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1.
Rev Neurol ; 76(10): 337-339, 2023 05 16.
Article in English, Spanish | MEDLINE | ID: mdl-37165530

ABSTRACT

INTRODUCTION: Wells syndrome, also known as eosinophilic cellulitis, is a rare dermatosis with approximately 200 cases previously described in the literature. Here, we present a case of a patient with multiple sclerosis with Wells syndrome induced by dimethyl fumarate (DMF). CASE REPORT: A 41-year-old Caucasian woman was treated with DMF in July 2021. One week later, she experienced itching on her upper and lower right arm, followed by the appearance of erythematous plaques covered with vesicles. The complete blood count showed an increased eosinophil count of up to 2,000 µL. The histological images demonstrated dermal eosinophil infiltration concordant with Wells syndrome. The clinical course was benign, with complete resolution of the lesions and normalization of the eosinophil count within four weeks. Administration of corticosteroids was not necessary. CONCLUSIONS: Eosinophilia is rare in patients with multiple sclerosis treated with DMF and usually does not require dosage adjustments. Although clinical manifestations of eosinophilia in these patients are very rare, it is important for practitioners to recognize the symptoms. Many neuroleptic drugs can induce eosinophilia and systemic symptoms; therefore, physicians must be aware of the risks associated with DMF and neuroleptic drugs, particularly for quetiapine, which contains fumarate.


TITLE: Síndrome de Wells secundario a dimetilfumarato. A propósito de un caso clínico.Introducción. El síndrome de Wells, también conocido como celulitis eosinofílica, es una rara dermatosis con aproximadamente 200 casos descritos en la bibliografía. Aquí presentamos un caso clínico de un paciente con esclerosis múltiple y síndrome de Wells secundario a dimetilfumarato (DMF). Caso clínico. Mujer de 41 años que en julio de 2021 inició el tratamiento con DMF. Una semana más tarde, comenzó con prurito en las extremidades derechas, seguido por la aparición de zonas eritematosas con vesículas. El hemograma mostró elevación del recuento de los eosinófilos hasta 2.000 µL. El estudio anatomopatológico evidenció un infiltrado eosinófilo a nivel de la dermis compatible con síndrome de Wells. La evolución clínica fue favorable, con resolución de las lesiones y normalización de la eosinofilia aproximadamente en cuatro semanas. No fue necesario administrar corticoesteroides. Conclusiones. La eosinofilia es rara en los pacientes con EM tratados con DMF y generalmente no precisa ajuste de dosis. A pesar de que las manifestaciones clínicas de la eosinofilia en estos pacientes sean raras, es importante que el médico reconozca los síntomas. Numerosos neurolépticos pueden causar eosinofilia y síntomas sistémicos; por lo tanto, los facultativos deben conocer los riesgos de la asociación entre DMF y neurolépticos, en particular por la quetiapina, que contiene fumarato.


Subject(s)
Antipsychotic Agents , Eosinophilia , Multiple Sclerosis , Humans , Female , Adult , Dimethyl Fumarate/adverse effects , Antipsychotic Agents/therapeutic use , Eosinophilia/chemically induced , Eosinophilia/complications , Eosinophilia/diagnosis , Multiple Sclerosis/drug therapy , Multiple Sclerosis/complications
2.
Rev. neurol. (Ed. impr.) ; 76(10): 337-339, May 16, 2023. ilus
Article in Spanish | IBECS | ID: ibc-220500

ABSTRACT

Introducción: El síndrome de Wells, también conocido como celulitis eosinofílica, es una rara dermatosis con aproximadamente 200 casos descritos en la bibliografía. Aquí presentamos un caso clínico de un paciente con esclerosis múltiple y síndrome de Wells secundario a dimetilfumarato (DMF). Caso clínico: Mujer de 41 años que en julio de 2021 inició el tratamiento con DMF. Una semana más tarde, comenzó con prurito en las extremidades derechas, seguido por la aparición de zonas eritematosas con vesículas. El hemograma mostró elevación del recuento de los eosinófilos hasta 2.000 µL. El estudio anatomopatológico evidenció un infiltrado eosinófilo a nivel de la dermis compatible con síndrome de Wells. La evolución clínica fue favorable, con resolución de las lesiones y normalización de la eosinofilia aproximadamente en cuatro semanas. No fue necesario administrar corticoesteroides. Conclusiones: La eosinofilia es rara en los pacientes con EM tratados con DMF y generalmente no precisa ajuste de dosis. A pesar de que las manifestaciones clínicas de la eosinofilia en estos pacientes sean raras, es importante que el médico reconozca los síntomas. Numerosos neurolépticos pueden causar eosinofilia y síntomas sistémicos; por lo tanto, los facultativos deben conocer los riesgos de la asociación entre DMF y neurolépticos, en particular por la quetiapina, que contiene fumarato.(AU)


Introduction: Wells syndrome, also known as eosinophilic cellulitis, is a rare dermatosis with approximately 200 cases previously described in the literature. Here, we present a case of a patient with multiple sclerosis with Wells syndrome induced by dimethyl fumarate (DMF). Case report: A 41-year-old Caucasian woman was treated with DMF in July 2021. One week later, she experienced itching on her upper and lower right arm, followed by the appearance of erythematous plaques covered with vesicles. The complete blood count showed an increased eosinophil count of up to 2,000 µL. The histological images demonstrated dermal eosinophil infiltration concordant with Wells syndrome. The clinical course was benign, with complete resolution of the lesions and normalization of the eosinophil count within four weeks. Administration of corticosteroids was not necessary. Conclusions: Eosinophilia is rare in patients with multiple sclerosis treated with DMF and usually does not require dosage adjustments. Although clinical manifestations of eosinophilia in these patients are very rare, it is important for practitioners to recognize the symptoms. Many neuroleptic drugs can induce eosinophilia and systemic symptoms; therefore, physicians must be aware of the risks associated with DMF and neuroleptic drugs, particularly for quetiapine, which contains fumarate.(AU)


Subject(s)
Humans , Female , Middle Aged , Inpatients , Physical Examination , Cryopyrin-Associated Periodic Syndromes , Dimethyl Fumarate , Quetiapine Fumarate , Multiple Sclerosis , Neurology
3.
Acta Neurol Scand ; 138(5): 388-393, 2018 Nov.
Article in English | MEDLINE | ID: mdl-29963693

ABSTRACT

OBJECTIVE: we aimed to evaluate the utility of transorbital ultrasonography (TOS) in optic nerve assessment and quantification of ON atrophy in MS patients, and to determine whether ON atrophy correlates with the disease duration and disability measured on the Kurtzke Expanded Disability Status Scale (EDSS). MATERIALS AND METHODS: Prospective, multicentre, blinded cohort study of 59 patients diagnosed with relapsing-remitting MS and 36 controls. RESULTS: When measured with TOS, the diameter of both the right (2.69 ± 0.30 mm in cases; 3.20 ± 0.19 mm in controls, P < .0001) and left (2.71 ± 0.26 mm in cases; 3.24 ± 0.15 mm controls, P < .0001) ON of study patients was smaller than controls. We observed a negative correlation between EDSS and both right (ρ = .524) and left (ρ = .469) ON diameter. We also observed a negative correlation between disease duration and both right (r = .602) and left (r = .538) ON diameter. No difference was observed in the diameter of both ON among patients with a history of optic neuritis (right OND 2.68 ± 0.29 mm; left OND 2.69 ± 0.25 mm) and patients with no history of optic neuritis (right OND 2.70 ± 0.30 mm; left OND 2.73 ± 0.27 mm) (P = .805; P = .651). CONCLUSIONS: The thickness of ON measured with TOS is correlated with EDSS and the duration of the disease without being interfered by the previous history of optic neuritis. TOS could be a reliable technique for measuring ON atrophy in MS.


Subject(s)
Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging , Multiple Sclerosis, Relapsing-Remitting/pathology , Optic Nerve/diagnostic imaging , Optic Nerve/pathology , Ultrasonography/methods , Adult , Atrophy/diagnostic imaging , Atrophy/pathology , Female , Humans , Male , Middle Aged , Prospective Studies
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