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The lesions of an unusual annular erythema in an infant evolved from erythematous papules, to rings, to interrupted arcs over 36 to 48 hours, and then resolved without a trace. New lesions appeared and evolved with remarkable uniformity for eight months and then disappeared. This seemingly unique eruption is compared with other annular erythemas described in infants.
Vascular spiders, palmar erythema and Dupuytren's contracture had been studied in four groups of patients with alcoholic cirrhosis, hepatic alcoholic involvement without cirrhosis, alcoholism without hepatic involvement, extrahepatic diseases without alcoholism. these cutaneous lesions had been observed more frequently in alcoholic cirrhosis, with an incidence of 72%, 38%, 24% respectively. Vascular spiders, palmar erythema and Dupuytren's contracture appeared related to the hepatic involvement from alcoholism rather than to the alcoholism by oneself. In the alcoholic cirrhosis the Dupuytren's contracture affected patients younger than those of the others groups and had been influenced from the association of diabetes mellitus, but not from the occupational activity.
Eleven patients seen at the Indiana University Medical Center and the Indianapolis Veterans Administration Hospital had erythema nodosum complicating a histoplasmosis infection. A massive, severe outbreak of histoplasmosis occurred in Indianapolis between September 1978 and August 1979. Four hundred thirty-five laboratory-confirmed cases were reported, although serologic findings suggested that from 20,000 to 200,000 persons were actually infected. During this epidemic, 18 (4.1%) of 435 patients were initially seen with erythema nodosum. Ten of 11 patients seen at the Indiana University Medical Center were women, and nine of 11 patients were seen during the first half of the epidemic; race was not a predisposing factor. Seven of 11 patients had respiratory or rheumatologic complaints. None of these 11 patients had evidence of dissemination, died, or required specific antifungal treatment.
A patient who presented with clinically atypical erythema multiforme was found, on investigation, to have an occult renal cell carcinoma. The skin eruption did not respond to systemic steroids, but resolved completely when the tumor was excised. Atypical erythema multiforme in a patient warrants a search for underlying malignancy.
The influence of the chemico-physical nature of the vehicle on the skin penetration of topically applied drugs was evaluated in vivo. Five different ointment formulations containing nicotinate esters as model penetrants were tested on human skin. The degree of drug penetration allowed by the various formulations was revealed by means of the erythema induced by the drug, detected by a X-Rite tristimulus reflection colorimeter. The excipient influenced the penetration of the nicotinate esters used to various extents. The concentrations of the tested drugs were found to be an important factor influencing drug penetration and persistence of erythema.
The infectious erythema is usually childhood disease associated with rash and caused by parvovirus B19. At the beginning of 1993., at the Clinic for infectious and tropical diseases of the Military Medical Academy 36 patients were treated for this disease, the average age 21 years. The prodromal phase of illness lasted approximately 2.9 days, the elevated temperature 5.2 days, and 17 patients had temperature above 39 degrees C. The rash was usually maculo-papullous and lasted about 6 days. Four patients had the recurrence of rash. The polyarthralgia appeared for short in six patients and in one patient lasted longer than 4 months. The mild anemia during infectious erythema was observed in 18 patients. IgM antiparvo B19 antibodies were proven in serum in 91.7%, and IgG antibodies in 58.3% of patients.
Erythema multiforme major and disseminated intravascular coagulation developed in a dog 24 hours after exposure to a d-limonene-based insecticidal dip. Clinical signs included severe lethargy and weakness, ulceration of the oral mucosa, and erythematous serpiginous, annular, and arciform lesions on the head, trunk, and limbs. Clinicopathologic abnormalities included leukocytosis with neutrophilia, normocytic normochromic anemia, thrombocytopenia, prolongation of prothrombin and partial thromboplastin times, increased fibrin degradation products, hypoproteinemia, hyponatremia, hypochloremia, azotemia, high serum alanine aminotransferase and alkaline phosphatase activities, and high serum bilirubin concentration. Despite intensive supportive care, the dog developed severe intrathoracic and abdominal hemorrhage and died. Necropsy revealed severe diffuse epidermal necrosis and widespread hemorrhage within organs. Insecticidal dips containing d-limonene have the potential to induce various toxic effects, including, possibly, erythema multiforme major, and should be used cautiously.
In 1967, Kawasaki reported an acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes that affected infants and young children in Japan. He called it mucocutaneous lymph node syndrome. We report here a case of Kawasaki's disease with characteristic findings that demonstrated a typical erythema multiforme rash. With the increased number of reported cases of Kawasaki's disease in the United States, it becomes increasingly important to differentiate the exanthem of Kawasaki's disease from early erythema multiforme.
One hundred patients with biopsy-proven erythema nodosum were studied at Ramathibodi Hospital from 1982 to 1992 to find out the etiology of this disease. Eighty-eight were females while twelve were males, with an age range from 6 to 72 years old (mean, 31 years old). Abnormal laboratory findings in these patients included elevation of erythrocyte sedimentation rate (76.9%), increase anti-streptolysin-O titer (10.7%), abnormal chest roentgenogram (16.7%), positive tuberculin test (50%). The cause of erythema nodosum is still unknown in a large group of patients, and it was found only in twenty-eight patients (28%). Twelve patients had tuberculosis, seven had history of antibiotic administration, six probably had streptococcal infection and the other three had Behcet's disease.
An extremely rare case of erythema multiforme associated with dermatophytosis by Trichophyton rubrum infection was reported in a 19-year-old woman. She had a reddish plaque resembling annular ringworm on her left arm. Treatment with an antifungal cream (clotrimazole) on the infected site cleared the condition in three weeks. Spontaneous regression of erythema multiforme in different parts of the body was recognized when the ringworm infection resolved. In recent years, only two cases have been reported in the English literature.
We reported a case of a 22-year old female with a microscopic form of polyarteritis nodosa (PN) who initially manifested Behçet's disease-like symptoms, such as fever, arthralgia, oral aphtha and erythema nodosum, and rapidly progressive glomerulonephritis (RPGN). On admission, her urinalysis showed active nephritic syndrome and her renal function rapidly deteriorated; serum creatinine levels elevated from 1.2 to 3.9 mg/dl within 2 weeks. Skin biopsy specimens from erythema showed panniculitis. Accordingly, she was treated with daily 30 mg of oral prednisolone and three-day intravenous pulse therapy of 1000 mg of methylprednisolone twice. After treatment, skin eruption and oral aphtha disappeared, and the serum creatinine level improved to 1.2 mg/dl. Percutaneous renal biopsy performed on the 28th day showed focal necrotizing glomerulonephritis and hyalinosis of small arteries. Immunofluorescence studies showed only trace stainings for IgG, IgA and beta lc. Electron microscopic findings revealed fusion of the foot process and swelling of endothelial cells, but no dense deposits. Anti-neutrophil cytoplasmic antibody (ANCA) was positive for IgG class with a 40-fold titer by indirect immunofluorescence test and showed a cytoplasmic pattern combined with high urinary IL-8 level (280.1 pg/ml). We diagnosed this case as a microscopic form of PN. ANCA titer and urinary IL-8 correlated positively with the disease activity, and were finally below 8-fold and 58.6 pg/ml, respectively after resolution of RPGN for 42 months. In this case, ANCA was useful not only for differential diagnosis of the patients with systemic vasculitis and crescentic glomerulonephritis, but also for evaluation of the disease activity.
A 47-year-old woman suffering from chronic abdominal pain developed erythema ab igne (reticular hyperpigmentation of the skin caused by exposure to heat). Histological examination revealed premalignant changes in two specimens of affected skin. The incidence of erythema ab igne is declining since fewer people use open fires for heating. Nowadays it is found mostly in patients suffering from chronic pain using hot water bottles, infrared lamps or heating pads. The disease is an important clinical indication for underlying chronic diseases. The affected skin runs a higher risk of development of actinic keratoses. Bowen's disease and squamous cell carcinomas. Dysplastic features of keratinocytes can be found histologically in lesions which are clinically not under suspicion.
A case of erythema elevatum diutinum showing an unusual distribution is reported. Hard nodules were located on the patient's fingertips and pulps while the extensor surfaces were not involved. The disease was initially misinterpreted based on both clinical and histologic examination. Dapsone therapy was followed by a remarkable recovery. The clinical and histologic features of erythema elevatum diutinum are summarized.
The authors treated and followed-up since July 1987 9 women with non-complicated erythema migrans and 4 women with erythema migrans associated with general signs and symptoms during pregnancy; two patients were treated only after delivery. For treatment antibiotics of the penicillin series were used. The course of gestation in 14 patients was without complications, one patient was followed-up on account of oedema of the lower extremities. The infants of 14 women were born in term, one infant was born during the 37th week of gestation. All infants were eutrophic. Umbilical blood for serological examination was collected from 8 infants, elevated IgG antibody levels against Borrelia burgdorferi were detected in one. The post-partum development of all infants was normal. During the subsequent follow-up for 6-26 months elevated antibodies against Borrelia burgdorferi were not found in any of the 4 infants subjected to serological examination. One child was operated at the age of one year on account of a patent ductus arteriosus, another child was treated at the age of two years on account of cryptorchism, two children were treated on account of hypoplastic enamel, in one infant at the age of 10 months the psychomotor development was retarded by two months. Transplacental transmission of Borrelia burgdorferi was not proved. With regard to the variety of the observed deviations and the small number of data the problem of a possible teratogenic action of this spirochete remains open.
Erythema chronicum migrans and acrodermatitis chronica atrophicans are both recognized to be lesions associated with Lyme disease, although they are thought to be distinct entities. In this paper, the clear evolution of erythema chronicum migrans into acrodermatitis chronica atrophicans is demonstrated.
FS ultraviolet (UV) lamps are used extensively to study the biological effects of ultraviolet radiation. Using published data, we investigated the relative contributions of the UVC (250-289 nm), UVB (290-319 nm), and UVA (320-400 nm) portions of the FS lamp emission spectrum to the induction of human erythema and murine ear edema. Many investigators contend that the biological activity of the spectrum emitted from these lamps resides primarily in the UVB region, based on the proportions of the power emission spectrum in this region (53.6%) versus the small relative contribution of UVC (3.2%) and the low biological activity of UVA (43.2%). However, if the biological effectiveness spectrum of FS lamps is calculated by multiplying the power spectrum with different action spectra, the biological effects of UVC are readily observed. For example, 10.4% of the murine ear edema activity and 11.1% (Parrish) or 16.7% (McKinlay-Diffey) of the human erythemal activity is due to the energy emitted in the UVC region. Experimental determination of human erythema and murine ear edema demonstrated that, for an equal amount of energy delivered, radiation from the unfiltered lamps was more potent in causing these responses than radiation from filtered lamps, and the ratio of effectiveness could be predicted by the effectiveness spectra. Thus, the contribution of UVC emitted from FS lamps to biological effectiveness spectra should not be ignored.(ABSTRACT TRUNCATED AT 250 WORDS)
A 9-month-old boy developed encephalopathy associated with the noset of erythema infectiosum, which resulted in permanent neurologic sequelae. This is the second reported case of encephalitis following erythema infectiosum and the first, to our knowledge with permanent sequelae.
Patients with abdominal pain resulting from pancreatitis are often misdiagnosed initially. There are no pathognomonic physical signs to implicate the pancreas as a source of chronic abdominal discomfort. Four patients seen consecutively (and one studied retrospectively) illustrate that erythema ab igne of the abdomen or low back may be a sign of pancreatitis. These patients had used heat on their abdomens or backs in attempts to relieve the pain. Using heat in this manner is common among patients with undiagnosed pancreatitis; the heat enhances the appearance of the erythema ab igne. The presence of pigmentation is a sign of organicity which should lead the physician to investigate the pancreas as a source of the patient's pain.