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At least 721 records · Page 40Linked to original sources
PubMed2000

Erythema multiforme: a case with unusual histopathological features.

A 14-year-old boy presented with widespread cutaneous and mucosal lesions clinically consistent with erythema multiforme. He gave a history of previous episodes of a similar eruption. Histological examination of a representative lesion showed changes consistent with erythema multiforme. It also, however, contained large numbers of eosinophils, forming a dermal interstitial infiltrate and epidermal microabscesses. The full blood examination showed a persistent eosinophilia. The appearances initially confused two experienced dermatopathologists.

Acyclovir↗
PubMed2001

Mid-dermal elastophagocytosis presenting as a persistent reticulate erythema.

Two men are presented with a widespread persistent reticulate erythema concentrated within the chronically sun-damaged skin on their trunk. A fine papular element was present in one case and both lacked annular lesions. One patient was human immunodeficiency virus positive. Multiple skin biopsies showed an interstitial infiltrate of histiocytes containing multiple elastic fibres in the upper dermis. There was scant perivascular lymphocytic inflammation but no evident necrobiosis or palisaded granulomas seen typically with granuloma annulare. Elastic stains showed focal mid-dermal elastolysis. Diffuse reticulate erythema in sun-damaged skin may be a clinical marker for elastophagocytosis. This presentation differs from that previously described with actinic granuloma, diffuse granuloma annulare or the inflammatory phase of mid-dermal elastolysis and expands the clinical spectrum of this phenomenon.

Diagnosis, Differential↗
PubMed2002

Congenital annular erythema persisting in a 15-year-old girl.

We present a 15-year-old girl who has had a persisting extensive annular erythematous eruption since birth. Otherwise, she is healthy and developmentally normal. Multiple investigations throughout the years have been normal or negative. Numerous treatments have been tried, but with little success. Both clinical and histological examination fit no known classification. It is most consistent with annular erythema of infancy but could be the first reported case of a new entity. A review of other causes of annular erythema in infancy is presented.

Adolescent↗
PubMed2001

Interaction of HSV-1 infected peripheral blood mononuclear cells with cultured dermal microvascular endothelial cells: a potential model for the pathogenesis of HSV-1 induced erythema multiforme.

The effect of herpes virus infection on human dermal microvascular endothelial cells and herpes-virus-1-infected peripheral blood mononuclear cells on human dermal microvascular endothelial cells was studied as a model of herpes-associated erythema multiforme. After infection of human dermal microvascular endothelial cells with native herpes virus and overnight culture, 60%--90% of human dermal microvascular endothelial cells showed cytopathic effects. HLA class I molecules and CD31 (PECAM-1) surface expression in herpes-virus-infected endothelial cells were substantially downregulated, whereas CD54 (ICAM-1) remained unchanged. Cocultivation with herpes-virus-1-infected peripheral blood mononuclear cells left characteristic plaques on the human dermal microvascular endothelial cell monolayer; however, very few human dermal microvascular endothelial cells (1%--3%) were infected. Adhesion molecule expression of human dermal microvascular endothelial cells cocultivated with herpes-virus-infected peripheral blood mononuclear cells demonstrated a 5-fold increase in CD54 expression, a 2-fold increase in HLA class I expression, but no change of CD31 by fluorescence-activated cell sorter analysis. Incubation of human dermal microvascular endothelial cells with ultraviolet-C irradiated herpes-virus-infected peripheral blood mononuclear cells had no effect on morphology or adhesion molecule expression levels. Changes of adhesion molecule expression by direct infection or cocultivation with peripheral blood mononuclear cells (with native and ultraviolet-C inactivated herpes virus infection) were also documented at the mRNA level. Adhesion assays demonstrated an increased binding of herpes-virus-infected peripheral blood mononuclear cells versus noninfected peripheral blood mononuclear cells to noninfected human dermal microvascular endothelial cells. Our results suggest that incubation of herpes-virus-infected peripheral blood mononuclear cells with human dermal microvascular endothelial cells induces significant upregulation of CD54 and major histocompatibility complex class I molecules in the surrounding noninfected human dermal microvascular endothelial cells, which is associated with an increased binding of peripheral blood mononuclear cells. Our in vitro findings may serve as a model for herpes-associated erythema multiforme possibly explaining the dermal inflammatory reaction seen in that condition.

Antigens, Surface↗
PubMed2003

A usual frameshift and delayed termination codon mutation in keratin 5 causes a novel type of epidermolysis bullosa simplex with migratory circinate erythema.

We report here two unrelated families in Japan and Korea having patients with a unique type of epidermolysis bullosa simplex and a novel mutation in the keratin gene KRT5, i.e., a frameshift and delayed stop codon inconsistent with any subtype described before. The patients showed migratory circinate erythema and multiple vesicles on the circular belt-like areas affected by erythema. Electron microscopy of skin biopsies showed a reduction in the number of keratin intermediate filaments in the basal cells without tonofilament clumping. We identified a novel heterozygous deletion mutation (1649delG of KRT5) in both cases. This deletion is predicted to produce a mutant keratin 5 protein with a frameshift of its terminal 41 amino acids and 35 amino acids longer than the wild-type keratin 5 protein due to a delayed termination codon. As the same abnormal elongated mutant KRT5 gene was found in the independent families, the predicted abnormal elongated keratin protein is likely to lead to an atypical clinical phenotype that has never been reported, possibly by interfering with the functional interaction between keratin and its associated proteins.

Amino Acid Sequence↗
PubMedDate not supplied

Unusual leukoderma after erythema multiforme: a case report.

Erythema multiforme is an inflammatory disorder of the skin that usually fades without sequelae. It is well known that after inflammatory events, hyper- or hypochromic spots can remain, especially in skin types III-VI, but achromia is very rare. We report a case of residual leukoderma after erythema multiforme.

Child↗
PubMed2003

[Febrile respiratory infection and erythema in a 25-year-old man].

HISTORY AND CLINICAL FINDINGS: A 26-year-old man fell acutely ill with fever (39 degrees C), rigor, dry cough, headache and pain in the neck and limbs. Ambulant treatment with amoxycillin, later cefuroximaxetil, worsened his general condition. At admission to hospital he had, over his trunk and limbs, cocarde-like, erythematous efflorescences up to 2 cm in diameter with central elevations and blisters. Additional acute bronchitis, pharyngitis, stomatitis, tonsillitis, conjunctivitis and urethritis indicated extensive mucosal involvement. INVESTIGATIONS: Significant findings were: 9900/microl WBC, ESR 57 mm at one hour, C-reactive protein 160 mg/l, capillary pO2 6.4 kPa, pCO2 4.2 kPa. Mycoplasma serology (days 1, 8, 15) took a typical course. Chest radiogram showed an interstitial infiltrate on day 5. DIAGNOSIS: Respiratory Mycoplasma infection with interstitial pneumonia and exudative erythema multiforme. TREATMENT AND COURSE: Because infection with an atypical pathogen was suspected, antibiotic treatment was changed to erythromycin and, at the suggestion of the dermatologist and ophthalmologist, local treatment (erythromycin, dexamethasone and dexpanthenol) was begun. Mycoplasma serology was first positive on day 3. The fever had disappeared on day 6 and the rash had regressed. Blood gases and blood picture were normal by day 8. The patient was discharged on day 18, after marked improvement of the skin and mucosal changes. CONCLUSION: The occurrence of a rare dermatological complication of a relatively common respiratory Mycoplasma infection can, when the erythema precedes positive Mycoplasma serology, aid in the differential diagnosis.

Administration, Topical↗
PubMed1997

[Unusual diagnosis in recurrent arthritis, erythema nodosum and arrhythmia].

HISTORY AND ADMISSION FINDINGS: A 42-year-old woman, with recurrent arthritis of the large joints and erythema nodosum for 7 years, was admitted because of recent onset of bouts of rapid heart rate. A 2/6 systolic murmur at Erb's point was the only contributory finding on physical examination. INVESTIGATIONS: The transaminases and gamma-GT were elevated, as were total cholesterol, LDL fraction, IgM, total protein, gamma-globulin and IgM. Antimitochondrial antibodies, especially anti-M2, were positive, while rheumatoid factor and C-reactive protein were negative. ANA, ANCA and antibodies against double-strand DNA were not demonstrated. ENA screening was negative. Abdominal computed tomography showed discrete intrahepatic cholestasis. Liver biopsy revealed chronic destructive cholangitis, i.e. the early stage of primary biliary cirrhosis. TREATMENT AND COURSE: On treatment with ursodeoxycholic acid (10 mg/kg daily) the patient has remained free of symptoms for 3 years and laboratory tests no longer showed evidence of impaired liver function. CONCLUSION: Primary biliary cirrhosis should be included in the differential diagnosis of recurrent arthritis and erythema nodosum, as early treatment with ursodeoxycholic acid can favourably influence its course.

Adult↗
PubMed1985

[Erythema migrans borreliosis in the Federal Republic of Germany. Epidemiology and clinical aspects].

A positive antibody titre against Ixodes-ricinus-Borrelia (burgdorferi), using indirect immunofluorescence or ELISA, could be detected in serum and (or) liquor of 935 (32%) out of a total of 2955 patients between January 1984 and July 1985. In 289 of these cases the typical clinical manifestations were lacking whereas a characteristic disease picture enabled a diagnosis to be made in 171 patients with negative or borderline antibody titres. The 1106 cases of infection observed covered all regions of the country. A typical clinical syndrome was seen in 817 (74%) of these. Most common were erythema chronicum migrans (n = 458) and meningopolyneuritis Garin-Bujadoux-Bannwarth (n = 404); in 42% of the cases meningopolyneuritis was preceded by an erythema. Arthritis (n = 63), acrodermatitis chronica atrophicans (n = 72), carditis (n = 13) and lymphadenosis benigna cutis (n = 5) were much less common. Chronic Borrelian encephalomyelitis (n = 45) appeared surprisingly often (n = 45). The fact that in 73% of cases the various syndromes appeared alone, were double in 24% and combined only in 3%, illustrates the polymorphic nature of this disease.

Adolescent↗
PubMed1983

[Chronic erythema migrans and tick-transmitted meningopolyneuritis (Garin-Bujadoux-Bannwarth): Borrelia infections?].

Antibodies against Borrelia duttoni using indirect immunofluorescence could be demonstrated in 6 patients with erythema chronicum migrans and in 8 persons with tick-borne meningopolyneuritis. Significant increases of IgG and IgM antibody titres in the course of the disease and IgG antibodies in the CSF indicate recent contact with Borrelia duttoni or a closely related agent. Demonstration by fluorescence serology of spirochaetaceae in Ixodes ricinus in two sites of infection equally indicate such an aetiology. The immunofluorescence test for patient sera used here improves the diagnosis of erythema chronicum migrans infection and of its various organ manifestations. Results are similar to those in Lyme disease in the United States.

Adolescent↗
PubMed1980

[Erythema chronicum migrans with arthritis (author's transl)].

In a 46-year-old woman arthritis developed in several large joints eight weeks after the onset of erythema chronicum migrans. The joints of the leg were swollen and painful. In addition there was painful involvement bilaterally of knee, hip and elbow joints. Circulating immune complexes were demonstrated in serum and the erythrocyte sedimentation rate was moderately increased. All other laboratory and radiological tests were within normal limits. On symptomatic treatment the arthritis regressed without sequelae within six weeks. The disease is nosologically related to Lyme disease recently described in the North East of the U.S.A. in which erythema chronicum migrans is followed by arthritis; here, too, circulating immune complexes have been demonstrated.

Antigen-Antibody Complex↗
PubMed1985

An erythema infectiosum-like illness caused by human parvovirus infection.

In the spring of 1980, an epidemic of an illness that resembled erythema infectiosum occurred in Manitoba, Canada. We initiated prospective epidemiologic, clinical, and microbiologic studies of this illness among elementary-school children and their families. Initial microbiologic studies failed to identify the cause of the exanthem. After a similar illness associated with serologic evidence of human parvovirus infection occurred in London, stored specimens of 12 patients with exanthem were investigated for parvovirus infection. Eleven patients had parvovirus-specific IgM antibody, as did two family contacts and a teacher with nonexanthematous illnesses, and two asymptomatic family members. None of 28 children with measles or rubella had serologic evidence of recent parvovirus infection. Human parvovirus was detected by DNA hybridization and immune electron microscopy in the serum of one patient who later had a rash and in one unaffected family contact. Parvovirus DNA was also detected in the pharyngeal specimen of the teacher who was ill but did not have a rash. We conclude that human parvovirus infection can be asymptomatic or cause a variety of clinical manifestations, including nonexanthematous illness and an illness resembling erythema infectiosum.

Adult↗
PubMed2000

Erysipelas-like erythema of familial Mediterranean fever: clinicopathologic correlation.

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive disease that tends to affect certain ethnic groups. It is characterized by recurrent, self-limited attacks of peritonitis, pleuritis, and synovitis. Erysipelas-like erythema (ELE) is the pathognomonic skin manifestation. Lesions are characterized by tender erythematous plaques, usually located on the lower legs. They may be triggered by physical effort and subside spontaneously within 48 to 72 hours of bed rest. Fever and leukocytosis may accompany this condition. OBJECTIVE: The purpose of this study was to describe the histology and the immunofluorescence findings in ELE and to discuss these observations in relation to the clinical findings in FMF. METHODS: We studied 7 patients with FMF in whom ELE developed. In all patients a biopsy was performed within 18 hours from onset of the lesion. In addition to routine hematoxylin and eosin stains, immunohistochemistry to evaluate the infiltrate and direct immunofluorescence were performed. Patients were followed up for their ELE lesions. RESULTS: Histologic examination revealed edema of the superficial dermis and sparse perivascular infiltrate composed of a few lymphocytes, neutrophils, and nuclear dust. Vasculitis was not observed. Direct immunofluorescence showed, in all cases, deposits of C3 in the wall of the small vessels of the superficial vascular plexus. In some cases fibrinogen and IgM were also observed. CONCLUSION: These findings are in accordance both with those found previously in the erysipelas-like phenomenon and those in the peritoneum of patients with FMF. The sparse infiltrate and the deposition of C3 also are compatible with the clinical picture of self-resolving lesions of short duration. It also suggests that erysipelas-like erythema belongs to the spectrum of neutrophilic dermatoses and supports a pathogenesis that involves abnormal inhibition of the inflammatory cascade.

Adult↗
PubMed2002

Leukocytoclastic vasculitis presenting as an erythema gyratum repens--like eruption on a patient with systemic lupus erythematosus.

Cutaneous leukocytoclastic vasculitis is a common finding among patients with systemic lupus erythematosus, although the clinical appearance of the lesions varies. We report the case of a 38-year-old woman with systemic lupus erythematosus who had leukocytoclastic vasculitis with peculiar clinical morphologic features of the cutaneous lesions. They consisted of figured erythema closely resembling erythema gyratum repens. We discuss the differential diagnosis with other annular eruptions.

Adult↗
PubMed2003

Erythema multiforme in a neonate.

We describe a case of erythema multiforme in a 2-week-old boy. He had no remarkable antecedents, and a polymerase chain reaction-based technique failed to detect herpes simplex virus DNA in the skin biopsy specimen. To our knowledge, only one previous biopsy-proven case of erythema multiforme during the neonatal period has been reported.

Biopsy↗
PubMed2003

Papular sarcoidosis of the knees: a clue for the diagnosis of erythema nodosum-associated sarcoidosis.

BACKGROUND: In recent years we have systematically explored the skin whenever sarcoidosis was suggested and we have observed with increasing frequency the presence of granulomatous cutaneous lesions of sarcoidosis involving the knees. OBJECTIVE: We sought to evaluate the specific cutaneous lesions of sarcoidosis involving the knees. METHODS: A total of 18 patients with biopsy-proven specific cutaneous sarcoidosis predominantly involving the knees were included in the study. Biopsy specimens were evaluated under polarized light. RESULTS: Of these cases, 4 corresponded to scar-sarcoidosis, 1 to plaque-type sarcoidosis, and 13 were an admixture of papules and minute scars frequently associated with erythema nodosum (papular sarcoidosis of the knees). Foreign particles were observed in 10 of 13 patients with papular sarcoidosis. CONCLUSION: Papular sarcoidosis of the knees can be considered a frequent form of cutaneous sarcoidosis, mainly observed in acute forms of the disease, and frequently associated with erythema nodosum.

Erythema Nodosum↗
PubMedDate not supplied

Occurrence of neutrophils and activated Th1 cells in UVB-induced erythema.

We investigated the sequential changes in infiltrating inflammatory cells and several cytokine levels over a period of 48 h in human back skin exposed to 3 minimal erythematous doses of UVB. The measurement of blood flow, using a laser Doppler method, indicated that UVB-induced erythema reached a peak 12-24 h after irradiation. Immunohistochemically, an increase in the number of CD4+ T cells was observed in perivascular areas 6 h after the UVB treatment and continued for up to 48 h. CD8+ T cells were scarce until 24 h, but their numbers gradually increased thereafter. HLA-DR+ cells were detected perivascularly and interstitially in parallel with the pattern of CD4+ T-cell infiltration. In contrast, neutrophils were found 3 h after UVB exposure and reached a peak at 24 h. Using a RT-PCR method, we demonstrated that mRNAs for the Th1 cytokines (interferon-gamma and interleukin-2), together with a proinflammatory cytokine (interleukin-8), became detectable at 6 h, whereas mRNA for the Th2 cytokine (interleukin-4) was not found at all during the first 48 h. In contrast, we found an increase in mRNA levels for C3 and tumor necrosis factor-alpha even at 3 h, suggesting a relationship between complement activation and accumulating neutrophils. Our results suggest that neutrophils and CD4+ T cells in UVB-induced inflammation play different roles: neutrophils are more closely related to UVB-induced erythema, while T cells appear to be involved in subsequent dermal and epidermal inflammation accompanied by epidermal hyperproliferation.

Base Sequence↗
PubMed2004

Detection of spirochaetal DNA simultaneously in skin biopsies, peripheral blood and urine from patients with erythema migrans.

Lyme borreliosis is an emerging zoonosis transmitted by infected hard-bodied ticks. The disease is multisystemic. In the initial stage its typical manifestation is the erythema migrans, a cutaneous lesion that occurs in up to 90% of patients. In order to investigate the presence of the specific agent, Borrelia burgdorferi, in the early stages of the disease, DNA from skin biopsies, urine and peripheral blood of 30 patients with clinically documented erythema migrans and without apparent systemic involvement was analysed by polymerase chain reaction. Borrelia DNA in both blood and skin biopsies was detected in 23 patients, while in 9 patients it was discovered in urine and skin biopsies. These results demonstrate that Borrelia DNA is detectable systemically also in patients with early Lyme borreliosis and strongly suggest a possible dissemination of the causative agents even when only a local infection is assumed.

Adult↗