Mixed Purpuric and Maculopapular Lesions in a Patient with COVID-19: A Case Report

Introduction: The coronavirus disease of 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 is a global pandemic that expresses itself with a wide variety of presenting symptoms in patients. There is a paucity of literature describing the dermatologic manifestations of the virus, particularly in the United States. Case Report: Here we present a case of COVID-19 that manifested with a purpuric rash on the lower extremities and a maculopapular eruption on the abdomen in a patient in acute diabetic ketoacidosis and normal platelet count. Discussion: The reported presenting symptoms of patients with COVID-19 vary greatly. This is the first documented case of COVID-19 presenting with mixed cutaneous manifestations of a purpuric as well as maculopapular rash. Conclusion: The cutaneous lesions associated with the COVID-19 infection may mimic or appear similar to other well-known conditions. We illustrate a case of COVID-19 infection presenting with purpuric rash on the lower extremities and a maculopapular rash on the abdomen.

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A Case Report of Hereditary Hemorrhagic Telangiectasia Diagnosed in a Podiatric Medical Patient

Journal of the American Podiatric Medical Association ◽

10.7547/15-144 ◽

2017 ◽

Vol 107 (2) ◽

pp. 155-157

Author(s):

Kunal Amin ◽

Douglas Mckay

Keyword(s):

Case Report ◽

Hereditary Hemorrhagic Telangiectasia ◽

Arteriovenous Malformations ◽

Case Reports ◽

Lower Extremities ◽

Medical Patient ◽

Cutaneous Manifestations ◽

Almost All ◽

Work Up

Hereditary hemorrhagic telangiectasia (HHT), which is also known as Osler-Weber-Rendu syndrome, is a group of related disorders characterized by the development of arteriovenous malformations. These malformations occur in almost all organs but predominantly in the skin, intestines, liver, lungs, and brain. This is a case report of a patient with cutaneous manifestations of HHT in the lower extremities as diagnosed by his podiatric physician. To our knowledge, the literature does not present any case reports in which cutaneous manifestations of the lower extremities followed by a further work-up allowed a diagnosis of HHT.

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Cutaneous manifestations in a patient with temporarily associated pediatric multisystemic inflammatory syndrome with COVID-19: case report

Residência Pediátrica ◽

10.25060/residpediatr-2021.v11n1-350 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alessandra Oliveira ◽

Kamilla Pádua ◽

Maria Carolina Alves ◽

Glaucia Silva ◽

Fernando Paula ◽

...

Keyword(s):

Case Report ◽

Reference Value ◽

Maculopapular Rash ◽

Cutaneous Manifestations ◽

The Face ◽

Hands And Feet ◽

Inflammatory Syndrome ◽

Positive Results ◽

Infectious Condition

OBJECTIVES: To describe the cutaneous manifestations presented by a patient with pediatric multisystemic inflammatory syndrome (MIS-C) temporarily associated with SARS-CoV-2. METHODS: Female patient, 10 years old, presenting arthralgia in the wrists and ankles, edema in hands and feet, persistent fever, appearance of diffuse, and itchy maculopapular rash associated with odynophagia and productive cough. Evolution of the rash to violaceous lesions on the face, trunk and limbs (upper and lower), in addition to the appearance of vesicles on the face, within 48 hours. CBC suggestive of an infectious condition, with CRP 307mg/L (insert reference value) and ESR 61mm. RT-PCR for SARS-CoV-2 positive. RESULTS: Diagnosis of pediatric multisystemic inflammatory syndrome temporarily associated with SARS-CoV2. Transferred to ICU for monitoring and intravenous human immunoglobulin initiated. Good evolution, with the disappearance of injuries and discharge with outpatient follow-up. CONCLUSION: MIS-C has several dermatological manifestations and pediatricians must be attentive to the diagnosis, not limited to a specific presentation. In this case report, the importance of referral to tertiary referral centers for better case management and timely recognition of the syndrome in these patients is emphasized.

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Presentation with Personality changes and Tinnitus to a Vascular Intervention: Rare case of Carotid Body Paraganglioma

Journal of Medical Research and Innovation ◽

10.15419/jmri.109 ◽

2018 ◽

pp. e000109

Author(s):

Ahsan Zil-E-Ali ◽

Zubair Ahmed ◽

Amber Ehsan Faquih ◽

Muhammad Ishaq ◽

Muhammad Aadil

Keyword(s):

Case Report ◽

Carotid Body ◽

Neuroendocrine Neoplasms ◽

Vascular Surgeon ◽

Vascular Intervention ◽

Presenting Symptoms ◽

Personality Changes ◽

Tender Mass ◽

Carotid Body Tumors ◽

General Physical

Background: Carotid body paragangliomas are rare neuroendocrine neoplasms of chromaffin negative glomus cells. This case report explains an atypical case with unusual presentation and treatment. Case Report: A healthy smoker technician by profession was brought to the emergency room (ER) with coprolalia. The general physical exam did not reveal any information. His history revealed unilateral tinnitus and odynophagia leading to a consultation by the neurologist with head imaging. Acoustic neuroma was ruled out and the caregiver was asked to elaborate the events mentioned in the history and a psychiatric examination was done. The personality changes were evaluated by the psychiatrist that showed overlapping of delirium and depression. The patient was further examined by a vascular surgeon. After careful revisiting of the history, examination and indication of tender mass in the neck by the patient's vascular surgeon, the diagnosis of carotid body paraganglioma was made which was followed by surgical resection for treatment. Conclusion: Carotid Body Paragangliomas are very vascular structures and their manipulation in a surgery setting requires expertise. This case presented with personality changes and tinnitus, a very less likely event to occur in a carotid body tumor. The present care report, thus adds on to the literature of carotid body tumors and its presenting symptoms.

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Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.1.3.8 ◽

2017 ◽

Vol 1 (3) ◽

pp. 156-160

Author(s):

Jacqueline Watchmaker ◽

Sean Legler ◽

Dianne De Leon ◽

Vanessa Pascoe ◽

Robert Stavert

Keyword(s):

United States ◽

Case Series ◽

The United States ◽

Screening Tools ◽

Dermatology Department ◽

Cutaneous Manifestations ◽

Serologic Testing ◽

Patient Reported ◽

History Of ◽

Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas. Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included. Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review. Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion: Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

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A Case Report on Glanzmann’s Thrombasthenia: A Rare Platelet Function Disorder

Haematology Journal of Bangladesh ◽

10.37545/haematoljbd201818 ◽

2018 ◽

Vol 2 (02) ◽

pp. 59-60

Author(s):

Farida Yasmin ◽

Md. Anwarul Karim ◽

Chowdhury Yakub Jamal ◽

Mamtaz Begum ◽

Ferdousi Begum

Keyword(s):

Case Report ◽

Platelet Function ◽

The Body ◽

Presenting Symptoms ◽

Glanzmann’S Thrombasthenia ◽

Glanzmann's Thrombasthenia ◽

Platelet Function Disorders ◽

Recurrent Epistaxis ◽

Severe Epistaxis ◽

History Of

Epistaxis in children is one of the important presenting symptoms for attending emergency department in paediatric patients. Recurrent epistaxis is common in children. Although epistaxis in children usually occurred due to different benign conditions, it may be one of the important presenting symptoms of some inherited bleeding disorder. Whereas most bleeding disorders can be diagnosed through different standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. In this article we describe one case report of platelet function disorders on Glanzmann’s thrombasthenia (GT). Our patient was a 10-year old girl who presented to us with history of recurrent severe epistaxis. She had a bruise on her abdomen and many scattered petechiae in different parts of the body. Her previous investigations revealed no demonstrable haemostatic anomalies. After performing platelet aggregation test, she was diagnosed as GT.

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Complications of drowning: A case report

Paediatrica Indonesiana ◽

10.14238/pi59.5.2019.284-8 ◽

2019 ◽

Vol 59 (5) ◽

pp. 284-8

Author(s):

Felicia Anita Wijaya ◽

I Gde Doddy Kurnia Indrawan

Keyword(s):

United States ◽

Case Report ◽

Brain Damage ◽

The United States ◽

Accidental Death ◽

Common Cause ◽

Death By Drowning

Unintentional drowning is the sixth most common cause of accidental death, accounting for 4,086 deaths (1.4 per 100,000) in the United States in 2007.1 In children, drowning is the second leading cause of injury-related death, and those aged 1–3 years have the highest rate of drowning.2 More than 1,400 pediatric drownings were reported in the United States in 2008.3 Many drowning deaths are due to lack of supervision in the bathtub, unprotected access to a pool, or lack of swimming skills.3 For every death by drowning, six children are hospitalized for drowning, and up to 10% of survivors experience severe brain damage.2

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Paliperidone induced neutropenia in first episode psychosis: a case report

BMC Psychiatry ◽

10.1186/s12888-021-03073-w ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Natalie Martos ◽

William Hall ◽

Alicia Marhefka ◽

Thomas W. Sedlak ◽

Frederick C. Nucifora

Keyword(s):

Adverse Effect ◽

Case Report ◽

The United States ◽

First Episode Psychosis ◽

Potential Adverse Effect ◽

Severe Neutropenia ◽

First Episode ◽

Antipsychotic Medications ◽

Increased Risk ◽

Episode Psychosis

Abstract Background Neutropenia, a decrease in total number of neutrophils below 1500/mm3 and particularly severe neutropenia, defined as neutrophils less than 500/mm3, is a potential adverse effect of antipsychotic medications that can lead to increased risk of infections and death. However, much of the attention on the potential adverse effect is centered exclusively on clozapine, which remains the only antipsychotic medication in the United States requiring standardized monitoring of blood work. We demonstrate here that paliperidone can also cause neutropenia and therefore clinicians should be aware of this possibility especially during initiation of treatment. Case presentation The following report presents the case of a 23-year-old African American male with first episode psychosis who developed neutropenia after initiation of paliperidone. Neutropenia resolved after discontinuation of paliperidone and initiation of an alternative antipsychotic, haloperidol. Conclusions This case report demonstrates an example of paliperidone induced neutropenia which resolved with a switch to haloperidol. We conclude that when initiating paliperidone, clinicians should be more aware of the risk of neutropenia. Moreover, neutropenia may be a more common and overlooked issue in patients on antipsychotic medications other than clozapine and increased awareness of comparative risk across antipsychotics could help direct treatment.

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Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

SAGE Open Medical Case Reports ◽

10.1177/2050313x21997194 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199719

Author(s):

Juan Carlos Palomo-Pérez ◽

Maria Elisa Vega-Memije ◽

David Aguilar-Blancas ◽

Erik González-Martínez ◽

Lucia Rangel-Gamboa

Keyword(s):

Respiratory Symptoms ◽

Case Series ◽

Signs And Symptoms ◽

Skin Lesions ◽

World Health ◽

Medical Community ◽

Atypical Pneumonia ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

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354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.549 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S246-S246

Author(s):

Kevin O’Laughlin ◽

Jennifer R Cope ◽

Zachary A Marsh

Keyword(s):

United States ◽

Case Reports ◽

The United States ◽

Severe Illness ◽

People Living With Hiv ◽

Cutaneous Lesions ◽

Free Living ◽

Organ Systems ◽

Free Living Ameba ◽

Soil And Water

Abstract Background Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States. Methods CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies. Results We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively. Conclusion Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment. Disclosures All Authors: No reported disclosures

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Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report

BMC Urology ◽

10.1186/s12894-021-00855-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matthew A. Anderson ◽

Tracey Ying ◽

Kate Wyburn ◽

Peter M. Ferguson ◽

Madeleine C. Strach ◽

...

Keyword(s):

Kaposi's Sarcoma ◽

Single Agent ◽

Lower Extremities ◽

Kaposi’S Sarcoma ◽

The Body ◽

Cutaneous Lesions ◽

Rare Presentation ◽

Post Transplant ◽

Transplant Patients ◽

Disseminated Disease

Abstract Background Kaposi’s sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable. Case presentation A 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment. Conclusion This case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi’s sarcoma.

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