ABSTRACT
Cutaneous mercury (Hg) granuloma is a rare disorder caused by the traumatic introduction of elemental Hg into skin or soft tissue. Typically, cutaneous elemental Hg deposits cause limited systemic effects. Prominent systemic toxicity may, however, occasionally occur. Herein we report a case of cutaneous Hg granuloma resulting in chronic painful local wounds and systemic toxicity in the form of abdominal pain, visual disturbances, and psychiatric abnormalities. The related literature also is reviewed.
Subject(s)
Granuloma, Foreign-Body/etiology , Mercury Poisoning/pathology , Skin Diseases/chemically induced , Adult , Female , HIV Infections/therapy , Honduras , Humans , Injections, Subcutaneous , Mercury/administration & dosage , Mercury/toxicitySubject(s)
Dermatitis/pathology , Panniculitis/pathology , Anti-Bacterial Agents/therapeutic use , Biopsy , Ceftriaxone/therapeutic use , Clindamycin/therapeutic use , Dermatitis/drug therapy , Dermatitis/microbiology , Female , Humans , Infant , Panniculitis/drug therapy , Panniculitis/microbiology , Vancomycin/therapeutic useABSTRACT
The B7 family of molecules on antigen presenting cells (APCs) regulate T cell activation. They deliver stimulatory signals through CD28 and inhibitory signals through CD152, or cytotoxic T lymphocyte-associated antigen-4 (CTLA-4). CTLA4Ig (abatacept) is a soluble chimeric protein consisting of the extracellular domain of human CD152 linked to the modified Fc portion of human IgG1. By binding to B7-1 (CD80) and B7-2 (CD86) molecules on APCs, CTLA4Ig blocks the CD28-mediated costimulatory signal for T cell activation. Success with abatacept has been noted in psoriasis. Abatacept was administered to two patients with refractory psoriasis and psoriatic arthritis after the patients had failed all conventional treatment methods. Both patients experienced very brief improvement in disease. The improvement, however, was not continued, and both patients were taken off the medication. The small patient population limits the extrapolation of the present authors' results to the larger population. Furthermore, the present authors' patients have very severe, refractory disease and do not adequately represent the majority of psoriasis patients. Although the present authors' patients demonstrated brief response to drug, this response was not sustained. No adverse events were reported in the present authors' patients.
Subject(s)
Arthritis, Psoriatic/drug therapy , Dermatologic Agents/therapeutic use , Immunoconjugates/therapeutic use , Psoriasis/drug therapy , Skin/drug effects , Abatacept , Adult , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/immunology , Humans , Male , Middle Aged , Psoriasis/diagnosis , Psoriasis/immunology , Skin/immunology , Skin/pathology , Time Factors , Treatment OutcomeSubject(s)
Sarcoma, Myeloid/pathology , Skin Neoplasms/pathology , Skin/pathology , Biopsy , Education, Medical, Continuing , Humans , Male , Middle AgedABSTRACT
The use of liquid injectable silicone for soft tissue augmentation is a controversial practice within the medical community. Injectable silicone has been illegally obtained, adulterated, and abused by nonmedical practitioners for the last five decades. Injection of silicone can result in catastrophic consequences including death, when grossly abused. Opponents of this practice cite the many serious adverse events that have occurred with its use both legally and illegally. Proponents argue that employment of a stringent regimen of use as well as a highly purified medical grade product allow for a safe utilization of the material. Both sides agree that this practice calls for a high degree of knowledge and technical skill. A continued evaluation of the long-term safety of this material is necessary before a consensus can be reached. Herein, we report a case of illegal administration of injectable silicone resulting in product migration accompanied by a granulomatous response. Further, the literature that both supports and refutes the practice of silicone injection is reviewed.
