Leukocytoclastic vasculitis following coronavirus disease 2019 (COVID-19): A case report

Leukocytoclastic vasculitis (LCV) refers to the histopathological changes observed in a common form of small vessel vasculitis that can affect skin and/or internal organs. LCV can be precipitated by several causes (including infections, drugs, and collagen vascular diseases) or can be idiopathic. We report a 50-year-old man who presented with fever, parotid enlargement and skin rash (discrete and confluent erythematous macules, papules, and plaques and a few purpuric lesions on the back of trunk and upper limbs), 3 weeks after being diagnosed with coronavirus disease 2019 (COVID-19). The patient showed four out of the five features required to satisfy the working case definition of multisystem inflammatory syndrome in adults (MIS-A). Histopathology of rash was consistent with LCV. Whether, COVID-19 was the cause for LCV in our patient remains unclear. The fever, parotid enlargement and rash showed complete resolution following treatment with systemic corticosteroids and enoxaparin.

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Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

The Journal of Infection in Developing Countries ◽

10.3855/jidc.7198 ◽

2016 ◽

Vol 10 (01) ◽

pp. 30-42 ◽

Cited By ~ 2

Author(s):

Ahmed F Kabapy ◽

Amira M Kotkat ◽

Hanan Zakaria Shatat ◽

Ekram W Abd El Wahab

Keyword(s):

Fever Of Unknown Origin ◽

Vascular Diseases ◽

Unknown Origin ◽

Fever Hospital ◽

Collagen Vascular Diseases ◽

Epidemiologic Profile ◽

Diagnostic Work ◽

Definition Of ◽

Epidemiological Profile ◽

Work Up

Introduction: Fever of unknown origin (FUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine. Clinicians should use the frequency distribution of disorders causing FUO to guide their diagnostic approach in patients with prolonged, unexplained fevers meeting the definition of FUO. Methodology: The present study was undertaken to examine the etiologies, clinico-epidemiologic profile, and prognosis of classical FUO in patients reporting to the Alexandria Fever Hospital in Egypt. Records of 979 patients admitted to the fever hospital (from January 2009 to January 2010) and diagnosed as having FUO were examined carefully. FUO was defined as three outpatient visits or three days in the hospital without elucidation of cause of fever. Results: A total of 979 cases (57.0% males and 43.0% females), with ages ranging from 0.2 to 90 years, were investigated. The mean duration of fever before hospitalization was 31 ± 10 days. The etiology of FUO was delineated in 97% of cases, and only 3% remained undiagnosed. Diagnoses were grouped into five major categories. Infectious causes of FUO were strongly associated with better outcome (73.7% improved). Smoking, contact with animals or birds, drug addiction, and HIV seropositivity were important risk factors associated with infections. Conclusions: Infections are the most common cause of FUO, followed by collagen vascular diseases, in our region. A three-step diagnostic work-up approach is recommended to be applied in Egypt in order to improve the quality of medical service provided to FUO patients.

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Use of Systemic Corticosteroids for Reasons Other than Asthma in Subjects with Asthma

Respiration ◽

10.1159/000518461 ◽

2021 ◽

pp. 1-7

Author(s):

Keisuke Watanabe ◽

Nobuyuki Horita ◽

Yu Hara ◽

Nobuaki Kobayashi ◽

Takeshi Kaneko

Keyword(s):

Adverse Events ◽

Systemic Corticosteroid ◽

Multivariable Analysis ◽

Vascular Diseases ◽

University Hospital ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Collagen Vascular Diseases ◽

Systemic Corticosteroids ◽

Asthma Patients

Backgrounds: Recent studies have reported increased risks of adverse events from systemic corticosteroids even with only low-dose or short-term use. Some patients with asthma experience complications requiring systemic corticosteroids. However, few studies have examined issues associated with administration of systemic corticosteroids for reasons other than asthma among subjects with asthma. Objectives: We investigated patterns of systemic corticosteroid exposure for reasons other than asthma in subjects with asthma. Method: We retrospectively reviewed the records of adult subjects with asthma followed up for >1 year at Yokohama City University Hospital from January 1, 2010, to December 31, 2019. We investigated patterns and reasons for systemic corticosteroid use during follow-up. In addition, factors related to systemic corticosteroid use for reasons likely other than asthma were investigated. Results: Among the 568 subjects with asthma analyzed, 326 (57.4%) had received systemic corticosteroids for some reason. Among those 326 patients, 120 (36.8%) had received systemic corticosteroids for reasons likely other than asthma. Multivariable analysis revealed rheumatoid arthritis, eosinophilic granulomatosis with polyangiitis, other collagen vascular diseases, chronic rhinosinusitis, and malignancy as positively associated with systemic corticosteroid exposure for reasons likely other than asthma in subjects with asthma. Conclusions: About 40% of systemic corticosteroid use in subjects with asthma was for reasons likely other than asthma. Clinicians should be aware of their asthma patients’ exposures to systemic corticosteroids for nonasthma reasons, to avoid missing adverse events or underestimating the severity of asthma, and to reduce systemic corticosteroid use.

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Pathology and Case Definition of Severe Perkinsea Infection of Frogs

Veterinary Pathology ◽

10.1177/0300985818798132 ◽

2018 ◽

Vol 56 (1) ◽

pp. 133-142

Author(s):

Marcos Isidoro-Ayza ◽

Daniel A. Grear ◽

Aurélie Chambouvet

Keyword(s):

Distinct Group ◽

Abdominal Distension ◽

The United States ◽

Case Definition ◽

Hematopoietic Tissue ◽

Internal Organs ◽

White Skin ◽

Subcutaneous Edema ◽

Definition Of ◽

Mass Mortalities

Severe Perkinsea infection (SPI) is an emerging disease of frogs responsible for mass mortalities of tadpoles across the United States. It is caused by protozoa belonging to the phylum Perkinsozoa that form a distinct group referred to as the Pathogenic Perkinsea Clade of frogs. In this work, we provide detailed description of gross and histologic lesions from 178 naturally infected tadpoles, including 10 species from 22 mortality events and 6 amphibian health monitoring studies from diverse geographic areas. On external examination, we observed abdominal distension (10, 5.6%), cutaneous erythema and petechia (3, 1.7%), subcutaneous edema (3, 1.7%), and areas of white skin discoloration (3, 1.7%). On macroscopic examination of internal organs, we found hepatomegaly (68, 38.2%), splenomegaly (51, 28.7%), nephromegaly (47, 26.4%), ascites (15, 8.4%), segmental irregular thickening and white discoloration of the intestine (8, 4.5%), pancreatomegaly (4, 2.2%), and pancreatic petechia (1, 0.6%). Histologically, over 60% of the liver (148/165, 89.7%), kidney (113/147, 76.9%), spleen (96/97, 99%), and pancreas (46/68, 67.6%) were invaded by myriad intracellular and extracellular Perkinsea hypnospore-like and trophozoite-like organisms. Numerous other tissues were affected to a lesser extent. Mild histiocytic inflammation with fewer lymphocytes or eosinophils was commonly observed in areas of infection that were not obscured by lympho-granulocytic hematopoietic tissue. In light of these observations, we suggest a logical pathogenesis sequence. Finally, we propose a “case definition” for SPI to promote standardized communication of results and prevent misdiagnosis with epidemiological and pathologically overlapping diseases such as ranavirosis.

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Relationship Between Fibrinopeptide A and Fibrinogen/Fibrin Fragment E in Thromboembolism, DIC and Various Non-Thromboembolic Diseases

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645965 ◽

1987 ◽

Vol 58 (02) ◽

pp. 758-763 ◽

Cited By ~ 11

Author(s):

G Mombelli ◽

R Monotti ◽

A Haeberli ◽

P W Straub

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Liver Cirrhosis ◽

Healthy Subjects ◽

Vascular Diseases ◽

Fibrinopeptide A ◽

Normal Range ◽

Collagen Vascular Diseases ◽

Intravascular Coagulation ◽

Fibrin Formation

SummaryIncreased fibrinopeptide A (FPA) levels have been reported in various non-thrombotic disorders, including cancer, acute myocardial infarction, liver cirrhosis and collagen vascular diseases. To investigate the significance of these findings, the present study combined the radioimmunoassay of FPA with that of fibrinogen/fibrin degradation fragment E (FgE) in the aforementioned disorders and compared the results with those observed in healthy subjects as well as in patients with thromboembolism and overt disseminated intravascular coagulation (DIC). Mean FPA and FgE in malignancy were 6.3 and 305 ng/ml, in myocardial infarction 5.6 and 98 ng/ml, in liver cirrhosis 2.7 and 132 ng/ml and in collagen vascular diseases 5.6 and 142 ng/ml. All these values were significantly higher than in healthy controls (mean FPA 1.6 ng/ml, mean FgE 49 ng/ml) but significantly lower than in thromboembolism (mean FPA 10.7 ng/ml, mean FgE 639 ng/ ml) and DIC (mean FPA 22.0 ng/ml, mean FgE 1041 ng/ml). The overall correlation between FPA and FgE was highly significant. Elowever, different disorders showed peculiar patterns in FPA, FgE and fibrinogen levels. In malignancy, a definite increase of FPA, FgE and plasma fibrinogen levels was observed. This finding probably indicates a compensated state of (intra- or extravascular) fibrin formation and lysis. Acute myocardial infarction was characterized by a high FPA to FgE ratio, which is interpreted to reflect acute thrombin generation and fibrin formation. FPA in cirrhosis was only marginally elevated with most single values within the normal range, indicating that intravascular coagulation was infrequent and unimportant in quantitative terms.

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Leukocytoclastic Vasculitis Associated with HHV6-A/ciHHV6-A and HHV6-B Coinfection in an Immunocompetent Woman

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530318666181106153758 ◽

2019 ◽

Vol 19 (2) ◽

pp. 221-225 ◽

Cited By ~ 1

Author(s):

Agata Calvario ◽

Caterina Foti ◽

Maria Scarasciulli ◽

Paolo Romita ◽

Eva Eliassen ◽

...

Keyword(s):

Transcriptional Activity ◽

Skin Infection ◽

Leukocytoclastic Vasculitis ◽

Human Herpesvirus ◽

Small Vessel Vasculitis ◽

Case Description ◽

Human Herpesvirus 6 ◽

Late Antigen ◽

Herpesvirus 6 ◽

Systemic Symptoms

Background and Objective: Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis that can be limited to the skin but may also affect other organs. Often, its cause is unknown. LCV has previously been reported to occur with the reactivation of human herpesvirus 6 (HHV-6). Here, we report a second instance of HHV-6 reactivation in a 43-year-old woman with idiopathic cutaneous LCV. Case Description: In this case, the patient was immunocompetent, and testing revealed that she had inherited chromosomally integrated human herpesvirus 6 variant A (iciHHV6-A) with a parallel skin infection of HHV-6B. The integrated ciHHV-6A strain was found to be transcriptionally active in the blood, while HHV-6B late antigen was detected in a skin biopsy. The patient’s rash was not accompanied by fever nor systemic symptoms and resolved over four weeks without any therapeutic intervention.Conclusion:In light of the transcriptional activity documented in our case, further examination of a possible role for HHV-6 in the etiology of LCV is warranted.

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Atypical Bacterial Pathogens and Small-Vessel Leukocytoclastic Vasculitis of the Skin in Children: Systematic Literature Review

Pathogens ◽

10.3390/pathogens10010031 ◽

2021 ◽

Vol 10 (1) ◽

pp. 31

Author(s):

Céline Betti ◽

Pietro Camozzi ◽

Viola Gennaro ◽

Mario G. Bianchetti ◽

Martin Scoglio ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Legionella Pneumophila ◽

Leukocytoclastic Vasculitis ◽

Systemic Vasculitis ◽

Bacterial Pathogen ◽

Small Vessel ◽

Small Vessel Vasculitis ◽

Systemic Involvement ◽

Symptomatic Disease ◽

Atypical Pathogen

Leukocytoclastic small-vessel vasculitis of the skin (with or without systemic involvement) is often preceded by infections such as common cold, tonsillopharyngitis, or otitis media. Our purpose was to document pediatric (≤18 years) cases preceded by a symptomatic disease caused by an atypical bacterial pathogen. We performed a literature search following the Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines. We retained 19 reports including 22 cases (13 females and 9 males, 1.0 to 17, median 6.3 years of age) associated with a Mycoplasma pneumoniae infection. We did not find any case linked to Chlamydophila pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Francisella tularensis, or Legionella pneumophila. Patients with a systemic vasculitis (N = 14) and with a skin-limited (N = 8) vasculitis did not significantly differ with respect to gender and age. The time to recovery was ≤12 weeks in all patients with this information. In conclusion, a cutaneous small-vessel vasculitis with or without systemic involvement may occur in childhood after an infection caused by the atypical bacterial pathogen Mycoplasma pneumoniae. The clinical picture and the course of cases preceded by recognized triggers and by this atypical pathogen are indistinguishable.

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