Biomedical subjects
Publications and source records attributed to B E Paredes.
A 38-year-old man presented with a 2-month history of progressive leg pain. An x-ray film of both tibial bones showed multiple osteolysis. At the same time, nasal polyps were present. A biopsy of the tibial bone remained unclear. A carcinoma was not found. A biopsy of the nasal polyps revealed a Rosai-Dorfman-Destombes disease.
BACKGROUND AND OBJECTIVE: In 1970 Ralph W. Grover described a clinicopathologic entity characterized by pruritic keratotic papules and papulovesicles predominantly on the trunk, disappearing spontaneously after a few weeks or months and demonstrating the histological features of epidermal acantholysis. The etiology remains unknown; sweating, heat and sunlight are suspected trigger factors. In our survey the clinical spectrum of the disease will be examined. PATIENTS AND METHODS: We have analyzed 21 cases of Grover's disease histologically diagnosed in Berne in 1997 and 1998. RESULTS: In most cases we observed isolated papules disseminated on the trunk. The predominant histological type was the Darier-type; presumably there is no correlation between histological type and clinical features. At the time of diagnosis the skin disorder had been present on average for 83 months. There was a strong association with sweating and heat. Topical steroids were successful in 50% of patients. CONCLUSIONS: Our 21 cases reflect in general the literature. Nevertheless, the long persistence of the skin lesions was striking perhaps making the term transient somewhat inaccurate.
BACKGROUND: Although they appear more rarely than electrolyte disturbances, cutaneous reactions are important adverse effects of furosemide. This is particularly true for bullous skin eruptions, because they may be life-threatening. CASE REPORT: We describe a patient who developed acute generalized exanthematic pustulosis (AGEP) during treatment with furosemide. Because the patient had developed similar skin eruptions during treatment with furosemide years before, furosemide was considered the most likely cause of this reaction. The short period of time between exposure to furosemide and the appearance of the skin reaction, as well as a positive lymphocyte transformation test, suggest an immunological mechanism of the skin disease. CONCLUSION: AGEP is a possible cutaneous side effect of furosemide.
We report a 36-year-old woman who slowly developed an ulceration on the left thigh 2 years after transplantation for Budd-Chiari syndrome. At this time point, the patient was treated with prednisone, tacrolimus and azathioprine for immunosuppression and with phenprocoumon and low-dose aspirin for anticoagulation in the presence of polycythemia vera. A biopsy of the skin lesion was obtained and revealed encapsulated yeast that was identified by microbiological and serological methods as Cryptococcus neoformans serotype D. The patient had no signs of systemic infection and a therapy with fluconazole (200 mg/day) was started. The lesion healed within 8 weeks and fluconazole was stopped after 3 months. Due to interactions between fluconazole, tacrolimus and phenprocoumon, the latter drugs were decreased to prevent toxicity. So far, 1 month after stopping fluconazole, no recurrence of skin lesions has been observed.
We report a multimorbid patient with end-stage renal failure showing a large necrosis and livedo racemosa on the right thigh. Histology revealed medial calcification of the small arteries typical of calciphylaxis. We found the typical features of the disease with different risk factors like elevated calcium-phosphate product, diabetes mellitus and oral anticoagulation. On account of the location of the skin lesions, a bad prognosis was expected. In spite of therapeutical measures with lowering of the calcium and phosphate levels, the patient died 1 month after the diagnosis had been made.
Photodamage starts early in childhood due to repeated and unprotected sun exposure. It is observed almost exclusively in individuals with white skin, especially skin phototypes I and II. Clinical studies show that 50 to 80% of an individual's life time ultraviolet (uv) radiation occurs before the age of 18 years. Photodamage, also known as dermatoheliosis, represents a polymorphic alteration of several structures of the skin, especially keratinocytes and melanocytes in the epidermis, the vascular system, and the dermal connective tissue. This damages caused by acute and chronic uv-exposure result in a substantially increased incidence of skin cancers. The severity of photodamages depends on constitual factors, e.g. skin phototype (skin color, capacity to tan), and on duration as well as intensity of sun exposure. Tanning for cosmetic purposes by sunbathing or by using artificial tanning devices is still widespread. Thus, it is important that clinicians are familiar with the clinical manifestations of photodamages and skin cancer. Further efforts to educate both public and medical professions are essential to direct more patients earlier to treatment. Furthermore new strategies need to be developed to influence behaviour as well as to increase awareness.
We report the case of a primary lymphocutaneous nocardiosis occurring on the right calf of a healthy 56-year-old man after an insect bite. Analysis of the purulent exudate obtained from the nodule revealed Nocardia brasiliensis. The initial therapy with trimethoprim-sulfamethoxazole had to be stopped due to a drug eruption. However, with minocycline treatment the patient recovered within 5 weeks. Superficial (sporotrichoid) infections and a history of outdoor injury should be considered suspicious for cutaneous nocardiosis.
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