A bullous rash

2020 ◽  
pp. edpract-2020-319179
Author(s):  
Vanessa Migliarino ◽  
Alberto Di Mascio ◽  
Irene Berti ◽  
Andrea Taddio ◽  
Egidio Barbi
Keyword(s):  
Bacterial Culture ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Antibody Detection ◽  
Topical Steroids ◽  
List Type ◽  
Bullous Dermatosis ◽  
History Of ◽  
Linear Iga Bullous Dermatosis ◽  
Severity Of The Disease

A 3-year-old boy presented with a 5-day history of bullous skin lesions localised mainly in the upper and lower limbs and in the genital region (figure 1). Lesions were not pruritic nor painful and showed a central crust. There was no family history of skin disorders or autoimmune diseases. The child never had fever and his physical examination was otherwise unremarkable.Figure 1Bullous skin lesions forming around a central crust, localised in the upper and lower limbs.QuestionsWhat is the most likely diagnosis based on this clinical presentation?Bullous impetigo.Bullous pemphigoid.Linear IgA bullous dermatosis.Dermatitis herpetiformis.What would be the next step in the investigation to confirm your diagnosis?Skin biopsy.Swab test for bacterial culture with an antibiogram.Anti-transglutaminase antibody detection.What is the mainstay of management?Dapsone.Systemic steroids.Topical steroids.All of the above answers are correct, according to the severity of the disease.Answers can be found on page 02.

P087 Polyarteritis nodosa: a case report

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
A Azirar ◽  
A Ghannam ◽  
A Elaouli ◽  
M Rkain ◽  
N Benaajiba ◽  
...  
Keyword(s):  
Polyarteritis Nodosa ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Periarteritis Nodosa ◽  
Minimal Effective Dose ◽  
First Child ◽  
History Of ◽  
Inflammatory Syndrome ◽  
Made In

Abstract Background Polyarteritis nodosa is a necrotizing vasculitis of small and medium caliber arteries. Rarely described in children, its pathophysiology is complex and remains poorly elucidated. Two main forms were described in the literature: cutaneous and visceral. Material and results We report the cases of two boys, aged of 7 and 11 years old. They had a history of recurrent sore throat with a recurrent aphthosis in the 11-year-old child. Both boys presented with polyarthralgias, myalgias, polymorphous skin lesions made of livedo reticularis with subcutaneous nodosa on the lower limbs in the first child and distal necrosis of the toes with oedema of the lower limbs in the second. Patients suffered also of cough evolving in a context of alteration of the general state made of fever and asthenia. A biological inflammatory syndrome was present in both children and the skin histology confirmed periarteritis nodosa. The evolution was marked by the disappearance of arthralgias and myalgias after a corticosteroid-based treatment with progressive dose reduction until minimal effective dose. Conclusion The diagnosis of Polyarteritis nodosa should be made in any child presenting with the following signs: fever, altered general condition, myalgias, arthralgias and skin manifestations. The prognosis is usually benign but long-term surveillance is necessary.

scholarly journals The Challenge of Skin Lesions in Systemic Diseases

2021 ◽  
Author(s):  
Ana Isabel Lopes ◽  
Isabel O. Cruz ◽  
Rui Môço
Keyword(s):  
Erythema Nodosum ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Low Grade ◽  
Systemic Diseases ◽  
Medical Problems ◽  
Anterior Side ◽  
History Of ◽  
Nodular Lesions ◽  
Inflammatory Drugs

A 47-year-old man, obese, without medical problems, presented with a 15-day history of painful erythematous nodular lesions on the anterior side of lower limbs. He had no improvement with antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). He developed migratory and symmetric arthralgias (ankles, knees, elbows) and low-grade fever. The skin lesions progressed to the upper limbs. On physical examination, a mild swelling and tenderness in both ankles was noted, and lesions suggestive of erythema nodosum were seen.[...]

scholarly journals A CASE STUDY ON MANAGEMENT OF ERYTHRODERMA

2021 ◽  
Vol 9 (5) ◽  
pp. 1131-1135
Author(s):  
Prasanna N Mogasale ◽  
Radhika. C ◽  
Nagaraj S
Keyword(s):  
Western Medicine ◽  
Skin Lesions ◽  
Topical Steroids ◽  
Exfoliative Dermatitis ◽  
History Of ◽  
Total Body ◽  
Total Remission ◽  
Therapy Treatment

Erythroderma also known as generalized Exfoliative dermatitis which refers to a scaling involving 90% or more of the cutaneous surface. Clinicians are challenged to find the cause of exfoliative dermatitis by eliciting history of illness prior to erythema. Patients presenting acutely with exfoliative dermatitis often require admission because their total body functions can require monitoring. In western medicine, the principle management is to maintain skin moisture, avoid scratching, apply topical steroids; prolonged glucocorticoids therapy often is needed. From Ayurvedic perspective it could be correlated to Eka Kusta. Eka Kusta is the Vata Kapha Pradhana Vikara. Where skin lesions are Mahavastu, Masthyashaklopamam, Krisha Aruna in Varna. Here presenting a case of 48 years old female with erythroderma who was on long- term steroidal therapy. Treatment was planned with Shamana line of management based on her Bala. The treatment is carried out for one and half month in OPD and IPD section, all the western medicine was stopped and there was total remission of symptoms with Shamana Aushadhis. Keywords: Erythroderma, Eka Kusta, Shamana Aushadhis

scholarly journals A Rare Case of Vancomycin-Induced Linear Immunoglobulin A Bullous Dermatosis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Pinky Jha ◽  
Kurtis Swanson ◽  
Jeremiah Stromich ◽  
Basia M. Michalski ◽  
Edit Olasz
Keyword(s):  
Joint Infection ◽  
Immunoglobulin A ◽  
Colchicine Treatment ◽  
Left Knee ◽  
Dermoepidermal Junction ◽  
Common Drug ◽  
Prosthetic Joint ◽  
Bullous Dermatosis ◽  
History Of ◽  
Linear Iga Bullous Dermatosis

Linear IgA bullous dermatosis (LABD) is an autoimmune vesiculobullous disease, which is typically idiopathic but can also rarely be caused by medications or infections. Vancomycin is the most common drug associated with LABD. Lesions typically appear 24 hours to 15 days after the first dose of vancomycin. It is best characterized pathologically by subepidermal bulla (blister) formation with linear IgA deposition at the dermoepidermal junction. Here we report an 86-year-old male with a history of left knee osteoarthritis who underwent a left knee arthroplasty and subsequently developed a prosthetic joint infection. This infection was treated with intravenous vancomycin as well as placement of a vancomycin impregnated joint spacer. Five days following initiation of antibiotic therapy, he presented with a vesiculobullous eruption on an erythematous base over his trunk, extremities, and oral mucosa. The eruption resolved completely when intravenous vancomycin was discontinued and colchicine treatment was begun. Curiously, complete resolution occurred despite the presence of the vancomycin containing joint spacer. The diagnosis of vancomycin-induced linear IgA bullous dermatosis was made based on characteristic clinical and histopathologic presentations.

scholarly journals Atypical clinical presentation of distal renal tubular acidosis: a case report registered in Amazonas, Brazil

2020 ◽  
Vol 42 (3) ◽  
pp. 380-383
Author(s):  
Daniel Monteiro Queiroz ◽  
Rolando Guillermo Vermehren Valenzuela ◽  
Ana Wanda Guerra Barreto Marinho ◽  
Samanta Samara Bicharra dos Santos ◽  
Danielle Ochoa da Silva ◽  
...  
Keyword(s):  
Renal Tubular Acidosis ◽  
Skin Lesions ◽  
Clinical Findings ◽  
Distal Renal Tubular Acidosis ◽  
Lower Limbs ◽  
Hypokalemic Paralysis ◽  
Immunological Tests ◽  
History Of ◽  
Similar Report ◽  
Renal Tubular

ABSTRACT We report an unusual case of a 24-year-old girl with a history of recurrent hypokalemic paralysis episodes and skin lesions on the lower limbs and buttocks, both of which had an acute evolution. In subsequent investigations, the patient also had nephrocalcinosis, nephrolithiasis, hyperchloremic metabolic acidosis and persistent alkaline urinary pH. The findings were consistent with distal renal tubular acidosis as the cause of hypokalemic paralysis. Clinical findings, immunological tests and the result of skin biopsy suggested primary Sjögren's syndrome as an underlying cause. The patient developed azotemia due to obstructive nephrolithiasis. All the features presented in this case are an unusual manifestation of distal renal tubular acidosis; so far, we are not aware of a similar report in the literature.

scholarly journals Study on safety and efficacy of low dose oral cyclosporine for the treatment of prurigo nodularis in Bangladeshi population

2018 ◽  
Vol 7 (1) ◽  
pp. 16-23
Author(s):  
Atia Sharmeen ◽  
Muhammad Hasibur Rahman ◽  
Mahmud Javed Hasan
Keyword(s):  
Family History ◽  
Side Effects ◽  
Low Dose ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Prurigo Nodularis ◽  
College Hospital ◽  
Modest Improvement ◽  
Dose Oral ◽  
History Of

Prurigo nodularis (PN) is a disease with multiple itching nodules situated chiefly on the extremities. The disease is often persistent and the therapy is refractory. Oral cyclosporine used in moderate to severe psoriasis has shown modest improvement in the skin lesions with significant side effects. The drug is recently used in the treatment of PN with variable efficacy. The present study was therefore intended to investigate whether low dose oral cyclosporine can be preferred as an effective and safe therapy for Prurigo nodularis. This quasi-experimental study was conducted in the Department of Dermatology and Venereology of Community Based Medical College Hospital, Mymensingh, Bangladesh, over a period of 6 months between July 2016 to December 2016. A total of 96 clinically diagnosed cases of prurigo nodularis attending at the above mentioned places were consecutively included in the study. After evaluation of the baseline clinical and laboratory features of the patients, oral cyclosporine was given as 2 mg/kg/day for consecutive 12 weeks. A female preponderance was observed in the study with female to male ratio being 7:3. The putative etiological factors present among the patients were a history of frequent mosquito bite (43.8%), anaemia (28%), hypertension (27.1%) bronchial asthma (22.9%), family history of PN (29.2%) and family history of atopy (24%). The nodules were mainly distributed in front of the lower limbs followed by upper limbs and trunk. In terms of nodule characteristics, 33.3% were excoriated, 38.5% were palpable, 26% flattened, 28.1% infected and 35.4% pruritic nodules In the present study, majority (87.5%) of the patients became free from visible lesions after 12 weeks of treatment with cyclosporine. Serum IgE and total eosinophil count reduced significantly after treatment than those before treatment (177.5 vs. 91.6 U/mL, p < 0.001 and 0.5 vs. 0.3 k/μL, p < 0.001 respectively. However, 8.2% of the patients exhibited albuminuria during the course of treatment. Most of the patients of Prurigo Nodularis after 12 weeks of treatment with low-dose oral cyclosporine became free from the lesions without any significant side-effects. CBMJ 2018 January: Vol. 07 No. 01 P: 16-23

scholarly journals A Case of Linear IgA Bullous Dermatosis Induced by Aspirin Therapy

2020 ◽  
Author(s):  
Mohammad Nabavi ◽  
Afshin Rezaeifar ◽  
Ali Sadeghinia ◽  
Saba Arshi ◽  
Sima Bahrami ◽  
...  
Keyword(s):  
Direct Immunofluorescence ◽  
Causative Role ◽  
Drug Induced ◽  
Autoimmune Blistering Disease ◽  
Bullous Dermatosis ◽  
Causative Agents ◽  
History Of ◽  
Blistering Disease ◽  
Linear Iga Bullous Dermatosis ◽  
String Of Pearls

Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disease that may be triggered by some diseases and medications. For the latter one, non-steroidal anti-inflammatory drugs (NSAIDs) have been identified as one of the potential causative agents to develop LABD. Here, a rare case of drug-induced LABD is introduced. A 13-month-old Iranian boy presented with a history of generalized blisters, displaying the classic “string of pearls” sign who was eventually diagnosed as a case of LABD. In his admission, he was diagnosed whit Mucocutaneous lymph node syndrome and treated with aspirin.  Some features like appearing the characteristic lesions one week following the administration of aspirin, rapid clearance of lesions after the withdrawal of the drug, and reappearance of new lesions after readministration of aspirin were highly suggestive of aspirin-induced LABD. To establish the diagnosis, we used the “Naranjo probability score” which determined the probable causative role of aspirin. The diagnosis was confirmed by showing the positive IgA deposition in the basement membrane zone in a direct immunofluorescence study of the skin biopsy. The child was treated with dapsone with dramatical response to the drug.

Idiopathic linear IgA bullous dermatosis treated with prednisone

2021 ◽  
Vol 14 (5) ◽  
pp. e242237
Author(s):  
Christopher Cantoria Garces ◽  
M Fahad Salam ◽  
Brian Nohomovich ◽  
Merryl Treasa Varghese
Keyword(s):  
Case Reports ◽  
Acute Onset ◽  
Direct Immunofluorescence ◽  
Dermoepidermal Junction ◽  
Mucosal Surfaces ◽  
Bullous Dermatosis ◽  
History Of ◽  
Linear Iga Bullous Dermatosis ◽  
Linear Band ◽  
Subepidermal Blister

We present a case of a 43-year-old man with a medical history of paroxysmal atrial fibrillation that presented with acute onset generalised vesiculobullous rash of 1-week duration. The rash was initially noticed on his groin and then spread to his hands, feet and mucosal surfaces. Laboratory tests were unremarkable, including an extensive infection aetiology work-up. Punch biopsies were obtained of a fresh lesion and were stained with H&E and sent for direct immunofluorescence. Light microscopy and immunofluorescence study demonstrated a subepidermal blister with predominant neutrophilic infiltrates and a linear band of IgA at the dermoepidermal junction, respectively. The patient was diagnosed with linear IgA bullous dermatosis and was subsequently treated with 0.5 mg/kg of prednisone daily following previous case reports. At 1-week follow-up as an outpatient, the bullae became crusted, and the rash was nearly completely regressed.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

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