ABSTRACT
Acne Fulminans (AF) is a severe form of cystic acne primarily affecting Caucasian adolescent males. The systemic clinical manifestations of the disease make it likely that the patient will present to his or her primary care provider rather than to a dermatologist. Promptly recognizing this disorder will aid in appropriate management, avoiding costly and invasive diagnostic procedures, multiple consultations, unnecessary pharmacologic treatments, and residual scarring of the skin. We report a case and a brief review of the literature regarding this enigmatic disorder.
Subject(s)
Acne Vulgaris/diagnosis , Acne Vulgaris/drug therapy , Adolescent , Biopsy , Diagnosis, Differential , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Isotretinoin/therapeutic use , Magnetic Resonance Imaging , Male , Prednisone/therapeutic useABSTRACT
Aggressive Systemic Mastocytosis (ASM), a rare subtype of Systemic Mastocytosis (SM), results from clonal proliferation and invasion of multiple organs by neoplastic mast cells. The clinical presentation varies, dependent on which organ systems are involved, and may take an indolent or rapidly fatal course. Several treatment strategies have been proposed. The most effective treatment, though not curative, is a combination of glucocorticoids and alpha-interferon 2b (IFN-alpha). We present a case report of ASM to demonstrate the clinical presentation, laboratory findings, and therapeutic response to treatment.
Subject(s)
Mastocytosis, Systemic/diagnosis , Aged , Antineoplastic Agents, Hormonal/therapeutic use , Biopsy , Bone Marrow Cells/pathology , Clinical Chemistry Tests , Diagnosis, Differential , Glucocorticoids/therapeutic use , Hepatocytes/pathology , Humans , Male , Mastocytosis, Systemic/drug therapy , Mastocytosis, Systemic/physiopathology , Prednisone/therapeutic use , Treatment OutcomeABSTRACT
Zinc is a ubiquitous element that is essential for normal enzymatic function in multiple metabolic pathways. Chronic excessive zinc ingestion causes severe reversible anemia in humans. In animals, zinc toxicity leads to anemia as well as physiologic and morphologic damage to the pancreas, kidneys, and often, multisystem failure and death. In this case, a young female ingested approximately 2000 mg of zinc gluconate daily for 12 months. She subsequently developed anemia consistent with zinc-induced copper deficiency and severe nephrosis. After cessation of zinc ingestion, her anemia and nephrosis resolved. This case study underscores the importance of an accurate and thorough investigation of nutritional supplements during the history and physical examination. Given the promulgation of zinc for the treatment of skin disorders and the common cold, along with the commercialization of nutritional supplements, unimpeded by regulatory guidelines, it is imperative that primary care physicians be attuned to the potentially dangerous consequences of excessive zinc ingestion.
