premature baby weighing 1180 g. Endotracheal intubation and ventilator support were provided after delivery due to respiratory distress. Blood culture yielded L. monocyto-genes. Cerebrospinal fluid showed pleocytosis but the culture was negative. Brain ultrasonography showed ventriculitis. Sudden deterioration with cyanosis and bradycardia developed on the 8th day and he died on the same day. Neonatal listeriosis is uncommon in Taiwan, but has significant mortality and morbidity. Early diagnosis of perinatal infection relies on high index of suspicion in perinatal health care professionals. [J Formos Med Assoc 2007;106(2:161-164

  4. Evidence of acute rickettsioses among patients presumed to have chikungunya fever during the chikungunya outbreak in Sri Lanka.

    Science.gov (United States)

    Premaratna, R; Halambarachchige, L P; Nanayakkara, D M; Chandrasena, T G A N; Rajapakse, R P V J; Bandara, N K B K R G W; de Silva, H J

    2011-12-01

    Chikungunya fever (CGF) and rickettsioses are known to cause acute onset febrile illnesses associated with severe arthritis. Rickettsial arthritis is curable with the use of appropriate anti-rickettsial antibiotics, however the arthritis of CGF tends to have a prolonged course leading to protracted disability. The aim of this study was to investigate the contribution of CGF and rickettsioses to cases of fever and arthritis during a presumed CGF outbreak in Sri Lanka. Fifty-eight consecutive patients with presumed CGF were further investigated to determine the occurrence of rickettsioses among them, and to identify differences in clinical, hematological, and biochemical parameters between the two diseases. Nearly a third of the patients had serological evidence of rickettsioses accounting for their illness. The presence of a late onset major joint arthropathy sparing the small joints of the hands and feet, and the occurrence of a late onset discrete maculopapular rash over the trunk and extremities, suggested rickettsioses over CGF. White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and liver function tests were not helpful in differentiating rickettsioses from CGF. Patients with rickettsioses and arthritis who received an empirical course of doxycycline recovered faster than those who did not receive specific treatment. The establishment of rapid diagnostic methods able to differentiate the etiological agents of fever and arthritis, such as CGF and rickettsioses, would be beneficial in endemic settings. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  5. Clinical Manifestations and Outcomes of Rickettsia australis Infection: A 15-Year Retrospective Study of Hospitalized Patients

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    Adam Stewart

    2017-06-01

    Full Text Available Queensland tick typhus (QTT; Rickettsia australis is an important cause of community-acquired acute febrile illness in eastern Australia. Cases of QTT were identified retrospectively from 2000 to 2015 at five sites in Northern Brisbane through a pathology database. Those included had a fourfold rise in spotted fever group (SFG-specific serology, a single SFG-specific serology ≥ 256 or SFG-specific serology ≥ 128 with a clinically consistent illness. Cases were excluded on the basis of clinical unlikelihood of QTT infection. Thirty-six cases were included. Fever was found in 34/36 (94% patients. Rash occurred in 83% of patients with maculopapular being the dominant morphology (70%. Thrombocytopenia, lymphopenia, and raised transaminases were common and occurred in 58%, 69%, and 89% of patients, respectively. Thirty-one of 36 (86% patients received antibiotic therapy (usually doxycycline and the time to correct antibiotic (from admission ranged from 3 to 120 h (mean 45.5 h. Four of 36 (11% required intensive care unit (ICU admission for severe sepsis and end-organ support. There were no deaths. QTT has a wide range of clinical and laboratory features. Early and appropriate antimicrobial therapy is important and may prevent severe disease. Further prospective studies are required to identify factors associated with severe infection and sepsis.

  6. Epidemiology and neurological complications of infection by the Zika virus: a new emerging neurotropic virus.

    Science.gov (United States)

    Carod-Artal, Francisco J

    2016-04-01

    The current epidemic outbreak due to Zika virus began in 2015 and since then it has been reported in 31 countries and territories in America. The epidemiological and clinical aspects related to infection by Zika virus are reviewed. Since 2007, 55 countries in America, Asia, Africa and Oceania have detected local transmission of the virus. This epidemic has affected almost 1.5 million people in Brazil. 80% of the cases are asymptomatic. The symptoms of Zika virus disease include fever, maculopapular rash, arthralgia and non-purulent conjunctivitis. The symptoms are usually self-limiting and last one week. An increase in the incidence of cases of microcephaly, retinal lesions and Guillain-Barre syndrome associated with the Zika virus has been reported. Zika-associated Guillain-Barre syndrome in Polynesia is a pure motor axonal variant. The RNA of the Zika virus has been identified in samples of brain tissue, placenta and amniotic liquid of children with microcephaly and in the still-born infants of women infected by Zika during pregnancy. The reverse transcription polymerase chain reaction test is recommended to detect viral RNA, and serological tests (IgM ELISA and neutralising antibodies) should be conducted to confirm infection by Zika. The differential diagnosis includes infection by the dengue and chikungunya viruses. Knowledge about the pathogenic mechanisms involved in infection due to Zika virus and its long-term consequences in adults and newborn infants is still limited.

  7. Double-blind crossover trial of lamotrigine (Lamictal) as add-on therapy in intractable epilepsy.

    Science.gov (United States)

    Binnie, C D; Debets, R M; Engelsman, M; Meijer, J W; Meinardi, H; Overweg, J; Peck, A W; Van Wieringen, A; Yuen, W C

    1989-01-01

    A double-blind, placebo-controlled trial is reported of lamotrigine as add-on treatment in therapy-resistant epilepsy. A within-patients serial design was used, with two 3-month treatment periods and an intervening 6-week washout/crossover period. An unblinded investigator adjusted lamotrigine dosage to achieve a plasma concentration within a previously predicted therapeutic range. All patients had therapy-resistant partial seizures, some in combination with other seizure types and were without serious neurological or intellectual deficit. Of 34 patients recruited only one was withdrawn because of an adverse experience (maculo-papular rash) probably related to the experimental drug and 30 completed the trial. The other 3 withdrawals were due to default during baseline, dispensing error and cholecystectomy. There was a modest statistically significant reduction in total and partial seizures on lamotrigine compared to placebo treatment. There was no difference in adverse experiences or abnormal biochemical or haematological findings between the lamotrigine and placebo periods. The plasma concentrations of concomitantly administered antiepileptic drugs were not affected by lamotrigine treatment. It is concluded that lamotrigine shows promise as an antiepileptic drug with low toxicity.

  8. Relapsing macrophage activating syndrome in a 15-year-old girl with Still's disease: a case report

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    Ben-Chetrit Eldad

    2009-11-01

    Full Text Available Abstract Introduction Macrophage activating syndrome is a severe, potentially life-threatening condition that may accompany Still's disease. It is characterized by fever, hepatosplenomegaly, lymphadenopathy, severe cytopenia, serious liver dysfunction, coagulopathy and neurologic involvement. The principal treatment for patients with this syndrome includes etoposide 150 mg/2 M twice a week for two weeks, dexamethasone 10 mg/2 M for two weeks and cyclosporine 3 mg/kg to 5 mg/kg for a longer period. Cases of relapse of macrophage activating syndrome are relatively rare. Case presentation We describe the case of a 15-year-old Iraqi girl with Still's disease who developed macrophage activating syndrome with acute respiratory distress syndrome that required resuscitation and mechanical ventilation. Following intensive treatment, including high dose steroids and cyclosporine, the patient improved significantly. Two weeks after cyclosporine was discontinued, however, she was readmitted with an acute relapse of macrophage activating syndrome manifested by spiking fever, arthralgias, maculopapular rash and leukocytosis. This time the patient recovered following the reintroduction of treatment with cyclosporine and the addition of mycophenolate mofetil (Cellcept. Conclusion We believe that cyclosporine is a cornerstone for the treatment of Still's disease. We recommend continuing this medication for several weeks following the patient's clinical recovery in order to prevent macrophage activating syndrome relapses.

  9. Miliária 'rash' após neutropenia febril e quimioterapia de indução para a leucemia mielóide aguda

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    Nguyen, Tuyet A.; Ortega-Loayza, Alex G; Michael P. Stevens

    2011-01-01

    Miliaria is a disorder of the eccrine sweat glands which occurs in conditions of increased heat and humidity. It can be associated with persistent febrile states as well as with certain drugs. We presented a 40 year-old female with myelodysplastic syndrome and progression to acute myelogenous leukemia who was admitted to the hospital for chemotherapy induction. The patient was treated with idarubicin and cytarabine. She became pancytopenic and developed neutropenic fever and was started on va...

  10. Evaluation of the Tetracore Orthopox BioThreat® antigen detection assay using laboratory grown orthopoxviruses and rash illness clinical specimens.

    Science.gov (United States)

    Townsend, Michael B; MacNeil, Adam; Reynolds, Mary G; Hughes, Christine M; Olson, Victoria A; Damon, Inger K; Karem, Kevin L

    2013-01-01

    The commercially available Orthopox BioThreat® Alert assay for orthopoxvirus (OPV) detection is piloted. This antibody-based lateral-flow assay labels and captures OPV viral agents to detect their presence. Serial dilutions of cultured Vaccinia virus (VACV) and Monkeypox virus (MPXV) were used to evaluate the sensitivity of the Tetracore assay by visual and quantitative determinations; specificity was assessed using a small but diverse set of diagnostically relevant blinded samples from viral lesions submitted for routine OPV diagnostic testing. The BioThreat® Alert assay reproducibly detected samples at concentrations of 10(7)pfu/ml for VACV and MPXV and positively identified samples containing 10(6)pfu/ml in 4 of 7 independent experiments. The assay correctly identified 9 of 11 OPV clinical samples and had only one false positive when testing 11 non-OPV samples. Results suggest applicability for use of the BioThreat® Alert assay as a rapid screening assay and point of care diagnosis for suspect human monkeypox cases. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Dermatitis irritativa del pañal: Tratamiento local con productos barrera y calidad de vida Diaper rash: Local treatment with barrier products and quality of life

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    Justo Rueda López

    2012-03-01

    Full Text Available Los trastornos cutáneos son derivados, en la mayoría de las ocasiones, de agresiones continuas por elementos externos que tiene como respuesta reacciones como la pérdida de lípidos epidérmicos por efecto de la humedad, cambios en el pH cutáneo (alcalinización y aumento del coeficiente de fricción (denudación junto al desequilibrio de la flora saprofita de la piel, que se traducen en procesos irritativos y en un aumento de la infecciones fúngicas y bacterianas en la zona expuesta a humedad. Dada la importancia de evaluar la calidad de vida de los pacientes con dermatitis que son tratados con productos barrera no irritantes (PBNI se ha desarrollado un estudio multicéntrico, con el objetivo de evaluar los aspectos relacionados con la mejora en la calidad de cuidados a pacientes tratados con Cavilon® que presentaban dermatitis por incontinencia mediante la escala ESCLI. Los pacientes incluidos en el estudio fueron 25. Los resultados muestran una mejora importante de los aspectos evaluados mediante la escala ESCLI sobre la evolución de la dermatitis. Esta escala valora aspectos como el área afectada por el enrojecimiento y la severidad, presentan una reversión del 47% de los casos. La denudación de la piel en la zona del pañal desaparece en el 56% de los casos y la severidad de la denudación que presenta una mejoría del 47%. La valoración del dolor en la zona de incontinencia se reduce en un 76% en la zona de incontinencia y en un 73% al realizar la limpieza de la zona. Las conclusiones del presente estudio ponen de manifiesto que la aplicación de productos formadores de una película barrera no irritante (PBNI en los pacientes que presentan dermatitis por incontinencia representa una alternativa a los tratamientos convencionales como son las cremas o ungüentos de óxido de cinc o pastas al agua. La reversión y reducción de la dermatitis es un aspecto que presenta una mejoría importante. Los resultados obtenidos que podemos relacionar con la calidad de vida o más concretamente con la mejora del dolor son destacables.The skin disorders are derived in most cases continuous injuries by external factors that have how responses the loss of epidermal lipids by the effect of moisture, derived of changes in skin pH (alkalinization, an increased coefficient of friction (denudation and the imbalance of the saprophytic flora of the skin, give how a result an increase to the irritative processes and the fungal and bacterian infections in the area exposed to moisture. Given the importance of assessing the quality of life of patients with dermatitis who are treated with No Sting Barrier Film (NSBF CavilonTM has developed a multicenter study, in order to evaluate the related to improving the quality of care that patients Incontinence Dermatitis with ESCLI scale. Patients included in the study were 25. The results show a significant improvement aspects ESCLI assessed by the scale of the evolution of the dermatitis. This scale assesses aspects such as the area affected by the redness and severity. Show a reversal 47% of cases. The denudation of the skin in the diaper area disappears in 56% of cases and the severity of the denudation which has a 47% improvement. The assessment of pain in the area of incontinence, is reduced by 76% in the area of incontinence and a 73% when cleaning the area. The findings of this study prove indicates that the application of forming products of a No Sting Barrier Film (NSBF in patients with incontinence dermatitis is an alternative to conventional treatments such as creams or ointments or zinc oxide paste water. The reversal and reduction of dermatitis is an aspect that has improved important. The results that we can relate to quality of life or longer specifically with the improvement of pain are significant.

  12. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.

    Science.gov (United States)

    Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

    2014-09-01

    Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

  13. A cross-sectional study of cutaneous drug reactions in a private dental college and government medical college in eastern India.

    Science.gov (United States)

    Chattopadhyay, C; Chakrabarti, N

    2012-01-01

    with bronchial asthma in the whole proceedings. The duration of drug intake varied from 15 minutes to 2 weeks. The most common reaction noted was maculopapular rash 37 (50.5%), urticaria 15 (20%), fixed drug eruption (FDR) 15 (20%), angioedema 6 (8%) in dental College whereas a little different trend was observed in the medical college. Hospitalization was required in two cases of Steven--Johnson syndrome caused by NSAIDS in the dental College whereas 11 patients were hospitalized for the same indication in the medical College. Except for maculopapular rash, all other skin reactions were observed more frequently with NSAIDS in dental College whereas Steven--Johnson syndrome is predominantly observed in Medical College with anticonvulsants. In all the cases causative drugs were withdrawn. A total 40% of the patients required only antihistaminic, 35% required antihistaminic and topical corticosteroid and rest required a combination of antihistaminic, oral and topical corticosteroids. Commonest drugs causing drug reactions are antibiotics mainly beta lactams and quinolones. Severe reactions were seen in our series with anticonvulsants and NSAIDS. Association with other diseases could not be inferred due to this modest patient pool.

  14. Asthma, Allergic Rhinitis And Atopic Eczema In Schoolchildren Kashan (1998 -1999

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    Gharagosloo M

    2003-06-01

    Full Text Available Wide variations in the prevalence of asthma, allergic rhinitis and eczema have been reported in the world, between regions and countries. The international study of asthma and allergies in childhood (ISAAC was developed to provide standardized method to ascertain the prevalence of asthma and allergies in different regions. Comparisons of prevalence rates across geographic regions may help to identify factors that influence the development of these conditions in individuals."nMethods and Materials: For doing this descriptive study the ISAAC written questionnaire was completed by the parents of 3000 school children aged 6-7 years in Kashan, the central area of Iran, with different geographic and cultural characteristics, during the fall of 1998."nResults: The overall cumulative and 12 month prevalence of wheezing were 10.2 percent, 6.9 percent in the girls and 18.2 percent, 13.1 percent in the boys respectively. The prevalence of doctor diagnosed asthma were 1.3 percent and 2.2 percent in the girls and boys. Rhinitis symptoms were reported by 14,7 percent, 16.9 percent and chronic pruritic rashes by 5.1 percent and 8.3 percent of the girls and boys respectively."nConclusion: Allergic disorders are common in this area and prevalence is comparable to other parts of Iran and many other countries. Prevalence of asthma by medical diagnosis is relatively low with respect to other studies performed with the same methodology.

  15. Pravastatin-Induced Eczematous Eruption Mimicking Psoriasis

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    Michael P. Salna

    2017-01-01

    Full Text Available Background. Statins, an example of the most commonly prescribed medications to the elderly, are not without side effects. Dermatologic events are often overlooked as arising from medications, particularly those which are taken chronically. Moreover, elderly patients are prone to pharmacologic interactions due to multiple medications. In this report, we describe a case of a statin-induced eczematous dermatitis with a psoriasis-like clinical presentation and review the skin manifestations that may arise from statin therapy. Case Presentation. An 82-year-old man with gout and hypercholesterolemia presented to dermatology clinic with new onset of pruritic, scaly erythematous plaques bilaterally on the extensor surfaces of his arms. He had never had similar lesions before. Despite various topical and systemic treatments over several months, the rash continued to evolve. The patient was then advised to discontinue his long-term statin, which led to gradual resolution of his symptoms. He was subsequently diagnosed with statin-induced eczematous dermatitis. Conclusions. This case report describes an adverse cutaneous reaction to statins that is rarely reported in the literature. Medications, including longstanding therapies, should be suspected in cases of refractory dermatologic lesions.

  16. Comorbidity of Stevens-Johnson syndrome and neutropenia associated with lamotrigine: a case report.

    Science.gov (United States)

    Yasui-Furukori, Norio; Hashimoto, Kojiro; Tsuruga, Koji; Nakamura, Kazuhiko

    2014-01-01

    A 19-year-old woman with a medical history of depressive mood arrived and was treated with lamotrigine at 25 mg/day. On day 10, a high fever of 39.3 °C and a diffuse, erythematous, pruritic full-body rash involving the palms of her hands and the soles of her feet developed, and she was diagnosed with Stevens-Johnson syndrome (SJS). On day 17, white blood cell count (WBC) result was 1,240/μl with 54.1% neutrophils (670/μl), and the WBC decreased to 840/μl with 60.7% neutrophils (510/μl) on day 18. The trend toward improvement included skin symptoms after steroid pulse therapy using 1000 mg/day. Based on the clinical course, we concluded that the SJS and leukopenia and/or neutropenia are associated with lamotrigine. Monitoring of WBC should be kept in mind when administering lamotrigine. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Leukocytoclastic vasculitis: A window to systemic Churg Strauss syndrome

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    Sudhir V Medhekar

    2012-01-01

    Full Text Available A twenty year old male presented with purpuric lesions with chronic painful ulcers over the lower extremities and a recurrent pruritic rash on the trunk for 10 years. He was diagnosed as idiopathic leukocytoclastic vasculitis (LCV after investigations failed to reveal a systemic association. He was treated with immunosuppressants at each visit with partial remission. In 2004, he was diagnosed with bronchial asthma and allergic rhinitis. In his recent admission, he showed necrotic ulcers on legs and extensive shiny, truncal micropapules. Examination revealed maxillary sinus tenderness and loss of sensation on the medial aspect of the left lower limb. Biopsy of ulcer and the micropapules showed the presence of extravascular eosinophils, while hematological investigations showed peripheral eosinophilia of 18%, raised serum Immunoglobulin E (IgE, Anti nuclear antibody (ANA positivity and negative antineutrophil cytoplasmic antibody (ANCA. Radiography confirmed maxillary sinusitis, nerve conduction studies revealed mononeuritis of the anterior tibial nerve and pulmonary function tests (PFT were normal. Clinical examination and investigations pointed towards the diagnosis of Churg-Strauss syndrome (CSS. This report highlights the development of full-blown CSS over a period of 12 years in a patient initially diagnosed as idiopathic LCV, emphasizing the need for regular follow-up of resistant and recurrent cases of LCV.

  18. Refractory case of adrenergic urticaria successfully treated with clotiazepam.

    Science.gov (United States)

    Kawakami, Yukari; Gokita, Mari; Fukunaga, Atsushi; Nishigori, Chikako

    2015-06-01

    Adrenergic urticaria (AU) is a rare type of stress-induced physical urticaria characterized by widespread pruritic urticarial papules. Diagnosis can be made by i.d. injection of adrenaline or noradrenaline, which produces the characteristic rash. Although the lesions of AU typically respond to beta-blockers such as propranolol, the therapeutic options for AU are limited. Here, we report a case of AU that was resistant to beta-blockers and successfully treated with clotiazepam. The clinical picture of AU resembles that of cholinergic urticaria (CU), however, positive noradrenaline test and negative acetylcholine skin test were useful for the differential diagnosis of AU and CU. Although his symptoms were resistant to several therapeutic methods including olopatadine (H1 antagonist), lafutidine (H2 antagonist) and propranolol, the severity and frequency of his attacks and his subjective symptoms were reduced by oral clotiazepam, an anxiolytic benzodiazepine. Dermatologists should be aware that anxiolytic benzodiazepines may be a therapeutic option in AU. © 2015 Japanese Dermatological Association.

  19. Active shingles infection as detected on 18F-FDG PET/CT

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    Razi eMuzaffar

    2013-04-01

    Full Text Available We present the case of a 56 year old male with a history of recurrent follicular lymphoma undergoing chemotherapy with multiple 18F-FDG PET-CT studies at an outside facility. He developed a painful erythematous, pruritic rash in the left back requiring a visit to the emergency room. He was diagnosed and treated for varicella zoster infection. He then presented to our imaging center 2 months later for a follow up 18F-FDG PET/CT study. Imaging demonstrated a cutaneous band of increased metabolic activity in the upper back following a dermatomal distribution. This was confirmed to be in the same area as the treated varicella zoster eruption. A subsequent follow up 18F-FDG PET-CT scan 4 months later to confirm tumor resolution demonstrated the abnormal band of uptake in the back had resolved. This case illustrates the significance of being aware of this entity and to distinguish it from metastasis, especially in patients with a known history of malignancy.

  20. Classic Hodgkin lymphoma in pelvis: A case report highlights diagnosis and treatment challenges.

    Science.gov (United States)

    Tang, Fan; Min, Li; Ye, Yunxia; Tang, Bo; Zhou, Yong; Zhang, Wenli; Tu, Chongqi

    2017-09-01

    Classic Hodgkin lymphoma with pelvic involvement is a rare entity. Diagnosis and treatment for such an uncommon disease are challenging. Here we report a special case of classic Hodgkin lymphoma in pelvis. A 20-year-old woman was admitted to our department due to left hip symptoms. The patient reported a history of drenching night sweats, low-grade fever, pruritic rash on the body, and an almost 15% weight loss during the previous 3 months. Imaging studies revealed osteolytic destruction of the left hemi-pelvic with a huge soft-tissue mass. Open biopsy established the pathological diagnosis of classic Hodgkin lymphoma. Considering the B symptom, bulky disease, and high risk of pathological fracture of the patient, we performed limb-salvage surgery and 6 cycles ABVD chemotherapy with 2 cycles before surgery. Up to now, at the 3-year follow-up, there is no sign of disease relapse and metastasis. Besides, her limb function recovered well. Based on this case and literature we reviewed, diagnoses for primary bone Hodgkin lymphoma should be cautious. For the treatment, chemotherapy was the main treatment option. Classic Hodgkin lymphoma patients seldom received tumor resection surgery, but for the special bone classic Hodgkin lymphoma individual with a huge tumor volume and high risk of pathological fracture in our study, limb-salvage surgery based on ABVD chemotherapy provided a satisfying clinical outcome.

  1. Urticaria mimickers in children.

    Science.gov (United States)

    Mathur, Anubhav N; Mathes, Erin F

    2013-01-01

    Acute urticaria is a self-limited cutaneous condition marked by transient, erythematous, and pruritic wheals. It is a hypersensitivity response that is often secondary to infection, medications, or food allergies in children. In contrast, the urticarial "mimickers" described in this review article are often seen in the context of fever and extracutaneous manifestations in pediatric patients. The differential diagnosis ranges from benign and self-limited hypersensitivity responses to multisystem inflammatory diseases. Establishing the correct diagnosis of an urticarial rash in a pediatric patient is necessary to both prevent an unnecessary work up for self-limited conditions and to appropriately recognize and evaluate multisystem inflammatory disorders. Herein, we describe two cases to illustrate the clinical manifestations, laboratory findings, histopathology and differential diagnoses for several mimickers of acute urticaria including: urticaria multiforme, serum sickness like reaction, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, systemic onset juvenile idiopathic arthritis, cryopyrin associated periodic syndromes, and urticarial vasculitis. © 2013 Wiley Periodicals, Inc.

  2. Reactive eccrine syringofibroadenomatosis secondary to primary cutaneous amyloidosis: a novel association.

    Science.gov (United States)

    Saggini, Andrea; Mully, Thaddeus

    2014-04-01

    We report the unprecedented case of reactive eccrine syringofibroadenoma (ESFA) secondary to primary cutaneous amyloidosis. A 62-year-old woman of Asian ethnicity presented with a pruritic rash on the back of long-standing duration. Physical examination revealed diffuse hyperpigmentation localized to the interscapular region; there were a multitude of hyperpigmented macules merged in a rippled pattern intermixed with scattered papules and cobblestone-like areas. A punch biopsy from a papule was taken. Histopathological examination revealed a network of epithelial strands and cords hanging from the epidermis and harboring foci of ductal differentiation. Eosinophilic collections of amorphous material were found between the epithelial strands, obscuring the superficial dermis. The microscopic picture was consistent with primary cutaneous amyloidosis associated with reactive ESFA. Results of histochemical and immunohistochemical staining confirmed the diagnosis. We speculate that pathogenetic mechanisms intrinsic to primary cutaneous amyloidosis, in addition to unknown genetic factors, resulted in clinical changes of lichen amyloidosus associated with an abnormal hyperplastic epithelial response with histopathological features of ESFA rather than the common epidermal change of acanthosis and hyperkeratosis. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Review-Essay: Something Rich and Strange

    DEFF Research Database (Denmark)

    Bjerre, Thomas Ærvold

    2014-01-01

    Review-essay of The Ron Rash Reader (2014), ed. Randall Wilhelm and John Lang's Understanding Ron Rash (2014).......Review-essay of The Ron Rash Reader (2014), ed. Randall Wilhelm and John Lang's Understanding Ron Rash (2014)....

  4. Systemic Allergy to Corticosteroids: Clinical Features and Cross Reactivity.

    Science.gov (United States)

    Barbaud, Annick; Waton, Julie

    2016-01-01

    Systemic hypersensitivity (HS) to corticosteroids (CS) is paradoxical but does exist. Some patients with a previous contact allergy to topical CS may develop a systemic contact dermatitis (SCD) while receiving CS orally or intravenously. However, a previous contact sensitization is not mandatory for developing a systemic HS to CS. Acute or delayed urticaria can occur in immediate HS. Immediate HS can be due to excipients, mainly carboxymethylcellulose or to CS themselves. Delayed reactions, mainly maculopapular rash and acute generalized exanthematous pustulosis can occur. Skin tests with systemic CS have to be standardized. It is necessary to determine if IDT with CS frequently induce skin atrophy or not and if such skin atrophy is transient by doing prospective studies using an standardized method and a limited injected volume (0.02 ml). Patch tests can be done in delayed HS, with readings at day 2, 4 and 7. In SCD, the Baeck's classification of CS in 3 chemical groups could explain cross reactivity between systemic CS. However, this classification is not applicable to explain cross-reactions between in systemic HS. According to the literature, 52/79 patients had a HS reaction to a group confirmed by a positive allergological investigations, but had a negative provocation test with another CS belonging to the same group. In case of non-severe cutaneous adverse reactions and when skin tests are negative, provocation tests have to be performed to find an alternative CS, even if it belongs to the same chemical group as those responsible for the initial reaction. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. Rapidly\tevolving\toutbreak\tof\ta\tfebrile\tillness\tin\trural\tHaiti:\tThe\timportance of\ta\tfield\tdiagnosis\tof\tChikungunya\tvirus\tin\tremote\tlocations

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    Ruth\tL\tBush

    2015-10-01

    Full Text Available Although\trarely\tfatal,\tChikungunya\tvirus\t(CHIKV\tinfection\tcan\tlead\tto\tchronic debilitating sequelae. We describe the outbreak of suspected CHIKV in 93 subjects who presented voluntarily over 2 months to a remote rural Haitian general\tmedical\tclinic\tstaffed\tby\tinternational\thealthcare\tproviders.\tDiagnosis was\tmade\ton\tclinical\tsigns\tand\tsymptoms,\tas\tno\tserum\tanalysis\twas\tavailable\tin this remote rural site. The subjects were 18.0 ± 16.2 (median±standard deviation\tyears\tof\tage\tand\twere\tof\tsimilar\tgender\tdistribution.\tThe\tpresenting vital\tsigns\tincluded\ta\ttemperature\tof\t102.3°±\t0.6F\twith\tfever\tlasting\tfor\t3.0\t±\t0.7 days. Symptoms mainly consisted of symmetrical polyarthralgia in 82.8%, headache in 28.0%, abdominal pain in 17.2%, cough in 8.6%, maculopapular rash\tin\t30.0%,\tand\textremity\tbullae\tin\t12.9%.\tIn\t84.9%\tof\tsubjects,\tsymptoms persisted for 7.1 ± 8.3 days with 16.1% having ongoing disability due to persistent\tpain\t(≥14\tday’s\tduration.\tThere\twere\tno\tdeaths.\tIn\tHaiti,\tespecially in remote, rural regions, the risk for CHIKV spread is high given the shortage of detection methods and treatment in this tropical climate. Preventative efforts are similarly lacking.\tImplications for a global public health\timpact\tare\tlikely\twith\toutbreak\textension\tand\tspread\tto\tneighboring\tcountries.

  6. Cutaneous drug reactions to antiepileptic drugs and relation with HLA alleles in the Turkish population.

    Science.gov (United States)

    Büyüköztürk, S; Kekik, Ç; Gökyiğit, A Z; Tezer Filik, F I; Karakaya, G; Saygi, S; Dursun, A B; Kirbaş, S; Tüfekçi, A; Sin, A Z; Aydoğdu, I; Sorgun, M H; Aydin, N; Gelincik, A; Çolakoğlu, B; Çelik, G; Oğuz, F

    2018-01-01

    Background and objective. Many studies have shown associations between HLAB*15:02, HLA-A*31:01 and carbamazepine (CBZ)-induced delayed cutaneous hypersensitivity reactions. The aim of this study is to evaluate a possible association between delayed cutaneous reactions to antiepileptic drugs (AEDs) and certain HLA-A and HLA-B alleles in the Turkish population. Methods. The study consisted of 3 groups: Group I (reactive group) included the patients who had documented delayed cutaneous reactions to any antiepileptic drug. Group II (non-reactive group) included the patients who have been on antiepileptic treatment at least for three months without any adverse reactions. Group III consisted of healthy subjects. The HLA-A and B alleles were analyzed in all groups. Results. Forty patients (29 female) had experienced different hypersensitivity reactions due to AEDs: maculopapular exanthema (26 patients), Stevens-Johnson syndrome (6 patients), drug rash with eosinophilia and systemic symptoms (7 patients), toxic epidermal necrolysis (1 patient). Lamotrigine (11) and CBZ (10) were the most common culprit drugs involved in the reactions. The HLA-B*15:02 was not present in any of the study groups. However, HLA-B*35:02 was found in 4 patients from the reactive group, while it was not observed in non-reactive patients and was detected in only one healthy subject (p = 0.021). Conclusion. Although our preliminary results did not indicate a strong allele association with AED hypersensitivity, HLA-B*35:02 appears to be a candidate allele for MPE / DRESS / DIHSS induced by AED's in Turkish population. Further studies with a larger sample size may result in more comprehensive data about the genetic tendency for AED hypersensitivity in the Turkish population.

  7. Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody.

    Science.gov (United States)

    Fukuda, Hidetsugu; Takahashi, Misaki; Kato, Keiichi; Oharaseki, Toshiaki; Mukai, Hideki

    2015-05-01

    Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29-year-old man visited our hospital for skin lesions on his lower lip, nipple-areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut-off index of 39.0. Histopathological examination of a nipple-areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti-T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase. © 2015 Japanese Dermatological Association.

  8. Zika virus infection during pregnancy and microcephaly occurrence: a review of literature and Brazilian data.

    Science.gov (United States)

    De Carvalho, Newton Sérgio; De Carvalho, Beatriz Freitas; Fugaça, Cyllian Arias; Dóris, Bruna; Biscaia, Evellyn Silverio

    2016-01-01

    In November of 2015, the Ministry of Health of Brazil published an announcement confirming the relationship between Zika virus and the microcephaly outbreak in the Northeast, suggesting that infected pregnant women might have transmitted the virus to their fetuses. The objectives of this study were to conduct a literature review about Zika virus infection and microcephaly, evaluate national and international epidemiological data, as well as the current recommendations for the health teams. Zika virus is an arbovirus, whose main vector is the Aedes sp. The main symptoms of the infection are maculopapular rash, fever, non-purulent conjunctivitis, and arthralgia. Transmission of this pathogen occurs mainly by mosquito bite, but there are also reports via the placenta. Microcephaly is defined as a measure of occipto-frontal circumference being more than two standard deviations below the mean for age and gender. The presence of microcephaly demands evaluation of the patient, in order to diagnose the etiology. Health authorities issued protocols, reports and notes concerning the management of microcephaly caused by Zika virus, but there is still controversy about managing the cases. The Ministry of Health advises notifying any suspected or confirmed cases of children with microcephaly related to the pathogen, which is confirmed by a positive specific laboratory test for the virus. The first choice for imaging exam in children with this malformation is transfontanellar ultrasound. The most effective way to control this outbreak of microcephaly probably caused by this virus is to combat the vector. Since there is still uncertainty about the period of vulnerability of transmission via placenta, the use of repellents is crucial throughout pregnancy. More investigations studying the consequences of this viral infection on the body of newborns and in their development are required. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

  9. Anticonvulsant hypersensitivity syndrome: clinical and laboratory features.

    Science.gov (United States)

    Mansur, Ayşe Tülin; Pekcan Yaşar, Sirin; Göktay, Fatih

    2008-11-01

    Anticonvulsant hypersensitivity syndrome (AHS) is a severe adverse drug reaction with multiorgan involvement. Aromatic anticonvulsants are the most frequently involved drugs. This study was aimed to highlight the clinical and laboratory findings of AHS. The medical records of 31 patients diagnosed as AHS in a 12-year period were evaluated retrospectively. The syndrome was related to carbamazepine in 48.38%, phenytoin in 35.48%, lamotrigine in 9.6% and cotreatment with lamotrigine and valproic acid in 6.45% of cases. Symptoms appeared 2-86 (mean: 35.96) days after ingestion of the offending agent. The type of skin rash was maculopapular and/or erythrodermic in 77.42% of patients, bullous in 19.35%, and erythematopustular in 3.22%. Fever and peripheral lymphadenopathy were detected in 61.29% and 54.82% of cases, respectively. Laboratory investigations revealed elevation of hepatic enzymes in 70.96%, leucocytosis in 43.3%, and peripheral eosinophilia in 64.3% of patients. Our analysis showed that carbamazepine and phenytoin are still the major causes of AHS, with lamotrigine being the third etiologic agent. Valproic acid and benzodiazepines are safe alternatives of the causative anticonvulsants. As there are yet no strict diagnostic criteria, the constellation of clinical and laboratory features that occur within 3 months of the associated anticonvulsant agents helps to recognize the disorder. The risk of seizure due to withdrawal or changing of the anticonvulsant drug and the potentially serious clinical features often necessitates providing care and treatment in an inpatient setting.

  10. An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia.

    Science.gov (United States)

    Choon, Siew-Eng; Lai, Nai-Ming

    2012-01-01

    The prevalence, clinical patterns, and causative drugs of cutaneous adverse drug reactions (cADR) vary among the different populations previously studied. To determine the prevalence, the clinical patterns of drug eruptions, and the common drugs implicated, particularly in severe cADR such as Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS) in our population. We analyzed the database established for all cADR seen by the department of Dermatology from January 2001 till December 2010. A total of 362 cADR were seen among 42 170 new clinic attendees, yielding an incidence rate of 0.86%. The most common reaction pattern seen was maculopapular eruption (153 cases) followed by SJS/TEN (110 cases) and DRESS (34 cases). Antibiotics was the most commonly implicated drug group (146 cases) followed by anticonvulsants (81 cases) and antigout drugs (50 cases). The most frequently implicated drug was allopurinol (50 cases). Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 21.8%, 20.9%, and 12.7%, respectively, of the 110 cases seen, whereas DRESS was mainly caused by allopurinol (15 cases). Mortality rates for TEN, SJS, and DRESS were 28.6%, 2.2%, and 5.9%, respectively. The low rate of cADR with a high proportion of severe reactions observed in this study was probably due to referral bias. Otherwise, the reaction patterns and drugs causing cADR in our population were similar to those seen in other countries. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN in our population.

  11. NAIL CHANGES IN CASE OF ENTEROVIRAL INFECTIONS IN WESTERN UKRAINE: A REPORT OF 34 CASES

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    O. R. Boyarchuk

    2017-02-01

    Full Text Available Background. Enteroviral infections are common infections, mostly affect children. Nail changes of enteroviral infection including transverse ridging (Beau's lines and nail shedding (onychomadesis were described in many countries worldwide. Objective. The aim of the research was to investigate the clinical features of the infection that was followed by nail changes during its outbreak in summer-autumn 2016 in Ternopil region, Ukraine. Methods. A case report of 34 children with nail changes that were observed in October 2016 in Ternopil region, Ukraine is presented. All patients were from one kindergarten. Nail trauma, periungual dermatitis, significant medication intake history, systemic diseases were excluded. The survey and clinical examination of cases was performed. Faecal samples were obtained from 13 children with onychomadesis. Results. The median age of the exemined children was 3.97±0.78 years. Interval between onsets of enteroviral infection to nail changes varied from 4 to 12 weeks. Clinical signs that preceded nail changes are fever (64.7%, herpangina (32.6%, pharyngitis (17.6%, gastrointestinal symptoms (44.1%, cutaneous lesions (82.4% as maculopapular, vesicular rash (44.2% or/and skin desquamation (41.2%. These clinical data indicate preceded enterovirus infection. In 21 (61.8% patients hand-foot-mouth disease was suggested. Nail changes were presented by Beau's lines and onychomadesis (nail shedding. The number of affected nails varied from 1 to 16, the median number was 4.88±4.09. Conclusions. Our study proved association between the outbreak of onychomadesis (nail shedding and enteroviral infection, mainly hand-foot-mouth disease, during summer-autumn 2016 in Western Ukraine (Ternopil region. Enteroviral infection was followed by onychomadesis in 4-12 weeks. Clinical features of enteroviral infection were very variable, with prevalence of cutaneous lesions. More studies are necessary to determine the serotype of the virus that

  12. A sudden paediatric death due to hand, foot and mouth disease: the importance of vigilance.

    Science.gov (United States)

    Rahimi, R; Omar, E; Tuan Soh, T S; Mohd Nawi, S F A; Md Noor, S

    2017-08-01

    Hand, foot and mouth disease (HFMD) is caused by enteroviruses such as Coxsackie virus A16 (CVA16) and Enterovirus 71 (EV71). The diagnostic hallmarks are oral ulcers and maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to death due to neurological and cardiopulmonary complications. This case report aims to describe a fatal case of HFMD with minimal oral and skin manifestations. A four-year-old girl was brought to a hospital after suddenly becoming unresponsive at home. She had a history of fever and lethargy for three days prior to her demise. The patient, and f ive other children in her neighbourhood had been diagnosed to have HFMD at a local health clinic; the other children had recovered without complications. Autopsy revealed a few punctate, sub-epidermal vesicles measuring 1 to 2 mm on the palm of her right hand and sole of the right foot, visible only with a magnifying glass. Internal examination revealed prominent nodularity at the oro- and hypopharynxes. The lungs were markedly congested and oedematous. Histopathology of the lung showed marked oedema and haemorrhage with mild pneumonic changes. Oedema with increase in macroglia and astrocytic proliferation were seen in the cerebral tissue, but no lymphocytic infiltration was evident. Enterovirus EV71 was detected by polymerase chain reaction in samples from the lung, cerebrospinal fluid and serum. The cause of death was given as HFMD complicated by pneumonia. Fatal HFMD may have minimal signs. A complete history, careful physical examination and relevant investigations lead to a diagnosis at post mortem examination. Awareness of the subtle signs and rapid deterioration associated with a fatal case of HFMD is a challenge to clinicians who encounter these cases.

  13. Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media.

    Science.gov (United States)

    Rosado Ingelmo, A; Doña Diaz, I; Cabañas Moreno, R; Moya Quesada, M C; García-Avilés, C; García Nuñez, I; Martínez Tadeo, J I; Mielgo Ballesteros, R; Ortega-Rodríguez, N; Padial Vilchez, M A; Sánchez-Morillas, L; Vila Albelda, C; Moreno Rodilla, E; Torres Jaén, M J

    2016-01-01

    The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported.

  14. Severe bullous hypersensitivity reactions after exposure to carbamazepine in a Han-Chinese child with a positive HLA-B*1502 and negative in vitro toxicity assays: evidence for different pathophysiological mechanisms.

    Science.gov (United States)

    Elzagallaai, Abdelbaset A; Garcia-Bournissen, Facundo; Finkelstein, Yaron; Bend, John R; Rieder, Michael J; Koren, Gideon

    2011-01-01

    Drug hypersensitivity syndrome (DHS) can present in several clinical forms ranging from simple maculopapular skin rash to severe bullous reactions and multi-system dysfunction. Genetic analysis of DHS patients has revealed a striking association between carbamazepine (CBZ)-induced severe bullous reactions, such as Steven-Johnson Syndrome, and toxic epidermal necrolysis in individuals from Southeast Asia who carry a specific HLA allele (HLA-B*1502). This ethnic-specific relationship with a disease phenotype has raised the question of the commonality of the pathogenesis mechanisms of these diseases. The aim of this study was to investigate the genetic and metabolic bases of DHS development to help predict patient susceptibility. A case of carbamazepine-induced Steven-Johnson Syndrome reaction in a HLA-B*1502 positive child of Han Chinese origin, a carbamazepine-induced DHS case in a Caucasian patient and 3 healthy controls were investigated. We performed two types of in vitro toxicity assay, the lymphocyte toxicity assay (LTA) and the novel in vitro platelet toxicity assay (iPTA) on cells taken from the Chinese child 3 and 9 months after recovery from the reaction and from two healthy volunteers. We also tested the Caucasian patient, who developed CBZ-induced DHS, 3 months after the reaction. Both LTA and iPTA tests were negative 3 and 9 months after the reaction on samples from the Chinese child whereas the tests were positive in the Caucasian patient. These results strongly suggest more than one mechanistic pathway for different CBZ-induced hypersensitivity reactions in patients with different ethnic backgrounds.

  15. Allelic variants of CD40 and CD40L genes interact to promote antibiotic-induced cutaneous allergic reactions.

    Science.gov (United States)

    Kim, Sae-H; Lee, J-E; Kim, Sang-H; Jee, Y-K; Kim, Y-K; Park, H-S; Min, K-U; Park, H-W

    2009-12-01

    The danger hypothesis provides a new perspective of the mechanisms underlying drug allergy. In this study, we evaluated associations between variations in the genes involved in danger signal pathways and antibiotic-induced cutaneous allergic reactions (AICARs). Two hundred cases with urticaria, angio-oedema, maculopapular rash, and erythema multiforme caused by antibiotics were extracted from the database of the Adverse Drug Reaction Research Group in Korea. All cases were confirmed by an allergy specialist. Causative antibiotics included penicillin, cephalosporin, quinolone, and others (approximately 40 different types). Ten single nucleotide polymorphisms (SNPs) in seven genes (-318C>T, +49A>G, and +6230G>A in CTLA4, IVS+17T>C in CD28, -3479T>G and I170V in CD86, -1C>T in CD40, -3458A>G in CD40LG, -308G>A in TNF, and -31T>C in IL1B) were scored for cases and for healthy subjects without a history of AICARs. Our analysis failed to reveal differences in the distribution of the 10 SNPs between cases and controls. However, we could find a gene-gene interaction between -1C>T in CD40 and -3458A>G in CD40L using multifactor dimensionality reduction analysis. Subjects with minor alleles of both SNPs showed a significant risk for developing AICARs [P=0.017, odds ratio (OR) (95% confidence interval)=2.93 (1.20-7.97)]. Our findings suggest that a genetic interaction between CD40 and CD40L favours the development of AICARs.

  16. Provocation proven drug allergy in Thai children with adverse drug reactions.

    Science.gov (United States)

    Indradat, Somying; Veskitkul, Jittima; Pacharn, Punchama; Jirapongsananuruk, Orathai; Visitsunthorn, Nualanong

    2016-03-01

    Adverse drug reactions (ADRs) are a common healthcare problem. The drug provocation test (DPT) is a gold standard for ADR diagnosis. To evaluate a correlation between history of ADRs, skin prick test (SPT), intradermal test (ID) and DPT in Thai children. This was a retrospective review of 211 children under 16 years of age who had a history of ADRs and underwent DPT from January 2006 to December 2012. Two hundred and thirty six (236) DPTs were performed in 211 children with a history of ADRs. The median age at which DPTs were performed was 4 years. Thirty-four children (14.4%) had positive DPT. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, likelihood ratio (LR) + and LR- of SPT were 50, 85.7, 6.9, 98.8%, 5.8 and 0.9, respectively. The PPV, NPV, sensitivity, specificity, LR+ and LR- of ID were 33.3, 84.6, 20, 91.7%, 2.4 and 0.9, respectively. Different presentation of symptoms (maculopapular rashes, urticaria, angioedema and anaphylaxis) did not predict SPT, ID and DPT results. Positive human immunodeficiency virus (HIV), but not atopy, was a risk in the present scope of evaluation for drug allergy (odds ratio 11.44, 95% confidence interval 2.60-50.41). Drug allergy, denoted by positive DPT, was present in 14.4% of Thai children with a history of ADRs. Antibiotics were the most common cause of ADRs. Both SPT and ID had high NPV and specificity but did not predict DPT results. HIV positivity is a risk factor of drug allergy in Thai children.

  17. Proven Non-β-Lactam Antibiotic Allergy in Children.

    Science.gov (United States)

    Guvenir, Hakan; Dibek Misirlioglu, Emine; Capanoglu, Murat; Vezir, Emine; Toyran, Muge; Kocabas, Can Naci

    2016-01-01

    Parallel to the increasing use of non-β-lactam (NBL) antibiotics, allergic reactions to this drug group seem to increase. Data about NBL antibiotic hypersensitivity in children are limited. The aim of this study is to evaluate characteristic reactions to NBL antibiotics in children. Patients with suspected NBL allergy were assessed between 2011 and 2015. Characteristics of the reactions and results of skin and drug provocation tests (DPTs) were recorded. In total, 96 patients aged 75.15 ± 56.77 months (range: 3-208) were assessed. Clarithromycin (63.6%) was the most common cause of reactions reported. After ingestion of NBL antibiotics, maculopapular rash, urticaria/angioedema and anaphylaxis presented in 48.9, 40.7 and 10.4% of the patients, respectively. Tests were performed in 85 patients. Intradermal tests were positive in 3 patients (clarithromycin, ciprofloxacin and cotrimoxazole) and DPT was positive in 1 patient (clarithromycin). Eleven patients could not be tested. Seven patients had severe anaphylaxis, and 4 patients with urticaria/angioedema had to take their medications at the time of the reaction so desensitization was performed. When only patients confirmed by tests were evaluated, NBL allergy was 4.7% (4/85) in our study group. However, when patients who could not be tested, but were regarded as suffering from drug hypersensitivity according to clinical findings, were included, the frequency of NBL allergy was 15.6% (15/96). Most of the children with suspected NBL do not have true hypersensitivity. The frequency of confirmed hypersensitivity is low, and thus a detailed history should be taken from patients with suspected NBL hypersensitivity and DPTs should be performed in patients without contraindications. © 2016 S. Karger AG, Basel.

  18. The Emergence of Zika Virus as a Global Health Security Threat: A Review and a Consensus Statement of the INDUSEM Joint working Group (JWG).

    Science.gov (United States)

    Sikka, Veronica; Chattu, Vijay Kumar; Popli, Raaj K; Galwankar, Sagar C; Kelkar, Dhanashree; Sawicki, Stanley G; Stawicki, Stanislaw P; Papadimos, Thomas J

    2016-01-01

    The Zika virus (ZIKV), first discovered in 1947, has emerged as a global public health threat over the last decade, with the accelerated geographic spread of the virus noted during the last 5 years. The World Health Organization (WHO) predicts that millions of cases of ZIKV are likely to occur in the Americas during the next 12 months. These projections, in conjunction with suspected Zika-associated increase in newborn microcephaly cases, prompted WHO to declare public health emergency of international concern. ZIKV-associated illness is characterized by an incubation period of 3-12 days. Most patients remain asymptomatic (i.e., ~80%) after contracting the virus. When symptomatic, clinical presentation is usually mild and consists of a self-limiting febrile illness that lasts approximately 2-7 days. Among common clinical manifestations are fever, arthralgia, conjunctivitis, myalgia, headache, and maculopapular rash. Hospitalization and complication rates are low, with fatalities being extremely rare. Newborn microcephaly, the most devastating and insidious complication associated with the ZIKV, has been described in the offspring of women who became infected while pregnant. Much remains to be elucidated about the timing of ZIKV infection in the context of the temporal progression of pregnancy, the corresponding in utero fetal development stage(s), and the risk of microcephaly. Without further knowledge of the pathophysiology involved, the true risk of ZIKV to the unborn remains difficult to quantify and remediate. Accurate, portable, and inexpensive point-of-care testing is required to better identify cases and manage the current and future outbreaks of ZIKV, including optimization of preventive approaches and the identification of more effective risk reduction strategies. In addition, much more work needs to be done to produce an effective vaccine. Given the rapid geographic spread of ZIKV in recent years, a coordinated local, regional, and global effort is needed

  19. Is the drug-induced hypersensitivity syndrome (DIHS due to human herpesvirus 6 infection or to allergy-mediated viral reactivation? Report of a case and literature review

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    Borgia Guglielmo

    2010-03-01

    Full Text Available Abstract Background Drug-Induced Hypersensitivity Syndrome (DIHS is a severe and rare systemic reaction triggered by a drug (usually an antiepileptic drug. We present a case of DISH and we review studies on the clinical features and treatment of DIHS, and on its pathogenesis in which two elements (Herpesvirus infection and the drug interact with the immune system to trigger such a syndrome that can lead to death in about 20% of cases. Case presentation We report the case of a 26-year old woman with fever, systemic maculopapular rash, lymphadenopathy, hepatitis and eosinophilic leukocytosis. She had been treated with antibiotics that gave no benefit. She was taking escitalopram and lamotrigine for a bipolar disease 30 days before fever onset. Because the patient's general condition deteriorated, betamethasone and acyclovir were started. This treatment resulted in a mild improvement of symptoms. Steroids were rapidly tapered and this was followed with a relapse of fever and a worsening of laboratory parameters. Human herpesvirus 6 (HHV-6 DNA was positive as shown by PCR. Drug-Induced Hypersensitivity Syndrome (DIHS was diagnosed. Symptoms regressed on prednisone (at a dose of 50 mg/die that was tapered very slowly. The patient recovered completely. Conclusions The search for rare causes of fever led to complete resolution of a very difficult case. As DIHS is a rare disease the most relevant issue is to suspect and include it in differential diagnosis of fevers of unknown origin. Once diagnosed, the therapy is easy (steroidal administration and often successful. However our case strongly confirms that attention should be paid on the steroidal tapering that should be very slow to avoid a relapse.

  20. Zika virus infections in pregnancy: epidemics and case management

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    Fatih sahiner

    2016-03-01

    Full Text Available Zika virus is an RNA virus belonging to the Flaviviridae family, and is primarily transmitted by Aedes mosquitoes. Only a small number of cases had been described until 2007 when the first major Zika virus outbreak occurred on Yap Island, Micronesia. Approximately 80% of people infected with Zika virus do not exhibit any symptoms. Symptomatic infections are generally moderate and characterized by acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. The virus has recently attracted a broad interest due to the emerging cases of microcephaly that are possibly associated with mothers infected by the Zika virus during pregnancy, and the regional increases in the incidence of Guillain-Barre syndrome during the epidemic periods. Although the relationship between Zika virus infection and these abnormalities is not obviously understood yet, Zika virus testing is recommended for infants with microcephaly or intracranial calcifications whose mothers were potentially infected with the Zika virus during pregnancy. Every day, new reports are being published about the outbreaks associated with this virus; nevertheless, no new cases of this virus have been reported in Turkey. Despite this, we cannot currently exclude the possibility of the encounter with the virus because of the presence of Aedes mosquitoes, which are responsible for the spread of the virus, are prevalent in Turkey, and an increasing number of travel-related cases are being reported from different countries. In the light of the current knowledge on this virus, this review aims to discuss the course of Zika virus infections in detail, especially congenital infection, and presenting current information about the case management and preventive measures. [Cukurova Med J 2016; 41(1.000: 143-151

  1. An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia

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    Siew-Eng Choon

    2012-01-01

    Full Text Available Background: The prevalence, clinical patterns, and causative drugs of cutaneous adverse drug reactions (cADR vary among the different populations previously studied. Aim: To determine the prevalence, the clinical patterns of drug eruptions, and the common drugs implicated, particularly in severe cADR such as Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN and drug rash with eosinophilia and systemic symptoms (DRESS in our population. Methods: We analyzed the database established for all cADR seen by the department of Dermatology from January 2001 till December 2010. Results: A total of 362 cADR were seen among 42 170 new clinic attendees, yielding an incidence rate of 0.86%. The most common reaction pattern seen was maculopapular eruption (153 cases followed by SJS/TEN (110 cases and DRESS (34 cases. Antibiotics was the most commonly implicated drug group (146 cases followed by anticonvulsants (81 cases and antigout drugs (50 cases. The most frequently implicated drug was allopurinol (50 cases. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 21.8%, 20.9%, and 12.7%, respectively, of the 110 cases seen, whereas DRESS was mainly caused by allopurinol (15 cases. Mortality rates for TEN, SJS, and DRESS were 28.6%, 2.2%, and 5.9%, respectively Conclusions: The low rate of cADR with a high proportion of severe reactions observed in this study was probably due to referral bias. Otherwise, the reaction patterns and drugs causing cADR in our population were similar to those seen in other countries. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN in our population.

  2. Cicatrizing Conjunctivitis in a Patient Diagnosed With Drug Reaction With Eosinophilia and Systemic Symptoms/Drug-Induced Hypersensitivity Syndrome but With Features of Stevens-Johnson Syndrome.

    Science.gov (United States)

    Bohm, Kelley J; Ciralsky, Jessica B; Harp, Joanna L; Bajaj, Shirin; Sippel, Kimberly C

    2016-06-01

    Severe cutaneous adverse reactions to drugs (SCARs) such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DIHS) serve as one of the main reasons for inpatient ophthalmic consultation. Although it is well-recognized that SJS/TEN is associated with severe ocular mucosal inflammation and cicatrizing, potentially blinding, sequelae, this association has not been described in relation to other SCARs. We present a patient fulfilling the diagnostic criteria for probable DRESS/DIHS but not for SJS/TEN, yet exhibiting the severe ocular surface involvement characteristic of SJS/TEN. Case report. A 64-year-old man presented with bilateral pseudomembranous conjunctivitis and conjunctival denudation (sloughing) in the setting of a maculopapular rash, fever, liver dysfunction, and hematologic abnormalities 1 month after initiating several medications. A skin biopsy was not consistent with SJS/TEN. The patient was diagnosed with probable DRESS/DIHS and treated with high-dose systemic corticosteroids. The ocular surface inflammation was addressed with intensive topical corticosteroid ointment. The pseudomembranes resolved over a 6-week period, but the patient exhibited residual conjunctival scarring of all palpebral surfaces. The development of severe ocular surface mucosal inflammation and denudation with cicatrizing sequelae in a patient carrying a diagnosis of DRESS/DIHS has diagnostic and therapeutic implications for the ophthalmologist. Careful ophthalmic assessment is indicated in any SCAR patient with ophthalmic symptoms, regardless of formal diagnosis. Furthermore, the early therapeutic interventions recently recommended in SJS/TEN to limit the ophthalmic cicatricial sequelae, such as systemic or topical corticosteroids, may be indicated.

  3. An exploratory factor analysis of the spontaneous reporting of severe cutaneous adverse reactions.

    Science.gov (United States)

    Hauben, Manfred; Hung, Eric; Hsieh, Wen-Yaw

    2017-01-01

    , shared variance, and communalities were low, suggesting caution in general against extrapolating causality between SCARs. SJS and TEN displayed most shared variance. AGEP and DRESS, the other SCAR pair most often observed in overlap syndromes, demonstrated modest shared variance, along with maculopapular rash (MPR). DRESS and TEN, another of the more commonly diagnosed pairs in overlap syndromes, did not. EM was uncorrelated with SJS and TEN. The notion that causality of a drug for one SCAR bolsters support for causality of the same drug with other SCARs was generally not supported.

  4. Immune-Related Adverse Events Associated with Anti-PD-1/PD-L1 Treatment for Malignancies: A Meta-Analysis

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    Peng-Fei Wang

    2017-10-01

    Full Text Available Background: Treatment of cancers with programmed cell death protein 1 (PD-1 pathway inhibitors can lead to immune-related adverse events (irAEs, which could be serious and even fetal. Therefore, clinicians should be aware of the characteristics of irAEs associated with the use of such drugs.Methods: The MEDLINE, EMBASE, and Cochrane databases were searched to find potential studies using the following strategies: anti-PD-1/PD-L1 treatment; irAEs; and cancer. R© package Meta was used to pool incidence.Results: Forty-six studies representing 12,808 oncologic patients treated with anti-PD-1/PD-L1 agents were included in the meta-analysis. The anti-PD-1/PD-L1 agents included nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and BMS-936559. The tumor types were melanomas, Hodgkin lymphomas, urothelial carcinomas, breast cancers, non-small cell lung cancers, renal cell carcinomas (RCC, colorectal cancers, and others. We described irAEs according to organ systems, namely, the skin (pruritus, rash, maculopapular rash, vitiligo, and dermatitis, endocrine system (hypothyroidism, hyperthyroidism, hypophysitis, thyroiditis, and adrenal insufficiency, digestive system (colitis, diarrhea, pancreatitis, and increased AST/ALT/bilirubin, respiratory system (pneumonitis, lung infiltration, and interstitial lung disease, and urinary system (increased creatinine, nephritis, and renal failure. In patients treated with the PD-1 signaling inhibitors, the overall incidence of irAEs was 26.82% (95% CI, 21.73–32.61; I2, 92.80 in any grade and 6.10% (95% CI, 4.85–7.64; I2, 52.00 in severe grade, respectively. The development of irAEs was unrelated to the dose of anti-PD-1/PD-L1 agents. The incidence of particular irAEs varied when different cancers were treated with different drugs. The incidence of death due to irAEs was around 0.17%.Conclusion: The occurrence of irAEs was organ-specific and related to drug and tumor types.

  5. Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009.

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    Prćić, Sonja; Gajinov, Zorica; Zrnić, Bogdan; Radulović, Anica; Matić, Milan; Djuran, Verica

    2013-12-01

    Erythema infectiosum (EI) is a common childhood illness, caused by human parvovirus B19. It occurs sporadically or in epidemics and is characterized by mild constitutional symptoms and a blotchy or maculopapular lacy rash on the cheeks (slapped-cheek) spreading primarily to the extremities and trunk. The aim of our study was to analyse the epidemiological and clinical characteristics of erythema infectiosum in children. This study included 88 children observed in the Department of Dermatology of the Institute for Child and Youth Health Care of Vojvodina, in Novi Sad, during the period January 2000-December 2009. We compared the data about the clinical characteristics during and after the outbreak of EI observed from December 2001 to September 2002. The data were retrieved from the hospital database. During the study period, EI was detected in 88 children (44 females and 44 males), 0.213% of the total number of 41,345 children observed in the Department of Dermatology. An outbreak of erythema infectiosum was observed from December 2001 to September 2002, with the peak frequency in April and May 2002 and 39 diagnosed cases, and stable number of cases from 2005 to 2009 (a total of 49 diagnosed cases). The average age of infected children was 7.59 +/- 3.339. Eleven (12.5%) children were referred from primary care pediatricians with the diagnosis of urticaria or rash of allergic origin. The most constant clinical sign was reticular exanthema on the limbs, present in 100% of the cases, followed by 89.77% of cheek erythema. Pruritus was present in 9.09% of the children, mild constitutional symptoms in 5.68% and palpable lymph glands in 3.41% of the children. In all the cases the course of the disease was without complications. The results of this study confirm the presence of EI (the fifth disease) in our area with a mild course in the majority of patients. Since the diagnosis of EI is usually based on clinical findings, continuing medical education of primary health care

  6. Lamotrigine. An update of its pharmacology and therapeutic use in epilepsy.

    Science.gov (United States)

    Fitton, A; Goa, K L

    1995-10-01

    Lamotrigine is an antiepileptic agent which blocks voltage-dependent sodium channels, thereby preventing excitatory neurotransmitter release. Clinical evidence indicates that lamotrigine is effective against partial and secondarily generalised tonic-clonic seizures, as well as idiopathic (primary) generalised epilepsy. As monotherapy, lamotrigine 100 to 300 mg/day has similar medium term (30 to 48 weeks) efficacy to carbamazepine 300 to 1400 mg/day and phenytoin 300 mg/day against partial onset seizures and idiopathic generalised tonic-clonic seizures in adults with newly diagnosed epilepsy, and appears to be better tolerated than the older agents. As adjunctive therapy, lamotrigine (50 to 500 mg/day) has shown efficacy in short term ( epilepsy, reducing total seizure frequency (by or = 50% reduction in seizure frequency) in generalised tonic-clonic seizures are reduced by lamotrigine, with generalised seizures (particularly absence seizures, atonic seizures and Lennox-Gastaut syndrome) tending to be more responsive than partial seizures. This reduction in seizure frequency is sustained on long term ( lamotrigine ( or = 50% reductions in seizure frequency and approximately equal to 10 % achieving abolition of seizures after 3 months' treatment. Generalised seizures, including atypical and typical absence seizures, atonic and tonic seizures and Lennox-Gastaut syndrome are most responsive. The most common adverse events associated with lamotrigine are primarily neurological, gastrointestinal and dermatological. Maculopapular or erythematous skin rash, occasionally severe, occurs in approximately equal to 10% of patients and is the most common cause of treatment withdrawal. The risk of rash can, however, be minimised through adoption of a low, slow dosage titration schedule on initiating therapy. As monotherapy, lamotrigine produces less drowsiness than carbamazepine or phenytoin, and less asthenia and ataxia than phenytoin. Clinical experience would therefore suggest

  7. Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009

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    Prćić Sonja

    2013-01-01

    Full Text Available Background/Aim. Erythema infectiosum (EI is a common childhood illness, caused by human parvovirus B19. It occurs sporadically or in epidemics and is characterized by mild constitutional symptoms and a blotchy or maculopapular lacy rash on the cheeks (slapped-cheek spreading primarily to the extremities and trunk. The aim of our study was to analyse the epidemiological and clinical characteristics of erythema infectiosum in children. Methods. This study included 88 children observed in the Department of Dermatology of the Institute for Child and Youth Health Care of Vojvodina, in Novi Sad, during the period January 2000-December 2009. We compared the data about the clinical characteristics during and after the outbreak of EI observed from December 2001 to September 2002. The data were retrieved from the hospital database. Results. During the study period, EI was detected in 88 children (44 females and 44 males, 0.213% of the total number of 4 1345 children observed in the Department of Dermatology. An outbreak of erythema infectiosum was observed from December 2001 to September 2002, with the peak frequency in April and May 2002 and 39 diagnosed cases, and stable number of cases from 2005 to 2009 (a total of 49 diagnosed cases. The average age of infected children was 7.59 ± 3.339. Eleven (12.5% children were referred from primary care pediatricians with the diagnosis of urticaria or rash of allergic origin. The most constant clinical sign was reticular exanthema on the limbs, present in 100% of the cases, followed by 89.77% of cheek erythema. Pruritus was present in 9.09% of the children, mild constitutional symptoms in 5.68% and palpable lymph glands in 3.41% of the children. In all the cases the course of the disease was without complications. Conclusion. The results of this study confirm the presence of EI (the fifth disease in our area with a mild course in the majority of patients. Since the diagnosis of EI is usually based on clinical

  8. Lichen planus pigmentosus inversus

    National Research Council Canada - National Science Library

    Barros, Hugo Rocha; Almeida, José Roberto Paes de; Mattos e Dinato, Sandra Lopes; Sementilli, Angelo; Romiti, Ney

    2013-01-01

    .... Lichen planus pigmentosus inversus is a rare subtype of lichen planus characterized by hyperchromic, asymptomatic or mildly pruritic macules, measuring from millimeters to centimeters in diameter...

  9. Lyme Disease (For Kids)

    Science.gov (United States)

    ... over, like you have the flu developing a red, circular rash (often called a bull's-eye rash) at the site of the tick bite The rash may be big — between the size of a quarter and 10 inches ... MY-gruns), or migrating red rash. Later, the rash also can appear somewhere ...

  10. Immune response in a cutaneous allergic drug reaction secondary to imidapril, benazapril and metformin

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    Ana Maria Abreu Velez

    2013-04-01

    Full Text Available Introduction:Cutaneous drug reactions may be classified with regard to pathogenesis and clinical morphology. They may be mediated by both immunologic and non-immunologic mechanisms.Case report:A 56 year old female presented with widespread patches and macules, concentrated on her face, trunk and extremities. The lesions were pruritic, and temporally associated with intake of benzapril hydrochloride, imidapril and metformin.Methods:Biopsies for hematoxylin and eosin (H&E examination, as well as for immunohistochemistry (IHC and direct immunofluorescence (DIF analysis were performed for diagnostic purposes, and also to evaluate the lesional immune response.Results:Hematoxylin and eosin staining demonstrated a histologically unremarkable epidermis. Within the dermis, a moderately florid, superficial and deep, perivascular infiltrate of lymphocytes, plasmacytoid lymphocytes, histiocytes and rare eosinophils was identified, consistent with an allergic drug reaction. DIF demonstrated deposits of IgE, Complement/C3 and fibrinogen around dermal blood vessels. IHC demonstrated positive staining with HAM-56 and myeloid/histoid antigen in the cell infiltrate around the upper dermal blood vessels. HLA-ABC was overexpressed around those vessels, as well as around dermal sweat glands. COX-2 demonstrated positive staining in both the epidermis and upper dermis.Conclusion:Drug reactions are significant causes of skin rashes. In the current case, we were able to identify multiple antigen presenting cells in the area of the main inflammatory process. The immunologic case findings suggest that allergic drug eruptions may represent complex processes. An allergic drug reaction should be suspected whenever dermal, perivascular deposits of fibrinogen, Complement/C3 and other markers such as IgE are identified via DIF.

  11. Primary irritant and delayed-contact hypersensitivity reactions to the freshwater cyanobacterium Cylindrospermopsis raciborskii and its associated toxin cylindrospermopsin

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    Seawright Alan A

    2006-03-01

    Full Text Available Abstract Background Freshwater cyanobacteria are common inhabitants of recreational waterbodies throughout the world; some cyanobacteria can dominate the phytoplankton and form blooms, many of which are toxic. Numerous reports in the literature describe pruritic skin rashes after recreational or occupational exposure to cyanobacteria, but there has been little research conducted on the cutaneous effects of cyanobacteria. Using the mouse ear swelling test (MEST, we sought to determine whether three toxin-producing cyanobacteria isolates and the purified cyanotoxin cylindrospermopsin produced delayed-contact hypersensitivity reactions. Methods Between 8 and 10 female Balb/c mice in each experiment had test material applied to depilated abdominal skin during the induction phase and 10 or 11 control mice had vehicle only applied to abdominal skin. For challenge (day 10 and rechallenge (day 17, test material was applied to a randomly-allocated test ear; vehicle was applied to the other ear as a control. Ear thickness in anaesthetised mice was measured with a micrometer gauge at 24 and 48 hours after challenge and rechallenge. Ear swelling greater than 20% in one or more test mice is considered a positive response. Histopathology examination of ear tissues was conducted by independent examiners. Results Purified cylindrospermopsin (2 of 9 test mice vs. 0 of 5 control mice; p = 0.51 and the cylindrospermopsin-producing cyanobacterium C. raciborskii (8 of 10 test mice vs. 0 of 10 control mice; p = 0.001 were both shown to produce hypersensitivity reactions. Irritant reactions were seen on abdominal skin at induction. Two other toxic cyanobacteria (Microcystis aeruginosa and Anabaena circinalis did not generate any responses using this model. Histopathology examinations to determine positive and negative reactions in ear tissues showed excellent agreement beyond chance between both examiners (κ = 0.83. Conclusion The irritant properties and cutaneous

  12. Investigation of the efficacy and tolerability of Dr Michaels® (also branded as Eczitinex® and Itchinex Eczitinex®) topical products in the treatment of atopic dermatitis in children.

    Science.gov (United States)

    França, K; Hercogovấ, J; Fioranelli, M; Gianfaldoni, S; Chokoeva, A A; Tchernev, G; Wollina, U; Tirant, M; Bayer, P; Coburn, M; Anderson, P; Donnelly, B; Kennedy, T; Gaibor, J; Arora, M; Clews, L; Novotny, F; Roccia, M G; Maximov, G K; Lotti, T

    2016-01-01

    Atopic eczema is a chronic relapsing inflammatory skin disorder, characterized clinically by intensely pruritic eczematous skin lesions and a defective epidermal barrier. It affects more than 15% of children and up to 10%of adults, which makes the disease a social health problem still without a challenging treatment. The aim of this study was to evaluate the efficacy and tolerability of Dr Michaels® (Eczitinex®) topical product family in the treatment of atopic dermatitis in children. We studied a group of 30 patients (17 female, 13 male), aged 5 to 13 (mean age: 9), affected by atopic dermatitis since they were newborn. All patients had been unsuccessfully treated with conventional anti-inflammatory therapies and ceased treatment 2 weeks before commencing research. The patients were treated with Dr Michaels® (Eczitinex® and Itchinex®) product family including a moisturising bar, topical ointment and PSC 900 oral herbal formulation. The treatment was evaluated clinically and photographically at 0, 1, 2, 4, 6, 8, 10, 12, and 14 weeks. Twenty-eight patients showed a significant improvement of cutaneous rashes and pruritus on the first week of treatment, with a complete remission at 10-12 weeks. Only two patients, brother and sister respectively, showed a slow response to treatment and reported an increasing itching. Following 14 weeks of treatment with the Dr Michaels® (Eczitinex® and Itchinex®) product family, patients demonstrated complete resolution of their AD. All patients showed a marked improvement in their condition within 3 days of treatment with most of the lesions and symptoms totally resolved within 10 to 12 weeks of treatment with Dr Michaels® (Eczitinex® and Itchinex®) family of products. This clinical report highlights that the Dr Michaels® (Eczitinex® and Itchinex®) product family is a safe and effective treatment option for AD.

  13. A high incidence of exanthematous eruption associated with niacin/laropiprant combination in Hong Kong Chinese patients.

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    Yang, Y-L; Hu, M; Chang, M; Tomlinson, B

    2013-12-01

    Niacin commonly causes cutaneous flushing, which is partially alleviated by laropiprant, a selective antagonist of prostaglandin D2 at the DP1 receptor. Here we report an unusually high incidence of exanthematous eruption associated with the use of the extended-release (ER) niacin/laropiprant combination treatment in Hong Kong Chinese patients. Among 201 patients treated with ER niacin/laropiprant 1000/20 mg over 7 days to assess flushing symptoms and 166 of the patients who continued the treatment for 12 weeks (doubling the dose after 4 weeks), 28 patients (14%) developed a highly pruritic cutaneous eruption at a mean of 5 days after starting the treatment or 4 days after increasing the dose. This resolved over several days after drug withdrawal with symptomatic treatment. Compared with the subjects who completed 12-weeks treatment uneventfully, those who developed cutaneous eruption were older, had significantly lower body weight, were taking background lipid-lowering treatment more frequently and had greater flushing responses in the first few days of treatment. The relationship of the exanthematous eruption with lower body weight and the increase in dosage suggests a pharmacokinetic effect that may be related to increased exposure to niacin or its metabolites and provoked by inhibition of the DP1 receptor with laropiprant, as we have not seen this rash with niacin used alone. This may suggest that the southern Chinese population may have some genetic predisposition; as such, a high frequency of exanthematous reactions has not been reported in other populations. © 2013 John Wiley & Sons Ltd.

  14. Swimmer's Itch in Belgium: First Recorded Outbreaks, Molecular Identification of the Parasite Species and Intermediate Hosts.

    Science.gov (United States)

    Caron, Yannick; Cabaraux, Ariane; Marechal, Françoise; Losson, Bertrand

    2017-03-01

    Cercarial dermatitis or swimmer's itch is a skin condition in humans due to the larval forms of bird schistosomes of some species of the genus Trichobilharzia. The life cycle of these schistosomes requires freshwater snails (intermediate host) and waterfowl (definitive host). Repeated exposures to cercariae can lead to skin sensitization with the induction of pruritic skin lesions. We describe, in this study, two outbreaks of human cercarial dermatitis at the Eau d'Heure Lakes, Belgium. In July and August 2012, a total of, respectively, 78 and 10 people reported a sudden skin rash accompanied by pruritus following recreational activities in the Plate Taille Lake. However, no ocellate furcocercariae were detected following light exposure of the snails collected between September 2012 and September 2013 (n = 402). No outbreaks were recorded in 2013 and 2014. In August 2015, about 30 new cases were recorded. Snails were collected (n = 270) in different locations around the lake. PCR was used to identify accurately the intermediate hosts and the parasite species involved. After light exposure, seven Radix spp. (2.6%) shed ocellate furcocercariae. Molecular identification based on the rDNA internal transcribed spacer 2 sequence ascribed the infected snails to R. balthica ( = R. peregra = R. ovata) (6/7) and R. auricularia (1/7). Based on the amplification of the D2 domain of the 28S rDNA, the cercariae were shown to belong to two different haplotypes of Trichobilharzia franki. This is the first record in Belgium of T. franki and associated skin condition.

  15. [Extensive cutaneous candidiasis revealing cutaneous T-cell lymphoma: 2 cases].

    Science.gov (United States)

    Duong, T; Ingen-Housz-Oro, S; Gaulier, A; Petit, A; Dubertret, L; Sigal-Grinberg, M

    2006-01-01

    During the course of immunodeficiency diseases, severe candidiasis can occur with extensive cutaneous and mucous membrane lesions. However, blood dyscrasias are very rarely revealed by diffuse candidiasis. We report two case of cutaneous T-cell lymphoma revealed by extensive and atypical cutaneous candidiasis. Case No. 1:A 72-year-old woman presented a pruritic rash of circinate, serpiginous patches on glabrous skin and skinfolds with multiple intertrigo and rapidly worsening palmoplantar keratoderma. All mycological skin specimens tested positive for Candida albicans. Histological examination of a biopsy sample from a serpiginous patch revealed the presence of fungal elements while palmoplantar keratoderma biopsy showed an epidermotropic lymphocytic infiltrate in the superficial dermis evocative of mycosis fungoides. Blood tests showed a white cell count of 28 600/mm3 with 14% circulating Sezary cells and a T-cell clone. The T-cell lymphoma was treated with methotrexate, but the disease worsened a few months later, progressing to CD30- large T-cell pleomorphic lymphoma. The patient died of severe sepsis. Case No 2:A 60-year-old man presented a macular rash over the face, trunk and skinfolds as well as erythematous scaly annular plaques of the glabrous skin with lymphadenopathy. Cultures of skin scrapings were all positive for Candida albicans. Blood tests showed a white cell count of 15 000/mm3 with 30% circulating Sezary cells. A trunk patch biopsy revealed the histological appearance of mycosis fungoides. There was a T-cell clone in the peripheral blood and skin. In both cases, the patients presented with widespread annular and erythematous scaly lesions of the glabrous skin and skinfolds with evidence of Candida albicans on fungal tests of all skin scrapings. The discovery of circulating Sezary cells on a systematic smear for hyperleukocytosis led us to suspect underlying cutaneous T-cell lymphoma, which was confirmed by biopsy of the skin lesions accompanying

  16. NECROLISIS EPIDERMICA TOXICA. DESCRIPCION DE DOS CASOS. ERUPCIÓN CUTÁNEA SEVERA PRODUCIDA POR FÁRMACOS COMUNES TOXICAL EPIDERMAL NECROLYSIS. REPORT OF TWO CASES. SEVERE SKIN RASH CAUSED BY COMMON DRUGS

    Directory of Open Access Journals (Sweden)

    Liz Lezcano

    2013-10-01

    Full Text Available Reacción adversa a medicamentos (RAM es definida por la OMS como cualquier respuesta a un medicamento, que sea nociva e inesperada, que ocurre a dosis normalmente utilizadas en el ser humano para profilaxis, diagnóstico, terapia de enfermedad o para modificación de la función fisiológica. Cuando RAM compromete a la piel se denomina farmacodermia, dermatosis medicamentosa o toxicodermia, la cual ocurre en el 1% de pacientes ambulatorios y 2-5 % de pacientes hospitalizados. La OMS acepta que el 2% de todas las reacciones adversas a fármacos (RAM son severas (Farmacodermia grave=FG. Son más frecuentes en mujeres, ancianos y pacientes con SIDA. La mayoría de las farmacodermias son leves, pero éstas pueden de inicio ser reacciones severas. 1 de cada 1.000 pacientes hospitalizados sufre una FG, dentro de las cuales se incluyen al síndrome de Stevens Johnson (SSJ y la Necrolisis Epidérmica Tóxica (NET. El Síndrome de Stevens Johnson (SSJ y la Necrolisis Epidérmica Tóxica (NET son reacciones cutáneas graves, con un potencial de morbilidad y mortalidad elevadas, ocurre en 0.4-2 casos por millón de habitantes por año para el SSJ y para la NET en 1.2-6.0 casos millón de habitantes por año. Se presenta en pacientes de todas las edades, razas y sexo. Estas patologías constituyen una verdadera emergencia dermatológica, donde su cuidado y manejo deben ser multidisciplinarios.

  17. Eritema infeccioso: un exantema infantil a considerar en la práctica diaria Fifth disease or infectious erythema: a childhood rash to consider in the daily medical practice

    Directory of Open Access Journals (Sweden)

    AD Pérez-Elizondo

    Full Text Available Se presenta el caso de un escolar con febrícula y leve ataque del estado general, quien desarrolla una erupción maculosa en mejillas, pocos días después un exantema en "encaje" o reticulado en tronco posterior y parte proximal de extremidades inferiores, compatible con la quinta enfermedad y confirmado por la morfología lesional característica y la inmuno-serología (IgM.We present a five years old child with a mild fever and malaise, a maculoedematous eruption on cheeks and a "lace" exanthema located on posterior aspect of the trunk and lower limbs, developed after a few days. A fifth disease was diagnosticated based on characteristic morphological presentation and immunoserological studies.

  18. Psychosomatic factors in pruritus

    OpenAIRE

    Tey, Hong Liang; Wallengren, Joanna; Yosipovitch, Gil

    2013-01-01

    Pruritus and psyche are intricately and reciprocally related, with psychophysiological evidence and psychopathological explanations helping us to understand their complex association. Their interaction may be conceptualized and classified into 3 groups: pruritic diseases with psychiatric sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Management of chronic pruritus is directed at treating the underlying causes and adopting a multidis...

  19. An outbreak of Psoroptic mange infestation and its management in ...

    African Journals Online (AJOL)

    One cow exhibited non-pruritic, widespread alopecia all over its body and appeared to recover after being treated with injectable ivermectin acaricide. Subsequently, an outbreak of severe non-pruritic alopecia ensued in the buffalo herd at the onset of winter May 2013. Laboratory diagnosis confirmed Psoroptes mites ...

  20. Atopic dermatitis in dogs_novel insights into mechanisms of disease

    NARCIS (Netherlands)

    Schlotter, Y.M.|info:eu-repo/dai/nl/311450806

    2009-01-01

    Atopic dermatitis in dogs Novel insights into mechanisms of disease Atopic dermatitis in dogs is the most important canine pruritic disorder, described for the first time in 1971. It is defined as a genetically-predisposed inflammatory and pruritic allergic skin disease with characteristic clinical

  1. Advanced oral HIV-associated Kaposi sarcoma with facial ...

    African Journals Online (AJOL)

    associated Kaposi sarcoma with HAART during the early maculopapular stage of ... then systemic chemotherapy should be added promptly, in order to prevent or delay the development of extensive exophytic oral lesions with facial lymphoedoema.

  2. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Kristi L. Koenig

    2016-05-01

    Full Text Available First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other

  3. Understanding Zika virus.

    Science.gov (United States)

    Murray, John S

    2017-01-01

    This article describes what pediatric healthcare professionals should know about Zika virus (ZIKV). ZIKV is classified as an arthropod-borne, single-stranded RNA virus of the Flaviviridae family and genus Flavivirus. ZIKV is not new. The virus was first discovered almost 70 years ago in Uganda. The first isolate of the virus was found in rhesus monkeys in the Zika Forrest, hence the nomenclature. The primary route of ZIKV transmission to humans is through the bite of an infected Aedes species mosquito-primarily Aedes aegypti. When the mosquito bites individuals infected with the virus, mosquitos then become the vector of transmitting the infection to others. Women can also pass ZIKV to their fetus during pregnancy and at the time of delivery. ZIKV can also be transmitted through sexual activity from an individual who is infected with the virus to his or her partners. It is estimated that approximately 18% of individuals infected with ZIKV will go on to develop symptoms. When symptoms develop, it is usually within 3-12 days, although this may vary. Most often, symptoms are mild and self-limited. The most common symptoms are fever, arthralgia, maculopapular rash, and conjunctivitis lasting up to seven days. Less frequent symptoms include headache, vertigo, myalgia, vomiting, and diarrhea. At present, there is no vaccine available to prevent ZIKV and no specific antiviral treatment. Supportive care consisting of rest, hydration, analgesics, antihistamines, and antipyretics is recommended as needed. Given that there is no vaccine or treatment for ZIKV, considerable efforts must be focused on prevention. One of the most effective ways of preventing ZIKV infection is through avoiding mosquito bites, especially when traveling to or residing in areas where transmission is present. Precautions should include wearing appropriate attire with the objective of having as little skin exposed as possible, use of screens for windows and doors, and use of insect repellent. What is

  4. A case of IgG subclass deficiency with the initial presentation of transient hypogammaimmuno-globulinemia of infancy and a review of IgG subclass deficiencies.

    Science.gov (United States)

    Nettagul, R; Visitsunthorn, N; Vichyanond, P

    2003-07-01

    Primary immunodeficiency diseases are not common in children. The possibility of an immunological defect should be considered in any individual with repeated infections. A definite diagnosis for immodeficiency is sometimes difficult to achieve because of overlapping clinical manifestations. Immunoglobulin subclass deficiency is an immunological deficiency disease with which, one or more IgG subclasses are deficient. T cell immunity is normal. Patients may develop recurrent bacterial and respiratory infections or could remain asymptomatic. The authors report a case of immunoglobulin G subclass deficiency presenting initially as transient hypogammaglobulinemia of infancy. A 2 month-old boy presented to Siriraj Hospital with a history of chronic protracted diarrhea, disseminated scabies and sepsis. On presentation, he had generalized scaly and maculopapular rash with no palpable lymph nodes. CBC revealed WBC 22,100 cells/cm3 with PMN 42 per cent, lymphocytes 38 per cent, Eosinophils 4 per cent, Basophil 2 per cent and platelets 254,000/cm3. The immunoglobulin levels were as follows: IgG 181 mg/dl, IgA IgG became normal at 2 years of age (after 12 months of IVIG). IVIG was stopped and the diagnosis was changed to transient hypogammaglobulinemia of infancy (THI). Nevertheless, during his 4 month follow-up he developed recurrent sinopulmonary infections (i.e, otitis media and pneumonia). Repeated immunoglobulin profile showed IgG 1,200 mg/dl, IgA 135 mg/dl, IgM 26 mg/dl, IgG subclass were IgG, 1,030 mg/dl (N 280-830), IgG2 30 mg/dl (N 40-2,400), IgG3 22 mg/dl (N 6-130), IgG4 3 mg/dl (N 3-120). A diagnosis of IgG2 subclass deficiency presenting early as transient hypogammaglobulinemia of infancy was then made. Treatment with monthly IVIG was reinitiated and the patient is currently doing well. The authors present a case of IgG subclass deficiency presenting as transient hypogammaglbulinemia of infancy. Follow-up of the immune profile and clinical manifestation is

  5. Enfermedad injerto contra huesped: sus manifestaciones bucales

    Directory of Open Access Journals (Sweden)

    Claudia Marcela Hernández Cancino

    Full Text Available La enfermedad injerto contra huésped es la principal complicación que sufren los pacientes que han recibido trasplante alogénico. Se produce como consecuencia de una reacción inflamatoria exagerada mediada por los linfocitos del donante y estimulada por aquellos tejidos que han sido lesionados por la enfermedad de base, por las infecciones previas o por el tratamiento de acondicionamiento. El diagnóstico es clínico e histopatológico. Los pacientes presentan rash maculopapular pruriginoso y doloroso que puede extenderse por toda la superficie corporal, fiebre, vómito, náuseas, diarrea y anorexia. En la mucosa bucal se observan erosiones ulceradas, extremamente dolorosas y pueden ser la primera o la única manifestación detectable clínicamente de esta enfermedad. El objetivo es presentar un caso de enfermedad de injerto contra huésped. Se trata de una mujer de 54 años de edad con linfoma no-Hodgking, que recibió tratamiento con quimioterapia, radioterapia y trasplante de células madre hematopoyéticas en el 2009. Tres meses después, presentó lesiones en la piel diagnosticadas como enfermedad injerto contra huésped y tratadas con corticoesteroides, a los seis meses fue remitida al odontólogo porque se quejaba de ardor en la boca, xerostomía y dificultad para masticar, tenía úlceras en la mucosa bucal y en la lengua. En la ocasión recibió tratamiento con corticoesteroides, clorhexidina, orientaciones de higiene bucal y controles clínicos permanentes. Aunque existen protocolos para la prevención y el tratamiento de la enfermedad injerto contra el huésped, su frecuencia ha aumentado en los últimos años debido al incremento en el número de trasplantes. Por esta razón, es fundamental que el odontólogo forme parte del grupo multidisciplinario que asiste al paciente y que esté familiarizado con los signos y síntomas de esta enfermedad en la mucosa bucal, pues las manifestaciones clínicas pueden ser las únicas para

  6. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department.

    Science.gov (United States)

    Koenig, Kristi L; Almadhyan, Abdulmajeed; Burns, Michael J

    2016-05-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  7. Proteomic profiling of chikungunya virus-infected human muscle cells: reveal the role of cytoskeleton network in CHIKV replication.

    Science.gov (United States)

    Issac, Too Horng Khit; Tan, Eng Lee; Chu, Justin Jang Hann

    2014-08-28

    Chikungunya virus (CHIKV) is an arthropod-borne, positive-sense, single-stranded RNA virus belonging to genus Alphavirus and family Togaviridae. The clinical manifestations developed upon CHIKV-infection include fever, myositis, arthralgia and maculopapular rash. Thus, the re-emergence of CHIKV has posed serious health threats worldwide. Due to the fact that myositis is induced upon CHIKV-infection, we sought to understand the dynamic proteomic regulation in SJCRH30, a human rhabdomyosarcoma cell line, to gain insights on CHIKV pathogenesis. Two-dimensional gel electrophoresis (2DE) in combination of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used to profile differential cellular proteins expression in CHIKV-infected SJCRH30 cells. 2DE analysis on CHIKV-infected cells has revealed 44 protein spots. These spots are found to be involved in various biological pathways such as biomolecules synthesis and metabolism, cell signaling and cellular reorganization. siRNA-mediated gene silencing on selected genes has elucidated the biological significance of these gene-translated host proteins involved in CHIKV-infection. More importantly, the interaction of vimentin with non-structural protein (nsP3) of CHIKV was shown, suggesting the role played by vimentin during CHIKV replication by forming an anchorage network with the CHIKV replication complexes (RCs). Chikungunya virus (CHIKV) is a re-emerging virus that has caused various disease outbreaks in Africa and Asia. The clinical symptoms of CHIKV-infection include fever, skin rash, recurrent joint paint, and myositis. Neuronal implications and death may be resulted from the severe viral infection. Up to date, there are no effective treatments and vaccines against CHIKV-infection. More importantly, little is known about the differential regulation of host proteins upon CHIKV infection, hence deciphering the viral-host cell interactions during viral infection provide critical

  8. Extramammary Paget's Disease Associated With Genital Wart and Lichen Sclerosus

    National Research Council Canada - National Science Library

    Rana Rafiei; Hojat Eftekhari; Siamak Granmayeh; Nahid Nickhah; Behnam Rafiee

    2017-01-01

    .... Genital wart is the most common sexually transmitted disease caused by human papilloma viruses and vulval lichen sclerosus is chronic pruritic dermatitis in genital area which could be able to change...

  9. Pruritus in Female Patients

    Directory of Open Access Journals (Sweden)

    Julien Lambert

    2014-01-01

    Full Text Available Pruritus is a frequent symptom in many dermatological diseases. In this review we want to focus on not only itch problems specific to women, namely, pruritic vulvodermatoses, but also the specific pruritic dermatoses of pregnancy. The specific characteristics of the vulva and the hormonal changes during the different age periods make these dermatoses very particular. It seems that vulvar diseases are still underdiagnosed and undertreated. Pruritic vulvar diseases have a huge impact on quality of life. The most common pruritic diseases will be discussed, such as atopic and contact dermatitis, psoriasis, lichen sclerosis, lichen planus, and infectious vulvaginitis. We focus on the diagnostic issue of these diseases and will consider the general principles of therapy.

  10. Demodex folliculitis.(PRACTICE: CLINICAL IMAGES)(Report)(Case study)

    National Research Council Canada - National Science Library

    Bachmeyer, Claude; Moreno-Sabater, Alicia

    2017-01-01

    Bachmeyer and Moreno-Sabater present a case of demodex folliculitis. A 66-year-old man was referred by his primary care physician for assessment of a three-year history of treatment-resistant pruritic facial lesions...

  11. May - August 2014 correct2

    African Journals Online (AJOL)

    Alopecia areata. Aquagenic pruritus. Atopic eczema. Contact dermatitis. Discoid dermatitis. Discoid lupus erythematosus. Erythroderma. Folliculitis. Icthyosis vulgaris. Keloid. Kaposi sarcoma. Lentigens. Lichen planus. Lichen simplex chronicus. Melasma. Pemphigus vulgaris. Porokeratosis. Pruritic papular eruption.

  12. Macular amyloidosis and hypothyroidism

    Directory of Open Access Journals (Sweden)

    Chopra Adarsh

    1999-01-01

    Full Text Available A 53 year old woman presented with extensive pruritic hyperpigmented macules in interscapular area and extremities of four years duration.She was an established case of hypothyroidism on treatment for last four years.

  13. Flagellate shiitake mushroom dermatitis.

    Science.gov (United States)

    Luber, Adam J; Ackerman, Lindsay S

    2015-08-15

    An 84-year-old woman presented with 5 days of a pruritic skin eruption that formed arciform and linear patterns. She was diagnosed with flagellate shiitake mushroom dermatitis related to shiitake mushroom consumption the day prior symptom onset.

  14. Common skin conditions during pregnancy.

    Science.gov (United States)

    Tunzi, Marc; Gray, Gary R

    2007-01-15

    Common skin conditions during pregnancy generally can be separated into three categories: hormone-related, preexisting, and pregnancy-specific. Normal hormone changes during pregnancy may cause benign skin conditions including striae gravidarum (stretch marks); hyperpigmentation (e.g., melasma); and hair, nail, and vascular changes. Preexisting skin conditions (e.g., atopic dermatitis, psoriasis, fungal infections, cutaneous tumors) may change during pregnancy. Pregnancy-specific skin conditions include pruritic urticarial papules and plaques of pregnancy, prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy. Pruritic urticarial papules and plaques of pregnancy are the most common of these disorders. Most skin conditions resolve postpartum and only require symptomatic treatment. However, there are specific treatments for some conditions (e.g., melasma, intrahepatic cholestasis of pregnancy, impetigo herpetiformis, pruritic folliculitis of pregnancy). Antepartum surveillance is recommended for patients with intrahepatic cholestasis of pregnancy, impetigo herpetiformis, and pemphigoid gestationis.

  15. Recreational and occupational field exposure to freshwater cyanobacteria – a review of anecdotal and case reports, epidemiological studies and the challenges for epidemiologic assessment

    Directory of Open Access Journals (Sweden)

    Webb Penelope M

    2006-03-01

    Full Text Available Abstract Cyanobacteria are common inhabitants of freshwater lakes and reservoirs throughout the world. Under favourable conditions, certain cyanobacteria can dominate the phytoplankton within a waterbody and form nuisance blooms. Case reports and anecdotal references dating from 1949 describe a range of illnesses associated with recreational exposure to cyanobacteria: hay fever-like symptoms, pruritic skin rashes and gastro-intestinal symptoms are most frequently reported. Some papers give convincing descriptions of allergic reactions while others describe more serious acute illnesses, with symptoms such as severe headache, pneumonia, fever, myalgia, vertigo and blistering in the mouth. A coroner in the United States found that a teenage boy died as a result of accidentally ingesting a neurotoxic cyanotoxin from a golf course pond. This death is the first recorded human fatality attributed to recreational exposure to cyanobacteria, although uncertainties surround the forensic identification of the suspected cyanotoxin in this case. We systematically reviewed the literature on recreational exposure to freshwater cyanobacteria. Epidemiological data are limited, with six studies conducted since 1990. Statistically significant increases in symptoms were reported in individuals exposed to cyanobacteria compared to unexposed counterparts in two Australian cohort studies, though minor morbidity appeared to be the main finding. The four other small studies (three from the UK, one Australian did not report any significant association. However, the potential for serious injury or death remains, as freshwater cyanobacteria under bloom conditions are capable of producing potent toxins that cause specific and severe dysfunction to hepatic or central nervous systems. The exposure route for these toxins is oral, from ingestion of recreational water, and possibly by inhalation. A range of freshwater microbial agents may cause acute conditions that present with

  16. Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood.

    Science.gov (United States)

    Roduit, Caroline; Frei, Remo; Depner, Martin; Karvonen, Anne M; Renz, Harald; Braun-Fahrländer, Charlotte; Schmausser-Hechfellner, Elisabeth; Pekkanen, Juha; Riedler, Josef; Dalphin, Jean-Charles; von Mutius, Erika; Lauener, Roger Pascal; Hyvärinen, Anne; Kirjavainen, Pirkka; Remes, Sami; Roponen, Marjut; Dalphin, Marie-Laure; Kaulek, Vincent; Ege, Markus; Genuneit, Jon; Illi, Sabina; Kabesch, Micahel; Schaub, Bianca; Pfefferle, Petra Ina; Doekes, Gert

    2017-07-01

    Atopic dermatitis is an inflammatory, pruritic skin disease that often occurs in early infancy with a chronic course. However, a specific description of subtypes of atopic dermatitis depending on the timing of onset and progression of the disease in childhood is lacking. To identify different phenotypes of atopic dermatitis using a definition based on symptoms before age 6 years and to determine whether some subtypes are more at risk for developing other allergic diseases. The Protection Against Allergy Study in Rural Environments (PASTURE) is a European birth cohort where pregnant women were recruited between August 2002 and March 2005 and divided in 2 groups dependent on whether they lived on a farm. Children from this cohort with data on atopic dermatitis from birth to 6 years of age were included. Atopic dermatitis, defined as an itchy rash on typical locations from birth to 6 years. The latent class analysis was used to identify subtypes of atopic dermatitis in childhood based on the course of symptoms. Multivariable logistic regressions were used to analyze the association between atopic dermatitis phenotypes and other allergic diseases. We included 1038 children; of these, 506 were girls. The latent class analysis model with the best fit to PASTURE data separated 4 phenotypes of atopic dermatitis in childhood: 2 early phenotypes with onset before age 2 years (early transient [n = 96; 9.2%] and early persistent [n = 67; 6.5%]), the late phenotype with onset at age 2 years or older (n = 50; 4.8%), and the never/infrequent phenotype (n = 825; 79.5%), defined as children with no atopic dermatitis. Children with both parents with history of allergies were 5 times more at risk to develop atopic dermatitis with an early-persistent phenotype compared with children with parents with no history of allergies. Both early phenotypes were strongly associated with food allergy. The risk of developing asthma was significantly increased among the early

  17. Dermatoses of Pregnancy - Clues to Diagnosis, Fetal Risk and Therapy

    OpenAIRE

    Ambros-Rudolph, Christina M.

    2011-01-01

    The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. They are associated with severe pruritus that should never be neglected in pregnancy but always lead to an exact work-up of the patient. Clinical charac...

  18. Sulphasalazine Induced Hypersensitivity Syndrome

    Directory of Open Access Journals (Sweden)

    Hatice Şanlı

    2013-05-01

    Full Text Available Drug-induced hypersensitivity syndrome (DIHS is one of the most dangerous drug reactions. Mortality and morbidity is increased by consequent systemic organ involvement. Maculopapular eruptions are the most common lesions accompanying DIHS, however, the morphology of skin lesions may vary. The most common cause of DIHS is the use of aromatic anticonvulsant drugs. However, one must not forget that other drugs may also cause DIHS. Early recognition of the condition is the most important step in the treatment. Herein, we present a case of DIHS triggered by sulphasalazine and associated with pustular eruption and maculopapular eruption.

  19. Ramsay Hunt Syndrome

    Science.gov (United States)

    ... painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear. Ramsay ... the affected ear Usually, the rash and the facial paralysis develop at the same time. But in some ...

  20. Genetics Home Reference: Hartnup disease

    Science.gov (United States)

    ... which can include skin rashes; difficulty coordinating movements ( cerebellar ataxia ); and psychiatric symptoms, such as depression or psychosis. ... signs and symptoms of this condition including rashes, cerebellar ataxia , and psychiatric symptoms. Researchers believe that many of ...

  1. New Vaccines Help Protect You

    Science.gov (United States)

    ... outbreak of rash or blisters caused by the varicella-zoster virus, the same virus that causes chickenpox. Following an ... potential of reactivating later in life. When the varicella-zoster virus reactivates, the viruses multiply and the characteristic rash ...

  2. Dandruff: How to Treat

    Medline Plus

    Full Text Available ... Hair and scalp problems Itchy skin Painful skin / joints Rashes Scaly skin Skin cancer Why see a ... Hair loss Scalp psoriasis Itchy skin Painful skin / joints Rashes Scaly skin Skin cancer Why see a ...

  3. Bug bites and stings: When to see a dermatologist

    Medline Plus

    Full Text Available ... and scalp problems Itchy skin Painful skin / joints Rashes Scaly skin Skin cancer Why see a board- ... symptoms after a bug bite, such as a rash, fever, or body aches, see your doctor or ...

  4. "'The Natural World Is the Most Universal of Languages'

    DEFF Research Database (Denmark)

    Bjerre, Thomas Ærvold

    2007-01-01

    Interview med den amerikanske forfatter Ron Rash. Rash taler bl.a. om de forskellige temaer i sine værker, om forholdet til naturen, og regionale fordomme i USA og om sine skrivevaner. Udgivelsesdato: Winter......Interview med den amerikanske forfatter Ron Rash. Rash taler bl.a. om de forskellige temaer i sine værker, om forholdet til naturen, og regionale fordomme i USA og om sine skrivevaner. Udgivelsesdato: Winter...

  5. Lyme disease (image)

    Science.gov (United States)

    ... rash on the skin that looks like a "bull's eye". The rash begins as a reddened area near the area of the tick bite. As the rash gets bigger, it clears in the center and develops a red ring around the outer perimeter. Other symptoms include ...

  6. One dose of varicella vaccine does not prevent school outbreaks: is it time for a second dose?

    Science.gov (United States)

    Lopez, Adriana S; Guris, Dalya; Zimmerman, Laura; Gladden, Linda; Moore, Tamara; Haselow, Dirk T; Loparev, Vladimir N; Schmid, D Scott; Jumaan, Aisha O; Snow, Sandra L

    2006-06-01

    The implementation of a routine childhood varicella vaccination program in the United States in 1995 has resulted in a dramatic decline in varicella morbidity and mortality. Although disease incidence has decreased, outbreaks of varicella continue to be reported, increasingly in highly vaccinated populations. In 2000, a varicella vaccination requirement was introduced for kindergarten entry in Arkansas. In October 2003, large numbers of varicella cases were reported in a school with high vaccination coverage. We investigated this outbreak to examine transmission patterns of varicella in this highly vaccinated population, to estimate the effectiveness of 1 dose of varicella vaccine, to identify risk factors for vaccine failure, and to implement outbreak control measures. A retrospective cohort study involving students attending an elementary school was conducted. A questionnaire was distributed to parents of all of the students in the school to collect varicella disease and vaccination history; parents of varicella case patients were interviewed by telephone. A case of varicella was defined as an acute, generalized, maculopapulovesicular rash without other apparent cause in a student or staff member in the school from September 1 to November 20, 2003. Varicella among vaccinated persons was defined as varicella-like rash that developed >42 days after vaccination. In vaccinated persons, the rash may be atypical, maculopapular with few or no vesicles. Cases were laboratory confirmed by polymerase chain reaction, and genotyping was performed to identify the strain associated with the outbreak. Of the 545 students who attended the school, 88% returned the questionnaire. Overall varicella vaccination coverage was 96%. Forty-nine varicella cases were identified; 43 were vaccinated. Three of 6 specimens tested were positive by polymerase chain reaction. The median age at vaccination of vaccinated students in the school was 18 months, and the median time since vaccination

  7. HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans.

    LENUS (Irish Health Repository)

    McCormack, Mark

    2011-03-24

    Carbamazepine causes various forms of hypersensitivity reactions, ranging from maculopapular exanthema to severe blistering reactions. The HLA-B*1502 allele has been shown to be strongly correlated with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) in the Han Chinese and other Asian populations but not in European populations.

  8. Sarcoidosis with bilateral leg lymphedema as the initial presentation: a review of the literature

    OpenAIRE

    Huang, Hsin-Wei; Wong, Lai-San; Lee, Chih-Hung

    2016-01-01

    Sarcoidosis is a granulomatous disease, characterized microscopically by noncaseating granulomas, which may involve multiple organs; however, the lung, skin, and lymph nodes are commonly affected. Sarcoidosis is a great imitator; in the skin, it presents with different cutaneous manifestations including lupus pernio, infiltrated plaques, maculopapular eruptions, infiltration of old scars, and subcutaneous sarcoidosis. Lymphedema as an initial presentation is extremely rare; cases are reported...

  9. HIV MARCH MAKE UP 01

    African Journals Online (AJOL)

    Winnie

    2006-03-02

    Mar 2, 2006 ... symmetrical, fine, erythematous, maculopapular eruption on the trunk, sparing the face and worse in the ... Erythema multiforme: erythematous iris-shaped papules and vesicobullous lesions on extremities and .... Stevens-Johnson syndrome: oral erosions. Fig. 4 (c). Stevens-Johnson syndrome: penile ...

  10. Acute generalised exanthematous pustulosis secondary to ...

    African Journals Online (AJOL)

    2012-11-02

    Nov 2, 2012 ... Cutaneous adverse drug reactions (CADRs) are a common complication of antiretroviral therapy (ART) and of drugs used to treat opportunistic infections.1 The common clinical manifestations range from mild maculopapular eruptions to the more severe recognised spectrum of Stevens-Johnson. Syndrome ...

  11. Testing for Zika virus infection in pregnancy: key concepts to deal with an emerging epidemic.

    Science.gov (United States)

    Eppes, Catherine; Rac, Martha; Dunn, James; Versalovic, James; Murray, Kristy O; Suter, Melissa A; Sanz Cortes, Magda; Espinoza, Jimmy; Seferovic, Maxim D; Lee, Wesley; Hotez, Peter; Mastrobattista, Joan; Clark, Steven L; Belfort, Michael A; Aagaard, Kjersti M

    2017-03-01

    Zika virus is an emerging mosquito-borne (Aedes genus) arbovirus of the Flaviviridae family. Following epidemics in Micronesia and French Polynesia during the past decade, more recent Zika virus infection outbreaks were first reported in South America as early as May 2013 and spread to now 50 countries throughout the Americas. Although no other flavivirus has previously been known to cause major fetal malformations following perinatal infection, reports of a causal link between Zika virus and microcephaly, brain and ocular malformations, and fetal loss emerged from hard-hit regions of Brazil by October 2015. Among the minority of infected women with symptoms, clinical manifestations of Zika virus infection may include fever, headache, arthralgia, myalgia, and maculopapular rash; however, only 1 of every 4-5 people who are infected have any symptoms. Thus, clinical symptom reporting is an ineffective screening tool for the relative risk assessment of Zika virus infection in the majority of patients. As previously occurred with other largely asymptomatic viral infections posing perinatal transmission risk (such as HIV or cytomegalovirus), we must develop and implement rapid, sensitive, and specific screening and diagnostic testing for both viral detection and estimation of timing of exposure. Unfortunately, despite an unprecedented surge in attempts to rapidly advance perinatal clinical testing for a previously obscure arbovirus, there are several ongoing hindrances to molecular- and sonographic-based screening and diagnosis of congenital Zika virus infection. These include the following: (1) difficulty in estimating the timing of exposure for women living in endemic areas and thus limited interpretability of immunoglobulin M serologies; (2) cross-reaction of immunoglobulin serologies with other endemic flaviruses, such as dengue; (3) persistent viremia and viruria in pregnancy weeks to months after primary exposure; and (4) fetal brain malformations and anomalies

  12. A case report of cutaneous larva migrans in a Mexican population of high marginalization

    Directory of Open Access Journals (Sweden)

    Isaac Aguirre Maldonadoa

    2014-09-01

    Full Text Available The creeping verminous dermatitis or cutaneous larva migrans is a parasitosis caused by percutaneous penetration and migration of larval nematode parasites characterized by producing one or more serpiginous erythematous, indurated, raised and pruritic lesion. The most common cause of cutaneous larva migrans is the Ancylostoma braziliense located in warm climate zones. In the present study, authors reported a case of cutaneous larva migrans with a characteristic clinical picture: erythematous-papular and vesicular lesion and serpiginous path, with progressive, and pruritic growth and it shown that a living area with immigration, tropical weather conditions and poverty may lead to this common infection.

  13. Bowen's disease: report of a case in a Nigerian man | Yahya | West ...

    African Journals Online (AJOL)

    ... only about 43 cases have been published in the medical literature. We report a 59-year old Nigerian man who presented with a five-year history of a mildly pruritic, slowly enlarging well-circumscribed plaque on the lower part of the anterior region of the chest on the right side. The lesion had an irregular crusted periphery ...

  14. Epidermolysis bullosa pruriginosa

    Directory of Open Access Journals (Sweden)

    Yesudia P

    2000-01-01

    Full Text Available Epidermolysis bullosa pruriginosa is a recently described variant of epidermolysis bullosa dystrophica. It is characterised by pruritic nodular prurigo like lesions, milia and with a histopathology of a subepidermal blister. We report 3 cases of this new variant.

  15. Nigella Sativa Concoction induced sustained seroreversion in HIV ...

    African Journals Online (AJOL)

    This case presentation is to highlight the complete recovery and sero-reversion of adult HIV patient after treatment with Nigella sativa concoction for the period of six months. The patient presented to the herbal therapist with history of chronic fever, diarrhoea, weight loss and multiple papular pruritic lesions of 3 months ...

  16. Pemphigoid gestationis

    DEFF Research Database (Denmark)

    Sävervall, Christine; Sand, Freja Lærke; Thomsen, Simon Francis

    2017-01-01

    Many skin diseases can occur in pregnant women. However, a few pruritic dermatological conditions are unique to pregnancy, including pemphigoid gestationis (PG). As PG is associated with severe morbidity for pregnant women and carries fetal risks, it is important for the clinician to quickly...

  17. Onifade et al., Afr J Tradit Complement Altern Med. (2013) 10(5):332 ...

    African Journals Online (AJOL)

    cadewumi

    infection or in children of HIV infected mothers (Coyne et al, 2007; Jurriaans et al, 2004 and Kassutto et al, 2005). The general dogma of un-curability of HIV ... prospective (doctoral) research study and presented with fever, diarrhoea, weight loss and malaise of 3 months duration. He had multiple popular pruritic skin lesions ...

  18. Allergen-specific cytokine polarization protects shetland ponies against culicoides obsoletus-induced insect bite hypersensitivity

    NARCIS (Netherlands)

    Meulenbroeks, C.; Lugt, van der J.J.; Meide, van der N.M.A.; Willemse, T.; Rutten, V.P.M.G.; Zaiss, D.M.W.

    2015-01-01

    The immunological mechanisms explaining development of an allergy in some individuals and not in others remain incompletely understood. Insect bite hypersensitivity (IBH) is a common, seasonal, IgE-mediated, pruritic skin disorder that affects considerable proportions of horses of different breeds,

  19. Halothane induced hepatitis: Case report | Otedo | East African ...

    African Journals Online (AJOL)

    Halothane as a cause of hepatitis is rare and may be overlooked when evaluating a patient with sudden onset jaundice. A 34-year-old lady, a nurse, presented to the liver clinic with sudden onset non - pruritic jaundice. Viral and collagen serological tests were all normal, malaria and sickling tests were negative, but ...

  20. Een kind met een S-vormige huidafwijking op zijn romp

    NARCIS (Netherlands)

    Lamberts, Aniek; Diercks, Gilles F H; Terra, Jorrit B

    2015-01-01

    A 14-year-old boy with a pruritic erythematous plaque on his abdomen along the lines of Blaschko, visited the dermatology outpatient clinic. Histopathology of a skin biopsy confirmed the clinical diagnosis linear cutaneous lupus erythematosus. We treated the patient with potent topical

  1. Bowen's disease: report of a case in a Nigerian man | Yahya | West ...

    African Journals Online (AJOL)

    Bowen's disease (cutaneous squamous cell carcinoma in situ), like other cancers of the skin, is rare in black people – to our knowledge, only about 43 cases have been published in the medical literature. We report a 59-year old Nigerian man who presented with a five-year history of a mildly pruritic, slowly enlarging ...

  2. Coping with itch, a nurse-led intervention

    NARCIS (Netherlands)

    Os-Medendorp, H. van

    2007-01-01

    The aim of this thesis is to provide insight into the psychosocial morbidity and itch cognitions of patients with chronic pruritic skin disease and to develop, test and implement a nursing programme, to help patients to cope with itch. In a study of 168 patients, it became clear that patients with a

  3. European EADV network on assessment of severity and burden of Pruritus (PruNet)

    DEFF Research Database (Denmark)

    Ständer, S.; Zeidler, C.; Riepe, Carsten

    2016-01-01

    Background: Chronic pruritus is a frequently occurring symptom of various dermatoses that causes a high burden and impaired quality of life. An effective anti pruritic therapy is important for the patient, but its effectiveness is difficult to evaluate. Diverse methods and interpretations of prur...

  4. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients

    NARCIS (Netherlands)

    Wollenberg, A; Oranje, A; Deleuran, M; Simon, D; Szalai, Z; Kunz, B; Svensson, A; Barbarot, S; von Kobyletzki, L; Taieb, A; de Bruin-Weller, M; Werfel, T; Trzeciak, M; Vestergard, C; Ring, J; Darsow, U

    2016-01-01

    Atopic dermatitis (AD) is a clinically defined, highly pruritic, chronic inflammatory skin disease of children and adults. The diagnosis is made using evaluated clinical criteria. Disease activity is best measured with a composite score assessing both objective signs and subjective symptoms, such as

  5. Intrathecal nalbuphine – Will it gain wider acceptance? – A narrative review

    Directory of Open Access Journals (Sweden)

    M.S. Raghuraman

    2017-07-01

    Conclusion: Nalbuphine is a very useful adjunct to intrathecal local anesthetics because of the good duration of analgesia, anti-pruritic,anti-shivering properties, lesser respiratory depression, nausea, and vomiting. The author hopes that this review article will be a forerunner for many more studies to come in the future, so that its acceptance will become widespread.

  6. Medical image of the week: maggots

    Directory of Open Access Journals (Sweden)

    Mosier JM

    2013-12-01

    Full Text Available An 80-year old man presented with pruritic exacerbation of his chronic wound. He had venous stasis ulcers chronically to the lower extremities bilaterally, requiring bandages. He presented with pruritis, but no fevers or pain. The bandage was removed which revealed the maggots (Figure 1.

  7. East African Medical Journal

    African Journals Online (AJOL)

    AIDS was significantly associated with mouth lesions, both ulcers and oral candidiasis, skin lesions especially eczema and generalised pruritic dermatitis, prolonged cough, ... Afterpre-testcounselling, asampleofperipheral venous blood was drawn from both mother (1 ml) and child (0.5 ml) for HIV-1 serology. Two ELISA ...

  8. Wet-wrap treatment using dilutions of tacrolimus ointment and fluticasone propionate cream in human APOC1 (+/+) mice with atopic dermatitis

    NARCIS (Netherlands)

    Oranje, A.P.; Verbeek, R.; Verzaal, P.; Haspels, I.; Prens, E.; Nagelkerken, L.

    2009-01-01

    Background: Wet-wrap treatment (WWT) with diluted topical steroids is widely used in atopic dermatitis (AD). Mice with transgenic overexpression of human apolipoprotein C1 (APOC1) in the liver and the skin are not only characterized by hyperlipidaemia and raised IgE levels, but also by pruritic

  9. Generalized granuloma annulare

    Directory of Open Access Journals (Sweden)

    Khatri M

    1995-01-01

    Full Text Available A 35-years-old female patient had generalized pruritic papular lesions, distributed like dermatitis herpetiformis for last 4 years. Histopathologic changes were typical of granuloma annulare with negative results of direct immunofluorescence. The patient did not have association of diabetes mellitus or any other systemic disease. She failed to respond to dapsone therapy and 13-cis-retinoic acid.

  10. Browse Title Index

    African Journals Online (AJOL)

    Items 151 - 200 of 1250 ... Vol 6, No 1 (2009), Anti hyperglycemic activities of Annona muricata (Linn), Abstract PDF. K Aderibigbe, OA Komolafe, OS Adewole, EM Obuotor, TK Adenowo. Vol 6, No 4 (2009), Anti-allergic, anti-pruritic, and anti-inflammatory activities of Centella asiatica extracts, Abstract PDF. M George, L Joseph.

  11. Evaluation of a proposed clinical case definition of paediatrics ...

    African Journals Online (AJOL)

    AIDS was significantly associated with mouth lesions, both ulcers and oral candidiasis, skin lesions especially eczema and generalised pruritic dermatitis, prolonged cough, prolonged fever and generalised lymphadenopathy. The WHO criteria had a sensitivity of 60%, a specificity of 94%, positive predictive value of 60%, ...

  12. Author Details

    African Journals Online (AJOL)

    Daramola, OOM. Vol 12, No 2 (2005) - Articles Unusual malignant transformation of a scrotal ulcer developing from chronic pruritic eczema: a case report. Abstract. ISSN: 1117-4153. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners ...

  13. Detection of R576 interleukin-4 receptor αn allele gene, serum interleukin-4, and eosinophilic cationic protein in atopic dermatitis patients

    Directory of Open Access Journals (Sweden)

    Abdel-Mawla M

    2009-01-01

    Full Text Available Atopic dermatitis (AD is a chronic pruritic skin disease. It results from a complex interplay between strong genetic and environmental factors. The aim of this work was to study some biochemical markers of the dermatosis. This included detection of R576 interleukin-4 receptor alpha allele gene. Twenty five patients with AD and 25 controls participated in this study.

  14. Nigerian Veterinary Journal (1) 54-61

    African Journals Online (AJOL)

    some other pruritic conditions of the skin, while the powdered dried leaves are applied to ulcers and parasitic skin conditions (Dalziel,. 193.7). The seed of C. fora is used in Chinese herbal medicine to improve ... plant has been shown to exert antioxidant activities (Kim et al., 1994; Choi et al., 1995). Close relationship has ...

  15. Treatment of scabies infestations

    Directory of Open Access Journals (Sweden)

    Mumcuoglu K.Y.

    2008-09-01

    Full Text Available Scabies is an intensely pruritic disorder induced by an immune allergic response to infestation of the skin by the mite Sarcoptes scabiei. The biology of the mite, the clinical aspects and diagnosis of scabies infestations as well as the treatment of choice with 5 % permethrin dermal cream and the use of scabicides based on other chemical substances are reviewed.

  16. Pruritis and palpable purpura from leeches in the Australian Rainforest

    Directory of Open Access Journals (Sweden)

    Elizabeth V. Seiverling

    2014-01-01

    Full Text Available Leeches are prevalent in the Australian Rainforest. We report two cases of leech bites resulting in pruritis and palpable purpura. The dermatologic sequelae of leech bites, differential diagnosis of pruritic palpable purpura, leech bite treatment, prevention, and complications are reviewed.

  17. East African Medical Journal

    African Journals Online (AJOL)

    lesions especially eczema and generalised pruritic dermatitis, prolonged cough, prolonged fever and generalised lymphadenopathy. The WHO criteria had a sensitivity of 60%, a specificity of 94%, positive predictive value of 60%, and negative predictive value of 94%. The Nairobi diagnostic criteria had a sensitivity of 80%, ...

  18. Case report

    African Journals Online (AJOL)

    ebutamanya

    2016-03-24

    Mar 24, 2016 ... muscle pain, with a slight fatigue and there was no personal or family history of connective tissue disease. Examination revealed a pink liliace periocular erythro edema of the face (Figure 1), pruritic papules on the dorsal hands, elbows and a purplish erythema of the buttocks (Figure 2), the external surface ...

  19. December 2005. 29 Use of Vaginal Speculums in Lower Rectal an

    African Journals Online (AJOL)

    user

    2005-12-02

    Dec 2, 2005 ... dermatological problems (including pruritic changes), abscess, fistula, scar, and deformity. Pain upon spreading the buttocks may indicate the presence of ... East and Central African Journal of Surgery Volume 10 Number 2 – December 2005. 31. Fig. 3. The left lateral subcutaneous internal sphincterotomy.

  20. Carcinoma of the scrotum in a Young man with HIV Infection: Is there ...

    African Journals Online (AJOL)

    Squamous cell carcinoma of the scrotum is rare and its occurrences in the young is even rarer. A 39-year-old gentleman presented with a large non-healing ulcer developing on his left hemi-scrotum 9 months after the excisional biopsy of multiple pruritic nodular lesions on the scrotum. On histological examination it was ...

  1. A rare cause of blepharoconjunctivitis: Phthiriasis palpebrarum

    African Journals Online (AJOL)

    pubic hair.[2] Phthiriasis palpebrarum infestation may lead to a form of pruritic blepharoconjunctivitis. The diagnosis of this problem may be considerably difficult because of the colonization of the lice initially to the roots of the eye lashes. The process of recognition without performing magnification property of biomicroscopy ...

  2. Bleomycin-induced flagellate dermatitis

    Directory of Open Access Journals (Sweden)

    Guilherme Devidé Mota

    2014-07-01

    Full Text Available A 29-year-old woman with stage IVB Hodgkin's lymphoma was treated with doxorubicin, bleomycin, vinblastine, and dacarbazine. Two weeks after the first cycle was completed, she developed pruritic, linear erythematous lesions in a flagellate-like pattern on the trunk, neck and arms. After oral prednisone therapy and cessation of bleomycin, the lesions started to recede.

  3. Minocycline-induced hyperpigmentation

    Directory of Open Access Journals (Sweden)

    Valena Fiscus

    2014-07-01

    Full Text Available A 62-year-old male with a long history of rosacea, which was well controlled on minocycline, presented to his primary care physician for routine examination. Physical examination was noted for non-palpable, non-pruritic blue patches of hyperpigmentation on the medial aspects of his lower extremities bilaterally. Recognition and management of the findings are discussed.

  4. Metoclopramide Injection

    Science.gov (United States)

    ... in the jaw or neck speech problems depression thinking about harming or killing yourself fever muscle stiffness confusion fast, slow, or irregular heartbeat sweating seizures rash hives swelling ...

  5. 78 FR 22442 - Infant Formula: The Addition of Minimum and Maximum Levels of Selenium to Infant Formula and...

    Science.gov (United States)

    2013-04-16

    ... brittleness and loss, gastrointestinal upsets, skin rash, garlic breath odor, fatigue, irritability, and... is incorporated into proteins to make selenoproteins, which are important antioxidant enzymes, the...

  6. Pediatric Viral Exanthema: A Review Article

    Directory of Open Access Journals (Sweden)

    Mohammed Jafar Saffar

    2017-04-01

    Full Text Available Context Many diseases caused by viral agents are associated with fever and cutaneous manifestations. Viral exanthema is a widespread nonspecific skin rash, commonly characterized by generalized eruption of erythematous macules and papular lesions. Although these rashes are mostly benign and self-limited, some may be serious and life-threatening. Differentiation between severe and benign types is clinically important and life-saving. Evidence Acquisition In this narrative review, electronic databases, including Google Scholar, Science Direct, PubMed (including Medline, Web of Science, Scientific Information Database, and Scopus, were searched. We conducted a narrative review of papers published on pediatric viral exanthema during 2000 - 2016. The used keywords included “viral exanthema”, “fever”, and “skin rash”. Articles on skin rash, caused by drug reactions or nonviral exanthema, were excluded. Results Different viral agents can cause different types of skin reactions. Cutaneous manifestations and skin rashes can be categorized, based on the form of the rash (macular, papular, vesicular, blistery, petechial, and purpuric or the general term, which denotes illnesses such as measles-like morbilliform rash, rubella or rubelliform rash, and scarlatiniform rash, a scarlet-fever like infection. Conclusions Based on the findings, a systematic approach relying on accurate history-taking and analysis of epidemiological cues and rash characteristics is of great significance.

  7. Exanthema in Legionnaires' disease mimicking a severe cutaneous drug reaction.

    Science.gov (United States)

    Ziemer, M; Ebert, K; Schreiber, G; Voigt, R; Sayer, H G; Marx, G

    2009-07-01

    Legionnaires' disease is an acute bacterial infection, generally caused by Legionella pneumophila, which primarily involves the lower respiratory tract, although it is often associated with multisystemic extrapulmonary features. Cutaneous features are very uncommon and may include erythematous or petechial, macular or maculopapular lesions. We report a male patient who expressed all features of a severe lobular pneumonia. Over the course of the disease the patient developed a livid erythematous, maculopapular exanthem rapidly extending over the entire body. Given the rapid development and target-like appearance of the skin lesions with extensive skin involvement and blister formation, the initial diagnosis was that of a severe cutaneous drug reaction. However, histological examination of biopsy did not confirm this diagnosis, but instead was suspicious for a viral exanthem or a more aggressive inflammatory response due to sensitization to bacterial antigens. L. pneumophila infection was verified during the course of the disease.

  8. Adverse reaction to tetrazepam.

    Science.gov (United States)

    Palacios Benito, R; Domínguez Ortega, J; Alonso Llamazares, A; Rodríguez Morales, A; Plaza Díaz, A; Chamorro Gómez, M; Martínez-Cócera, C

    2001-01-01

    Adverse reactions caused by benzodiazepines rarely occur. We present a case of a 70-year-old man who developed a maculopapular exanthema after the ingestion of tetrazepam. For his diagnosis, skin tests were performed, including prick and patch tests, not only with the benzodiazepine implicated in the reaction, but also with benzodiazepines of other groups. Single-blind oral challenge tests were also performed in the patient, in order to assess his tolerance to other benzodiazepines.

  9. HLA-A★3101 and Carbamazepine-Induced Hypersensitivity Reactions in Europeans

    Science.gov (United States)

    McCormack, Mark; Alfirevic, Ana; Bourgeois, Stephane; Farrell, John J.; Kasperavičiūtė, Dalia; Carrington, Mary; Sills, Graeme J.; Marson, Tony; Jia, Xiaoming; de Bakker, Paul I.W.; Chinthapalli, Krishna; Molokhia, Mariam; Johnson, Michael R.; O’Connor, Gerard D.; Chaila, Elijah; Alhusaini, Saud; Shianna, Kevin V.; Radtke, Rodney A.; Heinzen, Erin L.; Walley, Nicole; Pandolfo, Massimo; Pichler, Werner; Park, B. Kevin; Depondt, Chantal; Sisodiya, Sanjay M.; Goldstein, David B.; Deloukas, Panos; Delanty, Norman; Cavalleri, Gianpiero L.; Pirmohamed, Munir

    2011-01-01

    BACKGROUND Carbamazepine causes various forms of hypersensitivity reactions, ranging from maculopapular exanthema to severe blistering reactions. The HLA-B★1502 allele has been shown to be strongly correlated with carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS–TEN) in the Han Chinese and other Asian populations but not in European populations. METHODS We performed a genomewide association study of samples obtained from 22 subjects with carbamazepine-induced hypersensitivity syndrome, 43 subjects with carbamazepine-induced maculopapular exanthema, and 3987 control subjects, all of European descent. We tested for an association between disease and HLA alleles through proxy single-nucleotide polymorphisms and imputation, confirming associations by high-resolution sequence-based HLA typing. We replicated the associations in samples from 145 subjects with carbamazepine-induced hypersensitivity reactions. RESULTS The HLA-A★3101 allele, which has a prevalence of 2 to 5% in Northern European populations, was significantly associated with the hypersensitivity syndrome (P = 3.5×10−8). An independent genomewide association study of samples from subjects with maculopapular exanthema also showed an association with the HLA-A★3101 allele (P = 1.1×10−6). Follow-up genotyping confirmed the variant as a risk factor for the hypersensitivity syndrome (odds ratio, 12.41; 95% confidence interval [CI], 1.27 to 121.03), maculopapular exanthema (odds ratio, 8.33; 95% CI, 3.59 to 19.36), and SJS–TEN (odds ratio, 25.93; 95% CI, 4.93 to 116.18). CONCLUSIONS The presence of the HLA-A★3101 allele was associated with carbamazepine-induced hypersensitivity reactions among subjects of Northern European ancestry. The presence of the allele increased the risk from 5.0% to 26.0%, whereas its absence reduced the risk from 5.0% to 3.8%. (Funded by the U.K. Department of Health and others.) PMID:21428769

  10. [Uncommon cutaneous presentation of visceral Leishmaniasis associated with HIV].

    Science.gov (United States)

    Cossart, C; Le Moal, G; Garcia, M; Frouin, E; Hainaut-Wierzbicka, E; Roblot, F

    2016-12-01

    Visceral leishmaniasis is not normally expressed in skin. Herein, we describe the case of an HIV-positive patient who developed two unusual skin manifestations during an episode of visceral leishmaniasis. A 48-year-old female patient consulted initially for infiltrated purpura of all four limbs. Skin biopsy revealed leukocytoclastic vasculitis with Leishman-Donovan bodies. Laboratory tests showed medullary, splenic, gastric and colic involvement, suggesting systemic disease, and enabling visceral leishmaniasis to be diagnosed. Two years later, despite prolonged treatment, the patient presented maculopapular exanthema, and histology revealed persistent Leishman-Donovan bodies. We report herein an association of two rare skin manifestations in an HIV-positive patient with visceral leishmaniasis: infiltrated purpura and maculopapular exanthema. However, the underlying mechanisms remain hypothetical. The initial leukocytoclastic exanthema could be secondary to either polyclonal hypergammaglobulinaemia or to IgA deposits, or possibly to mechanical impairment of blood vessels by the actual parasite. The maculopapular exanthema occurring later raised the possibility of post-Kala-Azar leishmaniasis due to blood-borne dissemination in an anergic subject or perhaps even immune reconstitution inflammatory syndrome. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Mycoplasma Pneumoniae with Atypical Stevens-Johnson Syndrome: A Diagnostic Challenge

    OpenAIRE

    Ralph Yachoui; Kolasinski, Sharon L.; David E. Feinstein

    2013-01-01

    The Stevens-Johnson syndrome (SJS) classically involves a targetoid skin rash and the association of the oral mucosa, genitals, and conjunctivae. Recently, there have been several documentations of an incomplete presentation of this syndrome, without the typical rash, usually associated with the mycoplasma pneumoniae infection. Our case illustrates that this important clinical diagnosis should not be missed due to its atypical presentation.

  12. Common Dermatoses of Infancy

    OpenAIRE

    Gora, Irv

    1986-01-01

    Within the pediatric population of their practices, family physicians frequently encounter infants with skin rashes. This article discusses several of the more common rashes of infancy: atopic dermatitis, cradle cap, diaper dermatitis and miliaria. Etiology, clinical picture and possible approaches to treatment are presented.

  13. Common dermatoses of infancy.

    Science.gov (United States)

    Gora, I

    1986-09-01

    Within the pediatric population of their practices, family physicians frequently encounter infants with skin rashes. This article discusses several of the more common rashes of infancy: atopic dermatitis, cradle cap, diaper dermatitis and miliaria. Etiology, clinical picture and possible approaches to treatment are presented.

  14. Pattern of use of skin care products in children with and without ...

    African Journals Online (AJOL)

    Results: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash ...

  15. Tick-borne Diseases: The Big Two | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... is a key early-stage symptom. This circular red patch usually appears at the bite site 3 to 30 days after the bite. It expands to 5 to 6 inches in diameter, and persists for 3 to 5 weeks. As the rash enlarges, it may take on a "bull's-eye" appearance. In some people this rash never ...

  16. Herpes zoster: klinik, diagnostik og behandling

    DEFF Research Database (Denmark)

    Kofoed, Kristian; Rønholt, Finn; Gerstoft, Jan

    2011-01-01

    Herpes zoster (HZ) is a painful vesicular rash localized to one dermatome. Post-herpetic neuralgia (PHN) is persistent pain three months after the rash started. In recent years several Cochrane reviews and clinical studies on how to treat HZ and PHN have been published. These studies show...

  17. [A woman with skin abnormalities and muscle weakness

    NARCIS (Netherlands)

    Steggink, L.C.; Hettema, M.E.; Delsing, C.E.

    2013-01-01

    A 54-year-old woman presented to the emergency department with progressive proximal muscle weakness and a symmetric skin rash. Physical examination demonstrated a heliotrope rash, Gottron lesions, mechanic's hands and symmetrical erythema of the face, neck and upper legs. The diagnosis

  18. Een vrouw met huidafwijkingen en spierzwakte

    NARCIS (Netherlands)

    Steggink, Lars C; Hettema, Martha E; Delsing, Corine E

    2013-01-01

    A 54-year-old woman presented to the emergency department with progressive proximal muscle weakness and a symmetric skin rash. Physical examination demonstrated a heliotrope rash, Gottron lesions, mechanic's hands and symmetrical erythema of the face, neck and upper legs. The diagnosis

  19. Research

    African Journals Online (AJOL)

    cqq1a

    2010-08-29

    Aug 29, 2010 ... 2381410, Egypt. Key words: Systemic lupus erythematosus, SLE, quality of life, SLE Disease Activity Index, Short Form–36 health questionnaire ..... Items. No. %. Mucocutanous manifestations. Malar rash. 54. 91.5. Discoid rash. 12. 20.3. Photosensitivity. 49. 83.1. Oral ulcers. 50. 84.7. Arthritis. 31. 52.5.

  20. Case report

    African Journals Online (AJOL)

    abp

    2017-05-11

    May 11, 2017 ... 1University of Health Sciences, Umraniye Research and Training Hospital, Department of Pediatrics, Istanbul, Turkey, 2Haydarpasa Numune. Research and Training Hospital, ... our department with fever, rashes on legs and arms and intermittent mild abdominal pain. Multiple purpuric rashes were on his ...

  1. Parasites and the skin

    African Journals Online (AJOL)

    2009-06-11

    Jun 11, 2009 ... psoriasiform rash reminiscent of psoriasis. Diagnosis will be assisted ... Disinfect clothes and bed linen ... Psoriasiform rash of Norwegian scabies. ..... bug. O ccasion ally con tami- n ated blo o d. T setse fl y. (G lossin a). T rop.

  2. Research Articles in Simplified HTML: a Web-first format for HTML-based scholarly articles

    Directory of Open Access Journals (Sweden)

    Silvio Peroni

    2017-10-01

    Full Text Available Purpose This paper introduces the Research Articles in Simplified HTML (or RASH, which is a Web-first format for writing HTML-based scholarly papers; it is accompanied by the RASH Framework, a set of tools for interacting with RASH-based articles. The paper also presents an evaluation that involved authors and reviewers of RASH articles submitted to the SAVE-SD 2015 and SAVE-SD 2016 workshops. Design RASH has been developed aiming to: be easy to learn and use; share scholarly documents (and embedded semantic annotations through the Web; support its adoption within the existing publishing workflow. Findings The evaluation study confirmed that RASH is ready to be adopted in workshops, conferences, and journals and can be quickly learnt by researchers who are familiar with HTML. Research Limitations The evaluation study also highlighted some issues in the adoption of RASH, and in general of HTML formats, especially by less technically savvy users. Moreover, additional tools are needed, e.g., for enabling additional conversions from/to existing formats such as OpenXML. Practical Implications RASH (and its Framework is another step towards enabling the definition of formal representations of the meaning of the content of an article, facilitating its automatic discovery, enabling its linking to semantically related articles, providing access to data within the article in actionable form, and allowing integration of data between papers. Social Implications RASH addresses the intrinsic needs related to the various users of a scholarly article: researchers (focussing on its content, readers (experiencing new ways for browsing it, citizen scientists (reusing available data formally defined within it through semantic annotations, publishers (using the advantages of new technologies as envisioned by the Semantic Publishing movement. Value RASH helps authors to focus on the organisation of their texts, supports them in the task of semantically enriching the

  3. Predictors of Tumor Response to Cetuximab and Panitumumab in 116 Patients and a Review of Approaches to Managing Skin Toxicity.

    Science.gov (United States)

    Jaka, A; Gutiérrez-Rivera, A; López-Pestaña, A; del Alcázar, E; Zubizarreta, J; Vildosola, S; Arregui, M A; Sarasqueta, C; Lobo, C; Tuneu, A

    2015-01-01

    Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published. We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia. In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P=.03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P=.03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P=.002). The papulopustular rash was managed according to an algorithm developed by our department. Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

  4. Hyper immunoglobulin-E syndrome: a case with chronic ear draining mimicking polypoid otitis media.

    Science.gov (United States)

    Görür, Kemal; Ozcan, Cengiz; Unal, Murat; Akbaş, Yücel; Vayisoğlu, Yusuf

    2003-04-01

    The hyper-IgE syndrome is a rare, complex immunoregulatory disorder characterized by pruritic dermatitis, recurrent staphylococcus skin abscesses and extremely elevated levels of IgE in serum. In this report, an 8-year-old girl with hyper-IgE syndrome is presented. She had pruritic dermatitis and skin abscesses on her extremities and scalp. Discharge and granulation tissue in right external ear canal were recognized in otorhinolaryngologic examination. Cultures of the suppuration of the external ear canal yielded S. aureus. Biopsy of the lesion was reported as granulation tissue. Local treatment of the ear canal was performed with ear wick soaked with steroid and antibiotic solutions two times per day.

  5. Psychosomatic factors in pruritus.

    Science.gov (United States)

    Tey, Hong Liang; Wallengren, Joanna; Yosipovitch, Gil

    2013-01-01

    Pruritus and psyche are intricately and reciprocally related, with psychophysiological evidence and psychopathological explanations helping us to understand their complex association. Their interaction may be conceptualized and classified into 3 groups: pruritic diseases with psychiatric sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Management of chronic pruritus is directed at treating the underlying causes and adopting a multidisciplinary approach to address the dermatologic, somatosensory, cognitive, and emotional aspects. Pharmcotherapeutic agents that are useful for chronic pruritus with comorbid depression and/or anxiety comprise selective serotonin reuptake inhibitors, mirtazapine, tricyclic antidepressants (amitriptyline and doxepin), and anticonvulsants (gabapentin, pregabalin); the role of neurokinin receptor-1 antagonists awaits verification. Antipsychotics are required for treating itch and formication associated with schizophrenia and delusion of parasitosis (including Morgellons disease). Copyright © 2013 Elsevier Inc. All rights reserved.

  6. [Post-vaccination granulomas caused by delayed-type reaction to aluminum salts].

    Science.gov (United States)

    Wahl, R U; Wurpts, G; Merk, H F

    2014-05-01

    Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques. The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.

  7. Novel Functional Aspect of Antihistamines: The Impact of Bepotastine Besilate on Substance P-Induced Events

    Directory of Open Access Journals (Sweden)

    Shun Kitaba

    2009-01-01

    Full Text Available Besides histamine, substance P (SP has been demonstrated to play a crucial role in pruritic skin diseases. Although antihistamines are frequently used for pruritic skin diseases, little is known concerning the effect on an SP-induced event such as mast cell degranulation and the upregulation of adhesion molecules or the nitric oxide (NO synthesis in endothelial cells. Our aim was to study the effect of bepotastine besilate on SP-induced degranulation of rat basophillic leukemia (RBL-2H3 cells and expression of adhesion molecules and NO synthesis in human dermal microvascular endothelial cells (HMVECs. Bepotastine besilate significantly inhibited SP-induced degranulation of RBL-2H3 cells and NO synthesis in HMVECs. Bepotastine besilate significantly inhibited expression of adhesion molecules in HMVESs, while it failed to suppress SP-induced upregulation of the adhesion molecules in HMVECs. Therefore, bepotastine besilate is assumed to act favorably on SP-induced basophil degranulation and NO synthesis in HMVECs.

  8. [Sarcoptic mange: report of an outbreak in a family and their pet].

    Science.gov (United States)

    Gallegos, José L; Budnik, Isolda; Peña, Anamaría; Canales, Marilena; Concha, Mónica; López, Javier

    2014-02-01

    Scabies caused by the genus Sarcoptes scabiei var canis is a prevalent infection in dogs and affects abandoned, malnourished and overcrowded animals, causing hair loss and an intensely pruritic crusting dermatitis. In humans the manifestation is a self-limiting pruritic dermatitis, but persistent cases are described. An outbreak of sarcoptic mange is reported in a family group (seven people, including a 5 month infant and his mother). The infective source was their own house dog who was taken from the street. The diagnosis was confirmed by the detection of mites and eggs in the acarotest of the dog and mites of S. scabei in the infant. Sarcoptic mange should be suspected in individuals with allergic dermatitis who have contact with dogs. Treatment in humans is usually symptomatic and may need miticides if the infection persists. The control of the disease requires an appropriate pet treatment.

  9. Doença do enxerto contra hospedeiro pós-transfusional-guia para irradiação gama de hemocomponentes Transfusion-associated graft-versus-host disease-guideline on gamma irradiation of blood components

    Directory of Open Access Journals (Sweden)

    E.P. Landi

    1999-07-01

    syndrome. Clinical manifestations are fever, maculopapular skin rash, nausea, vomiting, diarrhea, hepatitis and pancytopenia owing to bone marrow hypoplasia. lt can occur in recipients with severe immunossuppression and in immunocompetent recipients after transfusion of ceillular components from HLA homozygous donor to recipients heterozygous for that HLA haplotype. The diagnosis is made by clinical manifestation and skin biopsy. Antithymocyte globulin and high dose systemic corticosteroids are both the most used therapy. The back of knowledge about this syndrome, the rapid evolution and the absence of treatement response are related to patients bad evolution. Gamma irradiation of blood products has been the mainstay of TA-GVHD prevention. Dose of 2500 cGy is required to completly inactivate T cells. lrradiation damage red cells membrane and the red celis units can not be storage for long time after irradiation. High potassium levels is the mainly change in red cells units.White cell-reduction filters do not prevent TA-GVHD and gamma irradiation does not prevent alloimmunization or blood reactions. Oniy cellular components like whole blood, red cells, platelets and granulocytes need be irradiated. Ali blood components should be irradiated to: first or second-degree relatives, patients need HLA-matched platelets, recipients of allogeneic or autologous bone marrow transplantation, patients with Hodgkin's disease, patients treated with purine analogue drugs, intrauterine transfusions, pre-term infants and when congenítal immunodeficiency states is suspected. lt is recomended irrradiated blood to patients with neoplastic disease when they receive intensive chemoterapy.

  10. Case report

    African Journals Online (AJOL)

    abp

    9 juin 2016 ... comme un mouvement de reptation perçu, accompagné d'un prurit intense qu'il impute aux morsures du parasite qui déchire sa peau pour se frayer chemin. Il affirme même pouvoir arrêter la progression sous-cutanée de ces « bestioles » en interposant son doigt sur leurs trajectoires. Malgré des tentatives ...

  11. Morgellons Disease

    OpenAIRE

    Ohn, Jungyoon; Park, Seon Yong; Moon, Jungyoon; Choe, Yun Seon; Kim, Kyu Han

    2017-01-01

    Morgellons disease is a rare disease with unknown etiology. Herein, we report the first case of Morgellons disease in Korea. A 30-year-old woman presented with a 2-month history of pruritic erythematous patches and erosions on the arms, hands, and chin. She insisted that she had fiber-like materials under her skin, which she had observed through a magnifying device. We performed skin biopsy, and observed a fiber extruding from the dermal side of the specimen. Histopathological examination sho...

  12. Itchy lesions in pigmented skin.

    Science.gov (United States)

    Hung, Rachel; Ahmeen, Mahreen; Fleming, Ann; Hoque, Shamali

    2013-10-10

    A 37-year-old woman with type VI skin presented with 1-year history of pruritic lesions affecting her arms, chest and legs. The lesions were approximately 5 mm in diameter, annular and with a raised border. A skin biopsy was performed which showed a diagnosis of disseminated superficial actinic porokeratosis. Porokeratosis is an unusual presentation in pigmented skin and there are very limited reports of this occurrence in the literature.

  13. GAMBARAN KLINIK DAN LATAR BELAKANG PASIEN DENGAN DIAGNOSIS KLNIK SEBAGAI LICHEN PLANUS DI POLI PENYAKIT MULUT RSCM DAN RSGM

    Directory of Open Access Journals (Sweden)

    Sri Tjahjani Sumantri

    2015-08-01

    Full Text Available Lichen planys is disorder of the skin and mucous membrane that presenting pruritic, purple and polygonal papules. Oral lesions may persist for years and with clinical appearance that sometimes very ocnfusing. In most cases, oral lesions are present as white, reticulated or natelike areas involving the mucosa. These lesions are characteristic and called Wickham's striae. This paper presented some cases with lesions that resembled oral lichen planus.

  14. 269 Refractory Chronic Urticaria Treated with Omalizumab

    OpenAIRE

    Saenz, Martinez; Del Pozo, Ramírez; JJ, Lopez Tiro; Vera, Javier Gomez

    2012-01-01

    Background Chronic urticaria (CU) is a common disorder characterized by recurrent episodes of urticaria pruritic erythematous lesions, associated with angioedema1. It affects 0.1% of the population, it is estimated that approximately 15 to 25% of the population will have hives at some point in their lives.2 About 80% of UC patients are diagnosed as idiopathic chronic urticaria and that no cause is identified, 3 experiencing deterioration in their quality of life affecting your work, social re...

  15. Association of pruritus with anxiety or aggression in dogs.

    Science.gov (United States)

    Klinck, Mary P; Shofer, Frances S; Reisner, Ilana R

    2008-10-01

    To evaluate the association between pruritus and anxiety-related and aggressive behaviors in dogs. Cross-sectional survey. 238 dogs between 1 and 8 years old. Information including a score for general degree of pruritus (visual analogue scale from 0 to 10) and frequency of anxiety-related and aggressive behaviors was collected via a survey distributed to clients at 3 privately owned practices. Median score for pruritus was 2.4. Dogs were assigned to 2 groups on the basis of pruritus score (nonpruritic [0 to 2.4] and pruritic [2.5 to 10]). There was no significant difference between pruritic and nonpruritic dogs with regard to aggression or with regard to reactivity to being alone; to thunderstorms or noises; or to unfamiliar people, animals, or objects. Post hoc analysis revealed significantly more reactivity to thunderstorms or noises in dogs treated with glucocorticoids (18/37 [49%]) than in those not administered glucocorticoids (57/197 [29%]). An association was not detected between pruritus and aggressive, anxious, or fearful behavior in dogs. There was greater reactivity to thunderstorms or noises in glucocorticoid-treated dogs. These findings do not preclude the possibility of a relationship between certain dermatoses or pruritic conditions and behavior. However, a concurrent behavioral abnormality cannot be assumed to result from a dermatosis and be expected to resolve with treatment of only the skin disease. Dogs with behavioral disorders and pruritic disease require primary treatment of both conditions. Additional studies to examine the effect of disease and glucocorticoids on canine behavior are warranted.

  16. Evaluation of generalized pruritus in patients without primary skin lesions in Razi Hospital

    OpenAIRE

    Jomhori P; Daneshpajooh M; Akhiani M

    2001-01-01

    Pruritus is an unpleasant sensation that provokes the desire to scratch. It has long been recognized as a presenting or concomitant symptom of many systemic diseases. Indeed, generalized pruritus is reported to be associated with underlying diseases in 10-50 percent of cases. This study was conducted to investigate the underlying diseases in pruritic patients without primary skin lesion. Seventy-five patients with at least one-month history of pruritus with no primary skin lesions, presenting...

  17. Disease: H01650 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available e dermal-epidermal junction that clinically can manifest with urticarial lesions, tense blisters, and erosio...ly protein BP230. Most of these antibodies belong to the immunoglobulin G class. Diagnosis of BP relies on the clinica...osis disease. It is primarily a disease of the elderly with an equal incidence in men and women. The clini...cal characteristics are the formation of tense blisters and pruritic urticarial ery

  18. Development of Immunotherapy for Insect Bite Hypersensitivity in Horses

    OpenAIRE

    Jónsdóttir, Sigríður

    2017-01-01

    Insect bite hypersensitivity (IBH) is a type I allergy of horses with production of IgE and release of inflammatory mediators. It is caused by bites of midges of the genus Culicoides. The disease is a recurrent dermatitis characterized by pruritic skin and hair loss, which can result in secondary infections. All breeds of horses can be affected, but horses born in Iceland and exported are more frequently affected than Icelandic horses born abroad. Allergens have been identified at the molecul...

  19. New world cutaneous leishmaniasis

    OpenAIRE

    Trufant, Joshua W; Lewin, Jesse M; Hale, Christopher S; Meehan, Shane A; Pomeranz, Miriam Keltz

    2015-01-01

    A 24-year-old Bangladeshi man presented with a 12-week history of a pruritic papule on his left elbow that had enlarged and ulcerated. He was without any constitutional or systemic symptoms. He reported a history of extensive travel in the two years prior to presentation that included Bangladesh, South and Central America, and Mexico. Histopathologic features were consistent with leishmaniasis. Speciation by the Centers for Disease Control showed L. brasiliensis.

  20. Fox-Fordyce Disease after Steven-Johnson Syndrome: case report

    Directory of Open Access Journals (Sweden)

    Havva Yildiz Seckin

    2016-09-01

    Full Text Available Fox-Fordyce Disease (FFD is a rare, chronic disorder of the apocrin sweat glands and characterized by pruritic papules. The disease primarily affects females and the etiology is unclear. A 19-year-old male patient developed FFD in his lips with a history of Steven-Johnson Syndrome is presented in this report. [J Contemp Med 2016; 6(3.000: 214-217

  1. THE DERMATOSES OF PREGNANCY

    OpenAIRE

    Sachdeva Silonie

    2008-01-01

    The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specific dermatoses. Pregnancy-specific skin dermatoses include an ill-defined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of t...

  2. Perianal Ulcer in an Asian Man.

    Science.gov (United States)

    Pillai, Nilanthy Sharon Anthony; Oh, Choon Chiat; Fung, Michelle Chan Mei; Wijaya, Limin

    2017-01-01

    A 79-year-old Chinese man presented with a 2-month history of pruritic, tender ulceration covering his perianal region. He was initially treated with oral amoxicillin/clavulanic acid and vancyclovir, with no improvement. His history included hypertension. On physical examination, there was a 1.5-cm solitary, pink shallow ulcer with a tender erythematous base on the right side of the buttock cleft (Figure 1).

  3. Mycobacterium fortuitum infection arising in a new tattoo

    OpenAIRE

    Philips, Rebecca C.; Hunter-Ellul, Lindsey A; Martin, Julie E; Wilkerson, Michael G.

    2014-01-01

    We report an uncommon case of a cutaneous infection with Mycobacterium fortuitum arising in a new tattoo. A 29-year-old man presented with a several month history of a non-pruritic papular eruption within a tattoo; the papules developed 1-to-2 weeks after the tattoo procedure. He denied similar symptoms with previous tattoos. He had been treated unsuccessfully with cephalexin. Histopathologic examination revealed perifollicular chronic and granulomatous inflammation, consistent with chronic f...

  4. Evaluation of the Effectiveness of Antibiotics against Eosinophilic Pustular Folliculitis

    Directory of Open Access Journals (Sweden)

    Sachiko Ono

    2013-05-01

    Full Text Available Eosinophilic pustular folliculitis (EPF is a chronic intractable pruritic dermatosis. Although indomethacin is generally effective against EPF and considered as a first-line therapy, quite a few patients with indomethacin still suffer from the symptoms. Among other therapeutic options, some antibiotics have been reported to be effective; however, there has been no epidemiological description regarding oral antibiotics use in patients with EPF. In this study, we investigated the frequency of antibiotics use and the effectiveness in patients with EPF.

  5. Case series

    African Journals Online (AJOL)

    raoul

    18 mars 2011 ... l'accident dramatique de choc anaphylactique avec œdème de Quick, et de manifestations plus atténuées à type de prurit, d'urticaire, de dyspnée asthmatiforme ou d'un malaise vagal de grande valeur diagnostique [6]. Ailleurs, la rupture est peu symptomatique et de découverte opératoire dans environ 5 ...

  6. Scabies in the age of increasing drug resistance.

    Directory of Open Access Journals (Sweden)

    Samar Khalil

    2017-11-01

    Full Text Available Scabies is an infestation of the skin by the mite Sarcoptes scabiei. It manifests with pruritic erythematous papules and excoriations, in addition to the pathognomonic burrows. Multiple drugs can be used for treatment, but resistance to conventional therapy is increasing throughout the years. This paper will review the mechanisms of resistance proposed in the literature and some of the potential solutions to this problem.

  7. Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations.

    Science.gov (United States)

    Rimoin, Lauren P; Kwatra, Shawn G; Yosipovitch, Gil

    2013-01-01

    There have been considerable advances in our understanding of the pathophysiology of pruritus in recent years. The purpose of this review was to highlight itch entities in women, and in particular pruritic vulvar dermatoses that women experience among different age groups. Unique temporal shifts may contribute to the etiology of many of these conditions. These changes lead to cyclical changes in the skin's basic composition. Specifically, estrogen receptors have been detected on keratinocytes that respond to rising and falling levels of estrogen. These receptors lead to changes in skin hydration, collagen content, and in the concentration of glycosaminoglycans that form the skin barrier. In addition, hormonal pH changes associated with the menstrual cycle may be an important factor in the aggravation of itch as increasing pH is known to activate the proteinase-activated receptor-2, a well-known itch mediator. Common pruritic conditions in women that will be discussed include atopic and irritant dermatitis, psoriasis, lichen sclerosus, infectious vulvovaginitis, vulvovaginal candidiasis, atrophic vulvovaginitis, squamous cell carcinoma, lichen simplex chronicus, and neuropathic itch. We also examine pruritic conditions associated with pregnancy including pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Finally, acceptable and contraindicated antipruritic agents in pregnancy are examined. © 2013 Wiley Periodicals, Inc.

  8. European EADV network on assessment of severity and burden of Pruritus (PruNet): first meeting on outcome tools.

    Science.gov (United States)

    Ständer, S; Zeidler, C; Riepe, C; Steinke, S; Fritz, F; Bruland, P; Soto-Rey, I; Storck, M; Agner, T; Augustin, M; Blome, C; Dalgard, F; Evers, A W M; Garcovich, S; Gonçalo, M; Lambert, J; Legat, F J; Leslie, T; Misery, L; Raap, U; Reich, A; Şavk, E; Streit, M; Serra-Baldrich, E; Szepietowski, J; Wallengren, J; Weisshaar, E; Dugas, M

    2016-07-01

    Chronic pruritus is a frequently occurring symptom of various dermatoses that causes a high burden and impaired quality of life. An effective anti pruritic therapy is important for the patient, but its effectiveness is difficult to evaluate. Diverse methods and interpretations of pruritic metrics are utilized in clinical trials and the daily clinical practice in different countries, resulting in difficulties comparing collected data. We founded a European Network on Assessment of Severity and Burden of Pruritus (PruNet) that is supported by the EADV. PruNet consists of 28 experts from 15 EU countries (21 dermatologists, 5 medical informaticists, 2 psychologists) and aims to unify the assessment of itch in routine dermatological care. Following a preliminary survey, a consensus conference was held in order to agree upon the prioritization of patient-reported outcome tools. Through utilizing the Delphi method, it was agreed that tools for measuring itch intensity (ex. the visual analogue scale) and quality of life (ex. ItchyQoL) are of primary importance and should urgently be foremost validated. The validation and harmonization of standards are needed for the improvement of quality care for patients suffering from pruritic dermatoses. This summer, the first validation studies in several EADV member countries already began. © 2015 European Academy of Dermatology and Venereology.

  9. Histamine H4 receptor antagonists are superior to traditional antihistamines in the attenuation of experimental pruritus.

    Science.gov (United States)

    Dunford, Paul J; Williams, Kacy N; Desai, Pragnya J; Karlsson, Lars; McQueen, Daniel; Thurmond, Robin L

    2007-01-01

    Histamine is a potent mediator of itch in humans, yet histamine H(1) receptor antagonists have been shown to be of limited use in the treatment of certain chronic pruritic diseases. The histamine H(4) receptor is a recently described histamine receptor, expressed on hematopoietic cells, linked to the pathology of allergy and asthma. The contribution of the novel histamine H(4) receptor to histaminergic and allergic pruritus was investigated. Histamine and a selective histamine H(4) receptor agonist caused scratching responses in mice, which were almost completely attenuated in histamine H(4) receptor knockout mice or by pretreatment with the selective histamine H(4) receptor antagonist, JNJ 7777120. Pruritus induced by allergic mechanisms was also potently inhibited with histamine H(4) receptor antagonist treatment or in histamine H(4) receptor knockout mice. In all cases, the inhibitory effect of histamine H(4) receptor antagonist was greater than those observed with histamine H(1) receptor antagonists. The histamine H(4) receptor-mediated pruritus was shown to be independent of mast cells or other hematopoietic cells and may result from actions on peripheral neurons. These results demonstrate that the histamine H(4) receptor is involved in pruritic responses in mice to a greater extent than the histamine H(1) receptor. Histamine H(4) receptor antagonists may have therapeutic utility for treating chronic pruritic diseases in humans where histamine H(1) receptor antagonists are not effective.

  10. Sarcoidosis with bilateral leg lymphedema as the initial presentation: a review of the literature

    Directory of Open Access Journals (Sweden)

    Hsin-Wei Huang

    2016-03-01

    Full Text Available Sarcoidosis is a granulomatous disease, characterized microscopically by noncaseating granulomas, which may involve multiple organs; however, the lung, skin, and lymph nodes are commonly affected. Sarcoidosis is a great imitator; in the skin, it presents with different cutaneous manifestations including lupus pernio, infiltrated plaques, maculopapular eruptions, infiltration of old scars, and subcutaneous sarcoidosis. Lymphedema as an initial presentation is extremely rare; cases are reported in African-American but not Asian patients. Lymphedema associated with sarcoidosis may result from lymphatic obstruction by infiltrating sarcoidosis. We present a case where the symptoms and signs of sarcoidosis were improved after treatment with systemic steroids.

  11. Unilateral hemorrhagic maculopathy: An uncommon manifestation of hand, foot, and mouth disease

    Science.gov (United States)

    Tandon, Manish; Gupta, Abhishek; Singh, Priyanka; Subathra, Gnanavelu N

    2016-01-01

    Hand, foot, and mouth disease (HFD) is a common systemic infection occurring in childhood or immunocompromised adults caused by enteroviruses, the most common being coxsackievirus A16 and enterovirus 71. It is characterized by maculopapular eruptions over the hands and feet and ulcerative stomatitis. Ocular involvement is a rare complication and commonly manifests as inflammatory macular pathology. We report a case of HFD in an immunocompetent adult male with unilateral ocular involvement presenting as hemorrhagic maculopathy and its management with complete anatomical and functional recovery. PMID:27905343

  12. Sudden sensorineural hearing loss following intramuscular administration of penicillin.

    Science.gov (United States)

    Escada, Pedro Alberto; Capucho, Clara; Madeira da Silva, José Francisco

    2004-02-01

    We report a case of sudden hearing loss in a patient with acute exudative tonsillitis, occurring 15 minutes after the intramuscular administration of penicillin. Audiological evaluation documented a profound sensorineural hearing loss of the cochlear type. The mechanism of the hearing loss was probably an immediate hypersensitivity (type I) allergic drug reaction. Penicillin is used frequently for the treatment of several infections. Allergic reactions to penicillin are well known and include urticaria, maculopapular exanthems, angio-oedema, bronchospasm and anaphylaxis, but sudden hearing loss has never been recorded.

  13. Dress Syndrome - A Case Report

    Directory of Open Access Journals (Sweden)

    Kremić Zorana

    2016-06-01

    Full Text Available The drug reaction with eosinophilia and systemic symptoms (DRESS syndrome is an adverse drug-induced reaction that occurs most commonly after exposure to drugs, most frequently anticonvulsants, sulfa derivates, antidepressants, nonsteroidal anti-inflammatory drugs, and antimicrobials. We present a 61-year-old male, with a generalized maculopapular exanthema on the trunk, face, extremities, palms, soles, palate, and fever (38°C. His medical history was notable for generalized epilepsy, treated with carbamazepine during 1 month. The diagnosis of DRESS syndrome was confirmed by specific RegiSCAR criteria. In our case, skin eruptions were successfully treated with oral methylprednisolone, cephalexin, and topical corticosteroid ointment.

  14. MMR (Measles, Mumps and Rubella) Vaccine: What You Need to Know

    Science.gov (United States)

    ... jerking and staring), brain damage, and death. Mumps • Mumps virus causes fever, headache, muscle pain, loss of appetite, ... ovaries, and rarely sterility. Rubella (German Measles) • Rubella virus causes rash, ... mumps, and rubella (MMR) vaccine can protect children (and ...

  15. MMR Vaccine (Measles, Mumps, and Rubella)

    Science.gov (United States)

    ... jerking and staring), brain damage, and death. Mumps:Mumps virus causes fever, headache, muscle pain, loss of appetite, ... ovaries, and rarely sterility. Rubella (German Measles):Rubella virus causes rash, ... mumps, and rubella (MMR) vaccine can protect children (and ...

  16. Mitotane

    Science.gov (United States)

    ... go away: loss of appetite nausea vomiting diarrhea depression lack of energy unusual drowsiness feeling that the room is spinning changes in vision rash or changes in skin color Some side effects can be serious. If you ...

  17. severe rhabdomyolysis following co-administration of simvastatin

    African Journals Online (AJOL)

    Underlying hepatitis may have increased the risk of rhabdomyolysis by decreasing the metabolism of ... drugs. This case calls for extra pharmacovigilance with proper patient education when prescribing drugs .... A rash from anti-TB treatment.

  18. Lansoprazole

    Science.gov (United States)

    ... 60 milliliters) of orange juice, apple juice or tomato juice, mix briefly, and swallow immediately. After you ... symptoms, call your doctor immediately: rash blistering or peeling skin hives swelling of the eyes, face, lips, ...

  19. Human immunodeficiency virus and anaesthesia

    African Journals Online (AJOL)

    syndrome (AIDS)-defining]. By taking a ... 109 per litre) and/or chronic thrombocytopenia (< 50 x. 109 per .... fatigue, headaches, and gastrointestinal side-effects. including ... Rashes, including Steven-Johnson syndrome, and toxic epidermal ...

  20. Sjogren's Syndrome

    Science.gov (United States)

    ... the set located behind your jaw and in front of your ears Skin rashes or dry skin Vaginal dryness Persistent dry cough Prolonged fatigue Causes Sjogren's syndrome is an autoimmune disorder. Your immune system mistakenly ...

  1. Dandruff: How to Treat

    Medline Plus

    Full Text Available ... hair, and nail care Skin care Hair care / hair loss Injured skin Nail care Anti-aging skin care ... scalp problems Alopecia areata Dandruff: How to treat Hair loss Scalp psoriasis Itchy skin Painful skin / joints Rashes ...

  2. Birth control pill overdose

    Science.gov (United States)

    Symptoms of an overdose of birth control pills include: Breast tenderness Discolored urine Drowsiness Heavy vaginal bleeding (2 to 7 days after the overdose) Headache Emotional changes Nausea and vomiting Rash

  3. Dandruff: How to Treat

    Medline Plus

    Full Text Available ... treatments Dry / sweaty skin Eczema / dermatitis Hair and scalp problems Itchy skin Painful skin / joints Rashes Scaly ... Public and patients Diseases and treatments Hair and scalp problems Dandruff: How to treat public SPOT Skin ...

  4. Autoantibodies

    Science.gov (United States)

    ... Factor Antibody Iron Iron Tests JAK2 Mutation Kidney Stone Analysis Kidney Stone Risk Panel KRAS Mutation Lactate Lactate Dehydrogenase (LD) ... include arthritis-type joint pain, fatigue, fever, rashes, cold or allergy-type symptoms, weight loss, and muscular ...

  5. Prolidase deficiency: it looks like systemic lupus erythematosus but it is not

    DEFF Research Database (Denmark)

    Klar, Aharon; Navon-Elkan, Paulina; Rubinow, Alan

    2010-01-01

    Three siblings with recalcitrant leg ulceration, splenomegaly, photosensitive rash, and autoantibodies were suspected of having prolidase deficiency. Urine was checked for iminodipeptiduria, fibroblasts were cultured and analyzed for prolidase activity, and DNA was extracted for identifying...

  6. Polymyositis: Medical Management

    Science.gov (United States)

    ... Plaquenil) Mechanism not understood; used in arthritis, lupus, malaria; can be used to reduce steroid dosage in myositis, particularly in children. Can treat muscle symptoms and dermatomyositis rash; can cause damage to eyes’ retinas or corneas; regular eye ...

  7. Dermatomysitis: Medical Management

    Science.gov (United States)

    ... Plaquenil) Mechanism not understood; used in arthritis, lupus, malaria; can be used to reduce steroid dosage in myositis, particularly in children. Can treat muscle symptoms and dermatomyositis rash. Can cause damage to eyes’ retinas or corneas; regular eye ...

  8. Bioterrorism

    Science.gov (United States)

    ... was contributed by: familydoctor.org editorial staff Categories: Crisis Situations, Prevention and Wellness, Staying HealthyTags: Critcal Care, diarrhea, emergency medicine, fever, Nausea and Vomiting, Skin Infections, skin rash, ...

  9. Looking at Your Newborn: What's Normal

    Science.gov (United States)

    ... newborns to breathe somewhat irregularly. When infants are awake, their breathing rate may vary widely, sometimes exceeding ... a rash present at birth, is characterized by dark brown bumps or blisters scattered over the neck, ...

  10. Exploring the Celiac Disease Mystery | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... the Celiac Disease Mystery Follow us Exploring the Celiac Disease Mystery Research looks at what’s causing the rise ... abdominal pain, rashes, and even death. Choice vs. celiac disease Dr. Murray said there are pros and cons ...

  11. Mycophenolate

    Science.gov (United States)

    ... rash itching fast heartbeat dizziness fainting lack of energy pale skin black and tarry stools red blood in stools bloody vomit vomit that looks like coffee grounds yellowing of the skin or eyes Mycophenolate ...

  12. Bug bites and stings: When to see a dermatologist

    Medline Plus

    Full Text Available ... aging skin care Kids’ zone About skin: Your body's largest organ About hair: Not just on your ... bug bite, such as a rash, fever, or body aches, see your doctor or a board-certified ...

  13. Identification of risk products for fragrance contact allergy

    DEFF Research Database (Denmark)

    Johansen, J D; Andersen, T F; Kjøller, M

    1998-01-01

    -mix-positive eczema patients and two control groups, one consisting of 1,279 subjects selected as a random sample of the general population and the other consisting of 806 fragrance-mix-negative eczema patients. The identification of risk products was based on the patients' histories of rash to scented products...... in a comparison with both control groups. The risk (odds ratio) of being diagnosed as fragrance allergic was 2.3 to 2.9 greater in cases of a history of first-time rash to deodorant sprays and 3.3 to 3.4 greater in cases of a history of rash to perfumes than if no such history were present. First-time rash...... to cleansing agents, deodorant sticks, or hand lotions was also statistically significant but only in comparison with one of the control groups. CONCLUSION: Safety evaluation of fragrance materials used in perfumes and deodorant sprays should be performed with special attention....

  14. Hydrocortisone Rectal

    Science.gov (United States)

    ... symptoms, call your doctor immediately: bleeding vision changes depression rash itching swelling of the eyes, face, lips, tongue, throat, hands, arms, feet, ankles, or lower legs hives difficulty breathing or swallowing Children who use rectal hydrocortisone may have an increased ...

  15. Helminth parasitic diseases status of school children within the ...

    African Journals Online (AJOL)

    Onchocerciasis), itching, rashes, abdominal problems and elephantiasis. Age of children affected the level of prevalence of the parasitic diseases e.g. younger children were more infected that the older children in many cases (except hookworm ...

  16. Reducing Risks of Birth Defects

    Science.gov (United States)

    ... a mild rash and a low fever. Having rubella during pregnancy can cause miscarriage or result in deafness, intellectual ... body fat. Preterm: Born before 37 weeks of pregnancy. Rubella: A virus that can be passed to the ...

  17. Fever: First Aid

    Science.gov (United States)

    ... a dry mouth, decreased or dark urine, or refusal to drink fluids Skin rashes Difficulty swallowing fluids Pain with urination or pain in the back When to seek emergency care Seek emergency medical care if your child has ...

  18. Lyme disease: report of two cases | Jowi | East African Medical Journal

    African Journals Online (AJOL)

    It is an inflammatory disease that has varied clinical manifestations ranging from skin rash (erythema migrans), arthritis, fibromyalgia, and regional lymphadenopathy, cardiac conduction defects to neurological manifestations of meningoencephalitis, Bell\\'s palsy, peripheral neuropathy, and painful radiculoneuropathy.

  19. Bug bites and stings: When to see a dermatologist

    Medline Plus

    Full Text Available ... care Younger skin Kids’ zone About skin: Your body's largest organ About hair: Not just on your ... bug bite, such as a rash, fever, or body aches, see your doctor or a board-certified ...

  20. Tarantula bite leads to death and gangrene

    Directory of Open Access Journals (Sweden)

    Banerjee Kalyan

    1997-01-01

    Full Text Available Chilobrachys hardwikii-giant black hairy spider bite produced two deaths, one case of gangrene of the foot and urticarial rashes in another person in a remote village of Churulia 30 km from Asansol.