ABSTRACT
Wells' syndrome is a rare disease that is even more uncommon in childhood. This case report illustrates the potential devastating extent of the disease and highlights the unusual presentation of bullae in a child. It is imperative to consider Wells' syndrome in patients with presumed cellulitis and eosinophilia who fail to respond to antibiotics.
Subject(s)
Cellulitis/diagnosis , Eosinophilia/diagnosis , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Biopsy , Blister/diagnosis , Burn Units , Cellulitis/drug therapy , Cellulitis/pathology , Child , Eosinophilia/drug therapy , Eosinophilia/pathology , Humans , Male , Skin/drug effects , Skin/pathology , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
Atypical fibroxanthoma (AFX) is a lesion that typically occurs on actinically damaged skin of the head and neck. Histopathology of these neoplasms reveals atypical cells, which often demonstrate positive staining for immunohistochemical markers such as vimentin and CD10. In the case reported, keloidal collagen was discovered on histopathology. To our knowledge, only rare reports in the literature describe an AFX with similar histopathologic findings, suggesting that this is a distinctive presentation of AFX.
Subject(s)
Collagen Type I/biosynthesis , Histiocytoma, Benign Fibrous/pathology , Procollagen/biosynthesis , Skin Neoplasms/pathology , Biomarkers, Tumor/analysis , Diabetes Mellitus , Ear/pathology , Histiocytoma, Benign Fibrous/metabolism , Histiocytoma, Benign Fibrous/surgery , Humans , Hypertension/complications , Immunohistochemistry , Kidney Failure, Chronic/complications , Male , Middle Aged , Neprilysin/biosynthesis , Renal Dialysis , Skin Neoplasms/metabolism , Skin Neoplasms/surgeryABSTRACT
BACKGROUND: A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum. OBJECTIVE: To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor alpha (TNF-alpha)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis. CONCLUSION: Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-alpha inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Glucocorticoids/therapeutic use , Prednisone/therapeutic use , Tinea/physiopathology , Tumor Necrosis Factor-alpha/adverse effects , Fatal Outcome , Female , Glucocorticoids/administration & dosage , Humans , Immunocompromised Host , Infliximab , Middle Aged , Prednisone/administration & dosage , Tinea/etiology , Tinea/immunologyABSTRACT
Rofecoxib, used for dysmenorrhea, caused a herpetiform fixed drug eruption predominantly involving the lips with classic clinical and histological findings in a red-brown lesion on the dorsal hand.