ABSTRACT
Introducción: la arteritis de células gigantes es la vasculitis de vaso grande más frecuente y se ve predominantemente en adultos ma-yores de 50 años. El diagnóstico es en base a la clínica que se compone de cefalea, polimialgia reumática, sensibilidad en relación a la arteria temporal, compromiso del estado general, entre otras cosas, más laboratorio que se evidencia reactantes de fase aguda elevados y anemia y se confirma con biopsia de arteria temporal. Métodos: reporte de un caso de una paciente con debut con cefalea y aumento de volumen facial, lo que conllevó un diagnóstico erróneo de celulitis facial. Debido a esta presentación atípica, se retrasó el diagnóstico de arteritis de la temporal y tratamiento oportuno. Resultados: la arteritis de células gigantes es una patología que posee un gran rango de presentaciones atípicas, lo que ocurre en hasta un 38% de los pacientes que poseen la enfermedad, manifestaciones que incluyen neuralgia del trigémino, infartos linguales, aneurismas aórticos, edema facial, entre otros. Conclusión: es muy relevante conocer las presentaciones atípicas de esta patología que son muy frecuentes de encontrar en los pacientes y conocerlas nos permite aumentar nuestra sospecha clínica permitiendo un diagnóstico y tratamiento oportuno, evitando consecuencias irreversibles por el retraso diagnóstico.
Introduction: giant cell arteritis is the most frequent large vessel vasculitis and is seen predominantly in adults over 50 years. The diag-nosis is based on the clinic that is composed of headache, polymyalgia rheumatic, sensitivity near the temporal artery, compromise of the general condition, among other things, added to a laboratory that is evidenced like severe acute phase reactants and anemia and finally, is confirmed with temporal artery biopsy. Methods: a case report of a patient who debuted with headache and increased facial volume that led to a wrong diagnosis of facial cellulite. Because of this atypical presentation of the disease, the diagnostic took more time than usual and delayed the accurate diagnosis and timely treatment; this could have caused irreversible consequences. Results:giant cell arteritis has a wide range of atypical presentations; this may occur even up to 38% of patients that have this disease; manifes-tations include: trigeminal neuralgia, lingual infarct, aortic aneurysm, facial edema, and other symptoms. Conclusion: it is important to study the atypical presentations of this pathology because they are usually founded in patients. If we are informed about the atypical presentations, we can increase our clinical suspicion, and that allows us to get the right diagnosis and opportune treatment, avoiding irreversible consequences because of a late diagnosis.
Subject(s)
Humans , Female , Aged , Rheumatology , Giant Cell Arteritis , Edema , Patients , Polymyalgia Rheumatica , Vasculitis , Biopsy , Acute-Phase Reaction , Face , Headache , AnemiaABSTRACT
Se presenta a un paciente de 18 años de edad, con antecedentes de hipotiroidismo y acné leve. Consulta por edema facial persistente, a predominio de la mitad superior del rostro, de 7 meses de evolución. El mismo es indoloro, con un leve eritema, principalmente en párpados, y con temperatura local conservada. Se le solicitan estudios complementarios y se lo trata con antihistamínicos sin mejoría. Se toma biopsia de piel y con el diagnóstico de enfermedad de Morbihan se inicia tratamiento con isotretinoína a dosis de 20 mg/día durante seis meses, con respuesta muy favorable (AU)
An 18-year-old male patient with hypothyroidism and mild acne is reported. He consults for a 7-month history of persistent facial edema, predominantly on the upper half of the face. Edema is painless, with eyelids mild erythema and local temperature preserved. Additional tests are requested and treatment with antihistamines is unsuccessful. Skin biopsy is undertaken with Morbihan disease diagnosis. Patient is treated with oral isotretinoin in a daily dose of 20 mg/day for six months, with significant clinical improvement (AU)
Subject(s)
Humans , Male , Adolescent , Edema/pathology , Erythema/diagnosis , Facial Dermatoses , Biopsy , Isotretinoin/therapeutic use , Rosacea/diagnosisABSTRACT
Introduction: Double dose of Goreisan was effective in a case of blepharophimosis due to facial edema caused by malignancy-related superior vena cava syndrome. Case: A 60-year old male patient diagnosed with squamous cell carcinoma of the tongue underwent brachytherapy, surgery, and several types of chemotherapy before cervical lymph node metastases developed. Cyberknife therapy was performed to reduce the volume of lymph node metastases, only to develop abscess and cause malignancy-related superior vena cava syndrome, leading to facial edema accompanied by blepharophimosis. Intravenous furosemide was not effective, so double dose of Goreisan, a traditional Chinese prescription was applied and the edema and blepharophimosis subsided immediately, thus enhanced the patient’s quality of life. Conclusion: Goreisan can be an effective option for cases of malignancy-related superior vena cava syndrome refractory to chemotherapy and/or radiotherapy.
ABSTRACT
Solid facial edema is a rare skin condition characterized by persistent, non-pitting, and non-tender edema on the forehead, glabellar region, mid-face, nasolabial folds, and cheeks. Exact etiology is still unknown; however, it is suggested that it can be secondary inflammatory response due to acne vulgaris. A 21-year-old male presented with erythematous swollen patches on the forehead and glabellar region. He had been intermittently treated for his acne vulgaris for 5 years at the local clinic. Focal soft tissue swelling with thickening of the skin and subcutaneous tissue was identified radiologically. Histopathologically, lymphatic vessels were dilated with chronic inflammatory cell infiltration and dermal edema. To the best of our knowledge, this is the first reported case of solid facial edema caused by acne vulgaris in Korea.
Subject(s)
Humans , Male , Young Adult , Acne Vulgaris , Cheek , Edema , Forehead , Korea , Lymphatic Vessels , Nasolabial Fold , Skin , Subcutaneous TissueABSTRACT
Solid facial edema is a rare skin condition characterized by persistent, non-pitting, and non-tender edema on the forehead, glabellar region, mid-face, nasolabial folds, and cheeks. Exact etiology is still unknown; however, it is suggested that it can be secondary inflammatory response due to acne vulgaris. A 21-year-old male presented with erythematous swollen patches on the forehead and glabellar region. He had been intermittently treated for his acne vulgaris for 5 years at the local clinic. Focal soft tissue swelling with thickening of the skin and subcutaneous tissue was identified radiologically. Histopathologically, lymphatic vessels were dilated with chronic inflammatory cell infiltration and dermal edema. To the best of our knowledge, this is the first reported case of solid facial edema caused by acne vulgaris in Korea.