scholarly journals 445. A Case of Disseminated Microsporidia Manifesting as Skin Lesions in a Patient with Acute Lymphoblastic Leukemia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S219-S220
Author(s):  
Christina M Kaul ◽  
Angela Kim
Keyword(s):  
Maintenance Therapy ◽  
Lymphoblastic Leukemia ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Blood Cell Count ◽  
Wound Culture ◽  
History Of ◽  
Disseminated Disease ◽  
Immunocompromised Hosts ◽  
Subsequent Improvement

Abstract Background We present a case of a 65-year-old male with a history of acute B-cell lymphoblastic leukemia (ALL) who presented with fevers and skin lesions. The patient achieved remission after induction chemotherapy. Nineteen months after diagnosis, while on maintenance therapy, the patient presented as noted above. He was instructed to hold maintenance therapy and sent to the hospital. Methods   Results On examination, the patient was febrile. He had papules present on the forehead, chest, arms, legs, and back. Physical examination was otherwise unremarkable. Labs were notable for a white blood cell count of 3600/uL (absolute neutrophil 3100/uL) and creatine kinase (CK) of 593 U/L. Blood and urine cultures, Histoplasma, Varicella, Toxoplasma, HIV, and an acute hepatitis panel were negative. CT of the chest, abdomen, and pelvis was unremarkable. He was empirically started on micafungin and valacyclovir. However, he continued to have fevers and myalgias. Wound culture was negative for fungus after four weeks of growth. Skin biopsy immunostains were consistent with an unknown protozoan. Specimens were sent to an outside facility and yielded a diagnosis of Anncaliia algerae. Antibiotics were changed to albendazole and voriconazole, with subsequent improvement in all symptoms. Conclusion Microsporidia most commonly infect immunocompromised hosts. Clinical manifestations of microsporidiosis are extremely diverse. Oftentimes, symptoms are not present in those found to be infected with Microsporidia. A disseminated disease has been identified but remains rare. Although Microsporidia have been identified as a cause of infection in immunocompromised patients, there are few reports of infection in those diagnosed with cancer, and only a few cases have been due to Anncaliia algerae. In studies pertaining to ALL patients, roughly one-fifth of patients were identified as being infected with Microsporidia, but most did not have symptoms. This is the first reported case of disseminated Microsporidia in a patient with ALL and the first disseminated infection presenting as a skin manifestation. Of identified cases of disseminated Microsporidial infection, mortality was high. Thus, prompt recognition of Microsporidia as a cause of infection in patients with ALL is of utmost importance. Disclosures All authors: No reported disclosures.

Cutaneous Metastases in Patients with Rectal Cancer: A Report of Six Cases

2008 ◽  
Vol 74 (2) ◽  
pp. 138-140 ◽  
Author(s):  
Leo M. Gazoni ◽  
Traci L. Hedrick ◽  
Philip W. Smith ◽  
Charles M. Friel ◽  
Brian R. Swenson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cause Of Death ◽  
Metastatic Disease ◽  
Retrospective Review ◽  
Skin Lesions ◽  
Rectal Tumor ◽  
Cutaneous Metastases ◽  
History Of ◽  
Disseminated Disease ◽  
Visceral Malignancy

Cutaneous metastases from rectal cancer are rare manifestations of disseminated disease and uniformly represent dismal survival. A retrospective review of six patients with rectal cancer metastatic to the dermis was performed. The diagnosis of rectal cancer was made concurrently with the diagnosis of the dermal metastases in all six patients. A 100 per cent histopathologic concordance existed between the tissue of the dermal metastases and primary rectal tumor. The progression of systemic metastatic disease was the cause of death in 83.3 per cent of patients (5/6). No patient survived more than 7 months from the time of diagnosis. Recognition of suspicious skin lesions as possible harbingers of undiagnosed visceral malignancy is important in managing patients both with and without a history of previous cancer.

scholarly journals Xeroderma Pigmentosum with Severe Neurological Manifestations/De Sanctis–Cacchione Syndrome and a Novel XPC Mutation

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Esteban Uribe-Bojanini ◽  
Sara Hernandez-Quiceno ◽  
Alicia María Cock-Rada
Keyword(s):  
Xeroderma Pigmentosum ◽  
Excision Repair ◽  
Genetic Disorders ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Panel Testing ◽  
First Case ◽  
Skin Malignancy ◽  
Increased Risk ◽  
History Of

Several genetic disorders caused by defective nucleotide excision repair that affect the skin and the nervous system have been described, including Xeroderma Pigmentosum (XP), De Sanctis–Cacchione syndrome (DSC), Cockayne syndrome, and Trichothiodystrophy. Cutaneous photosensitivity with an increased risk of skin malignancy is a common feature of these disorders, but clinical manifestations commonly overlap these syndromes. Several genes have been found to be altered in these pathologies, but we lack more genotype-phenotype correlations in order to make an accurate diagnosis. Very few cases of DSC syndrome have been reported in the literature. We present a case of a 12-year-old Colombian male, with multiple skin lesions in sun-exposed areas from the age of 3 months and a history of 15 skin cancers. He also displayed severe neurologic abnormalities (intellectual disability, ataxia, altered speech, and hyperreflexia), short stature, and microcephaly, which are features associated with DSC. Genetic testing revealed a novel germline mutation in the XP-C gene (c.547A>T). This is the first case of an XP-C mutation causing De Sanctis–Cacchione syndrome. Multigene panel testing is becoming more widely available and accessible in the clinical setting and will help rapidly unveil the molecular etiology of these rare genetic disorders.

scholarly journals Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

2021 ◽  
Vol 12 (e) ◽  
pp. 1-3
Author(s):  
Hafssa Chehab ◽  
Bertrand Richert
Keyword(s):  
Hair Loss ◽  
Previous History ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Laboratory Evaluation ◽  
History Of ◽  
High Level

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

scholarly journals Systemic mastocytosis: variable manifestations can lead to a challenging diagnostic process

2019 ◽  
Vol 12 (8) ◽  
pp. e229967 ◽  
Author(s):  
Susanna Nallamilli ◽  
Aideen O’Neill ◽  
Andrew Wilson ◽  
Mallika Sekhar ◽  
Jonathan Lambert
Keyword(s):  
Quality Of Life ◽  
Bone Marrow ◽  
Cell Clone ◽  
Systemic Mastocytosis ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Diagnostic Process ◽  
Histamine Antagonists ◽  
History Of

Systemic mastocytosis results from proliferation and activation of an abnormal mast cell clone. It is a heterogeneous disorder with clinical manifestations ranging from skin lesions alone to aggressive multi-organ infiltration and decreased survival. Given these varied manifestations, diagnosis can be difficult. We describe the case of a woman who presented with rash and diarrhoea and had a history of anaphylactic reactions. Over a protracted period, the patient’s symptoms were investigated by a number of specialties including gastroenterology, dermatology, immunology and haematology. Morphological, immunohistochemical and molecular analysis of bone marrow samples ultimately led to a diagnosis of systemic mastocytosis. Management with leukotriene and histamine antagonists resulted in significant improvement in symptoms and quality of life. The case serves to highlight the protean manifestations of systemic mastocytosis, the tests available to diagnose it and the agents available to treat it.

scholarly journals Invasive Fusariosis in Patients with Hematologic Diseases

2021 ◽  
Vol 7 (10) ◽  
pp. 815
Author(s):  
Marcio Nucci ◽  
Gloria Barreiros ◽  
Tiyomi Akiti ◽  
Elias Anaissie ◽  
Simone A. Nouér
Keyword(s):  
Fusarium Species ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Invasive Disease ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Hematologic Diseases ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Neutropenic Patients ◽  
Disseminated Disease

Fusarium species are filamentous fungi widely encountered in nature, and may cause invasive disease in patients with hematologic conditions. Patients at higher risk are those with acute leukemia receiving induction remission chemotherapy or allogeneic hematopoietic cell transplant recipients. In these hosts, invasive fusariosis presents typically with disseminated disease, fever, metastatic skin lesions, pneumonia, and positive blood cultures. The prognosis is poor and the outcome is largely dependent on the immune status of the host, with virtually a 100% death rate in persistently neutropenic patients, despite monotherapy or combination antifungal therapy. In this paper, we will review the epidemiology, clinical manifestations, diagnosis, and management of invasive fusariosis affecting patients with hematologic diseases.

scholarly journals Infantile Hemangioma: A Retrospective Study

2020 ◽  
Vol 32 (1) ◽  
pp. 21
Author(s):  
Eva Lydiawati ◽  
Iskandar Zulkarnain
Keyword(s):  
Clinical Features ◽  
Early Recognition ◽  
Clinical Manifestations ◽  
Infantile Hemangioma ◽  
Skin Lesions ◽  
Pediatric Dermatology ◽  
Facial Region ◽  
History Of ◽  
Nodular Lesions ◽  
One Year

Background: Infantile Hemangioma (IH) is a benign vascular neoplasm and most commonly found in newborns. IH appears in the first few weeks of life and mostly resolve immediately. Early recognition of symptoms, diagnosis, and therapy has an important role in determining the prognosis of this condition. Purpose: The purpose of this study is to evaluate the clinical features of new IH patients in the Pediatric Dermatology Division of the Dermatology & Venereology Department outpatient clinic of Dr. Soetomo General Hospital Surabaya in 2008-2017. Methods: This is a retrospective descriptive study from the medical records of new IH patients over a period of 10 years (2008-2017). Results: A total of 84 new IH patients were observed in this study. The data showed that: the most age group was 0-1 year old (71.43%), female (63.1%), and no family history of a similar condition (94.05%). The most common complaint reported was the presence of bumps (59.52%). Most complaints occurred before the patients turned one year old (89.29%) and involved the facial region (58.33%). From the clinical features, the most frequent skin lesions were macules (35.36%). In addition, there was a combination of macular and nodular lesions in 28.13% of patients. The most widely used therapy is laser modality found in 55.45% of patients. Conclusion: Clinical features of IH patients, in accordance with the theory and treatment choices, dependent on the patients’ conditions and clinical manifestations of the disease. 

Syphilis gastritis: a case report

2017 ◽  
Vol 29 (7) ◽  
pp. 723-725
Author(s):  
Kuan Lai ◽  
Nicolas Pinto-Sander ◽  
Daniel Richardson ◽  
Shanshan Wei ◽  
Kang Zeng
Keyword(s):  
Gastric Mucosa ◽  
Histopathological Examination ◽  
Epigastric Pain ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Maculopapular Rash ◽  
Skin Lesions ◽  
Lymphoplasmacytic Infiltrate ◽  
Assay Result ◽  
History Of

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.

Progressive varicella presenting with pain and minimal skin involvement in children with acute lymphoblastic leukemia.

1995 ◽  
Vol 13 (7) ◽  
pp. 1697-1703 ◽  
Author(s):  
P Rowland ◽  
E R Wald ◽  
J R Mirro ◽  
E Yunis ◽  
V C Albo ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Progressive Disease ◽  
Lymphoblastic Leukemia ◽  
Peripheral Blood Smear ◽  
Skin Lesions ◽  
Varicella Zoster ◽  
History Of ◽  
Therapeutic Measures ◽  
Record Review ◽  
Extensive Involvement

PURPOSE Here we report the experience at the Children's Hospital of Pittsburgh (CHP) with varicella zoster virus (VZV) in children with acute lymphoblastic leukemia (ALL). This record review was prompted by a patient with ALL who died suddenly of varicella hepatitis within 24 hours of presentation with a single skin lesion. METHODS We reviewed the medical records of children diagnosed with ALL at the CHP from January 1984 through December 1993, who subsequently developed VZV infection. RESULTS Of 294 patients aged 0 to 15 years, 41 (14%) were identified as having had 42 episodes of VZV infection. Twenty patients (49%) had received prophylaxis with varicella zoster immunoglobulin (VZIG), and all 39 patients in whom the diagnosis was made premortem were treated with acyclovir. Twenty-nine of the 42 cases (70%) had disease limited to the skin. Thirteen cases (30%) had extracutaneous involvement, and five of these episodes (12% of all cases) ended in death. Risk factors for progressive varicella included age greater than 6 years and intensive immunosuppressive therapy at the time of exposure. Six of eight patients with progressive varicella, including two who died, had received VZIG. The clinical presentation in 10 of 13 patients with progressive disease and in four of five patients who died was dominated by severe abdominal and/or back pain. In seven cases, these symptoms preceded the development of skin lesions by several days, and in six patients were associated with extensive involvement of the spleen by varicella, as demonstrated histopathologically by the presence of Howell-Jolly bodies on peripheral-blood smear or radiographically. No patient with uncomplicated varicella was reported to have had premonitory pain. CONCLUSION Recognition of these prodromes and suspicion of varicella even in the absence of skin lesions and even in children with a history of prior disease or VZIG administration should prompt early diagnostic and therapeutic measures.

KEJANG SEBAGAI MANIFESTASI NEUROLOGI DARI LEUKOSTASIS

2020 ◽  
Vol 3 (3) ◽  
pp. 127-131
Author(s):  
Eric Hartono Tedyanto ◽  
Ni Komang Sri Dewi Untari
Keyword(s):  
Lymphoblastic Leukemia ◽  
Clinical Manifestations ◽  
Emergency Situation ◽  
Early Mortality ◽  
Brain Cells ◽  
Trigger Factors ◽  
Medicine Department ◽  
Adult Age ◽  
Patient Morbidity ◽  
Laboratory Results

ABSTRAK Latar Belakang: Secara klinis, leukostasis didiagnosa pada pasien leukemia dengan hasil laboratorium hiperleukositosis (>100.000 u/L) disertai manifestasi respiratorik, neurologis, atau renal. Insidensi hiperleukositosis pada Leukemia Limfoblastik Akut (LLA) usia dewasa 10-30%, jarang pada wanita, dan jarang menyebabkan leukostasis. Laporan Kasus: Seorang wanita berusia 20 tahun dikonsulkan dari bagian penyakit dalam dengan kejang umum tonik-klonik. Hasil laboratorium menunjukkan leukosit 134.500 u/L, hasil EKG menunjukkan iskemik miokardium. Diskusi: Leukostasis jarang terjadi pada pasien leukemia. Leukostasis menyebabkan aliran oksigen dalam darah menuju sel menjadi inadekuat, termasuk salah satunya aliran darah yang menuju sel otak. Hipoksia jaringan otak merupakan salah satu faktor pemicu terjadinya kejang. Kesimpulan: Leukostasis merupakan suatu keadaan emergensi yang dapat meningkatkan morbiditas dan mortalitas pasien. Tujuan tatalaksana penyakit adalah mengurangi mortalitas dini, termasuk tatalaksana kejang, yang merupakan salah satu menifestasi klinis leukostasis. Kata kunci: kejang, leukostasis, leukemia.   ABSTRACT Background: Clinically, leukostasis is diagnosed in patients with leukemia with laboratory results of hyperleukocytosis (> 100,000 u / L) followed by respiratory, neurological, or renal manifestations. The incidence of hyperleukocytosis in Acute Lymphoblastic Leukemia (LLA) is 10-30% of adult age, rare in women, and rarely causes leukostasis. Case Report: A 20th-years-old woman was consulted from an Internal Medicine Department with a tonic-clonic general seizure. Laboratory results showed that leukocytes were 134,500 U / L and ECG results showed an ischemic myocardium. Discussion: Leukostasis rarely occurs in leukemic patients. Leukostasis causes the flow of oxygen in the blood to the cells to be inadequate, including the blood flow to brain cells. Brain tissue hypoxia is one of the trigger factors for seizures. Conclussion: Leukostasis is an emergency situation that can increase patient morbidity and mortality. The aim of disease management is to reduce early mortality, including management of seizures, which is one of the clinical manifestations of leukostasis. Keywords: seizure, leukostasis, leukemia.

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