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Biomedical subjects

M S Peters

Publications and source records attributed to M S Peters.

At least 55 records · Page 3Linked to original sources
PubMed1989

Follicular mucinosis: clinical and histopathologic study.

Fifty-nine patients with the histologic diagnosis of follicular mucinosis (alopecia mucinosa) were evaluated retrospectively. Thirty-seven were male and 22 were female; ages ranged from 10 to 76 years. Of 19 patients with mycosis fungoides, 16 had initial lesions of follicular mucinosis on the trunk or extremities. Two patients had Hodgkin's disease and follicular mucinosis; both were younger than 20 years of age. Seven other patients were 20 years of age or younger. Two of the nine adolescent patients had persistent plaques of follicular mucinosis up to 18 years after diagnosis. Evaluation of biopsy specimens for lymphocytes, eosinophils, nonlymphoid cell infiltration, epidermal lymphocytic exocytosis, mucin deposition, and epidermal hyperplasia revealed no predominant feature that differentiated the group with benign disease from the group with mycosis fungoides. We conclude that no single clinical or histopathologic observation predicts which patients with follicular mucinosis will have a benign course and that evaluation of multiple clinical and histologic variables is necessary.

Adolescent↗
PubMed1989

Clinical correlations of linear IgA deposition at the cutaneous basement membrane zone.

To determine the specificity of linear IgA deposition at the cutaneous basement membrane zone for primary bullous disease, we reviewed the results of all direct immunofluorescence studies of skin biopsy specimens taken from patients seen at Mayo Clinic during the period 1982 through 1986. Of 4642 specimens submitted for direct immunofluorescence during this 5-year period, 44 from 42 patients showed linear IgA deposition at the basement membrane zone, with or without other immunoglobulins. Of these 42 patients, 36 (86%) had primary subepidermal bullous disease. Of the 36, 20 had linear IgA without IgG at the basement membrane zone (10 with clinical adult linear IgA bullous dermatosis, 2 with chronic bullous disease of childhood, and 8 with cicatricial pemphigoid). Sixteen had linear IgA and IgG at the basement membrane zone (10 with clinical cicatricial pemphigoid, 5 with bullous pemphigoid, and 1 with epidermolysis bullosa acquisita). There was a high frequency of mucosal involvement (67% of the 36 patients) and a somewhat higher frequency of ocular involvement in patients with cicatricial pemphigoid who had linear IgA without IgG at the basement membrane zone (6 of 8) than in those who had both immunoglobulins at the basement membrane zone (4 of 10). These results show that the direct immunofluorescence finding of linear IgA deposition at the basement membrane zone correlates with primary subepidermal bullous disease in a high percentage of patients but reflects a heterogeneous group of blistering disorders.

Adolescent↗
PubMed1989

Necrotizing fasciitis: a clinical, microbiologic, and histopathologic study of 14 patients.

We studied the clinical, microbiologic, and histopathologic findings from 14 patients with necrotizing fasciitis; also tissue obtained at autopsy was available from six patients. In all cases, material cultured was positive for multiple organisms, including Clostridia and fungi; organisms were identified by histochemical staining of tissue sections in 12 of 14 cases. The histologic pattern comprised edema, necrosis, and inflammation of skin, subcutaneous fat, and fascial tissue. Hyalin necrosis of sweat glands was observed in five patients. Thrombosis of vessels at all levels was a prominent feature, suggesting that study of coagulation factors may be important. Diagnosis may be confirmed by the histologic picture; however, microbiologic material is essential to guide therapy.

Adult↗
PubMed1989

Lipophagic panniculitis of childhood.

The cases of three patients with an atrophic lipophagic granulomatous lipoatrophy are described and compared with 14 similar cases in the literature. In affected children erythematous lesions of the arms and legs usually occur, after which subcutaneous atrophy develops. Fever and edema are common. The histologic feature is a replacement of the fat lobule by lipophagic histiocytes and giant cells. No vasculitis or phlebitis is present. Previously, such cases have been called Weber-Christian disease or Rothmann-Makai syndrome, but they are best characterized by the distinctive clinical lesions, the course, and histologic findings. Corticosteroids apparently have been effective in some patients.

Arm↗
PubMed1989

Histologic findings of Hailey-Hailey disease in a patient with bullous pemphigoid.

The association of bullous pemphigoid with other immune-mediated diseases has been described; however, coexistence with other bullous dermatoses is unusual. We describe a patient with longstanding localized bullous pemphigoid and the recent finding of a Hailey-Hailey-like histologic pattern in a biopsy specimen obtained at a site of active pemphigoid involvement, as confirmed by immunofluorescence studies. Although this case suggests the possibility of coexistence of two bullous diseases, the Hailey-Hailey-like pattern more likely represents an incidental microscopic finding or a solitary acantholytic lesion.

Aged↗
PubMed1989

IgA antiendomysial antibodies in dermatitis herpetiformis.

Sera from 24 patients with dermatitis herpetiformis and 80 control subjects (patients with other bullous diseases, nonbullous dermatoses, and noncutaneous diseases) were studied to determine the usefulness of assay for IgA antiendomysial antibodies (IgA-EMA) in the diagnosis of dermatitis herpetiformis. The overall sensitivity of IgA-EMA for the diagnosis of dermatitis herpetiformis was 79% and the specificity was 96%. When the three patients with dermatitis herpetiformis who were faithfully following gluten-free diets were excluded, the sensitivity was 90% and the specificity was 96%. No patient in the bullous disease control group (including patients with linear IgA bullous dermatosis) had circulating IgA-EMA. One patient, who did not have direct immunofluorescence evidence for dermatitis herpetiformis but had IgA nephropathy, had a positive IgA-EMA result, an interesting association in light of the rare reports of dermatitis herpetiformis in patients with IgA nephropathy and IgA antigliadin antibodies associated with IgA nephropathy. Although direct immunofluorescence testing of skin biopsy specimens remains the most definitive diagnostic test for dermatitis herpetiformis, indirect immunofluorescence assay of serum for IgA-EMA is a minimally invasive study with a high sensitivity and specificity for dermatitis herpetiformis.

Adult↗
PubMed1989

Recurrent pyogenic granuloma with satellitosis.

The development of recurrent pyogenic granulomas as multiple satellite lesions is rare and often associated with trauma or treatment of the primary lesion. At least 34 cases of such lesions after various treatment modalities have been reported, but none occurred in conjunction with laser therapy. We report a case of recurrent pyogenic granuloma with satellite lesions that developed after carbon-dioxide laser excision of a previously recurrent lesion.

Cephalexin↗
PubMed1989

Bullous pemphigoid and dermatitis herpetiformis: mixed bullous disease or coexistence of two separate entities?

We present a 73-year-old man with a 5-year history of dermatitis herpetiformis who developed lesions with the clinical, histologic, and immunologic features of bullous pemphigoid. Direct immunofluorescence testing of a skin biopsy demonstrated both granular deposition of IgA, predominantly in the papillary bodies, and linear deposition of IgG and C3 at the basement membrane zone. This mixed direct immunofluorescence pattern, typical for dermatitis herpetiformis in the type of IgA deposits, but also typical for pemphigoid in the linear localization of IgG and C3, is unusual. This case emphasizes that even after a specific diagnosis has been established, if the clinical morphology or response to therapy changes, repeat histologic and immunofluorescence studies may be indicated in diagnosis and management of patients with bullous disease.

Aged↗
PubMed1989

Factitial leg ulcers associated with an unusual sleep disorder.

A 19-year-old woman presented with a 14-month history of multiple, factitially induced, full-thickness leg ulcers. Nocturnal polysomnography with video monitoring revealed a short sleep latency and frequent sleep stage changes. Rapid eye movement sleep was absent. All stages of non-rapid eye movement sleep were associated with leg rubbing. After treatment that included avoidance of daytime naps and administration of chlorpromazine at bedtime, affect, daytime behavior, nocturnal sleep, and the ulcers improved markedly. To our knowledge, there are no reports of factitial dermatosis associated with disordered sleep. Our findings suggest that abnormal sleep may play a role in initiating or perpetuating factitial dermatoses. This case illustrates that polysomnography and video monitoring may be indicated in the evaluation of patients with factitial dermatoses.

Adult↗
PubMed1989

Pyoderma gangrenosum and adrenocortical carcinoma.

Systemic disorders that have been associated with pyoderma gangrenosum include inflammatory bowel disease, rheumatoid arthritis, paraproteinemias, and hematologic malignancies. We report the case of a 55-year-old woman with pyoderma gangrenosum, IgA monoclonal gammopathy, and a cortisol-secreting adrenocortical carcinoma. Review of the literature revealed one previous case of pyoderma gangrenosum associated with a solid tumor; at autopsy, a carcinoid tumor and an adrenocortical adenoma were found. Our patient's rapid improvement after the carcinoma was resected and her subsequent disease-free course suggests that the two conditions were related. This case suggests that evaluation for underlying malignancy should be considered in patients with pyoderma gangrenosum.

Adrenal Cortex Neoplasms↗
PubMed1988

Follicular mucinosis of childhood and adolescence.

We cared for nine patients who were less than 21 years old at the time of diagnosis of follicular mucinosis. Four had clearing of the lesions, four did not, and one was lost to follow-up. Follicular mucinosis, even in childhood, may be persistent and be associated with lymphoma, which can result in death. Because there is no clinical pattern or single histopathologic criterion that correlates with the outcome, clinical follow-up and assessment of several histopathologic criteria must be relied on when evaluating this condition in children.

Adolescent↗
PubMed1988

Linear IgA deposition associated with cutaneous varicella-zoster infection: a case report.

The homogeneous linear deposition of IgA along the basement membrane zone of uninvolved skin is a distinguishing feature of linear IgA dermatosis in adults and chronic bullous dermatosis of childhood. Although linear IgA deposition may be seen in other cutaneous diseases, to our knowledge, there are no previous reports of a direct association with cutaneous infection. We describe the finding of intense fluorescence, in a linear pattern, of IgA at the basement membrane zone in an elderly man with disseminated cutaneous varicella-zoster infection.

Acyclovir↗
PubMed1988

Ultrastructural study of eosinophils from patients with the hypereosinophilic syndrome: a morphological basis of hypodense eosinophils.

We investigated the ultrastructural characteristics and the granule major basic protein (MBP) content of hypodense eosinophils from patients with the hypereosinophilic syndrome who had at least 90% hypodense eosinophils in their peripheral blood and compared these cells to normodense eosinophils from normal persons. The hypodense cells (density less than 1.082) contained significantly less MBP than normodense (density greater than 1.082) eosinophils (P less than .001) as measured by radioimmunoassay (RIA). Electron microscopic examination demonstrated a mean of 25.0 +/- 4.4 (X +/- 1 SD) granules per hypodense cell, compared to 30.6 +/- 8.4 granules per cell in the normodense group (P less than .1). The most striking difference between the hypodense and normodense eosinophils was the small individual granule size (X = .14 +/- .05 v .26 +/- .05 micron 2, respectively, P less than .001), and the smaller total granule area (3.2 +/- 1.8 vs 7.7 +/- 3.1 micron 2, respectively, P less than .001). Because the cytoplasmic areas were similar in the two groups, the mean percent area of cytoplasm occupied by granules was significantly lower in the hypodense group (P less than .001). The finding of consistently smaller granules in the presence of equal or fewer granules per cell in the hypodense eosinophils may explain the lower MBP content and thus provide a morphologic basis for the low density of eosinophils in patients with the hypereosinophilic syndrome.

Densitometry↗
PubMed1987

Extracellular deposition of eosinophil granule major basic protein in pressure urticaria.

Utilizing affinity chromatography-purified antibody to the eosinophil granule major basic protein and formalin-fixed paraffin embedded tissue, we investigated the localization of major basic protein by immunofluorescence in twenty-four skin biopsy specimens from ten patients with pressure urticaria. Fourteen of twenty-four biopsy specimens were obtained from spontaneously occurring urticarial lesions of 4 to 48 hours' duration, and ten of the twenty-four specimens were from dermographometer-induced lesions that had been present from 40 minutes to 24 hours. Twenty-one of twenty-four biopsy specimens showed extracellular fluorescence of eosinophil granule major basic protein within the dermis. The extent and intensity of extracellular staining were not related to the presence or degree of tissue eosinophilia. Serial section controls from each block were stained with protein A purified rabbit IgG and were negative. Previous immunofluorescence studies have demonstrated deposition of major basic protein in lesions of chronic idiopathic urticaria, episodic angioedema, and facial edema. Major basic protein causes release of histamine from human basophils and induces wheal-and-flare reactions on intradermal injection. The present observations add further evidence to support a role for eosinophil mediators, particularly major basic protein, in the pathogenesis of cutaneous disease characterized by edema.

Adult↗
PubMed1987

The eosinophil.

The eosinophil has characteristic granules containing a variety of mediators that may be important in the pathogenesis of cutaneous disease. Although numerous cutaneous diseases may be associated with tissue infiltration with eosinophils, in very few disorders, including Wells' syndrome, angiolymphoid hyperplasia with eosinophilia, and granuloma faciale, does the pattern of eosinophil infiltration contribute to the characteristic histopathologic picture. Immunofluorescence studies demonstrating eosinophil degranulation in the skin, particularly in urticaria and angioedema, have provided evidence to support a role for eosinophil mediators in the pathogenesis of certain cutaneous diseases.

Animals↗
PubMed1986

The eosinophil and cutaneous edema.

Although eosinophils are readily identified in skin tissue, their role in cutaneous disease has been obscure. Recent studies have elucidated the structure, content, and several activities of the eosinophil. The eosinophil is a potent parasite-killer cell and probably mediates damage to respiratory epithelium in bronchial asthma. We review information showing an association between cutaneous edema and eosinophil degranulation in tissue. These studies show that eosinophils release and deposit toxic granule proteins extensively in the skin despite the existence of few intact eosinophils in tissue. The evidence suggests that the eosinophil functions not only as a parasite-killer cell but also as a proinflammatory cell that may be pathophysiologically related to the development of cutaneous edema.

Adult↗
PubMed1986

The histopathology of localized lipoatrophy.

We studied 11 patients with the clinical diagnosis of lipoatrophy and found two histopathological subsets. Six patients presented with a distinctive picture, which we termed 'involutional' fat, consisting of lobules of small lipocytes embedded in hyaline connective tissue with numerous capillaries. Five of these six patients had a single lesion, usually of the upper arm. Serological studies were normal, and direct immunofluorescence, performed in three cases, showed immunoreactants in the blood vessels in only one. The four patients with inflammation of the fat had multiple areas of localized lipoatrophy. Three had biopsies for direct immunofluorescence and all three showed immunoreactants involving the basement membrane zone (two cases) or blood vessels (one case); and three had serological abnormalities. We suggest that the involutional histopathological pattern is a distinctive subset of localized lipoatrophy.

Adipose Tissue↗