Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 589
Filter
1.
Rev. Assoc. Méd. Rio Gd. do Sul ; 65(2): 01022105, Abr. - Jun. 2021.
Article in Portuguese | LILACS | ID: biblio-1369011

ABSTRACT

RESUMO As vasculites são um grupo heterogêneo de manifestações clínicas que podem ser idiopáticas ou secundárias a outras desordens. As principais causas de vasculite secundária são as infecções e medicamentos. No entanto, em alguns casos, elas podem ser secundárias a neoplasias, particularmente as neoplasias hematológicas. A vasculite leucocitoclástica é a forma mais comum de vasculite cutânea associada a distúrbios linfoproliferativos². É apresentado caso de homem caucasoide de 53 anos com história de lesões vasculares dolorosas em extremidades de surgimento recente. Realizada investigação complementar, o paciente apresentou exames compatíveis com mieloma de células plasmocitárias e vasculite leucocitoclástica cutânea. Descartando-se os demais diagnósticos diferenciais, foi, então, firmado o diagnóstico de vasculite leucocitoclástica cutânea associada ao mieloma múltiplo. PALAVRAS-CHAVE: Púrpura, vasculite leucocitoclástica secundária, mieloma múltiplo


ABSTRACT Vasculitis is a heterogeneous group of clinical manifestations that can be idiopathic or secondary to other disorders. The main causes of secondary vasculitis are infections and medications. However, in some cases, they can be secondary to neoplasms, particularly hematologic neoplasms. Leukocytoclastic vasculitis is the most common form of cutaneous vasculitis associated with lymphoproliferative disorders². We present the case of a 53-year-old Caucasian male with a history of recent onset of painful vascular lesions in the extremities. After further investigation, the patient presented tests compatible with plasma cell myeloma and cutaneous leukocytoclastic vasculitis. Discarding the other differential diagnoses, the diagnosis of cutaneous leukocytoclastic vasculitis associated with multiple myeloma was then established. KEYWORDS: Purpura, secondary leukocytoclastic vasculitis, multiple myeloma


Subject(s)
Humans , Purpura , Vasculitis, Leukocytoclastic, Cutaneous , Multiple Myeloma
2.
Säo Paulo med. j ; 139(2): 186-189, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1181004

ABSTRACT

ABSTRACT CONTEXT: Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported. CASE REPORT: Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura. CONCLUSION: The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.


Subject(s)
Humans , Male , Female , Middle Aged , Purpura/virology , Skin/virology , Skin Diseases, Viral/virology , Exanthema/virology , COVID-19/complications , COVID-19/virology , Hemangioma/virology , Skin/drug effects , Skin/pathology , Treatment Outcome , Skin Diseases, Viral/diagnosis , Skin Diseases, Viral/therapy , COVID-19 Testing , SARS-CoV-2 , COVID-19/drug therapy , COVID-19/therapy
4.
Med. lab ; 25(3): 569-580, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1343146

ABSTRACT

La glomerulonefritis rápidamente progresiva mediada por complejos inmunes (GMNRP II) es un síndrome clínico caracterizado por el rápido deterioro de la función renal asociado a hematuria, edemas y oliguria. Histológicamente se manifiesta como una glomerulonefritis crescéntica, con la presencia de depósitos granulares en la inmunofluorescencia. Aunque es una enfermedad rara, es grave y puede evolucionar a una enfermedad renal crónica, por lo cual es fundamental su identificación temprana. A continuación, se presenta una revisión sobre este tipo de glomerulonefritis, con énfasis en su etiología y en las opciones terapéuticas existentes en la actualidad


Rapidly progressive immune complex-mediated glomerulonephritis (RPGNMN II) is a clinical syndrome characterized by severe deterioration of renal function associated with hematuria, edema, and oliguria. It is histologically characterized as a crescentic glomerulonephritis, with the presence of granular deposits on immunofluorescence. Although it is a rare condition, it is a potentially serious disease that may progress to chronic renal disease, therefore its early identification is essential. Here we present a review of this form of glomerulonephritis, with emphasis on its etiology and the currently available therapeutic options


Subject(s)
Glomerulonephritis , Purpura , IgA Vasculitis , Steroids , Biopsy , ISCOMs , Glomerulonephritis, IGA , Kidney Failure, Chronic
6.
Rev. argent. reumatolg. (En línea) ; 31(3): 51-54, set. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1149676

ABSTRACT

Las manifestaciones cutáneas en las enfermedades autoinmunes son frecuentes y heterogéneas. En algunas de ellas, como en el caso del lupus eritematoso sistémico, la dermatomiositis, la esclerosis sistémica y el síndrome antifosfolípidico son de tal importancia que se incluyen como criterios clasificatorios de la enfermedad. Los diagnósticos diferenciales varían en gravedad, pudiendo en ocasiones presentar riesgo vital, por lo cual se jerarquizan el diagnóstico y tratamiento oportunos. Se describe el caso de una paciente de 22 años con diagnóstico previo de lupus eritematoso sistémico y síndrome antifosfolípídico, que concurre a la consulta con cuadro agudo caracterizado por lesiones cutáneas dolorosas de aspecto necrótico acompañadas de fiebre y livedo reticularis.


Cutaneous involvement is frequent and heterogeneous in autoimmune diseases. In some of them, such as in systemic lupus erythematosus, dermatomyositis, systemic sclerosis and antiphospholipid syndrome, some manifestations are so relevant that are included in the classification criteria. Differential diagnosis ranges in severity. Since the disease may be life-threatening, a prompt diagnosis and treatment are mandatory. We describe a clinical case of a twenty-two-year-old woman with diagnosis of systemic lupus erythematosus and antiphospholipidic syndrome, presenting with acute, painful cutaneous lesions with necrotic aspect, fever and livedo reticularis.


Subject(s)
Humans , Female , Purpura , Therapeutics , Antiphospholipid Syndrome , Lupus Erythematosus, Systemic
7.
Prensa méd. argent ; 106(1): 1-5, 20200000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1369670

ABSTRACT

El escorbuto es una enfermedad ocasionada por el déficit de vitamina C. La vitamina C, también llamada ácido ascórbico, actúa como cofactor de la propil-lisil hidroxilasa, enzima que interviene en la biosíntesis de colágeno; por ello es de vital importancia en la integridad estructural de piel, mucosas, anexos, vasos sanguíneos, huesos y dientes. Las manifestaciones clínicas incluyen síntomas constitucionales severos como debilidad y fatiga. Los hallazgos cutáneos iniciales son pápulas hiperqueratósicas foliculares y púrpura palpable perifolicular. Con el tiempo aparecen áreas extensas de equimosis, edema en miembros inferiores, hemorragias en astillas en uñas y alopecia difusa. Por lo general se describe esta enfermedad como asociada a tiempos pasados y extremadamente infrecuente en países desarrollados. Sin embargo, actualmente se ha detectado un aumento en el número de casos, asociados con malnutrición severa. Desórdenes psiquiátricos como la anorexia nerviosa, alcoholismo y deficiencias nutricionales por dietas excesivas y mal balanceadas o escasez de recursos económicos constituyen los principales factores de riesgo hoy en día. El tratamiento consiste en la corrección del déficit mediante la mediante suplementación con vitamina C vía oral. Presentamos una mujer de 24 años con escorbuto asociado a anorexia nerviosa y a dieta pobre en vegetales y fruta.


Scurvy is a disease caused by a deficit of vitamin C. Vitamin C, also called ascorbic acid, acts as a cofactor for propyl-lysyl hydroxylase, an enzyme that is involved in collagen biosynthesis, vitally important in the structural integrity of skin, mucous membranes, annexes, blood vessels, bones and teeth. Clinical manifestations include severe constitutional symptoms such as weakness and fatigue. The initial cutaneous findings are follicular hyperkeratotic papules and perifollicular palpable purpura. Over time, large areas of ecchymosis, edema of the lower limbs, splinter hemorrhages in nails and diffuse alopecia appear. Usually this disease is described as associated with past times and extremely uncommon in developed countries. However, the number of cases have been increasing, especially those associated with severe malnutrition. Psychiatric disorders such as anorexia nervosa, alcoholism and nutritional deficiencies due to excessive and poorly balanced diets or shortage of economic resources are the main risk factors nowadays. Correcting the deficit with oral vitamin C supplementation is the treatment of the disease. We present a 24-year-old woman with scurvy associated with anorexia nervosa and a diet low in vegetables and fruit.


Subject(s)
Humans , Female , Adult , Purpura , Ascorbic Acid/therapeutic use , Ascorbic Acid Deficiency/therapy , Scurvy/diagnosis , Deficiency Diseases/therapy , Malnutrition/complications , Early Diagnosis
8.
Annals of Dermatology ; : 164-167, 2020.
Article in English | WPRIM | ID: wpr-811079

ABSTRACT

Drug-induced vasculitis is an inflammation of small-sized blood vessel caused by the use of drugs. It accounts for approximately 10% of acute cutaneous vasculitis. Propylthiouracil, hydralazine, and allopurinol have been widely known as causative agents. The most common clinical feature of drug-induced vasculitis is palpable purpura on lower extremities. A 66-year-old Korean female presented with erythematous nodules on upper chest and back. She had been on medication for multiple myeloma. Laboratory results showed neutropenia. After a single injection of filgrastim (recombinant granulocyte colony-stimulating factor), she developed cutaneous lesions with concurrent increase in absolute neutrophil count. A skin biopsy revealed leukocytoclastic vasculitis. After discontinuation of filgrastim injection, her skin lesions disappeared spontaneously.


Subject(s)
Aged , Allopurinol , Biopsy , Blood Vessels , Female , Filgrastim , Granulocyte Colony-Stimulating Factor , Granulocytes , Humans , Hydralazine , Inflammation , Lower Extremity , Multiple Myeloma , Neutropenia , Neutrophils , Propylthiouracil , Purpura , Skin , Thorax , Vasculitis , Vasculitis, Leukocytoclastic, Cutaneous
9.
An. bras. dermatol ; 94(5): 582-585, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1054852

ABSTRACT

Abstract Granulomatous pigmented purpuric dermatosis clinically manifests as hyperpigmented maculae and petechiae, predominantly on the lower extremities. Histopathologically, it is characterized by a lymphocytic infiltrate in the upper dermis, extravasated erythrocytes, and hemosiderin deposits. There is an infrequent variant called granulomatous pigmented purpuric dermatosis, which histologically is characterized by the presence of non-necrotizing granulomas associated with the classic findings of other pigmented purpuric dermatoses. It more frequently affects middle-aged women of Asian origin, and predominantly on the lower extremities. The authors present the case of a female patient with granulomatous pigmented purpuric dermatosis on the lower extremities with blaschkoid distribution.


Subject(s)
Humans , Female , Middle Aged , Purpura/pathology , Skin Diseases/pathology , Granuloma/pathology , Biopsy , Dermoscopy , Erythrocytes/pathology , Latin America
10.
Medisur ; 17(2): 278-283, mar.-abr. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1002677

ABSTRACT

RESUMEN Se presenta el caso de una paciente femenina de 29 años de edad, con antecedentes de salud referida que acude a consulta por la presencia de máculas hiperpigmentadas asintomáticas de 21 días de evolución, distribuidas de forma lineal en el miembro superior derecho. Los resultados de laboratorio fueron normales y la histopatología confirmó el diagnóstico de sospecha: dermatosis purpúrica pigmentada (variedad lineal unilateral). Hubo una disminución satisfactoria del número de lesiones durante los dos primeros meses de evolución. La púrpura pigmentada unilateral se presenta con mayor frecuencia en varones adolescentes o pacientes adultos jóvenes, y afecta por lo general las extremidades inferiores y tiene una resolución espontánea.


ABSTRACT The case of a 29 year-old female patient is presented, with a referred health history who came to the consultation due to the presence of asymptomatic hyper-pigmented macules of 21 days of progress, distributed linearly in the right upper limb. Laboratory exams were normal and it was histopathology confirmed the diagnosis of suspicion: pigmented purpuric dermatosis (unilateral linear variety). There was a satisfactory decrease in the number of lesions during the first two months. Unilateral pigmented purpura occurs most frequently in adolescent males or young adult patients, and usually affects the lower extremities and has a spontaneous resolution.


Subject(s)
Humans , Female , Adult , Purpura/diagnosis , Skin Manifestations , Hand Dermatoses/pathology
11.
Annals of Dermatology ; : 472-475, 2019.
Article in English | WPRIM | ID: wpr-762343

ABSTRACT

No abstract available.


Subject(s)
Purpura
12.
Article in English | WPRIM | ID: wpr-759867

ABSTRACT

The deceased was found in the basement staircase of a commercial building. He was drunk the night before his death. He went into the building at 00:45 am as per the security camera recording. He was found at 9:10 am in an inverted and jackknife position causing the hyperflexion of his torso and neck. Autopsy findings revealed facial congestion and conjunctival petechiae. No evidence of critical trauma was noted. Therefore, he can be diagnosed with positional asphyxia. He must have lost his body balance and fallen on his back while climbing up the basement staircase for unknown reasons. His lower body was found to be in the jackknife position due to inertia. The drunken state and the accident prevented movement and this position was sustained for an extended period.


Subject(s)
Accidental Falls , Asphyxia , Autopsy , Estrogens, Conjugated (USP) , Neck , Purpura , Torso
13.
Neonatal Medicine ; : 96-101, 2019.
Article in Korean | WPRIM | ID: wpr-760577

ABSTRACT

PURPOSE: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. METHODS: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into “symptomatic,” “asymptomatic,” and “asymptomatic with isolated abnormal automated auditory brainstem response (AABR)” groups. Clinical data were analyzed based on this classification. RESULTS: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. CONCLUSION: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.


Subject(s)
Biomarkers , Brain , Classification , Cytomegalovirus Infections , Cytomegalovirus , Delivery of Health Care , Diagnosis , Evoked Potentials, Auditory, Brain Stem , Fetal Growth Retardation , Hearing , Hospitals, General , Humans , Incidence , Infant , Infant, Newborn , Live Birth , Mass Screening , Medical Records , Microcephaly , Purpura , Retrospective Studies , Ultrasonography
14.
Childhood Kidney Diseases ; : 128-133, 2019.
Article in English | WPRIM | ID: wpr-785571

ABSTRACT

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by purpura, arthritis, abdominal pain, and nephritis. Gastrointestinal involvement can manifest as pain, intussusception, intestinal bleeding, and intestinal perforation. We report a case of fulminant HSP at an age of eight in 1994, with multiple complications of intra-thoracic bleeding, massive intestinal perforation, nephritis, and various skin rashes. The brisk bleeding findings of intestinal on Technetium-99m-labeled red blood cell scan (99mTc RBC scan) were well matched to those of the emergency laparotomy and the resected intestine. The patient's abdominal conditions improved gradually but nodular skin eruptions developed newly apart from improving preexisting lower limb rashes and the urine findings continued abnormal, so skin and kidney biopsy were done for the diagnosis. After cyclosporine therapy, skin eruptions and urine findings returned to normal gradually. On a follow-up after 25 years in 2019, the patient is 33-year-old, healthy without any abnormality on blood chemistries and urine examination.


Subject(s)
Abdominal Pain , Adult , Arthritis , Biopsy , Cyclosporine , Diagnosis , Emergencies , Erythrocytes , Exanthema , Follow-Up Studies , Hemorrhage , Humans , Intestinal Perforation , Intestines , Intussusception , Kidney , Laparotomy , Lower Extremity , Nephritis , Purpura , Skin , Systemic Vasculitis
16.
An. bras. dermatol ; 93(4): 570-572, July-Aug. 2018. graf
Article in English | LILACS | ID: biblio-949929

ABSTRACT

Abstract: A 59-year-old atopic man referred to for the onset of a diffused itching papular-purpuric eruption involving his trunk and legs but without systemic symptoms. History revealed that he started feeling itching after spending few hours in his basement. Direct examination of the environmental dust (www.edpa.it) showed high level of infestation of Solenopsis fugax, a small Myrmicinae ant. The skin eruption completely healed without scarring in 2 weeks. Specific disinfestation measures were performed and the patient did not comply of any recurrence during a 6-months follow-up.


Subject(s)
Humans , Animals , Male , Middle Aged , Ants/classification , Pruritus/etiology , Purpura/etiology , Insect Bites and Stings/complications , Pruritus/diagnosis , Purpura/diagnosis , Insect Bites and Stings/diagnosis
17.
Rev. chil. infectol ; 35(4): 445-447, ago. 2018. graf
Article in Spanish | LILACS | ID: biblio-978056

ABSTRACT

Resumen La infección por Strongyloides stercoralis es una parasitosis frecuente en las regiones tropicales y subtropicales, incluyendo la Amazonía peruana. En pacientes con inmunocompromiso, las manifestaciones clínicas son variadas y es frecuente la diseminación sistémica de la enfermedad, con compromiso de diversos órganos. Las manifestaciones cutáneas son infrecuentes y se describen en pacientes con algún grado de inmunosupresión. Se presenta el caso de un paciente inmunocompetente que desarrolló una púrpura reactiva por una infección por Strongyloides stercoralis crónica. Ante ello, es posible el compromiso cutáneo en pacientes inmunocompetentes con reagudización sistémica por este parásito.


Infection with Strongyloides stercoralis is a common parasitic infection in tropical and subtropical regions, including the Peruvian Amazon. The clinical manifestations are varied in patients with immunocompromised disease, and the systemic spread of the disease is frequent, compromising different organs and systems. Cutaneous manifestations are infrequent, being described in patients with some degree of immunosuppression. We present the case of an immunocompetent patient who developed a reactive purpura due to chronic Strongyloides stercoralis infection. Thus, skin involvement is possible in immunocompetent patients with systemic exacerbation due to this parasite.


Subject(s)
Humans , Animals , Male , Adult , Young Adult , Purpura/etiology , Purpura/immunology , Strongyloidiasis/complications , Strongyloidiasis/immunology , Purpura/drug therapy , Ivermectin/therapeutic use , Chlorpheniramine/therapeutic use , Immunocompromised Host , Strongyloides stercoralis/isolation & purification , Antiparasitic Agents/classification , Antiparasitic Agents/therapeutic use , Antipruritics/therapeutic use
18.
An. bras. dermatol ; 93(3): 397-404, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-949898

ABSTRACT

Abstract: Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.


Subject(s)
Humans , Pigmentation Disorders/diagnosis , Purpura/diagnosis , Skin Diseases, Vascular/diagnosis , Purpura/etiology , Purpura/pathology , Skin/blood supply , Syndrome , Calciphylaxis/pathology , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/pathology , Skin Diseases, Vascular/pathology , Diagnosis, Differential , Purpura Fulminans/pathology
19.
Rev. colomb. reumatol ; 25(2): 79-84, abr.-jun. 2018. tab
Article in Spanish | LILACS | ID: biblio-990931

ABSTRACT

RESUMEN Objetivos: Describir la frecuencia de manifestaciones cutáneas extraglandulares en pacientes con síndrome de Sjögren primario. Determinar el perfil clínico y de laboratorio de los pacientes que presentan estas manifestaciones en comparación con aquellos que no las presentan. Materiales y métodos: Se analizaron los datos de los pacientes incluidos en la base GESSAR (Grupo de Estudio Síndrome de Sjögren de la Sociedad Argentina de Reumatología). Para la comparación entre grupos, los controles se seleccionaron en forma aleatoria con una relación casos: controles de 1:4. A su vez, se compararon los pacientes con púrpura con los controles. Resultados: Sesenta y siete (14,1%) de los 474 pacientes incluidos en la base de datos tuvieron manifestaciones cutáneas extraglandulares. De ellos, el 58% tuvo púrpura. La artritis, la neuropatía, el descenso de C3 y de C4, y la crioglobulinemia fueron estadísticamente más frecuentes en los casos en comparación con los controles; sin embargo, no se encontró asociación independiente con ninguna de estas variables. En lo que respecta a púrpura, la artritis, la neuropatía periférica, la anemia, el descenso de C3 y de C4, anti-La y crioglobulinemia fueron estadísticamente más frecuentes en comparación con los controles. Solo el descenso de C4 y la positividad de crioglobulinas se asociaron en forma independiente a la presencia de púrpura. Conclusión: El 14% de los pacientes presentaron manifestaciones cutáneas extraglandulares. La púrpura fue la manifestación más frecuente. Esta se asoció en forma independiente con el descenso de C4 y la presencia de crioglobulinas.


ABSTRACT Objectives: To describe the frequency of extra-glandular cutaneous manifestations in patients with primary Sjögren's syndrome. To determine the clinical and laboratory profile of patients who present with these manifestations compared to those who do not. Materials and methods: A study was made of patients included in GESSAR database (Sjögren Syndrome Society of Argentina Rheumatology Study Group) were analyzed. For the comparison between groups, the controls were randomly selected, with a case:control ratio of 1:4. Patients with purpura were compared with controls. Results: A total of 67 (14.1%) of the 474 patients included in the database had extra-glandular cutaneous manifestations. Of them, 58% had purpura. Arthritis, neuropathy, a decrease in C3 and C4 levels, and the presence of cryoglobulins, were statistically more frequent in cases compared to controls, although there was no independent association found with any of these variables. As regards purpura, arthritis, peripheral neuropathy, anaemia, decrease in C3 and C4, anti-La, and cryoglobulinemia were statistically more frequent compared to controls. Only the decrease in C4, and the presence of cryoglobulins were independently associated with the presence of purpura. Conclusion: Extra-glandular cutaneous manifestations were observed in 14% of the patients. Purpura was the most frequent cutaneous manifestation. This was independently associated with decreased C4 and the presence of cryoglobulins.


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Skin Manifestations , Sjogren's Syndrome , Arthritis , Purpura , Cryoglobulins
20.
Rev. chil. pediatr ; 89(1): 103-106, feb. 2018. graf
Article in Spanish | LILACS | ID: biblio-900076

ABSTRACT

Resumen: Introducción: El púrpura de Schonlein-Henoch (PSH) O Vasculitis IgA es la vasculitis sistémica más frecuente de la edad pediátrica. Se manifiesta clínicamente como púrpura palpable, artralgias, dolor abdominal y compromiso renal. El púrpura palpable buloso a diferencia de lo que ocurre en la edad adulta, es muy infrecuente en la infancia. Objetivo: Reportar una forma infrecuente de presentación cutánea del PSH en niños. Caso clínico: Niña de 14 años con historia de 2 semanas con ampollas dolorosas múltiples y confluentes en ambas extremidades inferiores asociado a artralgias. A la histo-patología destacan vesículas intracórneas, epidermis con acantosis y espongiosis e infiltrado dérmico perivascular. Inmunofluorescencia directa (+) para IgA. Se plantea el diagnóstico de PSH ampollar y se realiza tratamiento inicial con corticoides intravenosos. A los tres días del traslape a corticoides orales aparecen nuevas lesiones equimóticas en ambas piernas. Se decide asociar azatriopina e iniciar descenso de corticoides, obteniéndose buena respuesta. Conclusión: Si bien la formación de bulas en el PSH no agrega morbilidad, suele ser un fenómeno alarmante que requiere realizar diagnóstico di ferencial con otras patologías. El uso de corticoides estaría indicado en estos casos ya que disminuiría la producción de las metaloproteinsas responsables de la formación de las bulas.


Abstract: Henoch-Schönlein purpura (HSP) or IgA Vasculitis is the most common childhood vasculitis. The classic tetrad of signs and symptoms include palpable purpura, arthralgia, abdominal pain and renal disease. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. Objec tive: To report an unusual cutaneous manifestation of HSP in children. Case report: A 14-year-old girl complained about a 2-week painful bullous rash in both lower extremities and multiple arthral gias. There was no history of abdominal pain or urinary symptoms. In both lower extremities, there were numerous palpable purpura and hemmorrhagic bullae. In light of clinical findings, laboratory tests and skin biopsy are requested. The histopathology described intraepidermal blisters, acanthosis, spongiosis and perivascular dermal infiltrate. Direct immunofluorescence (IFD) (+) for IgA. The diagnosis of bullous HSP was made and treatment with endovenous corticosteroids was initiated. Three days after overlapping to oral corticosteroids, new ecchymotic lesions appeared in both legs. Due to the persistence of cutaneous involvement and negative control tests, azathioprine was associa ted obtaining a good response. Conclusion: Although bullous lesions in HSP does not add morbidity, it is often an alarming phenomenon with multiple differential diagnoses. The anti-inflamatory effect of corticoids is likely to be beneficial in the treatment of patients with severe cutaneous involvement through inhibition of proinflammatory transcription factors and decreasing the production of the metalloproteinases.


Subject(s)
Humans , Female , Adolescent , Purpura/diagnosis , Blister/etiology , Purpura/complications
SELECTION OF CITATIONS
SEARCH DETAIL