ABSTRACT
Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.
ABSTRACT
Cutaneous metastases from renal cell carcinoma (RCC) present as rapidly growing erythematous or purple-round nodules. An 88-year-old male presented with a solitary, deep-seated firm mass on his left forearm that had persisted for 3 years. Ultrasonography revealed an hypervascular mass with rich vessels. Magnetic resonance imaging revealed a 1.6×1.6×3.3 cm sized, high T2-weighted signal intensity mass at brachioradialis muscle. Histopathologic examination revealed cells with atypical, pleomorphic, oval to spindle-shaped nuclei, and clear cytoplasm with an alveolar pattern within an unencapsulated, lobulated mass. Immunohistochemical analysis showed that the tumor cells were positive for PAX8, CD10, epithelial membrane antigen, and vimentin. Ultrasonography of the urinary tract revealed a lesion suspected to be RCC, which was thought to be the primary tumor. As our patient showed peculiar clinical symptoms and the primary tumor was later diagnosed as a metastatic lesion inversely, we report a rare case of metastatic RCC with an intramuscular mass on the forearm.
ABSTRACT
Background@#Cyclosporine is an effective drug for the treatment of psoriasis. Nonetheless, little is known about the factors associated with its effectiveness. @*Objective@#This study aimed to analyze the factors affecting the treatment efficacy of cyclosporine in patients with psoriasis. @*Methods@#‘Good treatment response’ and ‘treatment failure’ were each defined as achievement of 75% improvement in the psoriasis area and severity index and failure to achieve 50% improvement in the psoriasis area and severity index, respectively. The factors affecting good treatment response were investigated by comparing the group that achieved psoriasis area and severity index 75 to the not achieved group. Similarly, we also analyzed the factors affecting treatment failure and the time required to achieve psoriasis area and severity index 75. @*Results@#In total, 78 patients (63 males and 15 females) were analyzed. Age of onset, body surface area, accompanying hypertension, accompanying psoriatic arthritis, induction phase mean dose, and cumulative dose showed a relationship with good treatment response. Body surface area, initial dose, and accompanying hypertension were correlated with treatment failure. The mean time taken to achieve psoriasis area and severity index 75 was 6.70±3.17 weeks and it did not correlate with any factor. @*Conclusion@#In patients with psoriasis vulgaris, maintaining an adequate mean dose in the induction phase may be necessary for successful treatment with cyclosporine, especially in the patients with early-onset psoriasis, severe psoriasis, or accompanying psoriatic arthritis. In addition, a sufficiently high start dose may be needed to prevent treatment failure, particularly in patients with severe psoriasis vulgaris.
ABSTRACT
Background@#Cyclosporine is an effective drug for the treatment of psoriasis. Nonetheless, little is known about the factors associated with its effectiveness. @*Objective@#This study aimed to analyze the factors affecting the treatment efficacy of cyclosporine in patients with psoriasis. @*Methods@#‘Good treatment response’ and ‘treatment failure’ were each defined as achievement of 75% improvement in the psoriasis area and severity index and failure to achieve 50% improvement in the psoriasis area and severity index, respectively. The factors affecting good treatment response were investigated by comparing the group that achieved psoriasis area and severity index 75 to the not achieved group. Similarly, we also analyzed the factors affecting treatment failure and the time required to achieve psoriasis area and severity index 75. @*Results@#In total, 78 patients (63 males and 15 females) were analyzed. Age of onset, body surface area, accompanying hypertension, accompanying psoriatic arthritis, induction phase mean dose, and cumulative dose showed a relationship with good treatment response. Body surface area, initial dose, and accompanying hypertension were correlated with treatment failure. The mean time taken to achieve psoriasis area and severity index 75 was 6.70±3.17 weeks and it did not correlate with any factor. @*Conclusion@#In patients with psoriasis vulgaris, maintaining an adequate mean dose in the induction phase may be necessary for successful treatment with cyclosporine, especially in the patients with early-onset psoriasis, severe psoriasis, or accompanying psoriatic arthritis. In addition, a sufficiently high start dose may be needed to prevent treatment failure, particularly in patients with severe psoriasis vulgaris.