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PubMed2001

Erythema elevatum diutinum in a patient with human immunodeficiency virus.

Erythema elevatum diutinum (EED) is a chronic cutaneous leukocytoclastic vasculitis. This rare disease is characterized by red, brownish-purple, and yellow papules, plaques, and nodules distributed symmetrically about the extremities. There have been recent reports of the disease in association with infection with the human immunodeficiency virus (HIV). We describe the case of a 51-year-old man with HIV who presented with EED, which was successfully treated with dapsone.

Anti-Infective Agents↗
PubMed2001

HLA-DRB1 associations in biopsy proven erythema nodosum.

OBJECTIVE: To examine the HLA-DRB1 associations of patients with erythema nodosum (EN), establish HLA-DRB1 differences among patients with idiopathic and secondary EN, and identify the HLA-DRB1 associations with specific conditions presenting with EN. METHODS: We conducted a retrospective study of 100 patients (83 women) with biopsy proven EN diagnosed for a defined population in Northwest Spain. Patients were classified into idiopathic or secondary if skin nodules occurred in the context of a well defined disease, or there was a precipitating event in close temporal relationship with the onset of EN. Patients and controls were HLA-DRB1 genotyped from DNA using molecular based methods. RESULTS: At the time of diagnosis no precipitating events or underlying diseases were identified in 35 cases and, due to this, they were considered to be idiopathic. Although strong associations do not appear to exist between HLA-DRB1 and unstratified EN, the idiopathic group showed a significantly lower frequency of HLA-DRB1*04 phenotype compared with controls. Among the patients with secondary EN, the patient subgroup with sarcoidosis exhibited a significantly increased frequency of HLA-DRB1* 13 compared with healthy controls. CONCLUSION: Idiopathic and some groups of secondary EN seem to have different HLA-DRB1 associations. These differences may have prognostic value in identifying patients with specific conditions associated with this syndrome.

Adolescent↗
PubMed2002

Comparative study of early Lyme disease: Erythema migrans in New York State and Northeastern Poland.

BACKGROUND: The objective was to compare the clinical features of early local Lyme Disease: Erythema Migrans (EM) between two highly endemic areas: New York State and Northeastern Poland. Study was based on self reporting questionnaires, physical examination, and laboratory results. MATERIAL/METHODS: Group I (n=27) consisted of citizens from New York State presenting with EM, referred to the study by their physicians. Group II (n=25) consisted of patients treated as outpatients in 1998-1999 at the Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Poland. The diagnosis of EM was based on patient history and clinical picture. RESULTS: Depending on the immune reaction of the host, the clinical picture is variable. The initial symptoms range from discrete to strongly expressed. The inflammatory reaction at the site of tick-bite seems to be milder in Europe than in North America, which is reflected in the prevalence of the annular form of rash and milder expression of general symptoms. Mild or absent general symptoms and the prevalence of the annular over homogenous form are observed in those areas of Europe where Ixodes ricinus is the main vector. In the endemic area of New York State, where Ixodes scapularis mainly occurs, uniform EM with flu-like symptoms is more common. CONCLUSIONS: There are distinct differences in the typical clinical pictures between the two separated endemic areas of New York State and Northeastern Poland, due to different vectors (saliva components?), bacterial genospecies, likely intermediate hosts and climatic differences. Familiarity with the presenting form of the disease can be very important, especially for primary care physicians.

Adult↗
PubMed2001

[Ulcerative colitis concomitant with pyoderma gangrenosum and erythema nodosum--presentation of two cases].

Authors present case of a 28-year old woman with skin symptoms of pyoderma gangrenosum and ulcerative colitis seriously advanced. The patient benefited from wide resection of the colon and steroid therapy. The other patient was 23-year old woman with ulcerative colitis concomitant with skin changes of erythema nodosum. In this case steroid therapy gave also a very good effect. We tried to find pathogenetic connection between these diseases based on the reports from the medical literature.

Adult↗
PubMed2001

Decreases in mean hemoglobin and serum albumin values in erythema nodosum leprosum and lepromatous leprosy.

Changes in hemoglobin (HGB) and serum albumin (SA) concentration associated with the onset of symptomatic erythema nodosum leprosum (ENL) were studied by comparing the values obtained on the day thalidomide or prednisone therapy commenced, with each patients' preceding values. In three groups of ENL patients mean HGB values fell with statistical significance: 1) in 38 patients who had been begun on thalidomide in the decade of the 1990s and who had been receiving dapsone for a minimum of 6 months, mean HGB values fell from 13.19 gm/dl to 12.27 gm/dl, or 7.0%, p = 6.0 x 10(-6); 2) in 8 patients who were in the active patient file not overlapping with the preceding group, and who had been on dapsone for a minimum of 6 months, mean HGB values feel from 13.40 gm/dl to 11.96 gm/dl, or 10.7%, p = 0.0015; and 3) in 8 patients not overlapping with the preceding groups, who were treated with rifampin and minocylcine or clarithromycin mean HGB values fell from 13.25 gm/dl to 12.48 gm/dl, or 5.8%, p = 0.0035. In two groups of ENL patients SA values also fell with statistical significance: 1) in 34 patients who were begun on thalidomide in the decade of the 1990s and who had been on dapsone for a minimum of 6 months, mean SA values fell from 4.14 gm/dl to 3.77 gm/dl, or 8.9%, p = 1.2 x 10(-5); and 2) in 10 patients from the active file not overlapping with the preceding group, and who had been on dapsone for a minimum of 6 months, mean SA values fell from 4.45 gm/dl to 4.06 gm/dl, or 8.8%, p = 0.039. A brisk fall in HGB values was often accompanied by a fall in SA concentration, and vice versa. Recovery from extreme falls in HGB and SA values was complete in 13 weeks. Recovery occurred in the presence of continued dapsone treatment. The falls could be rapid, occurring too soon to be the result of decreased erythropoiesis or hepatic SA synthesis. This study provides no direct evidence as to the mechanism responsible for the fall in these two parameters, but an interleukin-6 mediated hemodilution is an attractive hypothesis. The ENL-associated fall in HGB values was distinct from dapsone-induced hemolysis and the anemia of chronic disease. The ENL-associated anemia is not a good reason to discontinue dapsone therapy.

Anemia↗
PubMed2002

Centrifugal lipodystrophy presenting with serpiginous erythema and alopecia.

We describe serpiginous erythema with alopecia developing on the scalp of a 10-year-old boy during follow-up of centrifugal lipodystrophy. Because the clinical and histopathologic features of these lesions were identical to those of centrifugal lipodystrophy, we conclude that involvement of a hairy region by this disorder could cause alopecia and that the hair loss might be an indirect effect of interstitial inflammatory infiltrates around the hair follicles and in the subcutaneous fat.

Alopecia↗
PubMed2002

[Early diagnosis of Lyme borreliosis. Do not look only for erythema migrans].

Although the typical erythema migrans is a relatively easy-to-recognize manifestation of Lyme borreliosis, it is by no means the sole cutaneous manifestation of infection with borreliae. In particular the early stages of the disease, with their paucity of symptoms or wide variability of the clinical symptomatology, often present a diagnostic challenge. This means that in the event of unclear unspecific cutaneous lesions indicating, for example, erysipelas or urticaria, Lyme borreliosis should also receive differential diagnostic consideration. Culture of the organism, DNA-based confirmation of B. burgdorferi or, where indicated, a serological investigation can confirm the diagnosis at an early stage. The treatment of choice compromises an antibiotic administered for an adequate duration and at an adequate dose, e.g. doxycycline 2 x 100 mg over three weeks). If treatment is initiated in a local or disseminated early stage, healing rates of more than 85% can be achieved.

Adult↗
PubMed2002

[Eosinophilic-like erythema: a clinical subset of Wells' eosinophilic cellulitis responding to antimalarial drugs?].

BACKGROUND: Limits of Wells'syndrome, a nosologically enlarged entity defined after classic eosinophilic cellulitis, are imprecise. We report on a new "frontier" case, remarkable in its clinical pattern and its high sensitivity to antimalarial drugs. CASE REPORT: A 35-year-old woman was referred for evaluation of recurrent inflammatory, figurated and often annular lesions, mainly located on the trunk and the proximal parts of the limbs, associated with significant peripheral eosinophilia and featuring dense perivascular infiltrates throughout the dermis with abundant eosinophils but without any "flame figure". These lesions responded dramatically to protracted treatment with hydroxychloroquine. DISCUSSION: The relationship of this affection to Wells' syndrome is discussed along with its possible similarities to the sparse reports of so-called eosinophilic annular erythema.

Adult↗
PubMed2002

Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release.

Autoimmune progesterone dermatitis was manifested as deep-type erythema annulare centrifugum. Sensitivity to progesterone was studied in vivo by means of intradermal and patch tests, which revealed immediate-type and delayed-type hypersensitivity, respectively. Sensitivity to progesterone was further confirmed in vitro by results of an interferon-gamma release test, which imply a possible role for T(H)1-type cytokines in autoimmune progesterone dermatitis.

Adult↗
PubMed2002

Macrophage migration inhibitory factor gene polymorphism is associated with sarcoidosis in biopsy proven erythema nodosum.

OBJECTIVE: To assess whether polymorphism of the macrophage migration inhibitory factor (MIF) gene at the position -173 is implicated in the development of sarcoidosis. METHODS: Twenty-eight patients with biopsy proven erythema nodosum (EN) associated with sarcoidosis, 70 patients with biopsy proven EN related to other etiologies, and 122 healthy matched controls from the Lugo region of Northwest Spain were studied. Patients and controls were genotyped for a single nucleotide polymorphism in the 5'-flanking region at position -173 of the MIF gene, using SNapshot ddNTP primer extension, followed by capillary electrophoresis (ABI 3100). RESULTS: A significantly increased frequency of the C mutant allele was observed in patients with EN secondary to sarcoidosis compared to controls (p = 0.0016; p(corr) = 0.0032; OR 2.78, 95% CI 1.45, 5.35) and also compared to patients with EN unrelated to sarcoidosis (p = 0.0004; p(corr) = 0.0008; OR 3.72, 95% CI 1.75, 7.87). Patients with EN carrying an MIF 173 C allele were found to have an increased risk of sarcoidosis (57% in EN secondary to sarcoidosis vs 24% in patients with EN related to other etiologies; p = 0.002; p(corr) = 0.004; OR 4.16, 95% CI 1.64, 10.50). CONCLUSION: This is the first attempt to assess the influence of MIF genetic polymorphism at position -173 in the development of sarcoidosis. The MIF 173 C allele is associated with a significantly increased risk of developing sarcoidosis in patients with EN.

Adolescent↗
PubMed2002

Nodular fasciitis, erythema migrans, and oligoarthritis: manifestations of Lyme borreliosis caused by Borrelia afzelii.

We describe a 35-year old patient with nodular fasciitis, erythema migrans, and gonarthritis four months after a bite of a Borrelia afzelii infected tick. The Borrelia afzelii infection was identified by a polymerase chain reaction and direct sequencing of the amplification product. Borrelia-specific DNA was also detectable in nodular fasciitis tissue. We therefore conclude that Borrelia afzelii can be a causative agent of nodular fasciitis and Lyme arthritis in a highly endemic region of Northern Germany.

Adult↗
PubMed2002

[Concentration of macrophage inflammatory proteins MIP-1 alpha and MIP-1 beta and interleukin 8 in erythema migrants].

Chemokines constitute a group of proinflammatory cytokines with a strong chemotactic activity towards different populations of leukocytes. Their role in Lyme borreliosis has not been confirmed, although in vitro studies suggest possibility of chemokine synthesis during Borrelia burgdorferi infection. The aim of present study was to evaluate concentrations of chemokines: interleukin 8 (IL-8) and macrophage inflammatory protein 1 alpha and 1 beta (MIP-1 alpha and MIP-1 beta) in serum of patients with early clinical manifestation of Lyme borreliosis--erythema migrans (EM). Study group consisted of 20 patients with EM, control group of 12 healthy blood donors. Chemokine concentrations were measured with ELISA assays twice: before (examination 1) and after two weeks of antibiotic therapy (examination 2). Mean serum concentrations of IL-8, MIP-1 alpha and MIP-1 beta in examination 1 and of MIP-1 alpha and MIP-1 beta in examination 2 were significantly higher in comparison with control group. Chemokine concentrations were also significantly lower in examination 2 then in examination 1. These results show expression of IL-8, MIP-1 alpha and MIP-1 beta in the course of EM and suggest their role in the inflammatory response to Borrelia burgdorferi infection.

Adult↗
PubMedDate not supplied

Acute generalized exanthematous pustulosis with erythema multiforme-like lesions.

Acute generalized exanthematous pustulosis (AGEP) resembles generalized pustular psoriasis, but may manifest targetoid lesions, purpura, and blisters in addition to pustules. We describe a case of AGEP with erythema multiforme (EM)-like features in a 35-year-old woman who presented with acute onset of high fever and a strikingly polymorphic eruption consisting of numerous tiny pustules on erythematous bases, marked facial edema, oral and genital erosions, targetoid vesicular and purpuric lesions, pustules in string-of-pearl configuration and ring-like vesicles. The histology revealed, in addition to subcorneal pustules, vacuolar interface dermatitis with involvement of eccrine glands, and microabscesses in pilosebaceous structures. Systemic corticorsteroid and antibiotics were initiated, resulting in rapid resolution without recurrence. Recognition of EM-like lesions on a background of generalized pustular eruption could facilitate the diagnosis of AGEP and the institution of appropriate treatment.

Acute Disease↗
PubMedDate not supplied

Complement determinations in the synovial fluid and serum of a patient with Erythema nodosum leprosum.

Simultaneous serum and synovial fluid CH50, C1, C4, C2, C1 esterase inhibitor and C3 protein were determined in a patient with acute erythema nodosum leprosum. The pattern of synovial fluid complement activity coupled with the demonstration of multiple lepra bacilli free and within histiocytes is more consistent with an infectious than an immune complex induced synovitis.

Arthritis, Infectious↗
PubMed2002

Clinical and epidemiological findings for patients with erythema migrans. Comparison of cohorts from the years 1993 and 2000.

OBJECTIVES: i) To present clinical and epidemiological findings on adult patients diagnosed with typical erythema migrans (EM) at our institution during the year 2000 and ii) To compare the findings with data obtained by the same approach for an identical group of patients from 1993, with the aim of testing the hypothesis that, because of increased knowledge of Lyme borreliosis in 2000 compared with 1993, patients will visit us earlier and consequently present with smaller skin lesions. PATIENTS AND METHODS: Patients who qualified for inclusion in the study were adults diagnosed with typical EM in 2000 and 1993 at the Lyme borreliosis Outpatients' Clinic, Ljubljana, Slovenia. Epidemiological and clinical data were obtained from a questionnaire. RESULTS: In 2000, 535 patients had typical EM: 309 (57.8%) females and 226 (42.2%) males, aged 15-80 (median 47) years. Tick bite at the site of later EM was recalled by 311 (58.1%) patients a median of 14 days before the onset of the skin lesion, which was localised on the legs in 55.7% of patients. The median duration of EM prior to examination was 8.5 days, the largest diameter of EM was 12 (4-87) cm, and the average area of involved skin was 75 cm2. Thirty-six of 535 (6.7%) patients had more than one skin lesion (maximum number 21), 281/535 (52.5%) patients reported local symptoms (itching 45.2%, burning 12.9%, and pain 7.1%), and 191/535 (35.7%) reported systemic symptoms (fatigue 17.4%, headache 17.2%, myalgia 12.6%, arthralgia 11.2%, vertigo 3.6%, fever 2.5%, and chills 1.5%). In 1993, 892 patients with typical EM were diagnosed. They had similar characteristics to those in 2000 but were younger (44 versus 47 years; p = 0.025), more often remembered a tick bite (654/892 versus 311/535; p = 0.009), had a smaller diameter (10 versus 12 cm; p < 0.001) and surface area of EM (50.2 versus 75.0 cm2), presented more often with homogeneous skin lesions (378/892 versus 191/535; p = 0.010), and more frequently had some of the associated symptoms including nausea (43/892 versus 12/535; p = 0.021) and malaise (124/892 versus 51/535; p = 0.019). CONCLUSIONS: The majority of findings for the cohorts of EM patients seen in 1993 and 2000 were comparable but--contrary to expectations--in 2000 the duration of EM prior to attending our clinic was not shorter, and the skin lesions were larger and less often homogeneous. These findings indicate that knowledge of Lyme borreliosis did not increase during the period from 1993 to 2000.

Adolescent↗
PubMed2002

Electrocardiographic findings in patients with erythema migrans.

OBJECTIVE: To identify asymptomatic heart involvement early in the course of Lyme borreliosis by analysis of electrocardiograms (ECGs) of patients with solitary erythema migrans (EM). METHODS: We enrolled in this prospective study 220 consecutive previously healthy patients, receiving no medication, who were diagnosed with typical solitary EM at our Lyme borreliosis Outpatient Clinic in 1998. Their ECG findings were compared with the ECG results in 165 age and sex-matched healthy persons. RESULTS: Three patients with EM but none in the control group had first degree AV block (p = 0.319). Second and third degree AV blocks, electrocardiographic signs of pericarditis, myocarditis or rhythm disturbances were not found in any of the ECGs. Comparison of findings in patients with EM and the control group revealed statistically significant differences in frequency (66.2 +/- 1.47 beats/min in patients with EM versus 68.4 +/- 1.52 beats/min in controls; p = 0.043), duration of Q (0.013 +/- 0.001 s in patients with EM versus 0.015 +/- 0.001 s in controls; p < 0.001), and in depth of S (0.135 +/- 0.016 mV in patients with EM versus 0.104 +/- 0.012 mV in controls; p < 0.05), but not for several other ECG parameters. These differences were found in females as well as in males. Comparison of ECG findings in subgroups of patients with EM (grouped according to EM characteristics such as length of incubation, duration of skin lesion and the presence of associated systemic symptoms) did not reveal any significant difference. CONCLUSIONS: AV blocks, the most typical heart manifestation of early disseminated Lyme borreliosis, are a rare finding in patients with solitary EM, and in our study their frequency did not differ from that in the control group. We do not have a reliable explanation for the shorter duration of Q and deeper S wave in patients with EM compared with age and sex-matched controls.

Adolescent↗
PubMed2002

Sensitivity of culture and polymerase chain reaction for the etiologic diagnosis of erythema migrans.

Skin biopsy samples from 150 patients with typical cutaneous manifestation of Lyme borreliosis, erythema migrans, were cultivated for the presence of Borrelia burgdorferi sensu lato in modified Kelly Pettenkofer (MKP) medium and analysed with two different polymerase chain reactions using either flagellin or nested OspA primers. Cultivation was successful in 75 of 150 (50%) skin samples. Out of 70 strains that were typed using PFGE, B. afzelii was identified in 60 (86%), B. garinii in 10 (14%) specimens, while no B. burgdorferi sensu stricto strains were found. B. burgdorferi sensu lato DNA was detected with polymerase chain reaction in 28% and 61% of skin samples, using flagellin and nested OspA primers, respectively. Concordant results in all three procedures employed in the present study were found in 62 (41%) specimens: 25/150 (17%) were positive with all three methods and 37/150 (25%) samples were completely negative.

Bacteriological Techniques↗