Erosive acute colitis associated with intestinal spirochetosis

Background Although usually believed to be harmless, intestinal spirochetosis may active erosive colitis associated with intestinal spirochetosis that may mimic idiopathic chronic inflammatory bowel disease. Case presentation. A 49-year-old homosexual male patient sought medical assistance due to asthenia, rectal bleeding, tenesmus, and diarrhea for one month. He had been using corticosteroids for nine months to treat sciatic nerve pain. Colonoscopy showed rectum and distal sigmoid with diffuse erythema with many surface erosions. Rectal biopsy showed inflammatory changes including chronic changes such as architectural distortion and basal plasmacytosis, and active inflammation including crypt microabscesses. In all large bowel sample, dense colonization of intestinal spirochetosis was observed. Patient also had a positive PCR testing for Chlamydia trachomatis. The patient was treated with metronidazole for 14 days, ciprofloxacin for 14 days and azithromycin (single dose). Symptoms improved and the patient is asymptomatic after two months of follow-up. Conclusion In some high-risk groups, intestinal spirochetosis may cause colonic manifestations with overlapping features with intestinal bowel diseases. Awareness of this association is importance since proper antibiotic therapy against Brachyspira (metronidazole) is highly effective. Coinfection with other sexually transmitted infections is common and proper treatment is required.

Pattern of skin disorders in hilly district of Pauri Garhwal with their dermoscopic findings: an epidemiological study

<p><strong>Background:</strong> The pattern of skin disorders is largely affected by climate, geography, occupation, socio-economic status, nutrition, genetics and habits of the community. Nowadays, dermoscope is being increasingly used as a non-invasive aid in diagnosis of various skin disorders. Objective of the study was to study the etiology, distribution and dermoscopic findings of various skin disorders in 5 remote villages of hilly district of Pauri Garhwal, Uttarakhand over a period of 1 month (April 2021).</p><p><strong>Methods:</strong> The study was conducted as a weekly OPD in 5 villages of Hilly district of Pauri over a period of 1 month with free consultation and medications. Details of patients, their complaints, clinical diagnosis and dermoscopic findings were recorded.</p><p><strong>Results:</strong> Overall, allergic/irritant dermatitis were found to be most common (30%) followed by infective disorders (27.25%), photodermatitis (20.2%), inflammatory disorders (4.3%), miscellaneous disorders (LSC, stasis dermatitis, pityriasis rosea, others) up to 9.5% and viral exanthematous rash possibly COVID-19 associated in 8.62% cases. Most common dermoscopic finding of allergic/irritant dermatitis were red dots (92%), in photodermatitis were brown dots (82.09%) and viral exanthem was diffuse erythema (100%).</p><p><strong>Conclusions:</strong> Hilly areas contribute to a large burden of dermatological disorders which needs to be catered too. With the help of this knowledge, we can plan appropriate range of health services to meet the patient’s needs in hilly regions.</p>

Occipital Fibrosing Alopecia in a Young Male: A Case Report

<b><i>Introduction:</i></b> Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia with 3 recognized clinical variants. Lately, LPP clinical spectrum has expanded with new and overlapping clinical variants. First considered as a subtype of LPP affecting postmenopausal women, the increasing worldwide incidence of FFA including atypical lesions in young female and male suggests a different pathomechanism for this disease. Although LPP-spectrum disorders may share similar histopathological findings, clinical features and prognosis are different. <b><i>Case Report:</i></b> A 26-year-old Caucasian male presented with occipital scarring alopecia and pruritus for the last 6 months. The patient had been treated for an associated androgenetic alopecia and superficial recurrent scalp folliculitis over the vertex scalp for the last 5 years. Trichoscopy of the occipital scalp showed mild diffuse erythema, moderate peripilar scaling, and absence of follicular openings, suggestive of a scarring process. The patient underwent an occipital scalp biopsy that confirmed the diagnosis of a LPP-spectrum disorder. <b><i>Discussion/Conclusion:</i></b> Both LPP and FFA mostly affect the anterior-mid scalp of females. However, recent reports on FFA also in premenopausal women and men should make physicians aware of atypical features of this disease and unusual clinical presentation.

Epigenetics in Inflammatory Breast Cancer: Biological Features and Therapeutic Perspectives

Evidence has emerged implicating epigenetic alterations in inflammatory breast cancer (IBC) origin and progression. IBC is a rare and rapidly progressing disease, considered the most aggressive type of breast cancer (BC). At clinical presentation, IBC is characterized by diffuse erythema, skin ridging, dermal lymphatic invasion, and peau d’orange aspect. The widespread distribution of the tumor as emboli throughout the breast and intra- and intertumor heterogeneity is associated with its poor prognosis. In this review, we highlighted studies documenting the essential roles of epigenetic mechanisms in remodeling chromatin and modulating gene expression during mammary gland differentiation and the development of IBC. Compiling evidence has emerged implicating epigenetic changes as a common denominator linking the main risk factors (socioeconomic status, environmental exposure to endocrine disruptors, racial disparities, and obesity) with IBC development. DNA methylation changes and their impact on the diagnosis, prognosis, and treatment of IBC are also described. Recent studies are focusing on the use of histone deacetylase inhibitors as promising epigenetic drugs for treating IBC. All efforts must be undertaken to unravel the epigenetic marks that drive this disease and how this knowledge could impact strategies to reduce the risk of IBC development and progression.

Suspected Anaphylactic Reaction to Ketamine in 3 Yucatan Swine (Sus scrofa)

This case series describes the clinical courses of 3 juvenile Yucatan miniature swine (Sus scrofa) that experienced a suspected anaphylactic reaction to ketamine hydrochloride during premedication for protocol-related surgery. All 3 swine rapidly developed diffuse erythema shortly after injection with ketamine-containing drug combinations. Clinical signs ranged from tachycardia and erythema alone to tachycardia and erythema followed by respiratory and cardiac arrest. Ketamine was considered the most likely cause of these reactions because it was the only agent in the premedication sedation combination that was used in all 3 swine. Subsequent intradermal skin testing confirmed this suspicion. With supportive care measures and standard medical interventions for anaphylaxis, all 3 animals recovered well and went on to be successful experimental subjects when an alternative anesthetic regimen that did not contain ketamine was used. To our knowledge, this report is the first description of a suspected adverse ketamine reaction of this type in swine despite the widespread use of the drug in this species. Ketamine anaphylaxis is rare in people, but the few cases described presented with symptoms similar to the clinical signs seen in the pigs in this report. In addition to highlighting a potential adverse drug reaction to ketamine in swine, this case series demonstrates the value of emergency preparedness for even the most routine of procedures.

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are considered a single entity with variability in the extent of the lesions, characterized by erythema multiforme that may involve mucosa. Severe cutaneous reactions secondary to medications are classified according to the area of epidermal detachment. The activation of cytotoxic T cells and macrophages is mediated mainly by IL-2 and interferon gamma secreted by Th1 lymphocytes, and the activation of eosinophils and B lymphocytes in IgE is mediated by secreted IL-4, IL-5, IL-10 and IL13 by B lymphocytes. The topography of SJS is predominantly central, affecting the trunk and sometimes a generalized dissemination is shown that affects a body surface area of less than 10%, characterized by irregular violaceous erythematous macules of target shooting, which can form confluent blisters. TEN is characterized by a skin detachment greater than 30% of the body surface, whose predominant lesion is diffuse erythema with individual macules, which give rise to detachment surfaces greater than 5 cm. The treatment is symptomatic, nonspecific, and aimed at avoiding complications, carried out in specialized intensive care units, due to ignorance of the pathogenesis. Integral management with different therapeutic alternatives can represent a crucial part in the multisystemic management of SJS and TEN.

TANTANGAN FARMAKOLOGI PENGGUNAAN STEROID TOPIKAL PADA PASIEN ORAL LICHEN PLANUS

Background: Oral lichen planus (OLP) is a chronic autoimmune disease sprinkled by T cells on the oral mucosal surface. The goal of OLP treatment is to eliminate erythema, ulceration and relieve symptoms. Corticosteroids are the first line in the treatment of OLP, either systemically or topically. The problem arises when using topical steroids, namely the time of topical steroid attachment to the oral mucosa, especially in cases of OLP with clinical desquamative gingivitis. Some studies suggest that the use of individual gingival tray can overcome this problem. Objective: To provide information on topical steroid use in OLP cases with desquamative gingivitis clinical signs.Case Management: Women, age 31, complain that pain with burning on the lips and mouth is aggravated by spicy food. Intraoral examination shows irregular white plaques on the buccal, labial and dorsal mucosa of the tongue accompanied by diffuse erythema in the anterior gingiva of the upper and lower jaws. Patients diagnosed with OLP. Lesions improve 3 months after topical steroid administration, except lesions on the gingiva. Gingival individual tray is then used to obtain adequate attachment of topical steroids on the gingiva surface. The gingiva showed significant improvement after a month later.Conclusion: The use of topical steroid concoctions applied to the gingival individual tray is effective in treating OLP lesions especially with clinical signs of desquamative gingivitis.

Recognising the return of nutritional deficiencies: a modern pellagra puzzle

A 34-year-old previously well woman presented with a 4-week history of diffuse erythema and crusting of skin affecting all four limbs. Examination revealed erythematous skin plaques associated with ulceration and fissuring affecting sun-exposed areas of all four limbs primarily on the dorsal surfaces, and a body mass index of 17 kg/m2. She was admitted under the infectious diseases unit, and an autoimmune and infective screen was performed which returned unremarkable. Dietetic consultation led to the diagnosis of severe protein-energy malnutrition, consequent to a severely restricted, primarily vegan, diet. Analysis of the patient’s reported diet with nutritional software revealed grossly suboptimal caloric intake with risk of inadequacy for most micronutrients, vitamins and minerals, including niacin. Oral thiamine, multivitamin, iron supplementation and vitamin B complex were started, and a single intramuscular vitamin B12 dose was administered. Marked improvement was seen after 6 weeks, with near-complete resolution of skin changes. These findings supported a diagnosis of pellagra.