ABSTRACT
Erythroderma is a dermatological emergency presenting with generalized erythema and scaling involving <90% of the body surface.1 There are various causes of erythroderma, such as psoriasis, atopic dermatitis, phytophotodermatitis, pityriasis rubra pilaris, pemphigus foliaceus, cutaneous T-cell lymphoma, and drug eruptions.2 However, erythroderma induced by dermatophytosis is encountered rarely. We, here, describe a case of erythroderma developed secondary to extensive dermatophytosis.
Subject(s)
Dermatitis, Exfoliative , Humans , Dermatitis, Exfoliative/etiology , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/drug therapy , Male , Tinea/diagnosis , Tinea/drug therapy , Antifungal Agents/therapeutic use , Middle AgedABSTRACT
Cholinergic itch is part of symptom complex that also includes cholinergic erythema and cholinergic urticaria. It mostly occurs during the winters among young adults. It is characterized by onset of severe itching or burning sensation all over body, mostly, on exposure to sunlight, warm atmosphere and in some cases after hot and spicy food intake. In most of the cases, it is poorly responsive to antihistamine therapy. Materials and methods: This was a prospective, open labeled, clinical study done in patients of cholinergic itch, refractory to both sedating and non sedating anti-histamine drugs, who attended dermatology clinic of our tertiary care center from November, 2020 to February, 2021. Oral cyclosporine was given as treatment. Numerical rating scale (NRS) was used to record the treatment response. Results: Twenty patients with cholinergic itch meeting inclusion criteria were included in the study. Mean age of disease onset was 19.5 years. Average duration of each episode was 4.4-8 minutes. More than one site was involved in all patients with trunk being the commonest (100%). There was significant reduction in the number of episodes and cholinergic itch severity (mean NRS=7.8 to 0.3 at the end of second week after initiating cyclosporine therapy). P value of the study was <0.0001. Statistics: Mean and standard deviation were used as measure of central tendency. Paired t test was applied to analyze the data obtained. Conclusion: Oral cyclosporine effectively controlled cholinergic itch in all included patients. Drug was well tolerated by the patients.
ABSTRACT
BACKGROUND: Here, we outline the case of a US Veteran's Health Administration (VA) patient with a history of recent bioprosthetic aortic valve replacement (AVR) and recent intravenous drug use (IVDU) who was found to have three-valve infective endocarditis (IE) resulting in septic shock. We highlight this case because it represents an uncommon case of three-valve IE in the setting of recent bioprosthetic valve replacement and IVDU, and it raises the need for continued awareness of mental health and drug rehabilitation in the US military veteran population. CASE SUMMARY: A 62-year-old gentleman with recent bioprosthetic AVR presented with dyspnoea and lower extremity oedema and was found to have a heart failure exacerbation. He developed sepsis and was found to have three-valve endocarditis, as well as aortic root abscess and pacemaker lead infection. He was treated with broad-spectrum antibiotics and evaluated for surgical intervention. After discussion with the surgical team, the patient decided not to pursue surgery due to prohibitively high perioperative mortality risk. The patient was transferred to hospice and expired within 2 weeks. DISCUSSION: Three-valve IE is sparingly documented in published literature and can be difficult to treat. Providers must be cognizant of prosthetic valve endocarditis as an uncommon but known complication of valve replacement surgery. Intravenous drug use is a common risk factor for endocarditis and is prevalent in the US military veteran population. Prosthetic valve endocarditis should be treated with broad-spectrum antibiotics, and in general, if it leads to new significant valvular abnormalities, the valve should be replaced.
