Mycoplasma-Induced Rash and Mucositis in a Father and Son: A Case Report.

This case report describes a father and son with recurrent Mycoplasma-induced rash and mucositis (MIRM). A father with a remote history of a similar rash in childhood presented to the hospital with a severe rash with mucosal involvement, and elevated Mycoplasma pneumoniae immunoglobulin M titers, consistent with MIRM. Four years later, a similar rash developed in his son with a positive M. pneumoniae polymerase chain reaction assay, which was consistent with MIRM. His course was complicated by recurrence of disease shortly after discharge from the hospital. To our knowledge, this case report is the first to describe recurrent MIRM affecting individuals within the same family.

Self-limited neonatal periumbilical erythema.

We report three cases of neonatal, noninfectious, periumbilical erythema that resolved shortly after umbilical stump detachment. We hypothesize that these infants experienced an inflammatory and vasodilatory response during the normal umbilical cord separation process. We propose a new term: self-limited neonatal periumbilical erythema.

Patient viewing sessions: the patient experience.

Background Dermatology grand rounds and clinical conferences often include patient viewing sessions, during which groups of dermatologists and trainees see and discuss patient cases.Objective To understand experiences and attitudes of patients participating in patient viewing sessions.Methods Questionnaires were given to patients immediately before and after patient viewing sessions and by mail 3 months after participating in patient viewing sessions.Results Fifty one individuals responded to the survey during patient viewing sessions and 15 (29.4%) responded to the delayed survey three months after the patient viewing session. Of these, 98% and 80% of patients responded that grand rounds met their expectations in the immediate and 3 month surveys, respectively.Conclusions Dermatology patient viewing sessions are valuable and satisfying for patients.

Bone marrow engraftment and associated dermatologic sequelae in a three-yr-old after liver transplantation.

We present a case of a three-yr-old child with a history of multisystem Langerhans cell histiocytosis treated with systemic chemotherapy, who developed progressive liver failure and received an orthotopic split liver transplant while continuing on chemotherapy. One month following transplant, he developed acute graft-vs.-host disease of the skin and gastrointestinal tract. Peripheral blood chimerism studies post-transplant demonstrated an increasing predominance of donor lymphocytes and granulocytes. Shortly after, the patient developed vitiligo, and two yr after transplantation, the patient developed skin manifestations of psoriasis. We discuss and review the current literature, which demonstrates that chimerism following liver transplantation is rare and in our patient may be related to his profound immunosuppression around the time of liver transplant as well the development of acute graft-versus-host disease. While autoimmune disease can occur after solid organ and stem cell transplant, our patient developed skin manifestations of autoimmunity after liver transplantation, which is also rarely described.

Mechanisms of action of etanercept in psoriasis.

Psoriasis is a chronic inflammatory disease of the skin affecting up to 2.5% of the world's population. The scaly, erythematous plaques characteristic of this papulosquamous disorder are likely triggered and maintained by cytokines and chemokines manufactured by cells of the immune system. Overproduction of inflammatory mediators, such as tumor necrosis factor-alpha (TNF-alpha) and IFN-gamma, results in a self-sustaining inflammatory cascade, causing abnormal keratinocyte proliferation and differentiation. Therapeutic drug design targeting TNF has led to the emergence of successful biologic agents, such as etanercept, in recent years. Despite extensive clinical trials documenting efficacious clinical response to therapy, there is a paucity of data investigating the molecular mechanisms by which etanercept modulates the improvement of psoriasis. This brief review summarizes recent work investigating the in vivo actions of etanercept, including its effects on various cell types, inflammatory pathways, gene activation, nuclear factor kappa B expression, and apoptosis. The anti-inflammatory properties of etanercept reveal mechanisms by which a TNF blockade may result in the improvement of psoriasis.

Etanercept induces apoptosis of dermal dendritic cells in psoriatic plaques of responding patients.

BACKGROUND: Etanercept is a tumor necrosis factor-alpha binding fusion protein that demonstrates efficacy in the treatment of psoriasis, which is accompanied by decreased plaque infiltration of T cells and myeloid dendritic cells. We hypothesized that etanercept decreases inflammatory cell infiltration by inducing apoptosis. OBJECTIVE: We sought to investigate the effect of etanercept on circulating and plaque leukocyte apoptosis in psoriasis. METHODS: Blood and plaque specimens were obtained from 10 patients with psoriasis treated with etanercept (25 mg subcutaneously twice weekly) for 24 weeks. Apoptosis was determined in tissue samples using immunohistochemistry and flow cytometry. RESULTS: Etanercept selectively induced apoptosis in dermal dendritic cells in plaques of responding patients at 1 month, before most of the clinical and histologic response was achieved. No apoptosis was detected in plaque or circulating T cells or in circulating monocytes. LIMITATIONS: Addition of multiple time points earlier than 1 month would be valuable to establish the time point of maximum induction in cell apoptosis. CONCLUSION: Etanercept selectively induces apoptosis of pathogenic dermal dendritic cells in responding patients early in the course of treatment.

Induction of lesional and circulating leukocyte apoptosis by infliximab in a patient with moderate to severe psoriasis.

Infliximab demonstrates high efficacy in treating psoriasis in a high proportion of patients. In this report we demonstrate induction of plaque (T cells, dendritic cells) and peripheral blood (T cells, monocytes) leukocyte apoptosis following a single infliximab infusion in a psoriasis patient.