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.

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.

scholarly journals Prosthetic joint infection: an extremely rare complication of intravesicular BCG therapy

2019 ◽  
Vol 12 (12) ◽  
pp. e232809 ◽  
Author(s):  
Michael Storandt ◽  
Avish Nagpal
Keyword(s):  
Rare Complication ◽  
Joint Infection ◽  
Acid Fast Bacillus ◽  
Joint Effusion ◽  
Urothelial Bladder Carcinoma ◽  
Prosthetic Joint ◽  
Bcg Therapy ◽  
Urothelial Bladder ◽  
History Of ◽  
The Right

A 66-year-old man was seen in clinic due to concerns of tuberculosis of the right hip. He had a history of urothelial bladder carcinoma, which was treated via transurethral resection followed by intravesicular instillations of Mycobacterium bovis BCG (BCG). A few months later, he developed slowly worsening pain over his prosthetic right hip, and it was recommended he undergo surgical revision. During surgery, joint effusion was noted and synovial fluid was sent for bacterial and mycobacterial cultures, growing an acid-fast bacillus after 3 weeks, identified as Mycobacterium tuberculosis complex via nucleic acid probe. Susceptibility testing revealed resistance to pyrazinamide, which is typically seen in M. bovis. PCR confirmed the diagnosis of BCG infection. The patient was treated with isoniazid, rifampin and ethambutol, which he tolerated well. This case highlights the challenges associated with diagnosis and management of this rare complication of a commonly used therapy.

Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 91-97 ◽  
Author(s):  
B. P. Chalmers ◽  
J. T. Weston ◽  
D. R. Osmon ◽  
A. D. Hanssen ◽  
D. J. Berry ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Study Cohort ◽  
Study Group ◽  
Prosthetic Joint ◽  
Primary Tkas ◽  
History Of ◽  
Total Knee ◽  
Primary Total Knee

Aims There is little information regarding the risk of a patient developing prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) when the patient has previously experienced PJI of a TKA or total hip arthroplasty (THA) in another joint. The goal of this study was to compare the risk of PJI of primary TKA in this patient population against matched controls. Patients and Methods We retrospectively reviewed 95 patients (102 primary TKAs) treated between 2000 and 2014 with a history of PJI in another TKA or THA. A total of 50 patients (53%) were female. Mean age was 69 years (45 to 88) with a mean body mass index (BMI) of 36 kg/m2 (22 to 59). In total, 27% of patients were on chronic antibiotic suppression. Mean follow-up was six years (2 to 16). We 1:3 matched these (for age, sex, BMI, and surgical year) to 306 primary TKAs performed in 306 patients with a THA or TKA of another joint without a subsequent PJI. Competing risk with death was used for statistical analysis. Multivariate analysis was followed to evaluate risk factors for PJI in the study cohort. Results The cumulative incidence of PJI in the study cohort (6.1%) was significantly higher than the matched cohort (2.6%) at ten years (hazard ratio (HR) 3.3; 95% confidence interval 1.18 to 8.97; p = 0.02). Host grade in the study group was not a significant risk factor for PJI. Patients on chronic suppression had a higher rate of PJI (HR 15; p = 0.002), with six of the seven patients developing PJI in the study group being on chronic suppression. The new infecting microorganism was the same as the previous in only two of seven patients. Conclusion In this matched cohort study, patients undergoing a clean primary TKA with a history of TKA or THA PJI in another joint had a three-fold higher risk of PJI compared with matched controls with ten-year cumulative incidence of 6.1%. The risk of PJI was 15-fold higher in patients on chronic antibiotic suppression; further investigation into reasons for this and mitigation strategies are recommended. Cite this article: Bone Joint J 2019;101-B(7 Supple C):91–97

scholarly journals Mycobacterium bovis prosthetic joint infection following intravesical instillation of BCG for bladder cancer

2019 ◽  
Vol 12 (12) ◽  
pp. e231830 ◽  
Author(s):  
Ashka Patel ◽  
Joel Elzweig
Keyword(s):  
Bladder Cancer ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Fluid Collection ◽  
Acid Fast Bacillus ◽  
Intravesical Instillation ◽  
Susceptibility Data ◽  
Prosthetic Joint ◽  
Bcg Therapy ◽  
History Of

A 91-year-old man with a history of intravesicular BCG therapy for recurrent bladder cancer and bilateral total hip arthroplasty (THA) presented with left hip pain. He was noted to have a fluid collection over the left lateral hip and hip X-ray showed loosening of the prosthetic hip stem indicative of a prosthetic joint infection (PJI). He subsequently underwent removal of the THA and insertion of an antibiotic spacer. He was discharged on intravenous ceftriaxone for presumed culture negative PJI. Intraoperative acid fast bacillus culture later grew Mycobacterium tuberculosis complex, which was then differentiated to M. bovis. The M. bovis infection was thought to be a complication of the patient’s prior BCG therapy. He was initially started on isoniazid, rifampin, pyrazinamide and ethambutol pending cultures and sensitivities; pyrazinamide was discontinued after M. bovis was isolated on culture and susceptibility data confirmed the expected inherent resistance of M. bovis to pyrazinamide. The patient underwent successful THA revision and remains symptom-free at 1 year.

scholarly journals Linear IGA bullous dermatosis potentially triggered by vaccination

2022 ◽  
Vol 36 ◽  
pp. 205873842110212
Author(s):  
Alberto Corrà ◽  
Veronica Bonciolini ◽  
Lavinia Quintarelli ◽  
Alice Verdelli ◽  
Marzia Caproni
Keyword(s):  
Basement Membrane Zone ◽  
Dermoepidermal Junction ◽  
Pathogenetic Role ◽  
Autoimmune Blistering Disease ◽  
Bullous Dermatosis ◽  
Iga Antibodies ◽  
Blistering Disease ◽  
Adults And Children ◽  
Linear Iga Bullous Dermatosis

Linear IgA bullous dermatosis (LABD) is a mucocutaneous autoimmune blistering disease affecting both adults and children. It is caused by IgA antibodies targeting multiple antigens along the basement membrane zone, leading to disruption of dermoepidermal junction and development of bullous lesions which often presents in characteristic arrangement. Although most LABD cases have been reported to be idiopathic, different triggers have been described, including several drugs and infection. However, the occurrence of vaccine-induced cases of LABD is not widely known and accepted due to the few reports available. We present two cases of LABD occurred following different triggers, rising the suspicion for a possible pathogenetic role of vaccines.

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.

scholarly journals Diaminodiphenyl Sulfone-Induced Hemolytic Anemia and Alopecia in a Case of Linear IgA Bullous Dermatosis

2015 ◽  
Vol 7 (2) ◽  
pp. 183-186 ◽  
Author(s):  
Eijiro Akasaka ◽  
Sato-Jin Kayo ◽  
Hajime Nakano ◽  
Norito Ishii ◽  
Takashi Hashimoto ◽  
...  
Keyword(s):  
Side Effects ◽  
Hemolytic Anemia ◽  
Hair Loss ◽  
Laboratory Data ◽  
Immunoglobulin A ◽  
Deficiency Anemia ◽  
Diaminodiphenyl Sulfone ◽  
First Line Therapy ◽  
Bullous Dermatosis ◽  
Linear Iga Bullous Dermatosis

Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is an autoimmune mucocutaneous disease characterized by subepidermal blistering induced by IgA autoantibodies against several autoantigens in the basal membranous zone of the skin and mucosal tissue. Although diaminodiphenyl sulfone (DDS), also known as dapsone, is generally recognized as the first-line therapy for LABD, DDS can induce several severe side effects. We present a Japanese case of LABD with DDS-induced hemolytic anemia and alopecia. In the present case, the DDS-induced hemolytic anemia and hair loss made the DDS monotherapy difficult. When DDS is used in LABD patients with iron deficiency anemia (IDA), hemolytic anemia is concealed by IDA. It is thus necessary to carefully and frequently examine the laboratory data to find the signs of DDS-induced hemolytic anemia. Even though there is no literature on DDS-induced alopecia, alopecia was reported as one of the side effects of DDS in an FDA report, and, in our case, hair loss was improved after reducing its dosage. We have to recognize that alopecia is one of the side effects of DDS and that careful management is needed in order not to overlook the adverse side effects of DDS when treating LABD patients.

Total hip arthroplasty in patients affected by poliomyelitis

2018 ◽  
Vol 100-B (6) ◽  
pp. 733-739 ◽  
Author(s):  
C. M. DeDeugd ◽  
K. I. Perry ◽  
W. H. Trousdale ◽  
M. J. Taunton ◽  
D. G. Lewallen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Complication Rates ◽  
Total Hip ◽  
Radiographic Outcomes ◽  
Prosthetic Joint ◽  
Unaffected Control ◽  
Long Term Follow Up ◽  
History Of

Aims The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population. Patients and Methods A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded. Results In all, 32 THAs (63%) were performed on an affected limb, while 27 (37%) were performed on an unaffected limb. The overall ten-year survivorship free from aseptic loosening, any revision, or any reoperation were 91% (95% CI 0.76 to 0.99), 91% (95% CI 0.64 to 0.97) and 87% (95% CI 0.61 to 0.95), respectively. There were no revisions for prosthetic joint infection. There were no significant differences in any of the above parameters if THA was on the affected or unaffected control limbs. Conclusion Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed. Cite this article: Bone Joint J 2018;100-B:733–9.

Successful Clinical Use of Daptomycin-Impregnated Bone Cement in Two-Stage Revision Hip Surgery for Prosthetic Joint Infection

2013 ◽  
Vol 47 (1) ◽  
pp. e2-e2 ◽  
Author(s):  
Nicholas J Cortes ◽  
John M Lloyd ◽  
Leszek Koziol ◽  
Lawrence O'Hara
Keyword(s):  
Bone Cement ◽  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Past History ◽  
Joint Infection ◽  
Pmma Bone Cement ◽  
Prosthetic Joint ◽  
History Of

OBJECTIVE To describe the safe and successful use of daptomycin-impregnated polymethyl methacrylate (PMMA) bone cement in the treatment of a case of recurrent prosthetic joint infection in a patient with multiple antibiotic allergies and past colonization with multiply antibiotic-resistant organisms. CASE SUMMARY A 79-year-old female had a history of chronic recurrent left prosthetic hip infection. The patient had confirmed allergies to multiple antibiotics and a past history of colonization with methicillin-resistant Staphylococcus aureus. At first-stage revision surgery, the infected prosthesis was removed and samples were sent for microbiologic culture. A spacer device was fashioned, with incorporation of daptomycin and gentamicin into the PMMA bone cement at a concentration of 5% w/w for each antibiotic. Systemic daptomycin and gentamicin were administered postoperatively for 14 days. Propionibacterium acnes was isolated from deep-tissue specimens. The patient made excellent postoperative progress and was discharged after 2 weeks. Second-stage revision surgery was performed at 6 months, with no signs of persistent infection. She remained well, pain free, and mobilizing independently 2 years later. DISCUSSION Daptomycin, a cyclic lipopeptide antibiotic, is approved for systemic treatment of endocarditis and skin and soft tissue infections. In vitro data demonstrate acceptable drug elution from and tensile strength of daptomycin-impregnated PMMA bone cement; however, clinical data are lacking. In our patient's case, the cement formulation was well tolerated, with no adverse effects detected, and demonstrated adequate mechanical strength in vivo. Infection with P. acnes, an unusual pathogen, was successfully treated. Further clinical studies are required to assess the efficacy of daptomycin-impregnated cement in infection with more typical pathogens, such as S. aureus. CONCLUSIONS Daptomycin impregnation of PMMA bone cement may be an option in cases in which patient or pathogen factors preclude use of routinely incorporated agents.

scholarly journals Linear IgA bullous dermatosis: report of an exuberant case

2013 ◽  
Vol 88 (6 suppl 1) ◽  
pp. 67-70 ◽  
Author(s):  
Beatriz Cavalcanti de Souza ◽  
Nádire Cristina Freire Pontes Fregonesi ◽  
Antônio José Tebcherani ◽  
Ana Paula Galli Sanchez ◽  
Valéria Aoki ◽  
...  
Keyword(s):  
Immunoglobulin A ◽  
Response To Treatment ◽  
Bullous Disease ◽  
Autoimmune Bullous Disease ◽  
Bullous Dermatosis ◽  
Linear Iga Dermatosis ◽  
Linear Iga Bullous Dermatosis

Linear immunoglobulin A dermatosis is a rare autoimmune bullous disease, but the most common autoimmune bullous dermatosis in children. We report a typical exuberant case of linear IgA dermatosis in a ten-month old child, who showed good response to treatment with corticosteroids and dapsone.

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