A Novel Use of Topical Ketamine for the Treatment of Oral Pemphigus: A Case Report

2020 ◽  
pp. 082585972094650
Author(s):  
Elizabeth A. Higgins ◽  
Julia Arana West
Keyword(s):  
Palliative Care ◽  
Case Report ◽  
Standard Treatment ◽  
Stage Iv ◽  
Lymphoproliferative Disorders ◽  
Pain Level ◽  
Paraneoplastic Pemphigus ◽  
Autoimmune Blistering Disease ◽  
Blistering Disease ◽  
Topical Ketamine

Background: Paraneoplastic pemphigus (PNP) is a rare autoimmune blistering disease often associated with lymphoproliferative disorders. PNP causes hemorrhagic stomatitis of the lips, tongue, and cheeks which can be painful and difficult to treat. Case History: A 54-year-old man was referred to our hospital for treatment of Stage IV lymphoma and paraneoplastic pemphigus. Due to pain from oral stomatitis, he required a gastrostomy tube for delivery of nutritional tube feeds. He was placed on steroids and received both lidocaine mouthwash and opioids, but his pain persisted. Case Management and Outcome: A palliative care consult was obtained for management of his pain. The palliative team recommended topical ketamine for the treatment of the painful lip lesions. The patient felt immediate relief with the application of ketamine and his pain level was reduced to a 5/10. The following day, his pain was 0/10. Five days later, the opioids were discontinued and the pain relief continued. Conclusion: Painful stomatitis from PNP may be refractory to standard treatment. We found that the application of topical ketamine was very effective in this patient with hemorrhagic stomatitis from PNP.

scholarly journals Animal-Assisted Therapy in Palliative Care

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
Vanessa Quintal ◽  
Paulo Reis-Pina
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Case Report ◽  
Pain Management ◽  
Symptom Management ◽  
Colon Adenocarcinoma ◽  
Stage Iv ◽  
Animal Assisted Therapy ◽  
Yorkshire Terrier

There are still many cases where traditional medical care does not provide a realistic solution for patients with devastating diseases so other interventions should be adopted. We present a case report of a 76 year-old woman admitted to a Palliative Care unit due to stage IV colon adenocarcinoma, and we describe the contribution of a six-year-old Yorkshire terrier in her symptom management. Animal-assisted therapy can be of great use in palliative care, contributing to the patients’ pain management, relief from suffering and improvement of quality of life.

scholarly journals Acometimento neonatal do pênfigo vulgar: relato de caso

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Mariana das Neves Melo ◽  
Elisangela Pegas
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Fungal Infections ◽  
Pemphigus Vulgaris ◽  
Review Of Literature ◽  
Pregnancy Risk ◽  
Vertical Transfer ◽  
Autoimmune Blistering Disease ◽  
Blistering Disease ◽  
In Pregnancy

Os pênfigos são dermatoses bolhosas autoimunes, em que há a produção de autoanticorpos direcionados contra moléculas de adesão dos epitélios, levando à perda da coesão celular. As doenças bolhosas intraepidérmicas são compostas pelo grupo dos pênfigos: pênfigo foliáceo clássico, pênfigo foliáceo endêmico, pênfigo eritematoso, pênfigo vulgar, pênfigo vegetante, pênfigo herpetiforme (variante clínica dos pênfigos vulgar e foliáceo), pênfigo por IgA, pênfigo paraneoplásico e pênfigo induzido por medicamentos. Devido à transferência placentária dos anticorpos IgG, existem casos de recém-nascidos com diagnóstico de Pênfigo Neonatal. Este  artigo relata o caso de uma paciente recém-nascida de mãe com diagnóstico prévio de Pênfigo Vulgar com lesões exulceradas extensas na região perineal, couro cabeludo, cervical posterior e dorso, e também lesões bolhosas nos pés.Descritores: Pênfigo; Recém-Nascido; Dermatopatias; Doenças Autoimunes.ReferênciasSmolinski KN, Shah SS, Honig PJ, Yan AC. Neonatal cutaneous fungal infections. Curr Opin Pediatr. 2005;17(4):486-93.Zhao CY, Chiang YZ, Murrell DF. Neonatal autoimmune blistering disease: a systematic review. Pediatr Dermatol. 2016;33(4):367-74.Bellelli AG, Mantero NM, Rueda ML, Navacchia D, Cao G, Liloo L et al. Pénfigo vulgar de la infancia, a propósito de un caso [Childhood pemphigus vulgaris, a case report]. Arch Argent Pediatr. 2016;114(6):e457-60. Ali HS. Pemphigus vulgaris during pregnancy - a case report. J Pak Assoc Dermatol. 2011;21(4):301-3.Hanna S, Kim M, Murrell DF. Validation studies of outcome measures in pemphigus. Int J Womens Dermatol. 2016;2(4):128-39.Ibrahim SB, Yashodhara BM, Umakanth S, Kanagasabai S. Pemphigus vulgaris in a pregnant woman and her neonate. BMJ Case Rep. 2012;2012:bcr0220125850.Kodagali SS, Subbarao SD, Hiremagaloor R. Pemphigus vulgaris in a neonate and his mother. Indian Pediatr. 2014;51(4):316-17.Fainaru O, Mashiach R, Kupferminc M, Shenhav M, Pauzner D, Lessing JB. Pemphigus vulgaris in pregnancy: a case report and review of literature. Hum Reprod. 2000;15(5):1195-97.Abrams ML, Smidt A, Benjamin L, Chen M, Woodley D, Mancini AJ. Congenital epidermolysis bullosa acquisita: vertical transfer of maternal autoantibody from mother to infant. Arch Dermatol. 2011;147(3):337-41.Goldberg NS, DeFeo C, Kirshenbaum N. Pemphigus vulgaris and pregnancy: risk factors and recommendations. J Am Acad Dermatol. 1993;28(5 Pt 2):877-79.

scholarly journals Paraneoplastic pemphigus associated with Castleman’s disease in a 13-year-old boy

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Neema Joy ◽  
Anuja Elizabeth George ◽  
Lissy Skaria
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Clinical Remission ◽  
Castleman’S Disease ◽  
Skin Lesions ◽  
Treatment Evaluation ◽  
Castleman's Disease ◽  
Paraneoplastic Pemphigus ◽  
Autoimmune Blistering Disease ◽  
Underlying Malignancy ◽  
Blistering Disease

Paraneoplastic pemphigus is an autoimmune blistering disease associated with an underlying malignancy. This is a case of a 13-year-old boy initially presenting with isolated oral erosions – managed as a case of pemphigus, who one and a half years later developed toxic epidermal necrolysis like rash, both refractory to treatment. Evaluation for an underlying malignancy revealed a retroperitoneal Castleman’s tumor, following the excision of which there was clinical remission of the oral and skin lesions.

Concordance with the ASCO Provisional Clinical Opinion on the integration of palliative care into standard oncology care in Ontario.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 170-170
Author(s):  
Victoria Zwicker ◽  
Katharina Forster ◽  
Angelika Gollnow ◽  
Amy Liu ◽  
Jingxian Sun ◽  
...  
Keyword(s):  
Palliative Care ◽  
Standard Treatment ◽  
Phase 1 ◽  
Stage Iv ◽  
Small Cell Lung ◽  
Care Services ◽  
Ontario Cancer Registry ◽  
Palliative Care Services ◽  
Oncology Care ◽  
Initial Results

170 Background: In 2012, ASCO released a Provisional Clinical Opinion for patients with stage IV non-small cell lung cancer (NSCLC) and the need for integration of palliative care services concurrent with standard treatment from the time of diagnosis. To understand if this recommendation is being followed in Ontario, provincial administrative data was used to explore concordance. Methods: Various aspects of concordance were considered including: whether and when in the treatment trajectory patients received palliative care, and how much care was received. For Phase 1 of the analysis, a provincial database of outpatient cancer care was used to identify services received within Ontario’s regional cancer centers (RCCs) and select partner hospitals. The Ontario Cancer Registry and Staging databases were used to identify the patient cohort. The cohort included patients diagnosed with stage IV NSCLC between January 1, 2012 and December 31, 2013. Results: Phase 1 results indicate that 41% of patients received palliative and/or psychosocial oncology care at the RCC or partner hospital after diagnosis. Those receiving palliative care first received services an average of 148 days after diagnosis. See Table below for detailed results. Conclusions: A growing body of literature has identified the benefits of concurrent palliative care. Knowing whether these services are being provided for the NSCLC population is a promising start to understanding and improving the delivery of palliative care in Ontario. Initial results suggest that there is a need for quality improvement in this area. Future phases will expand the analysis to include services received in additional settings such as hospitals and community. [Table: see text]

scholarly journals Oral Pemphigus Vulgaris: A case report

2020 ◽  
Vol 10 (1) ◽  
pp. 91-93
Author(s):  
Radha Baral ◽  
Bidhata Ojha ◽  
Dipshikha Bajracharya
Keyword(s):  
Case Report ◽  
Mucous Membrane ◽  
Male Patient ◽  
Clinical Examination ◽  
Adhesion Molecule ◽  
Case History ◽  
Pemphigus Vulgaris ◽  
Underlying Mechanism ◽  
Autoimmune Blistering Disease ◽  
Blistering Disease

Pemphigus vulgaris is an autoimmune blistering disease clinically presenting as vesicles, bullae and erosion on the skin and mucous membrane. Histopathologically, it is characterized by acantholy­sis and supra basilar split. The underlying mechanism causing intra epithelial split in pemphigus vulgaris is binding of IgG autoantibodies to desmoglin 3 which belongs to a transmembrane gly­coprotein adhesion molecule. Here we present a case of 27 years old male patient suffering from pemphigus vulgaris. This Case report highlights the importance of detailed case history, thorough clinical examination and appropriate investigation to reach a diagnosis of vesiculobullous lesion.

Autoimmune Blistering Disease with Concurrent IgG Antibodies to Desmoglein 1 and BP180 : Two Cases

2013 ◽  
Vol 75 (5) ◽  
pp. 415-418
Author(s):  
Miki ICHIKAWA ◽  
Maya TANAKA ◽  
Kazunori URABE ◽  
Masutaka FURUE
Keyword(s):  
Igg Antibodies ◽  
Autoimmune Blistering Disease ◽  
Blistering Disease

Paraneoplastic Pemphigus in A Patient with Chronic Lymphocytic Leukemia: A Case Report

2018 ◽  
Vol 02 (03) ◽  
pp. 84-88
Author(s):  
Arif Kus ◽  
Abdulkerim Yildiz ◽  
Betul Erdem ◽  
Murat Albayrak ◽  
Cigdem Pala Ozturk ◽  
...  
Keyword(s):  
Case Report ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Paraneoplastic Pemphigus

scholarly journals An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care

2021 ◽  
pp. 104990912098612
Author(s):  
Alycia A. Bristol ◽  
Sobaata Chaudhry ◽  
Dana Assis ◽  
Rebecca Wright ◽  
Derek Moriyama ◽  
...  
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Stage Iv ◽  
The United States ◽  
Qualitative Description ◽  
Disease Stage ◽  
Structured Interviews ◽  
Care Clinic ◽  
Clinical Model

Objectives: The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. Methods: Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. Results: We identified 2 themes: “Communication addressing the emotional and physical aspects of disease” and “Filling gaps in care”; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. Significance of Results: Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.

Sign in / Sign up

Export Citation Format

Share Document