COVID-19 Related Acro-Ischemic Neuropathic-like Painful Lesions in Pediatric Patients: A Case Seriese

Background: A variety of skin manifestations have been associated with COVID-19 infection. Acral lesions on hands and feet, closely resembling chilblains, have been reported in association with COVID-19, which are nonspecific. These acro-ischemic painful lesions have been described mainly in asymptomatic and mildly symptomatic pediatric COVID-19 positive patients, without a precise pathogenetic mechanism.COVID-19-induced chilblains may portend an indolent course and a good outcome. In young patients, the IFN-1 response induces microangiopathic changes and produces a chilblain lupus erythematosus-like eruption with vasculitic neuropathic pain features. Objectives: This paper presented a case series of pediatric patients with COVID-19-related skin lesions and neuropathic-like pain. Methods: Clinical outcomes were collected from 11 patients diagnosed with painful erythematous skin lesions with neuropathic-like pain and positive IgG for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: It is a mildly symptomatic condition not related to severe pain rates, and it is treated with paracetamol due to the transitory nature of the problem, which provides good results. Conclusions: A particular point of interest is skin lesion manifestation as a further indirect sign of SARS-CoV-2 infection. Due to the initial manifestation of chilblains in pauci-symptomatic pediatric patients, they need to be immediately tested and isolated. Chilblains can be considered a clinical clue to suspect SARS-CoV-2 infection and help in early diagnosis, patient triage, and infection control.

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766. Everything Old is New Again-A Case Series of New World Leishmaniasis in African Children in Portland, Maine

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.956 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S428-S428

Author(s):

Jennifer Jubulis ◽

Amanda Goddard ◽

Elizabeth Seiverling ◽

Marc Kimball ◽

Carol A McCarthy

Keyword(s):

Latin America ◽

Cutaneous Leishmaniasis ◽

New World ◽

Pediatric Patients ◽

Data Extraction ◽

Clinical Manifestations ◽

Case Series ◽

Surgical Excision ◽

Skin Lesions ◽

Travel History

Abstract Background Leishmaniasis has many clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis is found primarily in Africa and Asia, and is associated with visceral disease, while new world disease, seen primarily in Latin America, is more commonly mucocutaneous. We present a case series of pediatric African patients with New World cutaneous leishmaniasis (NWCL). Methods Data extraction was performed via chart review, analyzing travel history, clinical presentation, diagnosis, and management in children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal CDC for identification by PCR and culture. Results Five cases of NWCL were diagnosed in pediatric patients in Maine from November 2018 through February 2020. Median age of patients was 10 years (range 1.5-15 years). Four cases (80%) occurred in children from Angola or Democratic Republic of Congo, arriving in Maine via Central/South America, with one case in a child from Rwanda who arrived in Maine via Texas. Three patients had multiple skin lesions and two had isolated facial lesions. Leishmaniasis was not initially suspected resulting in median time to diagnosis of 5 months (range 1-7 months). Four patients were initially treated with antibacterials for cellulitis and one was treated with griseofulvin. After no improvement, patients underwent biopsy with 2 patients diagnosed with L panamensis, 1 with L braziliensis, 1 with mixed infection (L panamensis and L mexicana), and 1 with Leishmania species only. One patient was managed with surgical excision, 3 with ketoconazole, and 1 was observed off therapy. Four patients were referred to otolaryngology. All continue to be followed in infectious disease clinic. Conclusion We present five cases of new world cutaneous leishmaniasis in African pediatric patients arriving to Maine through Latin America or Texas. Patients were diagnosed with cellulitis, tinea corporis or atopic dermatitis initially, underscoring importance of high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with illness not congruent with country of origin. Optimal therapy remains unclear. Disclosures All Authors: No reported disclosures

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Crusted scabies in systemic lupus erythematosus: More than a mite contagious case

Dermatology Reports ◽

10.4081/dr.2019.8085 ◽

2019 ◽

Author(s):

Eva Lydiawati ◽

Indropo Agusni ◽

Dwi Murtiastutik ◽

Evy Ervianti ◽

S. Sawitri ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Hematologic Malignancy ◽

Connective Tissue Diseases ◽

Skin Lesions ◽

Clinical Aspects ◽

Systemic Lupus ◽

Severe Condition ◽

Hands And Feet ◽

Crusted Scabies

Crusted scabies is characterized by hyperkeratosis and crusting of the skin due to the profuse proliferation of mites. It is resulting from an altered host response to the infestation. There are some various cutaneous and immunologic diseases that have been described to predispose to crusted scabies. It is typically associated with congenital and acquired immunocompromised conditions including human immunodeficiency virus (HIV), hematologic malignancy, and connective tissue diseases, including systemic lupus erythematosus (SLE). Adults with crusted scabies may lack the characteristic rash or itching. Sites of presentation have been reported on the scalp, face, neck, extremities, trunk, hands, and feet. The severe condition of SLE and super infection of scabies in the immunocompromised state highlight the need for appropriate care to avoid further morbidity. This case report aims to describe the characteristic of skin lesions and clinical aspects of crusted scabies in SLE. A 28-year-old man was diagnosed with crusted scabies who was treated more intensely with permethrin 5% cream that was combined with 2-4 ointment. There was clinical improvement and no side effect found during this study.

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The combined role of clinical, reflectance confocal microscopy and dermoscopy applied to chronic discoid cutaneous lupus and subacutus lupus erythematosus: A case series and literature review

Lupus ◽

10.1177/0961203320958141 ◽

2020 ◽

Vol 30 (1) ◽

pp. 125-133

Author(s):

Sara Mazzilli ◽

Laura Vollono ◽

Laura Diluvio ◽

Elisabetta Botti ◽

Gaetana Costanza ◽

...

Keyword(s):

Confocal Microscopy ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Clinical Manifestations ◽

Case Series ◽

Skin Lesions ◽

Reflectance Confocal Microscopy ◽

Discoid Lupus Erythematosus ◽

Cutaneous Lupus

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 μm, vertical ∼5 μm), en face tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.

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Spectrum of cutaneous manifestations in lupus erythematous -a dermatologist perspective

Health Renaissance ◽

10.3126/hren.v10i1.5999 ◽

1970 ◽

Vol 10 (1) ◽

pp. 8-11 ◽

Cited By ~ 2

Author(s):

S Bhattarai ◽

S Agrawal ◽

A Rijal ◽

SK Sharma ◽

SS Dhakal

Keyword(s):

Skin Lesion ◽

Lupus Erythematosus ◽

Skin Disease ◽

Case Series ◽

Skin Lesions ◽

Cutaneous Manifestations ◽

Malar Rash ◽

Skin Changes ◽

Nail Changes ◽

Eye Involvement

Background: The cutaneous manifestations of lupus erythematosus (LE) specific skin disease consists of acute cutaneous LE (ACLE), Subacute cutaneous (SCLE) and Chronic cutaneous (CCLE). Objective: To evaluate the spectrum of cutaneous manifestation in patients of LE. Methods: A case series of 41 clinically diagnosed cases of LE attending the outpatient department of Dermatology, BPKIHS were evaluated for the specific and non-specific skin changes. Results: All the patients enrolled in the study were female,with the age ranging from 14-64 years. ACLE was detected in 22/41(78.04%). Malar rash was the frequent skin lesion. CCLE was seen in 6/41 (14.63%) patients with classical discoid lesions (localized and generalized) in 4/6(66.66%) and 2/6(33.33%) respectively. Non specific skin lesions were found in 30/ 41(73.17%) of patients. Mucosal ulcers were seen in 23/41(56.09%), Facial telangiectasias 20/41(48.78%), Raynaunds phenomena 22/41(53.65%), Chronic urticaria 9/41(21.95%), Nail changes 12/41(29.26%) and non scarring alopecia was seen in 6/41(14.63%) patients. Eye involvement was seen in 3/41(7.3%), cutaneous vasculitis in 5/41(12.19%) and scaring alopecia in 3/41(7.3%) patients. Conclusion: The cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease. DOI: http://dx.doi.org/10.3126/hren.v10i1.5999 HREN 2012; 10(1): 8-11

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Bullous Cutaneous Larva Migrans And Generalized Cutaneous Larva Migrans: A Rare Clinical Manifestation

The Open Dermatology Journal ◽

10.2174/1874372202014010001 ◽

2020 ◽

Vol 14 (1) ◽

pp. 1-3

Author(s):

Hendra Gunawan ◽

Icha Rachmawati Kusmayadi ◽

Syawalika Ulya Isneny

Keyword(s):

Skin Lesion ◽

Case Series ◽

Skin Lesions ◽

The Other ◽

Larva Migrans ◽

Cutaneous Larva Migrans ◽

Clinical Variants ◽

Erythematous Skin ◽

Generalized Distribution ◽

Effective Result

Background: The skin lesions of Cutaneous Larva Migrans (CLM) commonly manifests as single, linear, irregular, serpiginous raised erythematous track, but the other clinical variants exist. This case series aimed to report one case of a vesiculobullous lesion in CLM and one case of CLM with generalized distribution serpiginous erythematous skin lesion. Objectives: We report one case of a vesiculobullous lesion in CLM and one case of CLM with generalized distribution serpiginous erythematous skin lesion. Conclusion: There were CLM with vesiculobullous lesions and also with generalized distribution of skin lesion. The pathogenesis of this condition is still unknown. In both cases, albendazole 400 mg per day for 3 and 5 days gave an effective result.

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Comparison of Oral Versus Intravenous Fluorescein Widefield Angiography in Ambulatory Pediatric Patients

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417705256 ◽

2017 ◽

Vol 1 (3) ◽

pp. 191-196 ◽

Cited By ~ 1

Author(s):

Niranjan Manoharan ◽

Paula E. Pecen ◽

Amy M. Cherof ◽

Scott C. N. Oliver ◽

Alan G. Palestine

Keyword(s):

Image Quality ◽

Fluorescein Angiography ◽

Clinical Utility ◽

Statistical Difference ◽

Pediatric Patients ◽

Young Patients ◽

Case Series ◽

Retinal Disease ◽

Tertiary Referral Center ◽

Significant Difference

Purpose: To compare the image quality and clinical utility of oral versus intravenous (IV) dye administration for fluorescein widefield angiography in pediatric patients. Design: Retrospective observational case series. Methods: Retrospective chart review of pediatric patients who underwent noncontact widefield fluorescein angiography (FA; Optos plc) at a single tertiary referral center (UCHealth Eye Center, Aurora, Colorado) between January 1, 2014, and May 31, 2016. Fluorescein angiography images were de-identified, and FA timing was hidden. A masked retinal specialist graded FA image quality and clinical utility. Results: A total of 103 FAs (62 IV and 41 oral) in 82 patients were reviewed. Oral fluorescein administration was more common in young patients (mean age: 8.1 years) compared to IV administration (mean age: 14.5 years; P < .001). Multivariate analysis with adjustment for age showed no statistical difference between oral and IV FA image quality ( P = .59). There was a high incidence of excellent clinical utility in both oral and IV FAs, with no statistically significant difference between the 2 methods. Subgroup analysis of familial exudative vitreoretinopathy, Coats’ disease, choroidal neovascular membrane, and uveitis also showed no statistical difference in clinical utility between IV and oral FA. Conclusion: Oral widefield FA had excellent clinical utility and comparable image quality to IV fluorescein widefield angiography (with adjustment for age). For the evaluation of pediatric retinal disease, oral FA can be a clinically useful diagnostic tool in pediatric patients who are intolerant to IV access, which may avoid some need for FA under general anesthesia.

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Nonuremiccalciphylaxis - A Systematic Review

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i39b32192 ◽

2021 ◽

pp. 158-170

Author(s):

Abdulmajeed Albalawi ◽

Ibrahim Dighriri ◽

Ahad Alsharif ◽

Emtenan Basahl ◽

Fatimah Alrajab ◽

...

Keyword(s):

Renal Transplantation ◽

Liver Disease ◽

Lupus Erythematosus ◽

Case Reports ◽

Sodium Thiosulfate ◽

Case Series ◽

Skin Lesions ◽

Vitamin D Supplementation ◽

Obese Women ◽

Systematic Lupus Erythematosus

Background: Calciphylaxis, also known as calcific uremic arteriolopathy, is a well-described condition in renal transplant and end-stage kidney disease (ESKD) patients; however, little is known about calciphylaxis induced by nonuremic causes. This systematic study aimed to determine the causes, prognosis of nonuremic calciphylaxis, clinical features and laboratory abnormalities. Patients and methods:A comprehensive review of the literature for nonuremic calciphylaxis case reports and case series published between 2016 and 2021 was performed. Cases included satisfied the criteria for a histological diagnosis of nonuremic calciphylaxis in the absence of ESKD, renal transplantation, or acute kidney injury requiring renal replacement therapy. Results: The authors identified 53 cases of nonuremic calciphylaxis (83.14 % women, Caucasian 13.33 %, aged 25 to 83 years). The most prevalent documented associations were of patients having multiple conditions 18 (33.33 %), warfarin-induced (7.4 %), calcium and Vitamin D supplementation (3.7 %), primary hyperparathyroidism (3.7 %), liver disease (3.7 %), Acenocumarol use (3.7 %), Systematic lupus erythematosus (3.7 %), alcoholic cirrhosis (3.7 %), respectively. Conclusion:When investigating skin lesions in patients with sensitive conditions, calciphylaxis must often be addressed in the absence of ESKD or renal transplantation. Obese women with various underlying illnesses such as alcohol intake, smoking, diabetes, liver disease, and so on are more likely to develop nonuremic calciphylaxis (NUC).Calciphylaxis is linked with high mortality; however, sodium thiosulfate (ST) has made clear progress in terms of treatment, yet there are still areas that need to be addressed to describe the effectiveness of ST.

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Non-lupus full-house nephropathy: a case series

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0242 ◽

2020 ◽

Author(s):

Márcia de Oliveira Silva ◽

Patrick Vanttinny Vieira de Oliveira ◽

Pedro Henrique Cavalcante Vale ◽

Rinadja de Melo Cunha ◽

Joyce Santos Lages ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Inflammatory Disease ◽

Lupus Erythematosus ◽

Case Series ◽

Kidney Injury ◽

Systemic Lupus ◽

Initial Manifestation ◽

Histological Pattern ◽

Autoimmune Inflammatory Disease

Abstract Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.

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Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus

Case Reports in Rheumatology ◽

10.1155/2015/373201 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Reshma M. Khan ◽

Rajaie Namas ◽

Sachin Parikh ◽

Bernard Rubin

Keyword(s):

Lupus Erythematosus ◽

Early Recognition ◽

Connective Tissue Diseases ◽

Young Patients ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

African American Female ◽

Systemic Lupus ◽

Initial Manifestation ◽

History Of

We present a case of a 21-year-old African-American female with no significant medical history, who presented to the emergency department with a one-week history of blurry and double vision. Ophthalmology evaluation revealed bilateral retinal artery occlusion. Further workup with imaging of the brain was consistent with an ischemic stroke. Hereditary hypercoagulable workup was unremarkable and initial testing for antiphospholipid syndrome was positive. She underwent transesophageal echocardiogram (TEE), which showed severe mitral regurgitation and thickening of mitral valve leaflets consistent with Libman-Sacks endocarditis. Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody. She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies). This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

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Neonatal lupus erythematosus presenting with rash, thrombocytopenia compounded by cytomegalovirus colonisation: a diagnostic dilemma

BMJ Case Reports ◽

10.1136/bcr-2019-233873 ◽

2020 ◽

Vol 13 (6) ◽

pp. e233873

Author(s):

Gopal Agrawal ◽

Bincy Varghese ◽

Manish Balde ◽

Sanjay Wazir

Keyword(s):

Lupus Erythematosus ◽

Organ Damage ◽

Skin Lesions ◽

Maternal Serum ◽

Cmv Infection ◽

Neonatal Lupus ◽

Cutaneous Lesions ◽

Diagnostic Dilemma ◽

Neonatal Lupus Erythematosus ◽

Erythematous Skin

Neonatal lupus erythematosus (NLE) should be considered when a newborn develops atrioventricular heart block along with the presence of autoantibodies to Sjogren’s syndrome autoantigens in the maternal serum. NLE can also present with features such as cutaneous lesions, hepatic dysfunction or haematological abnormalities. Differential diagnosis usually includes congenital infections as there is a significant overlap of symptoms with NLE. We report a case of NLE who had multiorgan involvement with macular erythematous skin lesions present at birth, and on investigation was found to have cytomegalovirus (CMV) infection. The diagnostic dilemma was whether to consider this infection as symptomatic or just colonisation. In the infant described, the absence of end organ damage specific to CMV infection (hearing loss, intracranial calcifications, retinitis, brain involvement) made a diagnosis of symptomatic CMV unlikely.

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