Pyoderma gangrenosum of the upper eyelid

A 3-year-old woman presented with a large ulcerated lesion involving the left upper eyelid and left earlobe with erythematous, swollen, undermined and advancing borders. Culture of the ulcer showed no growth of organisms. Treatment with empiric intravenous and topical antibiotics showed no improvement. Workup revealed an elevated white blood cell count with elevated neutrophil count, elevated erythrocyte sedimentation rate and C reactive protein and positive antinuclear antibody. A skin biopsy showed a neutrophilic dermatitis with vasculitis. The patient was started on oral prednisone, which resulted in halting of the progression of ulceration and clinically decreased skin inflammation. The skin biopsy and positive response to corticosteroids confirmed the diagnosis of pyoderma gangrenosum. Pyoderma gangrenosum is a rare inflammatory skin condition and rarely presents as lesions of the eyelid. Early initiation of immunosuppressive therapy prevents disfigurement. Eyelid reconstruction in these cases may prove to be difficult.

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Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

Digestive Diseases ◽

10.1159/000494438 ◽

2019 ◽

Vol 37 (3) ◽

pp. 239-246 ◽

Cited By ~ 5

Author(s):

Yohei Kida

Keyword(s):

Therapeutic Response ◽

Positive Response ◽

Body Weight Loss ◽

Newly Diagnosed ◽

C Reactive Protein ◽

Reactive Protein ◽

Significant Difference ◽

V2 Receptor ◽

Vasopressin V2 Receptor Antagonist ◽

Cirrhotic Patients

Aims: Ascites is one of the major complications in advanced cirrhotic patients. Tolvaptan is a non-peptide orally available arginine vasopressin V2 receptor antagonist. We investigated and found that tolvaptan therapy improved the prognosis and predictive factor of cirrhotic patients with ascites. Methods: Overall, 99 patients with newly diagnosed ascites with cirrhosis were enrolled. No patients had intrahepatic malignancy. The patients were divided into 2 groups based on tolvaptan therapy: 86 patients treated with tolvaptan (tolvaptan-group) and 13 patients treated without tolvaptan (non-tolvaptan-group). Tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan. Results: Tolvaptan therapy was effective in 61.6% of cirrhotic patients. There was a significant difference in the overall survival (OS) between the tolvaptan-responder-group and the other groups (p < 0.001). Male (HR 5.05; p = 0.01), tolvaptan responder (HR 0.21; p = 0.02), and dosage of furosemide < 40 mg/day (HR 0.17; p = 0.01) were factors that were independently associated with the OS. The multivariate analysis revealed that C-reactive protein < 0.9 mg/dL (HR 0.07; p = 0.001), and furosemide dosage < 40 mg/day (HR 0.09; p = 0.003) were independently associated with the tolvaptan response. Conclusion: Therapeutic response to tolvaptan was associated with longer survival in cirrhosis patients complicated with ascites. These preliminary findings warrant validation and further exploration.

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Escherichia coli Panophthalmitis after Pecking by a Great Egret (Ardea alba)

Case Reports in Ophthalmology ◽

10.1159/000509340 ◽

2020 ◽

Vol 11 (2) ◽

pp. 466-472

Author(s):

Takashi Ono ◽

Kentaro Abe ◽

Yosai Mori ◽

Ryohei Nejima ◽

Takuya Iwasaki ◽

...

Keyword(s):

Elevated Serum ◽

Ocular Infection ◽

Ocular Injury ◽

C Reactive Protein ◽

Upper Eyelid ◽

Protein Levels ◽

Reactive Protein ◽

Cell Counts ◽

Open Globe ◽

The Right

We report a case of open globe injury caused by Ardea albapecking that resulted in Escherichia colipanophthalmitis. A woman in her 70s complaining of ocular pain was referred to our hospital because her right eye had been pecked by an A. alba2 days earlier. Visual acuity in her right eye was reduced to light sensation. The right conjunctiva became hyperemic and edematous with swelling of the right upper eyelid. The upper side of the right cornea was densely cloudy with focal defect. Ultrasonography showed a thick sclera and choroid-like structure. Pathological investigation of a scraped sample from the infected site revealed gram-negative rods; E. coli was isolated. She had fever with elevated serum C-reactive protein levels and leukocytosis confirmed by laboratory examination. Topical levofloxacin and cefmenoxime and intravenous fosfomycin and aspoxicillin were initiated, but the right cornea melted near the perforated site with leakage of the eyeball contents on the next day. We decided to perform eye evisceration because of difficulty in controlling corneal melting and panophthalmitis. Her general state recovered the day after surgery. Orbital cellulitis improved gradually with normal C-reactive protein levels and white blood cell counts. As ocular injury caused by birds could become severe and cause ocular infection and visual dysfunction, it is important to exercise caution in the vicinity of wild birds, especially when they are aggressive.

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Long-term results of immunosuppressive oral prednisone after coronary angioplasty in non-diabetic patients with elevated C-reactive protein levels

EuroIntervention ◽

10.4244/eijv5i2a39 ◽

2009 ◽

Vol 5 (2) ◽

pp. 250-254 ◽

Cited By ~ 11

Author(s):

Valeria Ferrero ◽

Fabrizio Tomai ◽

Francesco Versaci ◽

Mauro Feola ◽

Igino Proietti ◽

...

Keyword(s):

Coronary Angioplasty ◽

Oral Prednisone ◽

Long Term Results ◽

Diabetic Patients ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein

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Serum C-Reactive Protein Measurement in Pyoderma gangrenosum

Dermatology ◽

10.1159/000249256 ◽

1986 ◽

Vol 173 (5) ◽

pp. 216-219 ◽

Cited By ~ 2

Author(s):

I.F. Rowe ◽

A.C. Deans

Keyword(s):

Pyoderma Gangrenosum ◽

C Reactive Protein ◽

Reactive Protein ◽

Protein Measurement

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Drug Hypersensitivity due to Azathioprine with Elevated Procalcitonin

Case Reports in Dermatological Medicine ◽

10.1155/2018/2648325 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Tania Ahuja ◽

Frank R. Chung ◽

Tania Ruiz-Maya

Keyword(s):

Skin Biopsy ◽

Myasthenia Gravis ◽

Acute Phase ◽

Drug Hypersensitivity ◽

C Reactive Protein ◽

Acute Phase Reactants ◽

Reactive Protein ◽

Microbial Cultures

We present a case of azathioprine hypersensitivity presenting as sepsis with elevated procalcitonin in a 68-year-old man with myasthenia gravis. The patient presented with fever, chills, nausea, vomiting, and headache. He developed numerous 1 cm erythematous papules over his upper torso. Infectious workup including bacteriological tests and microbial cultures was negative and a skin biopsy was performed which revealed suppurative folliculitis with eosinophils, consistent with drug hypersensitivity. Notably, acute phase reactants including C-reactive protein and procalcitonin were elevated upon presentation, likely secondary to drug hypersensitivity.

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Chitinase-3-like Protein 1 (YKL-40): A New Biomarker of Inflammation in Pyoderma Gangrenosum

Acta Dermato Venereologica ◽

10.2340/actadv.v101.978 ◽

2021 ◽

Author(s):

Alina Jankowska-Konsur ◽

Magdalena Łyko ◽

Klaudia Rubas ◽

Danuta Nowicka-Suszko ◽

Joanna Maj ◽

...

Keyword(s):

Serum Level ◽

Pyoderma Gangrenosum ◽

Skin Lesions ◽

Enzyme Linked Immunosorbent Assay ◽

C Reactive Protein ◽

Blood Cell Count ◽

Inflammatory Biomarker ◽

Reactive Protein ◽

Inflammatory Parameters ◽

Immune Mediated

Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis with unclear aetiopathology, considered as an autoinflammatory disease, associated with other immune-mediated disorders. Chitinase-3-like protein 1 (YKL-40) is an inflammatory biomarker secreted by a wide variety of cells, including neutrophils. To evaluate YKL-40 serum level in relation to clinicopathological data, 48 patients with PG and 40 healthy controls were enrolled in the study. Skin lesions were measured to calculate the affected area. Inflammatory parameters (C-reactive protein, white blood cell count with neutrophils) were determined from blood samples. YKL-40 and IL-6 levels were measured in serum by enzyme-linked immunosorbent assay. YKL-40 serum level was significantly higher in patients with PG than in controls (58.4 vs 36.4 ng/ml, respectively; p < 0.00001). The positive correlation between YKL-40 level and IL-6 level was observed (r=0.48, p = 0.0006) along with a trend towards significance of relationship between YKL-40 level and C-reactive protein (r=0.28, p = 0.052). YKL-40 can be considered a valuable biomarker of inflammation in PG.

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DRESS syndrome (drug rash with eosinophilia and systemic symptoms): sometimes, not all signs are there

Italian Journal of Medicine ◽

10.4081/itjm.2021.1475 ◽

2021 ◽

Vol 15 (3) ◽

Author(s):

Fábio Murteira ◽

Pedro Oliveira ◽

João Miranda ◽

Albina Moreira ◽

Margarida Correira

Keyword(s):

Skin Biopsy ◽

Late Onset ◽

Skin Lesions ◽

Skin Tone ◽

C Reactive Protein ◽

Dress Syndrome ◽

Reactive Protein ◽

Drug Rash ◽

Systemic Symptoms ◽

Elevated Transaminases

DRESS syndrome is a rare and potentially fatal multisystemic reaction that occurs two to six weeks after exposure to certain drugs. It is characterized by fever, eosinophilia, and skin rash. Case of a 37-year-old man, black, with gout (started allopurinol 4 weeks before). He arrived at the Emergency Room complaining of headache, fever, abdominal pain, and scattered maculopapular skin lesions. The conducted study showed elevated transaminases and C-reactive protein, hepatomegaly, and peri-hepatic adenomegalies. Allopurinol was stopped, but throughout hospitalization, liver, renal and neurological dysfunctions (with meningoencephalitis) worsened; it also appeared eosinophilia. A skin biopsy was performed, the possibility of DRESS syndrome was assumed, and methylprednisolone 2 mg/kg/day was started, with progressive improvement. The skin biopsy was compatible with DRESS. The described case reveals some peculiarities. Among the most relevant arethe late onset of eosinophilia and the difficulty in evaluating the rash due to the patient's skin tone and neurological manifestations (rare).

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