ABSTRACT
El diagnóstico diferencial entre la enfermedad de injerto contra huésped aguda grave (estadio IV) y la necrólisis epidérmica tóxica pude resultar difícil en el contexto de un paciente trasplantado, ya que ambas tienen presentaciones clínicas similares. Sin embargo, la distinción entre ellas es fundamental porque ocasionan una gran morbimortalidad, y su manejo y pronóstico difieren. Algunas pequeñas diferencias clínicas e histopatológicas son de gran ayuda para el diagnóstico diferencial y el dermatólogo deberá reconocerlas para tomar una conducta correcta y oportuna. Se comunica el caso de un paciente que presentó ampollas y epidermólisis después del trasplante de células hematopoyéticas y en el que se planteó la dificultad diagnóstica para diferenciar entre ambas afecciones.
The differental diagnosis between severe graft-versus-host disease (stage IV) and toxic epidermal necrolysis can be difficult in the context of a transplant patient, since both conditions have similar clinical presentations. However, the distinction between these two entities is critical because they produce great morbidity and mortality and their management and prognosis differ. Some small clinical and histopathological differences are of great help for the differential diagnosis, and the dermatologist must recognize them in order to take a correct and timely conduct. We present the case of a patient who developed blisters and epidermolysis after hematopoietic cell transplantation, and in whom the diagnostic difficulty to differentiate between the two entities was raised.
Subject(s)
Humans , Male , Adult , Hematopoietic Stem Cell Transplantation/adverse effects , Graft vs Host Disease/diagnosis , Methylprednisolone/administration & dosage , Cyclosporine/administration & dosage , Graft vs Host Disease/pathology , Graft vs Host Disease/drug therapy , Antilymphocyte SerumABSTRACT
Objetivo: Describir los resultados estéticos y funcionales con el uso de colgajos o injertos cutáneos en la corrección de defectos palpebrales de gran tamaño. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, de 15 pacientes con lesiones tumorales o cicatrizales que provocaron defectos palpebrales de gran tamaño, desde enero a diciembre del año 2016, en la Consulta de Oculoplastia del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Resultados: El 73,3 por ciento de los pacientes fue del sexo masculino y mayores de 60 años. Las lesiones tumorales representaron el 73,3 por ciento y el carcinoma basal el 53,3 por ciento. El párpado inferior fue el más comprometido. En el 60 por ciento de los casos se realizó colgajo cutáneo; de ellos, a 8 pacientes (88,8 por ciento) de tipo Tenzel. En el 73,3 por ciento de los pacientes no se presentaron complicaciones. El hematoma posquirúrgico fue la complicación general más frecuente (25 por ciento). Conclusiones: Los defectos palpebrales de gran tamaño se presentan en mayor cantidad en los pacientes mayores de 60 años, del sexo masculino. Predomina el carcinoma basal en el párpado inferior. La técnica reconstructiva con colgajos e injertos cutáneos resulta efectiva en la mayoría de los casos y se reporta un mínimo de complicaciones(AU)
Objective: To describe the esthetic and functional results of the use of flaps or cutaneous grafts for the correction of large eyelid defects. Method: A prospective, descriptive and observational study of 15 patients with tumoral or scar lesions that caused large eyelid defects was conducted from January to December, 2016 in the Oculoplasty Service of Ramon Pando Ferrer Cuban Institute of Ophthalmology. Results: In the study, 73.3 percent of patients were males aged over 60 years. Tumoral lesions were present in 73.3 percent of patients whereas basal carcinoma was found in 53.3 percent. The lower eyelid was the most affected. Sixty percent of cases were corrected with cutaneous flap, eight of them (88.8 percent) with Tenzel-type flap. No complications were seen in 73.3 percent of patients. Postsurgical hematoma was the most common complication (25 percent). Conclusions: Large eyelid defects were observed in a higher number of male patients aged 60 years. Basal carcinoma in the lower eyelid predominated. The reconstructive technique using flaps or cutaneous grafts proved to be effective in most of the cases, with minimal complications(AU)
Subject(s)
Humans , Male , Middle Aged , Surgical Flaps/surgery , Plastic Surgery Procedures/methods , Eyelid Diseases/epidemiology , Meibomian Glands/abnormalities , Epidemiology, Descriptive , Prospective Studies , Observational StudyABSTRACT
Resumen: Introducción: La enfermedad injerto contra huésped (EICH) se produce por una respuesta patoló gica y destructiva del organismo, como resultado de la interacción entre linfocitos T inmunocompetentes del donante y los antígenos del tejido receptor. Se considera la complicación más grave del trasplante de células madres hematopoyéticas, descrito con mayor frecuencia posterior al trasplante de médula ósea (TMO). La piel suele ser el primer órgano y el más comúnmente afectado, tanto en su forma aguda como crónica, con un espectro clínico de presentación variable. Objetivo: Reportar un caso de vitiligo como manifestación de EICH cutánea crónica, signo de baja prevalencia, cuyo reconocimiento podría ayudar a la sospecha de esta grave complicación. Caso clínico: Escolar de sexo masculino de 8 años de edad, con antecedente de leucemia linfoblástica aguda (LLA) diagnosticada a los 3 años de edad, con recaída combinada medular y del sistema nervioso central (SNC) con enfer medad mínima positiva en los 3 años siguientes. Cuatro años posterior al diagnóstico de LLA, recibió TMO alogénico y siete meses después presentó múltiples nevos melanocíticos con hipopigmentación perilesional y máculas acrómicas en cara, tronco y extremidades, asintomáticas. La biopsia de piel fue compatible con EICH crónica tipo vitiligo y esclerodermiforme. Recibió tratamiento tópico con Tacrolimus, logrando estabilización del cuadro. Conclusiones: La EICH conlleva a la aparición de autoanticuerpos que podrían actuar como un factor desencadenante en la aparición de enfermedades autoinmunes, como lo es el vitiligo. En consecuencia podría explicar esta manifestación, poco descri ta en la literatura, de la EICH cutánea crónica.
Abstract: Introduction: Graft-versus-host disease (GVHD) is caused by a pathologic and destructive response of the organism as a result of the interaction between donor immunocompetent T lymphocytes and the recipient tisular antigens. It's considered the most serious complication of hematopoietic stem cell transplantation, most frequently described after bone marrow transplantation (BMT). The skin is usually the first and most commonly affected organ, in both acute and chronic, with a variable clinical spectrum of presentation. Objective: To report a case of vitiligo as a manifestation of cutaneous chronic GVHD, a low prevalence sign, which recognition could help to suspect this severe compli cation. Case report: 8 years old male, diagnosed with acute lymphoblastic leukemia (ALL) at 3 years old, had a combined medullary and central nervous system (NCS) relapse with minimal positive disease 3 years afterwards. After 4 years ALL was diagnosed, he received an allogeneic bone marrow transplant. Seven months after the BMT he presented multiple melanocytic nevi with peripheral hypopigmentation, and some isolated asymptomatic, confluent achromic macules on the face, trunk and limbs. The skin biopsy was compatible with chronic vitiligo and sclerodermiform type GVHD. He received topical treatment with Tacrolimus, achieving clinical stabilization. Conclusions: GVHD leads to the appearance of autoantibodies that could act as a trigger in the onset of autoimmune diseases, such as vitiligo. Consequently it could explain this poorly described manifestation in the literature of chronic cutaneous GVHD.
Subject(s)
Humans , Male , Child , Vitiligo/etiology , Graft vs Host Disease/diagnosis , Chronic Disease , Bone Marrow Transplantation , Graft vs Host Disease/complicationsABSTRACT
BACKGROUND: Graft-versus-host disease(GVHD) frequently produces cutaneous and systemic complications in patients receiving allogenic bone marrow transplantation. Familiarity with these reactions and their treatment is important to dermatologists involved in the care of bone marrow transplant recipients. OBJECTIVE: Our purpose was to find the clinical and histopathological features of cutaneous graft versus host reaction(GVHR). METHODS: We retrospectively reviewed patients who had undergone cutaneous GVHR after allogenic bone marrow transplantation in our institute over ten years. RESULTS AND CONCLUSION: 1.We found GVHD in 40% patients with allogenic bone marrow transplantation. 2.There was cutaneous GVHR in 86.5%, liver GVHR in 44.2% and gastrointestinal systems involvement in 34.6% of all GVHD patients. 3.Acute cutaneous GVHR presented as a generalized maculopapular exanthem and chronic cutaneous GVHR appeared as generalized maculopapular eruptions or lichenoid lesions. 4.Histopathologically, in 65.4%(17/26) of acute GVHR showed characteristic changes such as basal cell degeneration, dyskeratotic cells in epidermis, spongiosis, subepidermal cleft, and inflammatory cell infiltration and in 78.3% of chronic GVHR revealed acute GVHR-like or lichenoid change. 5.Treatment of moderate to severe GVHD consisted of high-dose corticosteroids and cyclosporine. There were 23.1% mortality due to sepsis in GVHD patients.
Subject(s)
Humans , Adrenal Cortex Hormones , Bone Marrow , Bone Marrow Transplantation , Cyclosporine , Drug Eruptions , Epidermis , Liver , Mortality , Recognition, Psychology , Retrospective Studies , Sepsis , Transplantation , TransplantsABSTRACT
BACKGROUND: The histopathological findings of acute cutaneous graft-versus-host reaction are similar to that of erythema multiforme. OBJECTIVE: The objective of this study was to compare the histopathological findings of acute cutaneous graft-versus-host reactions with that of erythema multiforme. METHODS: Histopathological setions of 9 patients with grade 2 acute cutaneous graft-versus- host. reactions and of 13 patient,, with erythema multiforme were reviewed. RESULTS: Parakeratosis, the degree of the exocytosis and the endothelial cell swelling were not useful in the differential diagnosis between acute cutaneous graft-versus-host reactions and ery- thema multiforme. Rete ridge effacement and relative hyperkeratosis were characteristic in many cases of acute cutaneous graft-versus-host reactions but absent in erythema multiforme. Spongiosis, vacuolar degeneration of the basal cells, perivascular lymphocytic infiltration and erythrocyte extravasation were usually more prominent in erythema multiforme than in acute cutaneous graft-versus-host reactions. The number of dyskeratotic cells per epidermal linear mm was usually higher in erythema multiforme but not in acute cutaneous graft-versus-host reactions. An eosinophilic infiltrate was observed occasionally in erythema multiforme but not in acute cutaneous graft-versus-host reactions. CONCLUSION: The histopathological findings show the same pattern of interface dermatitis and are different only in degree beween acute cutaneous graft-versus-host reactions and eryt,hema multiforrne. Rete ridge effacement and relative hyperkeratosis speaks for a diagnosis of acute cutaneous graft-versus-host reactions, and an eosinophilic infiltrate for a diagnosis of erythema multiforme.