ABSTRACT
is missing (Short communication).
Subject(s)
Depression , Hyperhidrosis , Anxiety/diagnosis , Anxiety/epidemiology , Depression/diagnosis , Depression/epidemiology , Humans , Hyperhidrosis/diagnosis , Hyperhidrosis/epidemiology , Hyperhidrosis/psychology , Outpatients , Sweden/epidemiologyABSTRACT
We present a 60-year-old female with a 23-year history of anhidrosis with concomitant heat intolerance. At examination, we found a right-sided tonic pupil, absent tendon reflexes, and a segmental patch of compensatory hyperhidrosis in the left lower quadrant of her trunk. To further confirm this finding, a minor test (a starch-iodine test, which is used to evaluate the sudomotor function, sweating) was performed. Nerve conduction studies revealed evidence of a mild distal sensory polyneuropathy of the axonal type. Tilt-table testing showed signs of orthostatic hypotension with evidence of reduced sympathetic function. Skin biopsy excluded pathology in the sweat glands. Our patient met the criteria for a diagnosis of Ross syndrome. This case describes the long-term outcome of this rare entity and highlights how careful examination and bedside autonomic testing can confirm the diagnosis of autonomic neurological disorders.
ABSTRACT
Since 2008, outbreaks of atypical hand, foot, and mouth disease (HFMD) in children and adults have been reported worldwide. The majority of these outbreaks are caused by a new lineage of Coxsackie virus A6 (CV-A6) presenting a more severe clinical phenotype than the classical childhood HFMD caused by CV-A16. Between June 2014 and January 2016, 23 cases of atypical HFMD disease presented at a Dermatology Department at a regional University Hospital in Denmark. Patients were referred by general practitioners and dermatologists with a variety of clinical diagnoses, including eczema herpeticum, vasculitis, syphilis, dermatophytid, erythema multiforme and Stevens-Johnson syndrome. Three adults and 3 children required hospitalization due to extensive skin involvement and fever. All reported patients had laboratory-confirmed enterovirus infection. This study demonstrated an upsurge in atypical HFMD caused by CV-A6 in the Region of Southern Denmark and that atypical HFMD can be difficult to diagnose clinically as it may mimic other severe skin diseases.
Subject(s)
Enterovirus A, Human/isolation & purification , Hand, Foot and Mouth Disease/diagnosis , Hand, Foot and Mouth Disease/virology , Skin/virology , Adult , Aged , Child , Child, Preschool , Denmark/epidemiology , Diagnosis, Differential , Enterovirus A, Human/pathogenicity , Female , Hand, Foot and Mouth Disease/epidemiology , Hand, Foot and Mouth Disease/transmission , Hospitals, University , Host-Pathogen Interactions , Humans , Infant , Male , Middle Aged , Phenotype , Predictive Value of Tests , Skin/pathology , Young AdultABSTRACT
We present the first case of atypical hand, food, and mouth disease in our department with the distinct cutaneous morphology of eczema coxsackium. Clinicians should be aware of the possibility for more extensive cutaneous eruption related to coxsackievirus A6 infection and the diagnostic methods required to determine the diagnosis.
