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[An autopsy case of postoperative erythroderma after nephroureterectomy possibly induced by graft-versus-host reaction following blood transfusion].

The case is a 45-year-old female who underwent right total nephroureterectomy and partial cystectomy for renal pelvic cancer. During the operation, she received blood transfusion. On the 10th postoperative day, she developed high fever and skin rush on the face, which were followed by liver dysfunction and pancytopenia. On the 18th post-operative day, she died of sepsis. Autopsy revealed hypoplasia and aplasia of the bone marrow and severe atrophy of the systemic lymph nodes and spleen. The characteristic clinical course and autopsy findings of this case closely resembled graft-versus-host disease which is observed after bone marrow transplantation or blood transfusion given to patients with severe immunodeficiency. It is therefore strongly suggested that postoperative erythroderma of this case was induced by graft-versus-host reaction due to blood transfusion given during the operation.

Dermatitis, Exfoliative↗

Postoperative erythroderma after cardiac operations. The possible role of depressed cell-mediated immunity.

Erythroderma as a manifestation of graft-versus-host disease after cardiac operations with blood transfusion may occur more frequently in Japan than in other countries. We have seen this problem in five patients who, after heart operations, died with symptoms and signs characteristic of graft-versus-host disease: cutaneous eruption, fever, diarrhea, leukopenia associated with agranulocytosis, and liver dysfunction. In the three patients seen most recently, skin biopsy showed findings similar to those of graft-versus-host disease after bone marrow transplantation. In addition, immunologic investigation showed remarkable differences in the findings in these patients and in those who did not have a graft-versus-host disease-like syndrome after cardiac operations. In particular, interleukin-2 production in response to mitogen stimulation was markedly diminished after operation in our patients, and the ratio of OKT4+ cells to OKT8+ cells in peripheral blood was low, reflecting increased numbers of OKT8+ cells after the occurrence of symptoms. The results raise the possibility that transient depression of cellular immunity after cardiac operations with blood transfusion may contribute to the occurrence of postoperative acute graft-versus-host disease.

Aged↗

Acute generalized pustular psoriasis presenting with erythroderma associated with shock and acute renal failure.

Acute generalized pustular psoriasis is an uncommon but dangerous form of psoriasis with a systemic presentation. Acute exacerbation, an early picture of acute generalized pustular psoriasis (AGPP), can be fatal, therefore, early recognition and systemic therapy is critical. It is an important differential diagnosis of erythroderma. Epidemiology, etiology, diagnosis, and treatment options are discussed in this paper.

Acute Kidney Injury↗

Erythroderma due to aztreonam and clindamycin.

A 73-year-old woman developed erythroderma with intense pruritus, malaise, and chills 7 days after treatment with intravenous clindamycin. Two years later she experienced a similar reaction with more rapid onset (48 hours) after treatment with aztreonam. Resolution followed withdrawal of treatment in both instances, and intradermal tests proved positive at delayed reading for both drugs.

Aged↗

[Two cases of postoperative erythroderma--clinical and pathological investigation].

Two cases of postoperative erythroderma, considered the Graft-Versus-Host disease like syndrome following blood transfusion during open heart surgery, were reported. In one, a 74-year-old female underwent the patch closure of ventricular septal perforation complicated with acute myocardial infarction, and in the other, a 67-year-old female underwent coronary artery bypass surgery. They had sudden fever, general eruption, liver dysfunction, leucopenia and thrombocytopenia, and died on the 15th and the 21st days after operation. In both, pathologically, eosinophilic necrosis was seen in agreement with basal cells and prickle cells on the epidermis. T-cells and monocytes widely infiltrated on the upper dermis, particularly around blood vessels. Furthermore, similar to on the skin, cellular infiltration and eosinophilic necrosis were seen on the esophageal mucosa. Various immunoglobulin-positive cells were seen on the dermis and the esophageal mucosa, but it is not clear that this is characteristic or not, because secondary infection possibly existed on them.

Aged↗

[A case of "postoperative erythroderma" following coronary artery bypass grafting operation].

So-called "Postoperative Erythroderma" was experienced in a 68 year-old man who received CABG for unstable angina. After a seemingly uneventful recovery, he revealed high grade fever on 13th post operative day (POD), rashes over the whole body on 15th POD and pancytopenia on 20th POD. He died of sepsis, multiple organ failure and DIC on 21st POD. Blood transfusion (concentrated red cell: 3 units) was done on operation. In this case, the rate of premature and atypical lymphocytes increased, and the ratio of OKT4 (helper)/OKT8 (suppressor) decreased. These findings of the examination suggested that there was a possibility of cell-mediated immunological depression. We considered this to be acute GVHD after blood transfusion.

Aged↗

[Trichophyton rubrum-induced erythroderma].

A case of generalized T. rubrum-induced induced trichophytosis running the course similar to erythroderma is described. Factors conducive to universal involvement of the skin integument, hair, and nail plates of the female patient are analyzed. The authors emphasize that dissemination of the mycotic process was favored by changed body reactivity explained by allergic reactions to drugs the patient handled as a nurse and by focal infection, advanced age, and prolonged use of corticosteroid ointments to treat the developing skin inflammation of a mycotic nature.

Chronic Disease↗

Lindane neurotoxic reaction in nonbullous congenital ichthyosiform erythroderma.

A 3-year-old boy with nonbullous congenital ichthyosiform erythroderma with a four-month history of scabies was treated with a single dose of lindane cream. In a 48-hour period, he developed nausea and vomiting and also suffered from an epileptiform convulsion and muscular spasms. Seventy-two hours after application of the cream, his blood lindane level was 54 ng/mL. Caution should be exercised when using lindane in patients with compromised epidermal barrier function.

Child, Preschool↗

Erythroderma from systemic contact dermatitis: a complication of systemic gentamicin in a patient with contact allergy to neomycin.

A patient who was sensitive to potassium dichromate and neomycin showed a universal exfoliative erythroderma following intravenous gentamicin therapy. When his ear canals were later treated with a neomycin-containing topical medication, he reacted so severely that the skin of his ears was temporarily depigmented. Withdrawal of aminoglycoside antibiotics along with use of a topical steroid preparation under occlusion brought the eruption under control. Since approximately half of the persons with contact allergy to neomycin will also react to gentamicin, it seems unwise to treat such patients with other intravenous aminoglycosides that are closely related chemically. In our patient, multiple patch tests to other aminoglycosides caused positive reactions to all reagents containing a deoxystreptamine ring, but there was no reaction to streptomycin, which lacks that structure.

Aged↗

[Bullous congenital ichthyosiform erythroderma in a mother and son].

The occurrence of two cases of bullous congenital ichthyosiform erythroderma (BCIE) in a mother and son is reported. Clinical diagnosis was confirmed by histological and ultrastructural findings, which demonstrated marked changes in the cyto-skeleton of the keratinocytes of the Malpighian layer and areas of cytolysis and hypoplasia of the tonofilament-hemidesmosome complexes in the cells of the granulosa layer. These results and the possible aetiopathogenic mechanisms are discussed in the light of the most recent data in the literature. Treatment with oral etretinate proved to be helpful, but not long lasting.

Adult↗

Erythroderma with fulminant hepatitis: a possible association.

Exfoliative dermatitis or erythroderma may be a sign of systemic disease, usually a T-cell lymphoma, although other malignancies may also be associated. We observed two patients in whom severe hepatitis and an exfoliative dermatitis occurred simultaneously. We believe that this association has not been reported previously.

Adult↗

Syndrome of erythroderma, failure to thrive, and diarrhea in infancy: a manifestation of immunodeficiency.

Five infants with a triad of symptoms comprising generalized erythroderma, failure to thrive, and diarrhea are presented. All of these children demonstrated significant immunologic abnormalities. This is a recognizable clinical syndrome that reflects immunodeficiency; however, the responsible immunodeficiencies do not appear to be the same in every case. Early investigation and appropriate therapy may considerably reduce morbidity, and mortality in children with this syndrome.

Child, Preschool↗

Distinctive eruption characterized by linear supravenous papules and erythroderma following broxuridine (bromodeoxyuridine) therapy and radiotherapy.

A distinctive cutaneous eruption occurred in two patients with central nervous system tumors who were treated with broxuridine (bromodeoxyuridine) and radiotherapy. Findings included the initial appearance of papular lesions within skin directly overlying acral superficial veins and the later development of a more generalized eruption eventuating into exfoliative erythroderma.

Brain Neoplasms↗

Progress of a harlequin fetus to nonbullous ichthyosiform erythroderma.

The term harlequin fetus is used to describe the most severe form of congenital ichthyosis. All except one previously reported patient died during the first few weeks of life. The development of one such fetus to the age of 2 years 6 months is reported, along with a photographic record of progress. Details of the progress of another harlequin fetus to 6 months of age are given. The clinical diagnosis of the former patient is nonbullous ichthyosiform erythroderma.

Age Factors↗

[Congenital ichthyosiforme erythroderma, pregnancy under aromatic retinoid treatment].

Long-term treatment with aromatic retinoid (Tigason) gives excellent results in lamellar ichthyosis (non-bullous congenital ichthyosiform erythroderma), which is demonstrated in a young woman who was treated with Tigason for about 4 years. She was under treatment when a pregnancy was beginning. Although 2 days after birth the child showed pronounced icterus, except for elevations of SGOT and SGPT at present, the 5-month-old boy has no symptoms of internal or skin disease. It is known that aromatic retinoid has embryotoxic and teratogenic effects and should not to be given to women of childbearing potential without contraception. Pregnancy should not be allowed until 2 years after withdrawal of therapy because retinoid remains in the body for a long time.

Adult↗