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Swan-neck deformity and paresthesia following giant orf.

Orf is a zoonotic infection caused by a parapoxvirus that primarily infects sheep and goats. Human orf infection can take place when abraded skin comes into contact with infected animals. It occurs most commonly on the index finger. The characteristic lesion resembles a tumor and resolves spontaneously, usually without any complications. However, rare complications such as lymphangitis, adenitis, erythema multiforme, erysipelas, papulovesicular eruption, Pseudomonas aeruginosa infection, and bullous pemphigoid have been reported. Herein, we report a case of giant orf causing swan-neck deformity and paresthesia. These complications have not been previously reported in the literature.

Animals↗

Primary varicella infection associated with stevens-johnson syndrome in a Turkish child.

Stevens-Johnson syndrome (SJS) is defined as a severe erythema-multiforme-like eruption of the skin and lesions of the oral, genital and anal mucosa and hemorrhagic crusting on the lips; it is associated with fever, headache, and arthralgia. The disease is a part of a continuum of immunologically mediated mucocutaneous diseases at various grades of severity. SJS is often induced by drugs, but the pathophysiologic mechanism is completely unknown. Patients and their first degree-relatives may have genetic defects in their metabolic pathways that lead to the accumulation of toxic metabolites. However, viral infections are known triggers of this skin disorder. Varicella zoster virus has been only very rarely reported as an etiological agent in SJS, despite its high incidence as a pathogen in childhood. In this study, we report a case of primary varicella infection associated with SJS because of its rare presentation. To the best of our knowledge, our case is the youngest child in the literature.

Biopsy, Needle↗

The diagnostic significance of immunoglobulin and fibrin deposition in lichen planus.

Direct immunofluorescent (IF) staining was performed on biopsy specimens from fifty-three patients with active lichen planus. In fifteen of these cases uninvolved skin sites were also examined. Globular or cytoid body-like deposits of immunoglobulins, mainly IgM, were detected in forty-six of the active lesions, and in half the uninvolved skin biopsies. The deposition of fibrin in the papillary dermis and around follicular structures was seen only in the active lichen planus papules. The significance of these findings was assessed by comparison with the IF results obtained in 252 biopsies from various cutaneous disorders, stained by the same technique during the period of this study. Although the presence of immunoglobulin cytoid bodies and fibrin was found to be highly characteristic of lichen planus, these findings were not specifically diagnostic. Morphologically identical deposits were seen not infrequently in lupus erythematosus and in eczema. Active lesions of dermatitis herpetiformis, erythema multiforme and other rare dermatoses also showed these cytoid body-like immunoglobulin deposits.

Fibrin↗

Involvement of macrophages in the pathology of toxic epidermal necrolysis.

In toxic epidermal necrolysis (TEN), as in the 'epidermal type' of erythema multiforme, the necrotic epidermis is infiltrated with mononuclear cells. We studied the epidermal infiltrate in seven cases of TEN. About half the cells obtained from pieces of cleaved epidermis dissociated by trypsin were non-epithelial. On cytologic analysis, 80% of these foreign cells exhibited markers of macrophages, 15% were granulocytes and only 5% were lymphocytes (almost exclusively OKT8 T lymphocytes). Semi-thin sections of early prenecrotic lesions showed exocytosis of mononuclear cells within the epidermis with features of satellite cell necrosis and formation of colloid bodies. Almost all these mononuclear cells were macrophages as evidenced by endogenous peroxidase-positive granules. These findings suggest that some kind of macrophage-mediated cytotoxicity may play a role in the necrosis of epidermal cells during TEN.

Adolescent↗

Histoanalytical study of the cellular infiltrate in the tuberculin reaction.

In contrast to the generally held view, in previous studies it has been found that the histopathological changes in delayed-type hypersensitivity reactions to intradermal purified protein derivative of tuberculin (PPD) in humans were not uniform. These were classified into three types based on their resemblance to features seen in other dermatoses, i.e.: (i) perivascular dermatitis type; (ii) basal spongiotic dermatitis type; and (iii) erythema multiforme type. These histopathological patterns correlated well with the clinical response seen in tuberculin hypersensitivity of tested subjects. In the present study, the immunohistopathological features in 44 skin biopsy specimens were assessed quantitatively by using multivariate analysis. The numbers of infiltrating cells in the epidermis and in the dermis which were immunohistologically positive to monoclonal antibodies against various mononuclear cells were counted separately to determine if there was any statistical correlation between the histopathological patterns and the phenotypes of infiltrating cells. As a result, a significant correlation was found between the histopathological patterns and the phenotypes of cells infiltrating the epidermis, such as CD8+ cells, CD4+ cells, CD11c+ cells and interleukin 2 receptor positive cells. All these cells showed a high correlation coefficient to the expression of HLA-DR antigen by keratinocytes. Next, factors that might regulate the inflammation and interaction among the infiltrating cells were assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Vancomycin-induced linear IgA bullous disease presenting as toxic epidermal necrolysis.

Linear IgA bullous dermatosis (LABD) is a rare autoimmune vesiculobullous disorder characterized by variable clinical presentations that may mimic bullous pemphigoid, dermatitis herpetiformis, cicatricial pemphigoid and erythema multiforme. A few cases of drug-induced LABD that clinically resembled toxic epidermal necrolysis (TEN) have been reported. A subset of patients with LABD have been found to be drug-induced; the most common drug being vancomycin. The diagnosis of LABD is confirmed by the presence of a linear band of IgA along the basement membrane zone on direct immunofluorescence microscopy. We report a case of a 77-year-old man who presented to us with vancomycin-induced LABD that presented clinically as TEN. He had a complete recovery over a 3-week period following discontinuation of the vancomycin and the addition of oral dapsone therapy. It is important to be aware that drug-induced LABD can mimic TEN.

Aged↗

Stevens-Johnson syndrome and abnormal root development: a case report.

A boy developed Stevens-Johnson syndrome (erythema multiforme) 2 weeks after taking a course of slow-release theophylline at the age of 9 years. He had suffered from bronchial asthma since early infancy. He did not attend for dental treatment until the age of 14 years, when panoramic radiography demonstrated varying degrees of arrested root development in the permanent dentition.

Adolescent↗

Herbal medicine induced Stevens-Johnson syndrome: a case report.

A severe form of Erythema multiforme (EM), diagnosed as Stevens-Johnson syndrome (SJS) was detected in a 10-year-old Indian male child who took herbal medication of plant origin prescribed by a traditional healer for remission of his fever. The child developed a severe and florid form of mucocutaneous oral ulceration, severe ocular manifestations, along with marked constitutional disturbances and dehydration. An extensive literature search revealed few previous reports of herbal drug induced EM and SJS. In India, traditional therapy with herbal preparation (Ayurvedic medicine) is not uncommon.

Child↗

Cutaneous toxoplasmosis.

Nine patients with cutaneous toxoplasmosis had slowly regressing erythema-multiforme-like eruptions or lichenoid, papulonodular and purpurictelangiectatic disorders. The most common histologic finding was subacute histiolymphocytic perivasculitis with frequent demonstration of the parasite. Another group of patients showed similar clinical and histological findings, but the parasite was not evidenced in these.

Adolescent↗

Cutaneous manifestations of systemic lupus erythematosus: study from Lahore, Pakistan.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disorder in which cutaneous lesions occur in 85% of patients. This study from Lahore, Pakistan, was conducted to determine the pattern and incidence of such lesions in SLE. METHODS: Forty patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) (1982) were examined between October 1992 and September 1993 for the presence of cutaneous manifestations. RESULTS: Skin changes noted were: noncicatricial diffuse alopecia (82.5%), malar rash (60%), mucosal lesions (60%), discoid eruption (57.5%), photosensitivity (60%), nail involvement (55%), vascular lesions (50%), pruritus (45%), and pigmentary changes (37.5%). Peripheral gangrene, chronic ulcers, Raynaud's phenomenon, urticaria, chilblains, thrombophlebitis, palmar erythema, and erythema multiforme were rare. Antinuclear antibody reaction was positive in 80% and anti-dSDNA antibodies in 70%. CONCLUSION: A different clinical pattern was noted in our patients than reported previously.

Adolescent↗

The prevalence of apoptotic keratinocytes in equine epidermis: a retrospective light-microscopic study of skin-biopsy specimens from 253 horses with normal skin or inflammatory dermatoses.

A retrospective study was performed to assess the prevalence of apoptotic epidermal keratinocytes in biopsy specimens from 226 horses with inflammatory dermatoses and from 27 normal specimens. One or more apoptotic keratinocytes were found in specimens from 28 of 226 (12%) horses with various dermatoses, and in one of 27 (4%) specimens from normal horses. The prevalence (proportion of cases with apoptotic epidermal keratinocytes) of apoptotic keratinocytes in the group composed of discoid lupus erythematosus, erythema multiforme, photodermatitis, and systemic lupus erythematosus was significantly greater (52% prevalence in these cases) than that in a grouping of all other dermatoses (prevalence 8%). There was no correlation between the number of apoptotic keratinocytes and the extent of epidermal hyperplasia or hyperkeratosis.

Animals↗

Skin reactions to diltiazem.

A survey of Australian dermatologists was conducted into skin reactions observed to diltiazem. These have included: erythema multiforme, subcorneal pustular dermatosis, photosensitive erythroderma, macular exanthem, allergic vasculitis and urticarial vasculitis. The range of clinical and histopathological features are described. A review of the literature is presented. Photosensitive erythroderma and urticarial vasculitis have not, to our knowledge, been reported in the literature previously.

Aged↗

Orf. Clinical and epidemiological study.

Twenty eight human cases of orf were studied from clinical and epidemiological points of view. Most of the patients were shepherds who were inoculated from infected animals during all seasons of the year. Typical lesions of different stages of orf were located on the hands, and were accompanied by local symptoms such as pain, pruritus, lymphangitis and adenitis, or less frequently by systemic symptoms such as fever or malaise. Two cases developed erythema multiforme, one developed erysipelas and another a papulovesicular eruption. Tzanck test may contribute to the diagnosis. The course of the disease can not be influenced by antibiotics, and only measures of local hygiene are recommended, except in complicated cases.

Adolescent↗

Mechanisms of drug eruptions: Part I.

The pathogenetic mechanisms underlying common, and less common but severe, adverse cutaneous drug reactions are reviewed. Pharmacogenetic variability may account for a susceptibility to serious drug reactions to sulphonamides and anticonvulsants, as well as to lupus erythematosus (LE)-like syndrome. Exanthematous drug reactions may have an immunological basis. Cell mediated cutaneous drug reactions, including lichenoid reactions, LE-like syndrome, fixed drug eruption, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis, will inevitably involve elements of the skin immune system. Graft-versus-host disease provides a useful model for aspects of these drug-induced disorders. Urticaria, angioedema, anaphylaxis and anaphylactoid reactions may involve Type I immunoglobulin (Ig)-mediated or Type III hypersensitivity, or may be caused by pharmacological, non-allergic means. Drug-induced vasculitis, serum sickness and the Arthus phenomenon are manifestations of the immune complex disease. Drug-induced pemphigus may involve immune dysregulation, but several thiol-containing drugs are able to cause antibody-independent acantholysis directly.

Drug Eruptions↗

Chlorambucil allergy--a series of three cases.

Three cases of chlorambucil-related skin eruption in patients with low-grade non-Hodgkin's lymphoma are described. Cases were confirmed by exclusion of other drugs, rechallenge, skin testing and histology. One patient died due to florid erythema multiforme. Only two other adequately documented cases are described.

Aged↗