Necrobiosis séptica de un fibroma uterino / Septic Necrobiosis of Uterine Fibroma

Los miomas o fibromas, son tumores benignos que aparecen frecuentemente en el útero, y aunque a veces pueden ser asintomáticos, en muchas mujeres son la razón más común de las intervenciones ginecológicas. Algunos autores consideran que la causa es desconocida, otros le dan valor al estímulo estrogénico mantenido o aumentado, que activa los genitoblastos, mesodérmico y celular embrionario que responden a este estímulo. Se presenta el caso de un fibroma uterino complicado con una necrobiosis séptica diagnosticada en una paciente de 63 años de edad. El apoyo diagnóstico con ultrasonografía es de vital importancia en la sospecha diagnóstica de este tipo tumor y sus complicaciones.

Myomas or fibroids are benign tumors that frequently appear in the uterus, and although they can sometimes be asymptomatic, in many women they are the most common reason for gynecological interventions. Some authors consider that the cause is unknown. Others give value to the maintained or increased estrogenic stimulus, which activates the embryonic cell, mesodermal and genitoblasts that respond to this stimulus. We present the case of a complicated uterine fibroid with a septic necrobiosis diagnosed in a 63-year-old patient. Ultrasonography is of vital importance in the diagnosis when there is suspicion of this type of tumor and its complications.

Diabetes mellitus and the skin

Abstract: Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.

Necrobiosis lipoidica en un paciente con prediabetes / Necrobiosis lipoidica in a prediabetic patient

La necrobiosis lipoidica es una dermatosis poco frecuente, de origen desconocido. Puede observarse en pacientes sin alteración de la glucosa, pero frecuentemente está asociada a la diabetes mellitus bien establecida. Menos común es que estas lesiones en la piel aparezcan en estadios prediabéticos. Se describe el caso de una paciente femenina, de 65 años de edad, que hace 10 años comenzó a presentar una lesión papuloeritematosa de 1 cm, con bordes bien definidos, en la cara lateral interna de la pierna derecha. Recientemente le realizan biopsia de la lesión dermatológica y prueba de tolerancia a la glucosa oral, y se diagnostica necrobiosis lipoidica y tolerancia a la glucosa alterada respectivamente. Se piensa que los pacientes con esta enfermedad deben tener seguimiento a largo plazo, para diagnosticar oportunamente diabetes mellitus u otros estados prediabéticos(AU)

Necrobiosis lipoidica is a rare dermatosis of unknown origin. It can be observed in patients with unaltered glucose indexes but frequently associated to well-established diabetes mellitus. It is even less common that this type of skin lesions occur in pre-diabetic staging. This is the case of 65 years-old woman, who had presented 1 cm-long papulloerythematous lesion with well-defined contours for 10 years in the inner lateral side of her right leg. She had been recently biopsied in her cutaneous lesion and made a glucose-tolerance test, which yielded necrobiosis lipoidica and altered glucose tolerance. It is considered that the patients with this disease should be followed-up for a long period to timely diagnose diabetes mellitus or other pre-diabetic conditions(AU)

Necrobiosis lipoídica en paciente diabético tipo 1: reporte de un caso / Necrobiosis lipodica in a type 1 diabetic patient: case report

La necrobiosis lipoídica es una enfermedad crónica granulomatosa de la piel de origen desconocido, que se caracteriza por placas inflamatorias amarronadas con bordes indurados y centro atrófico. Dos tercios de los casos se reportan en pacientes diabéticos, con predominio en el sexo femenino. Se describe el caso de una mujer de 18 años de edad con diagnóstico de diabetes tipo 1 de más de 15 años de evolución, en tratamiento con insulina detemir 88 U/día, con inadecuada adherencia al tratamiento y mal control metabólico. Presentó lesiones hipotróficas en cara anterior de ambas piernas (región pretibial derecha y antepié izquierdo), de centro ulcerado, no dolorosas, con bordes indurados, de meses de evolución. Se realizó diagnóstico de necrobiosis lipoídica mediante biopsia de piel. La paciente mejoró con tratamiento local de las lesiones (corticoides intralesionales y antibióticos tópicos) y adecuado control de la glucemia. En la literatura se discuten numerosas opciones de tratamiento, pero no existen recomendaciones terapéuticas firmes basadas en estudios controlados.

Necrobiosis lipoidica is a chronic granulomatous skin disease of unknown origin characterized by inflammatory plaques with indurated edges and brownish atrophic center. Two thirds of cases are reported in diabetic patients, with a predominance in females. The case of a 18-year-old woman with type 1 diabetes for 15 years is described; she was on insulin detemir 88 U/day, with inadequate adherence to treatment and poor metabolic control. She presented painless hypotrophic dermic lesions in the anterior aspect of both legs and in the left forefoot; they had ulcerated center and indurated edges; the evolution was chronic (several months). Diagnosis of necrobiosis lipoidica was made by skin biopsy. The patient improved with local treatment of lesions (intradermic steroids and topical antibiotics) and adequate glycemic control. In the literature many treatment options are discussed, but there are no firm therapeutic recommendations based on controlled studies.

Necrobiosis lipoídica diabética / Diabetic lipoidic necrobiosis

Se describe el caso clínico de una fémina de 39 años de edad, con diabetes mellitus de tipo II, quien ingresó en el Servicio de Dermatología del Hospital Provincial Clinicoquirúrgico Docente "Celia Sánchez Manduley" de la provincia de Granma por presentar, desde hacía más de un año, múltiples lesiones en los miembros inferiores, superiores y tronco. Teniendo en cuenta los resultados de los exámenes físico y complementarios, incluida la biopsia, se le diagnóstico necrobiosis lipoídica diabética. Se le indicó tratamiento con triamcinolona y evolucionó favorablemente.

The case report of a 39 years female patient with diabetes mellitus type II who was admitted in the Dermatology Service of "Celia Sánchez Manduley" Teaching Clinical Surgical Provincial Hospital of Granma province is described. She presented, for more than a year, multiple lesions in the lower and higher extremities and trunk. Keeping in mind the results of the physical and complementary exams, including biopsy, she had a diagnosis of diabetic lipoidic necrobiosis. She was prescribed a treatment with triamcinolona and she had a favorable clinical course.

Necrobiosis lipoidica de localizacion atipica / Necrobiosis lipoidica in unusual location

La necrobiosis lipoidica constituye una dermatosis de origen desconocido incluida dentro de los procesos con granulomas necrobi¢ticos. La necrobiosis lipoidicase presenta en la mayor¡a de los casos con una morfolog¡a e histolog¡a caracter¡sticas y diagn¢sticas y son muy poco frecuentes las formas at¡picas. Se presenta el caso de una paciente mujer de 75 a¤os de edad con un tiempo de enfermedad de cuatro meses, que acude a la consulta por una lesi¢n papuloeritematosa de 0,5 cm, en la regi¢n proximal posterior del brazo izquierdo, con leve prurito espor dico. Esta lesi¢n fue aumentando de tama¤o, hasta alcanzar aproximadamente 4 cm, y presenta un cambio de coloraci¢n (viol cea) y dolor a la fricci¢n o roce.

The necrobiosis lipoidica is a dermatosis of unknown origin included within the processes with necrobiotic granuloma, necrobiosis lipoidica. The presents in most cases with a morphology and histology and diagnostic features are rare and atypical. We report the case al a female patient aged 75 with a time of 4 months disease presents with a lesion 010,5 cm erythematous papulo in posterior proximal region o] the left arm, with occasional mild pruritus. The lesion was increasing in size (up to about 4 cm) and features color change (purple) and pain to friction.

A Case of Necrobiosis Lipoidica Treated with Cyclosporine / 대한피부과학회지

No abstract available.

Necrobiosis lipoidica: A case report and review of treatment

Necrobiosis lipoidica (NL) is a dermatologic disorder characterized by sharply demarcated yellow-brown plaques or indurated plaques with violaceous, irregular borders usually located on the pretibial region. Lesions may flatten and develop a central yellow or orange area as it becomes atrophic, often accompanied by the appearance of telangiectasias, giving it the characteristic "glazed¬porcelain" sheen. Typical histologic findings are seen at the edge of the lesions and include: variable amount of dermal fibrosis, particularly in its lower two-thirds of the dermis; and a superficial and deep perivascular inflammatory reaction. The dermal changes extend to the underlying subcutaneous septa. Although these histologic findings were first described in diabetic patients, not all patients with NL have concurrent diabetes. Treatment of NL involves the use of potent topical steroids and the prevention of the development of ulcers. This is a case of a 29-year-old female who presented with few erythematous plaques on the left anterolateral portion of the left lower extremity, histologically confirmed as NL with normal fasting blood sugar levels.

Necrobiosis Lipoidica Over Surgical Scar in a Patient without Diabetes Mellitus / 대한피부과학회지

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease typified by indurated plaques on the shin. Although this condition is strongly associated with diabetes mellitus, its etiology and pathogenesis remains unknown. Localization of NL to the lower extremities suggests that local injury may be a contributing factor to the disease. A healthy 38-year-old man presented with localized erythematous to yellowish plaques on his right thigh that developed over several years. The lesion developed in the scar where suture had been done for laceration repair 25 years ago. A biopsy specimen showed degenerated collagen with surrounding palisading granulomas. Numerous lymphocytes and multinucleated giant cells were infiltrated throughout the reticular dermis. Plasma cells aggregation was found at the dermal subcutaneous junction.

Necrobiosis Lipoidica Presenting as Unilateral Papulovesicular Eruptions on the Lower Leg / 대한피부과학회지

Necrobiosis lipoidica is a chronic granulomatous disease that has a well-known association with diabetes mellitus. It usually affects the bilateral lower legs of middle-aged women. Over time, the clinical features vary from red-brown papules to sharply demarcated yellow-brown plaque with atrophic center. Some of the lesions may become ulcerated, especially in diabetic patients. A 61-year-old Korean female with a history of diabetes, ischemic heart disease, and pancreatic cancer was referred to our clinic for evaluation of the painful papulovesicles on her left lower leg. Under the assumptive diagnosis of herpes zoster, we immediately started an antiviral agent. However, her skin lesions rapidly increased in size and in number, and progressed to the multiple ulcerations in 9 days. Histopathologic examination showed several poorly circumscribed necrobiotic granulomas in the deep dermis and subcutis levels of the skin. In addition, prominent vascular ectasia and vasculitis were observed. We diagnosed the patient as having necrobiotic lipoidica, and treated her with oral dapsone, colchicine, phentoxifylline and antiplatelets. Her leg ulcerations healed after four weeks of treatment.

Necrobiosis lipoídica ulcerativa tratada con ciclosporina / Ulcerative necrobiosis lipoidica treated with cyclosporin

La necrobiosis lipoidica es una enfermedad de etiología desconocida. La ulceración es una de sus complicaciones y es de difícil tratamiento. Algunos reportes han demostrado la eficiencia de la ciclosporina en al necrobiosis lipoidica. Presentamos a un varón de 51 años de edad con necrobiosis lipoidica ulcerativa en la pierna izquierda que fue tratado exitosamente con ciclosporina.

Necrobiosis lipoidica is a disease of unknown etiology. Recalcitrant ulceration, not responsive to therapy, may be a complication. Cyclosporin therapy has been reported as an effective therapy. We present the case of a 51-year-old man with ulcerative necrobiosis lipoidica on the left leg, successfully treated with cyclosporine.

Ulcerative Necrobiosis Lipoidica Improved by Hydroxychloroquine / 대한피부과학회지

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease of unknown etiology, which can be seen in patients with diabetes mellitus. Typical lesions of NL appear on the pretibial skin as painful yellow-brown inflammatory plaques with raised borders and atrophic centers. Ulceration occurs in approximately 35% of cases, leading to increased risk of secondary bacterial infection and scarring. Although there have been many proposed therapies for ulcerative NL, the response to treatment is often met with limited success. Here, we report a case of a 19-year-old girl with ulcerative NL, which showed improvements with oral hydroxychloroquine, an antimalarial agent.

Cutaneous Sarcoidosis Clinically Mimicking Necrobiosis Lipoidica in a Patient with Systemic Sarcoidosis

A 70-year-old woman with an 8-year history of systemic sarcoidosis developed round, red-brown eruptions, with central atrophic lesions on her lower legs. The features of the biopsy specimen resembled those of necrobiosis lipoidica (NL), but although necrobiosis was present there were well-formed non-necrotizing granulomas in the dermis. The histological diagnosis was cutaneous sarcoidosis. Systemic sarcoidosis presenting with NL has rarely been reported. The histological features of cutaneous sarcoidosis sometimes mimic those of other granulomatous diseases, including NL and granuloma annulare, which are difficult to distinguish. We discuss the novel association between sarcoidosis and other granulomatous diseases.

Ocorrência simultânea de necrobiose lipoídica ulcerada e granuloma anular em um paciente: relato de caso / Simultaneous occurrence of ulcerated necrobiosis lipoidica and granuloma annulare in a patient: case report

Ocorrência simultânea de granuloma anular e necrobiose lipoídica é rara. Sete casos dessa associação foram encontrados na literatura, sendo somente um de necrobiose lipoídica ulcerada. Relata-se caso de concomitância de granuloma anular e necrobiose lipoídica ulcerada, não associada a diabetes mellitus, em paciente masculino de 39 anos, com confirmação histopatológica.

Simultaneous occurrence of granuloma annulare and necrobiosis lipoidica is quite rare. There are seven reported cases in the literature, but only one presenting ulcerated necrobiosis lipoidica. We report a 39-year-old male with histopathologically confirmed granuloma annulare and ulcerated necrobiosis lipoidica, without diabetes mellitus.

Necrobiose lipoídica diabeticorum: relato de caso / Necrobiosis lipoidica diabeticorum: case report

O diabete melito (DM) é um distúrbio endocrinológico bastante prevalente na popula- ção e caracteriza-se pelo estado hiperglicêmico patológico e crônico, ao qual surgem diversas manifestações sistêmicas e grande prejuízo à qualidade de vida a longo prazo. A necrobiose lipoídica diabeticorum é uma dermatose rara, porém característica e marcadora do DM, podendo ser precursora da enfermidade. Clinicamente apresenta-se com máculas ou placas de forma oval ou irregular, confluentes, com uma área central atrófica e/ou depressiva, com telangectasias, sendo inicialmente eritematosa e, posteriormente, de coloração amarelada. Embora não desencadeie sintomas aos pacientes, pode causar complicações secundárias a traumas ou infecções e desconforto estético. Não há consenso quanto ao tratamento, de modo que muitas medicações são sugeridas, com resultados controversos, mas promissores (AU)

Diabetes mellitus (DM) is a highly prevalent endocrinological disease among the general population. It is featured by chronic and pathological hyperglycemia, which may result in systemic manifestations and great loss of quality of life in the long run. Although necrobiosis lipoidica diabeticorum (NLD) is a rare dermatosis, it is commonly associated with DM and can be a precursor of it. Clinically seen as confluent, irregular oval maculae or papules, with an atrophic and/or depressed central area and telangiectasis, NLD begins as erythematous lesions which eventually become yellowish. Although NLD does not cause symptoms in the patient, it may lead to secondary complications due to trauma or infection and aesthetic discomfort. As yet there is no standard treatment for NLD, and so plenty of medications have been suggested, with controversial but promising results (AU)