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Biomedical subjects

D Creamer

Publications and source records attributed to D Creamer.

At least 19 recordsLinked to original sources
PubMed2006

Microscopic polyarteritis presenting with skin necrosis in a patient with sickle-cell disease.

A 20-year-old Caribbean woman with sickle cell anaemia was admitted with a 4-day history of fever and a painful swollen right ankle. She rapidly developed skin necrosis. The differential diagnosis is discussed. This case illustrates the difficulty in identifying the cause of cutaneous necrosis in an acutely ill patient. In our patient, histopathology implicated a vasculitic process, which was subsequently identified as a manifestation of microscopic polyarteritis.

Adult↗
PubMed2006

Spectrum of clinical presentation, treatment and prognosis in a series of eight patients with leukaemia cutis.

All types of leukaemia can disseminate to the skin, producing cutaneous deposits known as leukaemia cutis (LC). We undertook a retrospective study to review the clinical presentations, treatment and outcome of eight patients with LC managed in our department over a period of 12 years. The clinical phenotype varied, with erythematous papules and nodules occurring with greatest frequency. Infiltrated haemorrhagic plaques and perifollicular acneiform papules were also seen. Although patients were treated aggressively for their underlying leukaemia, and received therapy directed towards LC, they tended to be refractory to treatment and the diagnosis was generally associated with a poor prognosis. The exception was a patient with chronic lymphocytic leukaemia, who survived 3 years after developing LC.

Aged↗
PubMed2005

PNP with Waldenström's macroglobulinaemia.

We describe a 65-year-old Caucasian man with Waldenstrom's macroglobulinaemia who developed paraneoplastic pemphigus (PNP) 3 years after his haematological diagnosis. This is a very rare malignancy that is associated with PNP. The evolution of PNP in this patient appears to exhibit the postulated immunological phenomenon of epitope spreading.

Aged↗
PubMed2005

Cardiac presentation of ALK positive anaplastic large cell lymphoma.

Cardiac involvement as an initial presentation of malignant lymphoma is a rare occurrence. We report the case of an immunocompetent 29-year-old male who presented with syncope and arrythmias secondary to a ventricular cardiac mass. Transcutaneous cardiac biopsy was non-diagnostic, therefore an open cardiac biopsy was performed from which a provisional diagnosis of a cardiac inflammatory pseudotumour was made. Six months after presentation, he developed several subcutaneous lesions with systemic symptoms. Histological and immunophenotypic review of the initial cardiac biopsy revealed features consistent with a diagnosis of CD30, ALK1 positive anaplastic large cell lymphoma (ALCL). Despite intensive treatment with combination chemotherapy, there was significant progression of disease, and he died 11 months after diagnosis. The overall prognosis of cardiac lymphoma remains poor, which may be due to the often late presentation of the tumour. To our knowledge, this is the first reported case of a cardiac ALK positive ALCL. Although rare, cardiac presentation of ALCL should be added to the list of differential diagnoses of cardiac lymphomas.

Activin Receptors, Type I↗
PubMed2004

Whipple's disease presenting with symmetrical panniculitis.

Specific cutaneous involvement in Whipple's disease is extremely rare. The condition usually runs a chronic course, with symptoms preceding diagnosis by years or even decades. We report a 44-year-old man who presented with a rapid onset of progressive, extensive, symmetrical plaques of panniculitis affecting the inner thighs and forearms. He had accompanying large joint arthritis and was profoundly anaemic. Biopsy of the subcutis revealed a florid septal panniculitis with infiltration of the septa by foamy macrophages containing intracellular granules that stained strongly with periodic acid-Schiff reagent. A similar but more intense infiltrate was seen in the small bowel lamina propria, and a diagnosis of Whipple's disease was made. Symmetrical panniculitis has not previously been reported as a manifestation of Whipple's disease.

Adult↗
PubMed2004

Arsenic-induced keratoses and Bowen's disease.

We report a patient with arsenic-induced keratoses and Bowen's disease. Chronic arsenicism may lead to both cutaneous and systemic neoplasms and patients should undergo regular long-term examination. Our patient had widespread cutaneous disease, which responded well to acitretin.

Acitretin↗
PubMed2004

Lues maligna.

The incidence of syphilis in the UK is rising, particularly in HIV-positive men. We describe a Caucasian, HIV-negative woman who presented with secondary syphilis taking the form known as lues maligna. She also demonstrated the prozone phenomenon whereby the rapid plasmin reagin test was negative, but the Venereal Disease Research Laboratory and Treponema pallidum haemagglutination tests were positive.

Adult↗
PubMed2004

A case of post-partum borderline tuberculoid leprosy complicated by a median nerve abscess, peptic ulceration and rifampicin-induced haemolytic renal failure.

We report a case of borderline tuberculoid leprosy complicated by a median nerve abscess, acute renal failure secondary to rifampicin-induced haemolysis and duodenal ulceration secondary to steroid use. Rifampicin induced hameolysis is a rare and probably under-reported complication of leprosy multi-drug therapy. It should be considered when patients complain of flu-like symptoms after taking their monthly rifampicin.

Abscess↗
PubMed2003

Onychomycosis due to Onychocola canadensis.

Onychocola canadensis is an uncommon nondermatophyte mould which can occasionally cause onychomycosis, and rarely, tinea manuum. It typically affects elderly individuals, some of whom have been farmers, in temperate climates. We describe a patient with onychomycosis due to this organism. She failed to respond to a 12-week course of terbinafine 250 mg o.d.

Aged↗
PubMed2000

Reactive angioendotheliomatosis in association with the antiphospholipid syndrome.

A 50-year-old woman with systemic lupus erythematosus developed extensive necrotic skin lesions on her chest and abdomen after the discontinuation of warfarin. The presence of antiphospholipid antibodies suggested a diagnosis of antiphospholipid syndrome. Histopathology from a skin lesion demonstrated marked expansion of the dermal microvasculature by intravascular cellular proliferation and focal thrombosis. The intravascular cells stained positive for the endothelial cell markers CD31 and factor VIII-associated antigen confirming reactive angioendotheliomatosis (RAE). This report is the first to identify RAE occurring in the context of the antiphospholipid syndrome. We suggest that intravascular endothelial proliferation, in concert with thrombosis, contributed to the angio-occlusive pathology.

Antibodies, Antiphospholipid↗
PubMed2000

Widespread cutaneous necrosis occurring in association with the antiphospholipid syndrome: a report of two cases.

The antiphospholipid syndrome is an acquired prothrombotic state where thrombosis and/or pregnancy loss is related to the presence of antiphospholipid antibodies. Cutaneous necrosis secondary to intravascular thrombosis of small dermal vessels is a recognized but rare association with antiphospholipid syndrome. We report two patients with high circulating levels of anticardiolipin antibodies who developed widespread cutaneous necrosis as the first clinical manifestation of the antiphospholipid syndrome. The exact mechanism by which antiphospholipid antibodies mediate thrombosis is uncertain; however, proposed mechanisms of activity include endothelial cell activation, altered endothelial production of prostacyclin, activation of platelets, and modulation of the protein C and S pathways.

Aged↗
PubMed2000

Incipient osteomalacia occurring in chronic actinic dermatitis.

Incipient osteomalacia developed in a Pakistani patient living in the UK after strict sunlight avoidance forming part of the management of the photosensitivity disorder, chronic actinic dermatitis. The patient's skin type and diet, which included calcium-binding phytates in chappattis, had increased his risk of the condition. Proximal muscle weakness and bony tenderness resulting from the disorder resolved on vitamin D replacement therapy.

Humans↗