ABSTRACT
Herpes zoster classical clinical presentation is the acute onset of multiple vesicles over an erythematous base, disposed over one or two dermatomes with up to 20 vesicles located outside the main dermatome. Disseminated herpes zoster is an atypical and rare form of presentation of herpes zoster, which manifests with lesions beyond the described territory. It occurs mainly in patients with some type of cellular immunosuppression. The diagnosis is made with the medical history and physical examination, however, it should be confirmed with laboratory tests. Treatment must be initiated early to avoid serious complications, such as bacterial infection of the lesions, post-herpetic neuralgia, or even central nervous system involvement. The drug of choice is intravenous acyclovir that must be maintained until the cessation of the appearance of new lesions, and then switch to its oral presentation for another 5-7 days. Disseminated herpes zoster mortality rounds 5-15%. There are varicella-zoster virus vaccines, that have been shown to reduce the incidence of herpes zoster relapses, however its utility to disseminated herpes zoster is uncertain and further studies are required. We present the case of a male patient with a history of rheumatoid arthritis who consults with multiple vesicles distributed throughout his body. (AU)
Subject(s)
Humans , Male , Middle Aged , Herpes Zoster/diagnosis , Acyclovir/administration & dosage , Herpes Zoster/physiopathology , Herpes Zoster/drug therapyABSTRACT
Grover's disease (GD) or transient acantholytic dermatosis, is a papulovesicular pruritic disease of unknown etiology. It´s most important histopathological finding is the presence of focal acantholysis. The incidence has not been firmly established. Case report: We report two cases of papulovesicular rashes, the first one in a 79 year old man with good response to second line treatment and the second one, in a 30 year old woman. Both with different suspected triggering factors. Comment: GD predominates in white men with an average age of presentation of 61. Clinically, it presents as erythematous papules, crusted-papule and is usually pruritic. The etiopathology is still unknown, but it is associated with triggers such as: ultraviolet radiation (UVR), ionizing radiation, heat, sweat, friction and chemotherapy. Acantholysis is the classic histological finding. Management includes general measures, topical corticosteroids, calcineurin inhibitors, tretinoin, calcipotriene and antihistamines. In refractory cases, second-line treatment is used: oral isotretinoin, systemic corticosteroids and phototherapy. Paradoxically, phototherapy can also trigger GD. Conclusions: Due to the low prevalence of GD in Chile, 2 new cases are provided to the literature. In both cases, the diagnostic presumption was based on an exhaustive clinical history, confirmed by histopathological findings. (AU)
Subject(s)
Humans , Male , Female , Adult , Aged , Acantholysis/diagnosis , Acantholysis/physiopathology , Acantholysis/therapyABSTRACT
We present the case of a 52 year old woman with a history of bilateral ovarian cancer operated. The patient attended the dermatology unit for a sudden onset of a left plantar nodule of three weeks of evolution, painful on walking, with no other history in particular. At physical examination, the patient presented a surface nodule slightly hyperpigmented, with ill-defined edges, round shape, firm consistency, mobile and painful to compression, one cm of diameter, in the middle third of the left plant. No concomitant scars are seen. Doppler soft tissue ultrasound is requested, showing a granulomatous nodule on the surface of the plantar aponeurosis. The biopsy lesion revealed non-caseating granulomas in cell tissue, PAS and Ziehl-Neelsen staining are negative A left plantar subcutaneous sarcoidosis is diagnosed, systemic involvement is ruled out. Within the first year of follow-up, there are no new lesions or findings compatible with systemic disease. (AU)