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PubMed1983

Possible drug-induced pemphigus-like antibodies with the clinical manifestation of erythema multiforme.

A patient with bullae and target lesions on the extremities and mucous membranes was seen with the clinical picture of erythema multiforme following an episode of pneumonia and a course of penicillin G potassium and tobramycin sulfate therapy. An unusually high titer of intercellular circulating (IC) antibodies was identified in the serum by indirect immunofluorescence (IF) microscopy, but direct lesional IF microscopy study results were negative. These IC antibodies were not true pemphigus antibodies and can best be termed pemphigus-like antibodies. These antibodies were characterized by their ability to fix complement, in contrast to pemphigus antibodies, which apparently fail to do so.

Antibodies↗
PubMedDate not supplied

[Oral contraceptives :misunderstood etiology of erythema nodosum (author's transl)].

The cutaneous side effects of oral contraceptives are uncommon but their manifestations are many and varied. Erythema nodosum is rare, it is typical but the associated signs are few and do not permit the etiological diagnosis. The latter rests mainly on the spontaneous disappearance of the symptomatology when the prescription of oral contraceptivae is discontinued and on the relapse on resumption of the retake. The physiopathology, much controversed, causes immunological disorders on the predisposed individual. Only stopping oral contraceptives intake brings about the cure.

Adult↗
PubMed1980

Angiotensin-converting enzyme in newly detected sarcoidosis. With special reference to enzyme levels in patients with erythema nodosum.

Serum angiotensin-converting enzyme (SACE) was measured in 56 patients with sarcoidosis within three months after diagnosis. Serial analyses were performed in 42 patients, who were followed for two months to one year. SACE was elevated in 49 (70%) of the patients at some time during the period of observation. Erythema nodosum (EN) was present in 14 patients. Only one out of seven had elevated SACE during EN, but four months later SACE was elevated in all 14. In this group there was a negative correlation between SACE and S-lysozyme. Among 42 patients without EN the frequency of SACE elevation was rather constant, about 60%. In half of the patients SACE was normal at first examination, and subsequent elevation was observed in 19%. SACE and S-lysozyme were positively correlated. Enzyme activity was independent of mode of presentation, but a non-significant trend toward higher SACE in patients with pulmonary involvement was observed, and changes in SACE were roughly correlated to roentgenological changes. Among healthy controls, significantly higher SACE levels were found in children up to 17 years of age (reference interval 21.2-42.2 U/ml) than in adults aged 18-65 years (12.0-36.8 U/ml). The observations on patients with sarcoidosis demonstrate that a unique pattern of SACE occurs in those with EN, different from that of patients without EN. The findings support the view that EN is a hallmark of acute-onset sarcoidosis. The value of serial SACE analyses is emphasized.

Adolescent↗
PubMed1982

Herpes simplex antigen in immune complexes of patients with erythema multiforme: presence following recurrent herpes simplex infection.

Serum samples from patients with erythema multiforme (EM) were examined for the presence of herpes simplex virus (HSV) antigen in immune complexes using the Raji cell radioimmunoassay. Raji-cell-bound immune complexes from eight of 12 patients with EM after HSV infection and four of four patients with EM of uncertain cause had increased anti-HSV binding, while patients with EM after drug exposure and patients with recurrent HSV infections without EM had binding in the same range as controls. Viral cultures for HSV of immune complexes eluted from Raji cells were negative. Sucrose density gradient ultracentrifugation studies of serum samples of patients with EM after HSV infection showed HSV antigen in large molecular weight fractions. The HLA typing of lymphocytes from 16 patients with EM after HSV infection was not different from that of controls. Immune complexes composed of antibody and HSV antigen are present in serum samples of patients with EM after HSV infection and some cases of EM of uncertain cause and may mediate the pathogenesis of these disorders.

Antigen-Antibody Complex↗
PubMed1982

Ultrastructural studies of necrolytic migratory erythema.

Necrolytic migratory erythema is a disorder highly suggestive of glucagonoma syndrome. We carried out histologic and electron microscopic studies of the skin lesions in a 57-year-old woman with the glucagonoma syndrome. Light microscopic studies revealed hyperkeratosis, parakeratosis, formation of clefts in the upper epidermis, and scattered dyskeratotic cells. Ultrastructurally, the intercellular spaces were widened in the upper epidermis and desmosomes were reduced in number. The cytoplasm of affected cells showed vacuolar degeneration; the organelles were lysed or absent. There were scattered dark cells and dyskeratotic cells. These changes appear to represent a degenerative process of the keratinocytes.

Adenoma, Islet Cell↗
PubMed1978

Erythema chronicum migrans in America.

Erythema chronicum migrans (ECM) developed in a man after a tick bite; the tick was probably lxodes pacificus. Despite extensive laboratory evaluation, including bacterial culture of involved skin, viral and rickettsial titers, biopsy and special stains, animal inoculation, and electron microscopy, the causal agent could not be identified. Although probably unrelated, an elevated measles titer with a twofold drop on serial determinations was of interest. To our knowledge, this report documents the first reported case of ECM acquired in this country in which the tick that caused the disease has been recovered.

Adult↗
PubMed1983

[Hairy cell leukemia associated with tuberculosis, disclosed by erythema nodosum].

A forty-two-year-old man presented with erythema nodosum of undeterminated etiology and pancytopenia. A bone marrow biopsy revealed extensive hairy-cell infiltration. Four months later, the diagnosis of pulmonary tuberculosis was suggested by the appearance of a pulmonary infiltrate in the left upper lobe. Despite antituberculous chemotherapy, the patient died. Post-mortem bacteriologic confirmation was given by sputum culture.

Adult↗
PubMedDate not supplied

IgM antibodies against phenolic glycolipid I from Mycobacterium leprae in leprosy sera: relationship to bacterial index and erythema nodosum leprosum.

Serum IgM antibodies against Mycobacterium leprae-derived phenolic glycolipid I (PG) were determined in 121 leprosy patients, in contacts and controls by an enzyme-linked immunosorbent assay technique. Anti-PG IgM levels correlated with disease classification, increasing from the tuberculoid towards the lepromatous pole of the disease spectrum. There was a linear correlation between serum IgM PG-antibody levels and bacillary index (BI), a measure of bacterial load. Elevated anti-PG IgM in bacillary negative patients was usually indicative of active disease, undetected by BI. We conclude that anti-PG IgM levels are valuable for monitoring the degree of disease activity. Serum anti-PG IgM levels were significantly lower in patients with erythema nodosum leprosum (ENL) as compared to those without ENL, suggesting that IgM PG-antibodies are also involved in the pathogenesis of ENL.

Antibodies, Bacterial↗
PubMed1980

Erythema elevatum diutinum treated with niacinamide and tetracycline.

A 60-year-old woman with recurrent papular and vesiculobullous lesions of erythema elevatum diutinum responded to treatment with 100 mg of oral niacinamide three times a day and 250 mg of tetracycline hydrochloride four times a day. Prior therapy with 2.5 mg of dexamethasone daily and 1.0 g of erythromycin daily had been unsuccessful. After four weeks, tetracycline therapy was discontinued, and niacinamide alone sufficed to suppress the disorder. Recurrent lesions developed whenever niacinamide therapy was stopped.

Drug Therapy, Combination↗
PubMed1981

[Erythema rheumaticum].

A case of typical erythema rheumaticum is presented with emphasis on clinical, histological, immunopathological and immunological findings. Pathogenesis and therapy are shortly discussed.

Acute Disease↗
PubMed1984

Erythema chronicum migrans of Lyme disease.

Erythema chronicum migrans (ECM) is the distinctive cutaneous lesion of the multisystem tick-borne spirochetosis, Lyme disease. Its clinical and histologic pictures are variable. Of the 51 patients with ECM of Lyme disease, 38 patients (75%) had single lesions, 13 patients (25%) had multiple lesions, and 32 patients (62%) had extracutaneous signs and symptoms. Only 15 patients (29%) had symptoms referable to ECM. Extracutaneous signs and symptoms were absent in 12 (80%) of the 15 patients. These patients had uneventful recoveries following treatment with systemic antibiotics. Thirty-four skin biopsy specimens were obtained from the ECM lesions of 30 patients. With Warthin-Starry silver stain, the Ixodes dammini spirochete was found in 14 specimens (41%) taken from 12 (40%) of the 30 patients. Two of the Ixodes dammini spirochete-positive specimens were obtained from secondary ECM lesions. Careful clinical and histologic examination of skin lesions suggestive of ECM of Lyme disease will expedite its early diagnosis and treatment.

Adolescent↗
PubMed1984

Erythema elevatum diutinum.

First described by Hutchinson in 1878, erythema elevatum diutinum (EED) is a rare disease characterized by persistent red, raised nodules and plaques in a symmetrical, acral distribution. The disease occurs equally in the sexes, primarily in the 30- to 60-year age group. We report a representative case of EED which responded to current agents, and briefly review the status of the disease.

Adult↗
PubMed1984

Sarcoidosis presenting with erythema multiforme-like cutaneous lesions.

Sarcoidosis is a systemic disease that involves the skin in approximately 35 percent of cases. Typical cutaneous lesions are violaceous or hyperpigmented papules, plaques, or nodules. Less commonly, cutaneous lesions of sarcoidosis simulate the lesions of other cutaneous diseases such as psoriasis, ichthyosis, and erythroderma. We report on a patient who presented with cutaneous sarcoidal lesions resembling the target lesions of erythema multiforme (EM).

Adult↗
PubMed1984

Recurrent acute appendicitis with erythema annulare centrifugum.

Erythema annulare centrifugum (EAC), a chronic figurate eruption, occurred in a 28-year-old male physician several months following the onset of recurrent abdominal pain. Two months after the manifestation of EAC, another episode of abdominal pain culminated in appendectomy for perforated appendicitis. During his convalescence, the skin lesions faded and did not reappear. We propose that recurrent appendiceal inflammation caused both the episodic pain and the skin eruptions. Additionally EAC may be a sign of chronic infection, internal malignancy, or food allergy. Although truly chronic appendicitis is a disputed entity, recurrent, spontaneously resolving episodes of appendicitis occasionally do precede surgical appendicitis. The presence of EAC in a patient having recurrent abdominal pain should discourage a precipitant diagnosis of functional illness and prompt further investigation.

Acute Disease↗
PubMed1984

Histoplasmosis presenting as erythema multiforme and polyarthritis.

Erythema multiforme and polyarthritis occurred in association with serologic evidence of primary histoplasmosis. Although such occurrences have been noted in epidemics, recognition of this triad outside of the epidemic setting has been described only once before.

Acute Disease↗