scholarly journals Hydroxyurea Associated Cutaneous Lesions: A Case Report

2018 ◽  
Vol 6 (8) ◽  
pp. 1458-1461 ◽  
Author(s):  
Viktor Simeonovski ◽  
Hristina Breshkovska ◽  
Silvija Duma ◽  
Ivana Dohcheva-Karajovanov ◽  
Katerina Damevska ◽  
...  
Keyword(s):  
Side Effects ◽  
Actinic Keratosis ◽  
Myeloproliferative Disorders ◽  
Skin Lesions ◽  
Term Therapy ◽  
Cutaneous Lesions ◽  
Cutaneous Side Effects ◽  
Dermatological Examination ◽  
The Right ◽  
Hands And Feet

BACKGROUND: Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas.CASE REPORT: We report a case of a 52-year-old man, on long-term therapy with HU for essential thrombocytosis, with several concurrent skin lesions. Despite the perennial use of HU, the cutaneous changes were neglected. The local dermatological examination revealed oval perimalleolar ulcer on the right leg, with dimensions 6 x 4 cm, clearly demarcated from the surroundings with regular margins, periulcerous erythema, with very deep and highly fibrinous bed of the ulcer, positive for bacterial infection. The ulcer was treated with topical wound therapy with alginate and parenteral antibiotics. The extended dermatological screening also showed two nummular lesions in the right brachial region, presenting as erythematous papules with sharp margins from the surrounding skin, gritty desquamation and dotted hyperpigmentations inside the lesion. Further dermoscopy and biopsy investigations confirmed a diagnosis of basal cell carcinoma. Nasal actinic keratosis was also noted. The patient was advised for discontinuing or substituting the HU therapy.CONCLUSION: We present this case to draw attention to the various cutaneous side effects that occur with perennial HU use and suggest an obligatory reference to a dermatological consult.

scholarly journals Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

2016 ◽  
Vol 8 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Lucija Kosi ◽  
Jelena Perić ◽  
Milica Pantović ◽  
Gorana Bijelić ◽  
Jelica Vukićević Sretenović ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Knee Arthroplasty ◽  
Skin Lesions ◽  
Direct Immunofluorescence ◽  
Topical Steroids ◽  
Cutaneous Lesions ◽  
Predisposing Factor ◽  
Dermatological Examination ◽  
The Right ◽  
Split Skin

Abstract Localized bullous pemphigoid is a rare variant of bullous pemphigoid, and its exact etiopathogenesis is yet to be elucidated. We present a case of a 74-year-old Caucasian male with a 3-month history of skin lesions that appeared 9 months after he underwent a knee arthroplasty. Dermatological examination showed several pruritic tense bullae on the right knee, localized around the surgical scar, as well as erosions covered with crusts. The diagnosis of localized bullous pemphigoid was confirmed by direct immunofluorescence test (conventional and split-skin). The patient was treated with potent topical steroids, which led to complete resolution of cutaneous lesions. We suppose that the occurrence of localized bullous pemphigoid in our patient may be explained by the concept of “immunocompromised district” in which one disease (surgery) caused an immunological alteration which is a predisposing factor for the development of secondary disease such as localized bullous pemphigoid.

Cutaneous Angiomatosis in a Young Dog

2005 ◽  
Vol 42 (3) ◽  
pp. 378-381 ◽  
Author(s):  
Y. Kim ◽  
S. Reinecke ◽  
D. E. Malarkey
Keyword(s):  
Blood Vessels ◽  
Skin Lesions ◽  
Punch Biopsy ◽  
Cutaneous Lesions ◽  
Mixed Breed ◽  
Skin Punch Biopsy ◽  
Surgical Preparation ◽  
Well Differentiated ◽  
The Right ◽  
Extensive Involvement

A 1-year-old, spayed, female, mixed-breed dog had two reddish-purple cutaneous lesions, one on the right dorsal antebrachium and the other on the right shoulder. The lesions consisted of approximately 13 x 3 cm and 15 x 10 cm, irregular, patchy regions of 0.5-3.0 cm, circular, sometimes raised, reddish-purple swellings resembling ecchymoses. The lesion on the antebrachium had been noticed since the dog was adopted at 6 months of age and appeared to have increased in size over an 11-week period, at which time skin punch biopsy revealed an infiltrative pattern of well-differentiated blood vessels leading to an interpretation that the lesion was a well-differentiated hemangiosarcoma. The second lesion was revealed when the dog had its fur shaved in that area during surgical preparation to excise the antebrachial lesion. No other skin lesions were found on the dog. Microscopically, there was a widely disseminated and infiltrative-like pattern of benign-appearing small blood vessels, which were throughout the superficial and deep dermis and subcutis. Although the disseminated nature suggested malignancy, the histologic appearance of well-differentiated small blood vessels and nonprogressive clinical features indicate that the lesions were benign. The dog has been followed for 6 years and to date has no evidence of progression of the antebrachial lesion or shoulder lesion. To the authors' knowledge, this is the first report of a congenital angiomatosis-like lesion in a young dog, with extensive involvement of the forelimb.

scholarly journals Keratoacanthoma of the Nasal Septum Secondary to Ranibizumab Use

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Jason E. Cohn ◽  
Hilary M. Caruso Sales ◽  
Giang Huong Nguyen ◽  
Harvey Spector ◽  
Kenneth Briskin
Keyword(s):  
Nasal Septum ◽  
Skin Lesions ◽  
Low Grade ◽  
Cutaneous Lesions ◽  
Epithelial Tumor ◽  
Vegf Inhibitor ◽  
Central Crater ◽  
Well Differentiated ◽  
The Right ◽  
Endothelial Growth Factor

Keratoacanthoma (KA) is a benign epithelial tumor that typically presents as a firm, cone-shaped, flesh-colored nodule with a central horn-filled crater. KA is considered to be a low-grade variant of squamous cell carcinoma (SCC). We report a rare case of a 72-year-old male who presented with a KA involving the nasal septum, possibly related to ranibizumab use. A flesh-colored lesion on the right anterior nasal septum lesion was visualized on examination. Histologic examination revealed a well-circumscribed, dome-shaped central crater filled with keratin, well-differentiated squamous epithelium with ground-glass cytoplasm with pushing margins, and intraepithelial microabscesses establishing the diagnosis of KA. KA of the nasal septum has only been reported once in the literature. This case is unusual because it normally presents on sun-exposed areas. Additionally, this patient was taking ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor for macular degeneration. Despite ranibizumab not being directly linked to precancerous and cancerous skin lesions, agents in this medication class have been. Although it is difficult to prove associations in this isolated case, the role of ranibizumab causing cutaneous lesions should be further investigated.

scholarly journals Cutaneous Side Effect of Hydroxurea in a Sickle Cell Anaemia Child-A Case Report

2019 ◽  
pp. 1-6
Author(s):  
A. O. Salako ◽  
S. O. Ogunmefun ◽  
O. W. Aworanti
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Sickle Cell ◽  
Side Effect ◽  
Low Dose ◽  
Sickle Cell Anaemia ◽  
Skin Lesions ◽  
Cutaneous Lesions ◽  
Care Givers ◽  
Cutaneous Side Effect

Background: Hydroxyurea (HU) has redefined the quality of life of children with sickle cell anaemia and their care givers. Despite the acclaimed benefits of HU, the drug could be associated with variable side effects affecting different systems in the human body, including the skin and integuments. The aim of this report is to raise the awareness about the less common side effects of HU. Case Report: A 5-year 8 months old homozygous sickle cell anaemia child presented with pruritic hyperpigmented lesions on the trunk, arms and the legs, four weeks after commencement of HU. HU was initially discontinued for two weeks and thereafter recommenced with a different brand but there was worsening skin lesions despite at a daily low dose of 10 mg/kg. The rashes eventually resolved with low dose once in 3 days HU therapy.  She had recurrent episodes of acute painful crisis; average of three [3] episodes per year warranted hospital admission prior to commencement, but with HU therapy, there has been significant improvement in the crisis. Discussion: Cutaneous lesions are uncommon side effect of hydroxyurea. This side effect is dependent on genetic predisposition and photosensitivity. However, with the established benefit of HU in the management sickle cell anaemia, it is important for the sickle cell experts to continue to monitor closely the children for both the common and rare side effects and to individualize therapy to ensure maximal benefit with minimal or no side effects.

scholarly journals A Rare Case of Ixazomib-Induced Cutaneous Necrotizing Vasculitis in a Patient with Relapsed Myeloma

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Heather Katz ◽  
Mina Shenouda ◽  
Deena Dahshan ◽  
George Sonnier ◽  
Yehuda Lebowicz
Keyword(s):  
Multiple Myeloma ◽  
Side Effects ◽  
Proteasome Inhibitor ◽  
Rare Case ◽  
Skin Lesions ◽  
Necrotizing Vasculitis ◽  
Cutaneous Side Effects ◽  
Relapsed Myeloma

Ixazomib is the only oral proteasome inhibitor used in relapsed/refractory myeloma. Cutaneous side effects due to ixazomib have been documented in the literature; however, cutaneous necrotizing vasculitis is extremely rare. We describe a case of a 74-year-old man with relapsed multiple myeloma who was started on ixazomib, lenalidomide, and dexamethasone. He developed several skin lesions that were biopsied and revealed cutaneous necrotizing vasculitis. Ixazomib was held with resolution of the vasculitic lesions and restarted with dexamethasone to 20 mg on the day of treatment and 20 mg dose the day after treatment.

Cutaneous genital complications of antiangiogenic agents

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e14568-e14568
Author(s):  
C. Mateus ◽  
C. Massard ◽  
G. Tomasic ◽  
J. Wechsler ◽  
V. Boige ◽  
...  
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Cell Cancer ◽  
Skin Lesions ◽  
Antiangiogenic Agents ◽  
Topical Steroids ◽  
Cancer Therapies ◽  
Cutaneous Side Effects ◽  
Treatment Interruptions ◽  
Vegfr Inhibitor

e14568 Background: Multikinase inhibitors targeting VEGFR, i.e. sorafenib and sunitinib are associated with various cutaneous side effects (1). Five cases of scrotal skin lesions were recently reported in male patients treated with sunitinib (2). Our observations of 8 patients presenting with genital inflammatory lesions during various anti-VEGFR therapies show that this side effect is linked to VEGFR blockade and not specifically to sunitinib and that it can also occur in women. Results: Six men and two women were seen for a genital eruption. They were treated with sorafenib (3 pts), sunitinib (5 pts), and a new pan-HER and VEGFR inhibitor (BMS 514, EVRI) (1 pt) for renal cell cancer (4 pts), hepatocellular carcinoma (2 pts), lung cancer (1 pt) and sarcoma (1 pt). Genital lesions occurred during the first six weeks of treatment. They appeared as a painful erythematous and squamous inguinal, intergluteal, and perianal rash rapidly involving all genital areas in 4 patients. Lesions became erosive in 3 cases. Four men presented more limited, pruriginous and lichenoid penile papules which were associated with a genital erythema for 3 of them. In one patient, penile inflammation resulted in a phimosis. One patient successively treated with sunitinib, sorafenib and once again with sunitinib experienced genital side effects with both agents. Patients taking sequential sunitinib treatment reported symptoms improvement during treatment interruptions and recurrences during the weeks on therapy. Microbiological samples were negative. Pathology of erythematous and squamous lesions showed a psoriasiform or a lichenoid aspect. Topical steroids were efficient for 5 patients but 3 patients had to interrupt anti-VEGF therapy because of their genital rash. Conclusions: Polymorphous genital inflammatory rash is a new skin side effect that can be associated with any cancer therapies targeting VEGFR in men and in women. Its frequency is unknown and probably underestimated because many patients might not report this side effect and its mechanism is still obscure. Physicians should be aware of this side effect and should inquire as to whether the patients have noticed such symptoms in order to avoid worsening thereof by symptomatic measures. No significant financial relationships to disclose.

scholarly journals Cutaneous Leishmaniasis – Dermoscopic Findings And Cryotherapy

Folia Medica ◽  
2015 ◽  
Vol 57 (1) ◽  
pp. 65-68 ◽  
Author(s):  
Hristo P. Dobrev ◽  
Desislava G. Nocheva ◽  
Dimitar Iv. Vuchev ◽  
Rumyana D. Grancharova
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Skin Lesions ◽  
Serological Tests ◽  
Non Invasive ◽  
Dermatological Examination ◽  
Invasive Method ◽  
Vascular Structures ◽  
Central Ulceration ◽  
The Right ◽  
Southern Greece

AbstractWe present a 60-year-old male patient who, three months after a holiday in Southern Greece, found a small ‘pimple’ on his back, which gradually got as big as a small walnut, the central part becoming ulcerated and scabby. Dermatological examination found an erythematous-to-livid nodular lesion on the right shoulder; it was 16 mm in diameter with central ulceration, covered with brownish crust which discharged pus-like secretion upon pressure. Microscope examination of Romanowsky-Giemsa stained lesion material detected amastigote forms ofLeishmania tropica. The culture investigation and serological tests for leishmaniasis were negative. Dermoscopy of the lesion found the following features: erythema, hyperkeratosis, central ulceration covered with brownish crust, “yellow tears-like” structures and “white starburst-like” patterns, and various vascular structures (including dotted vessels, comma-shaped vessels, hairpin- and glomerular-like vessels). The patient was diagnosed with cutaneous leishmaniasis and underwent four cryotherapy sessions every other week with excellent therapeutic results - complete resolution of infiltrate with subsequent gentle hypopigmented scarring. In conclusion, dermoscopy is an easily accessible non-invasive method which can be useful for the diagnosis of cutaneous leishmaniasis. Cryotherapy is the treatment of choice for single skin lesions.

Megakaryocytes and Platelets as the Main Cause for Vascular Events in Chronic Myeloproliferative Disorders

1996 ◽  
Vol 16 (02) ◽  
pp. 151-163 ◽  
Author(s):  
W. Schneider ◽  
A. Wehmeier
Keyword(s):  
Mononuclear Cells ◽  
Buoyant Density ◽  
Myeloproliferative Disorders ◽  
Term Therapy ◽  
Volume Distribution ◽  
Bleeding Tendency ◽  
Vascular Events ◽  
Chronic Myeloproliferative Disorders ◽  
Clonal Hematopoiesis ◽  
Induced Aggregation

SummaryMegakaryocytes are part of clonal hematopoiesis in chronic myeloproliferative disorders and are responsible for most of the clinical complications in this disease. About 30-40% of patients with polycythemia vera (PV) and essential thrombocythemia (ET) suffer from thrombotic complications, and microcirculatory disorders are common. Spontaneous bleeding mainly from the gastrointestinal tract is another complication that is especially prevalent in myelofibrosis and advanced stages of chronic myeloid leukemia.In vivo, the bone marrow is hypercellular and the concentration of megakaryocytes increased with characteristic morphological abnormalities. Megakaryocytes are enlarged and ploidy is increased in PV and ET but small mononuclear cells with decreased ploidy are a feature of CML. Despite spontaneous growth in cul-ture, megakaryocytes in chronic MPD are hypersensitive to added interleukin-3, interleukin-6 and GM-CSF.Platelets released from these megakaryocytes show abnormal morphology and ultrastructure, reflected in loss of storage granules and organelles, increased volume distribution and low buoyant density. Uptake, storage and secretion of platelet dense granule constituents is abnormal, and the plasma levels of platelet specific proteins which may also include growth factors for fibroblasts are elevated. At high platelet counts, spontaneous aggregation is observed, whereas agonist-induced aggregation in vitro with adrenaline, ADP and collagen is often defective. Platelet thromboxane generation may be stimulated, and production along the lipoxygenase pathway is decreased. Abnormalities of glycoprotein receptors and decreased fibrinogen binding have been reported but their clinical significance is uncertain. Several observations suggest that not only receptor defects but ineffective intracellular signalling may be responsible for platelet function abnormalities.No single underlying defect has been discovered that could explain this variety of pathological findings. Moreover, a combination of intrinsic megakaryocyte abnormalities and increased susceptibility of platelets to activation makes it difficult to differentiate secondary phenomena from effects of clonal hematopoiesis. How-ever, there are some clinical guidelines for therapy.Most elderly patients will be treated with cytoreductive therapy. Alkylating drugs and 32P have been shown to be leukemogenic, but even hydroxyurea may have a 10% incidence of leukemia induction after long-term therapy. Therapy with platelet-inhibitory drugs is often not sufficient to control thrombosis, and may aggravate a bleeding tendency, so that younger patients with PV and ET are increasingly treated with anagrelide or interferon alpha (A-IFN). Anagrelide is a quinazolin derivative that specifically inhibits megakaryocytopoiesis, while A-IFN may suppress clonal hematopoiesis by an unknown mechanism.

Renal Infarction and Pulmonary Embolism in Patient with Myelodysplastic

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Mounia Bendari ◽  
Nouama Bouanani ◽  
Mohamed Amine Khalfaoui ◽  
Maryam Ahnach ◽  
Aziza Laaraj ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Myeloproliferative Neoplasms ◽  
Bone Biopsy ◽  
Bone Marrow Aspiration ◽  
Myeloproliferative Disorders ◽  
Acute Onset ◽  
International Prognostic Scoring System ◽  
Renal Infarction ◽  
The Right ◽  
Enhanced Computed Tomography

The myelodysplastic syndrome-myeloproliferative neoplasms (MDS/MPNs) are defined by a group of heterogeneous hematological malignancies resulting from stem cell−driven clonal growth of pathological hematopoietic progenitors and ineffective hematopoiesis, they are characterized concomitant myelodysplastic and myeloproliferative signs. Myelodysplastic/myeloproliferative disorders have been considered to have a higher risk of thrombus formation.We report a rare case about a 64 years old Moroccan woman, experienced renal infarction (RI) associated with pulmonary embolism as a complication of a myelodysplastic/myeloproliferative disorder.The patient complained of acute-onset severe left flank pain, a contrast-enhanced computed tomography (CT) of the chest and abdomen revealed RI by a large wedge-shaped defect in the right kidney with pulmonary embolism.Biological exam showed deep anemia, the bone marrow aspiration found myelodysplasia.the bone biopsy showed signs of myeloproliferatif disease. The karyotype was normal, BCR-ABL, JAK2, CALR mutations were absents, and MPL mutation was positive. The International Prognostic Scoring System (IPSS-R) was 0, and the patient was included to the low risk group.Anticoagulation therapy was initiated with heparin to treat RI and pulmonary embolism. Three months later, pulmonary embolism had resolved without the appearance of additional peripheral infarction.This case emphasizes the need to consider myelodysplastic/myeloproliferative disorders as a cause of infraction renal and pulmonary embolism.

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