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Journal of Yeungnam Medical Science Jul 2023Thallium poisoning is usually accidental. We present a case of a 51-year-old woman who was evaluated in June 2018 for myalgia, vertigo, asthenia, and abdominal pain....
Thallium poisoning is usually accidental. We present a case of a 51-year-old woman who was evaluated in June 2018 for myalgia, vertigo, asthenia, and abdominal pain. Physical examination revealed temporal-spatial disorientation, jaundice, and asterixis. The laboratory reported the following: bilirubin, 10.3 mg/dL; aspartate transaminase, 78 U/L; alanine transaminase, 194 U/L; albumin, 2.3 g/dL; prothrombin time, 40%; and platelet count, 60,000/mm3. Serology performed for hepatitis A, B, and C; Epstein-Barr virus; cytomegalovirus; and human immunodeficiency virus was negative, and a collagenogram was negative. Physical reevaluation revealed alopecia on the scalp, armpits, and eyebrows; macules on the face; plantar hyperkeratosis; and ulcers on the lower limbs. Tests for lead, arsenic, copper, and mercury were carried out, which were normal; however, elevated urinary thallium (540 µg/g; range, 0.4-10 µg/g) was observed. The patient was treated with ᴅ-penicillamine 1,000 mg/day and recovered her urinary thallium levels were within normal range at annual follow-up. Thallium poisoning is extremely rare and can be fatal in small doses. An adequate clinical approach can facilitate early diagnosis.
PubMed: 36537175
DOI: 10.12701/jyms.2022.00647 -
Wounds : a Compendium of Clinical... Dec 2022LP is an uncommon reaction characterized by outbreaks of erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration that...
INTRODUCTION
LP is an uncommon reaction characterized by outbreaks of erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration that occurs in patients with Lucio leprosy and lepromatous leprosy; it can be considered a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs, and pregnancy.
CASE REPORT
A 17-year-old female presented with fever, tachycardia, adynamia, extensive hyperchromic and purplish macular lesions, erythematous plaques, multiple blisters with serohematic content, and necrotic exulcerations and ulcers on the lower and upper limbs, ears, nose, palms, and soles. Past medical history included leprosy and a first trimester miscarriage. The patient was diagnosed with borderline lepromatous leprosy in reactional state (ie, LP) and MDT was restarted in association with systemic corticosteroid and pentoxifylline. Local therapy was performed with cleansing solution (0.9% sodium chloride), dressing with silver sulfadiazine ointment, and surgical debridement of the necrotic lesions.
CONCLUSION
LP is a rare manifestation that may be fatal because of considerable inflammatory activity and the extent and severity of dermatologic lesions. Pregnancy is strongly associated with exacerbation of symptoms. Debridement is required to excise nonviable tissue and promote wound healing.
Topics: Humans; Female; Adolescent; Leprosy, Lepromatous; Leprosy, Multibacillary; Leprosy; Erythema
PubMed: 36645661
DOI: 10.25270/wnds/21095 -
Endocrinology, Diabetes & Metabolism... May 2023We report the case of a 69-year-old female with systemic mastocytosis, diagnosed based on widespread pigmented papules and macules, elevated serum tryptase levels and...
SUMMARY
We report the case of a 69-year-old female with systemic mastocytosis, diagnosed based on widespread pigmented papules and macules, elevated serum tryptase levels and confirmatory skin and bone marrow biopsy, on a background of osteoporosis. A CT demonstrated multiple sclerotic lesions within lumbar vertebral bodies, sacrum and ileum, with surrounding osteolysis but no obvious compression fractures. She was treated with the RANK-L inhibitor denosumab, resulting in significant bone mineral density gain over the following 5 years. However, her serum tryptase levels gradually increased during this period despite treatment with the multikinase inhibitor, midostaurin. It is thus conceivable that her rapid increase in bone mineral density may be partly contributed by a predominance of pro-osteoblastic mediators released by abnormal mast cells, suggestive of more advanced disease. This case highlights the complexities of systemic mastocytosis-related bone disease and the interplay of numerous mediators contributing to a phenotype of both increased bone resorption and formation.
LEARNING POINTS
Systemic mastocytosis is a neoplastic disease of mast cells characterized by abnormal proliferation and accumulation in the skin and other organs. It is most frequently associated with the somatic gain-of-function KIT D816V mutation. Systemic mastocytosis should be suspected in patients presenting with not only cutaneous symptoms suggestive of mast cell degranulation such as anaphylaxis, flushing or urticaria but also unexplained osteoporosis and gastrointestinal and constitutional symptoms. The prevalence of osteoporosis in systemic mastocytosis is high. Mast cell activation leads to the secretion of numerous chemical mediators which either promote or inhibit osteoclastic and/or osteoblastic activity, with the balance usually in favour of increased bone resorption. However, in advanced diseases with high mast cell burden, mast-cell-derived cytokines and mediators may promote osteoblastic activity, leading to osteosclerosis and apparent increases in bone mineral density. Treatment of osteoporosis in systemic mastocytosis involves antiresorptive therapy with bisphosphonates and more recently, denosumab. There are limited data on the role of osteoanabolic agents.
PubMed: 37166908
DOI: 10.1530/EDM-22-0408 -
Journal of Clinical Medicine May 2021Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from... (Review)
Review
Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from localized dark-blue macules to a generalized slate-gray/bluish tinge following systemic absorption. This work aims to fully review the state of the art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic features of argyria. Argyria has been diagnosed in a wide range of ages, both sexes and varied ethnicities, with no known individual predisposing factors. Ultraviolet radiation with subsequence increases of melanin production aggravates the discoloration due to a reduction in the silver deposits. Physical examination and silver exposure in the anamnesis can be highly suggestive of the diagnosis, but a histopathological analysis with Energy-Dispersive X-ray Spectroscopy is required to unequivocally determine the discoloration etiology. Safe and effective treatment has only been accomplished with laser techniques, though only a few cases have been reported and with limited follow-up time. In conclusion, argyria typically has an occupational or iatrogenic etiology. It should be suspected when a patient presents with typical skin or eye lesions. A seemingly viable treatment modality, with laser technology, is finally within the horizon.
PubMed: 34068024
DOI: 10.3390/jcm10102086 -
Journal of Infection in Developing... Mar 2021Exfoliative dermatitis (ED) or erythroderma is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface, which can be...
Exfoliative dermatitis (ED) or erythroderma is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface, which can be caused by variety of systemic and cutaneous diseases, such as infection, including dermatophytosis. Dermatophytosis is a superficial fungal infection of keratinized tissue caused by dermatophytes. There are only few case reports of ED due to dermatophytosis in literature. A 39-year-old male present with history of diffuse erythematous macules and scales almost on entire body due to dermatophytosis was reported. The diagnosis of dermatophytosis was confirmed by direct microscopic examination, fungal culture, and histopathological examination. Patient was treated with 2% ketoconazole shampoo and two pulses of 1-week of 200 mg itraconazole twice a day for each month. Clinical improvement was showed on the 7th day of observation characterized by decreasing of erythematous macules and scales. Mycological and clinical improvements were obtained on the 29th day of observation. The etiology of ED should be determined in order to give an appropiate treatment.
Topics: Adult; Antifungal Agents; Dermatitis, Exfoliative; Dermatomycoses; Histological Techniques; Humans; Male; Skin
PubMed: 33690216
DOI: 10.3855/jidc.12218 -
The American Journal of Emergency... Mar 2023Mpox, formerly known as monkeypox, is a public health emergency most commonly presenting with a painful rash and several systemic findings. However, there are several... (Review)
Review
INTRODUCTION
Mpox, formerly known as monkeypox, is a public health emergency most commonly presenting with a painful rash and several systemic findings. However, there are several conditions that may mimic its presentation.
OBJECTIVE
This narrative review provides a focused overview of mpox mimics for emergency clinicians.
DISCUSSION
Mpox is a global health emergency. The disease is primarily spread through contact, followed by the development of a centrifugally-spread rash that evolves from macules to papules to vesicles to pustules. This is often associated with lymphadenopathy and fever. As the rash is one of the most common presenting signs of the infection, patients mpox may present to the emergency department (ED) for further evaluation. There are a variety of mimics of mpox, including smallpox, varicella, primary and secondary syphilis, acute retroviral syndrome, and genital herpes simplex virus.
CONCLUSION
Knowledge of mpox and its mimics is vital for emergency clinicians to differentiate these conditions and ensure appropriate diagnosis and management.
Topics: Humans; Mpox (monkeypox); Exanthema; Emergency Medicine; Emergency Service, Hospital; Fever
PubMed: 36640626
DOI: 10.1016/j.ajem.2023.01.007 -
Medical Archives (Sarajevo, Bosnia and... Aug 2022Focal dermal hypoplasia is a genetic disease of multiple systems initially affecting the skin, skeleton, dental, eyes and face with developmental abnormalities and...
BACKGROUND
Focal dermal hypoplasia is a genetic disease of multiple systems initially affecting the skin, skeleton, dental, eyes and face with developmental abnormalities and facial dysmorphism. Focal dermal hypoplasia is X-linked dominant disease affecting the ectoderm, mesoderm and endoderm. 95% feature de novo and 90% of these are females. Focal dermal hypoplasia is induced by a mutation in the PORCN gene.
OBJECTIVE
The aim of this article is to present a case of a one-year-old girl child with multi-hypopigmented reticulated atrophic macules and patches grouped in linear mode at the lines of blaschko, skeleton abnormalities, umbilical hernia, developmental delay, hypoplastic nails, syndactyly and lobster claw deformity.
CASE REPORT
A one-year-old girl child presented to the dermatology clinic with asymptomatic lesions since childhood with no improvement, with multi- hypopigmented skin lesions on the trunk and extremities since birth as linear erosions that heal gradually during few days, leaving peripheral hypopigmentation with hyperpigmentation with anomalies of limbs and nails and delayed development. She was born by normal vaginal delivery and weighed 2.5 kg at birth. None of the family members had such features. She had dental enamel anomaly and partial anodontia in the lower jaw. Sparse hair and partial alopecia (scalp, eyebrows and eyelashes) were recorded.
CONCLUSION
Focal dermal hypoplasia is a congenital skin disease with a unique clinical feature. Thorough examination of the extremities is indicated for early proper genetic counseling and therapy.
Topics: Female; Humans; Infant; Acyltransferases; Focal Dermal Hypoplasia; Limb Deformities, Congenital; Membrane Proteins; Mutation; Skin
PubMed: 36313953
DOI: 10.5455/medarh.2022.76.301-304 -
Proceedings (Baylor University. Medical... 2022Urticaria pigmentosa is most frequently observed in children. The associated symptomatology in mastocytosis is vague and not always diagnostic, and Darier's sign is...
Urticaria pigmentosa is most frequently observed in children. The associated symptomatology in mastocytosis is vague and not always diagnostic, and Darier's sign is often negative, making the diagnosis challenging. We describe a case of a 61-year-old man with extensive brown papules and macules in different locations of the body that slowly progressed in the last 10 years with a previous anaphylactic reaction after an ant bite. This suggests that urticaria pigmentosa in an adult should be furthered assessed for the possibility of systemic involvement for a correct diagnosis and treatment.
PubMed: 35991727
DOI: 10.1080/08998280.2022.2081914 -
Cureus Feb 2023In this case report, we outline a case of a 36-year-old woman who presented to the dermatology clinic with a history of a hypopigmented macule on her lip. After...
In this case report, we outline a case of a 36-year-old woman who presented to the dermatology clinic with a history of a hypopigmented macule on her lip. After conducting hepatitis C antibody testing and a shave biopsy, the patient was diagnosed with lichen sclerosus. Because of the increased risk for squamous cell carcinoma, she underwent an anogenital exam, where no lesions were found.
PubMed: 36968933
DOI: 10.7759/cureus.35234