Oropharyngeal dysphagia as dominant and life-threatening symptom in dermatomyositis.

BACKGROUND: Dysphagia can be a serious problem in patients with inflammatory myopathies. It may be associated with nutritional deficit, aspiration pneumonia, and poor prognosis. CASE REPORT: We presented a 60-year-old male, suffering from difficulty in swallowing, pain and weaknes in the proximal parts of his extremities, and skin manifestation. Laboratory findings showed increased creatine kinase and aldolase. Antinuclear antibodies to HEP-2 subtrate revealed titer of 1:40. Electromyoneurography demonstrated evidence of a proximal myopathy. A muscle biopsy revealed myositis. The baruim swallow test was remarkable for regurgitation, and nasal emerging of barium. Nuclear magnetic resonance images of cranium was normal. Tumor markers CEA, and Ca 19-9 were increased. A dose of 1 mg daily prednisolone was administered and percutaneous enteral feeding was performed. Two months later, the patient developed febrile state, aspiration pneumonia, and died due to respiratory failure. CONCLUSION: In cases of dermatomyositis with the serious dysphagia, percutaneous endoscopic gastrostomy should be performed as soon as possible. Overall survival rate is low, even with an adequate therapy administration. Inflammatory myopathies should be considered in any patient with oropharyngeal dysphagia.

[Dermatomyositis associated with metastatic rectal adenocarcinoma: case report].

INTRODUCTION: Dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous changes. The disease belongs to paraneoplastic dermatosis. Association of dermatomyositis with malignant conditions has been described in various studies. We present a patient with paraneoplastic dermatomyositis associated with metastatic rectal adenocarcinoma. CASE REPORT: A 66-year-old man was hospitalized in our Institute due to skin changes and myopathy in October 2006. According to the medical documents and history, he underwent surgery because of rectal adenocarcinoma in April 2006. Skin changes appeared 5 months before, while aggravation occurred 6 months after the surgery. The diagnosis of dermatomyositis was based on: characteristic clinical picture; the elevated serum level of following enzymes: creatinine kinase, lactate dehydrogenase; the presence of anti-Mi 2 antibodies in serum; electromyographic finding; and by histology of the muscle biopsy. Paraneoplastic nature of dermatomyositis was confirmed by computer tomography of the abdomen which revealed multiple deposits in the liver, by explorative laparotomy showing peritoneal dissemination and histopathological analysis that verified metastatic adenocarcinoma of the rectum. The oncological consulting team suggested chemotherapy which was not carried out because of the rapid lethal outcome. CONCLUSION: We report a case of paraneoplastic dermatomyositis associated with metastatic rectal adenocarcinoma and lethal outcome, and suggest a comprehensive evaluation of patients with dermatomyositis older than 50 years in order to exclude or verify the occult malignancy.

Two cases of probable endogenous extensive cutaneous larva migrans in Serbia.

Cutaneous larva migrans (CLM) is a skin infestation clinically characterized by erythematous serpiginous lesions caused by nematode larvae, usually of animal hookworms. It is most commonly seen in tropical and subtropical geographic areas. It is occasionally seen in Europe and other temperate climates, most often in patients that have previously traveled to tropical areas. We present two male patients that did not travel abroad with clinical features of extensive CLM located on the trunk acquired in an unusual way. CLM is not characteristic of Serbia, which is located in southeast Europe Unusually hot and sunny weather with heavy rainfall and high humidity during the summers of 2005 and 2006 were favorable conditions for the development of parasites in the soil and infestation with large numbers of larvae. To the best of our knowledge, this is the first report of extensive CLM in Serbia.

Male urethritis with and without discharge: relation to microbiological findings and polymorphonuclear counts.

OBJECTIVE: We studied the relation between the presence or absence of urethral discharge, urethral pathogens, and polymorphonuclear (PMN) counts on Gram stained urethral smears in men with symptomatic urethritis. METHODS: The study population was composed of 630 sexually active heterosexual men (aged 18-45 years) who had urethral symptoms and signs (discharge, dysuria or urethral discomfort). Participants were divided into two groups: the first (n=320) was comprised of men with urethral discharge confirmed on examination, while the other (n=310) was composed of patients with urethral symptoms but without discharge. Urethral swabs for Gram stained smears and microbiological analyses (N. gonorrhoeae, C. trachomatis, T. vaginalis and U. urealyticum) were taken from all study participants. Polymorphonuclear leukocytes (PMN) on Gram-stained urethral smears were counted in 5 oil immersion x1000 PMN per high power fields (phpf). Urethritis was defined as the presence of > or =5 PMN/hpf. RESULTS: N. gonorrhoeae was isolated only in men with urethritis accompanied by discharge. The prevalence of T. vaginalis, C. trachomatis and U. urealyticum was significantly higher (F=8.854, P<0.01) in urethral swabs of urethritis patients with discharge compared to patients with no discharge. The most common urethral pathogen in both groups of patients was T. vaginalis (31.56% and 26.45%, respectively). One or more microorganisms were isolated in 258 (81%) subjects with urethritis with discharge, and in 166 (53.5%) urethritis patients without discharge. There was a positive correlation between the significant number of PMN in Gram stained urethral smears and positive microbiological findings in men with urethritis both with and without urethral discharge (Spearmanns coefficients rho=0.986 and rho=0.993, respectively; P<0.01). CONCLUSIONS: The study found a relatively high prevalence of T. vaginalis among our men with urethritis irrespective of the presence or absence of urethral discharge, and showed that taking into account both discharge found on examination, and relevant PMN counts on Gram stained urethral smears fails to detect only 4.2% of oligosymptomatic urethritis patients who are infected with one of the strict urethral pathogens.

Ocular rosacea and treatment of symptomatic Helicobacter pylori infection: a case series.

Rosacea is a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, papules, pustules, and telangiectasia. More than half of all rosacea patients may have ocular symptoms. Rosacea is associated with certain digestive diseases, such as gastritis, hypochlorhydria, or a number of jejunal mucosal abnormalities, and many patients have Helicobacter pylori infection. The role of Helicobacter pylori has often been a subject of investigation; these studies show conflicting results. Here we present results of the effects of treatment given for H. pylori eradication in seven patients with ocular rosacea that, at the same time, had clinical and serological evidence of H. pylori infection. Six weeks after completion of the treatment, all patients experienced improvement of their rosacea symptoms. Ocular disease responded better than cutaneous rosacea.

The prevalence of cutaneous manifestations in young patients with type 1 diabetes.

OBJECTIVE: The aim of the study was to assess the prevalence of cutaneous disorders and their relation to disease duration, metabolic control, and microvascular complications in children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: The presence and frequency of skin manifestations were examined and compared in 212 unselected type 1 diabetic patients (aged 2-22 years, diabetes duration 1-15 years) and 196 healthy sex- and age-matched control subjects. Logistic regression was used to analyze the relation of cutaneous disorders with diabetes duration, glycemic control, and microvascular complications. RESULTS: One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous disorder vs. 52 (26.5%) control subjects (P < 0.01). Diabetes-associated skin lesions were found in 81 (38%) patients. Acquired ichthyosis, rubeosis faciei, diabetic hand, and necrobiosis lipoidica were seen in 22 vs. 3%, 7.1 vs. 0%, 2.3 vs. 0%, and 2.3 vs. 0% of type 1 diabetic and control subjects, respectively. The frequency of cutaneous reactions to insulin therapy was low (-2.7%). The prevalence of fungal infections in patients and control subjects was 4.7% and 1.5%, respectively. Keratosis pilaris affected 12% of our patients vs. 1.5% of control subjects. Diabetic hand was strongly (odds ratio 1.42 [95% CI 1.11-1.81]; P < 0.001), and rubeosis faciei weakly (1.22 [1.04-1.43]; P = 0.0087), associated with diabetes duration. Significant association was also found between acquired ichthyosis and keratosis pilaris (1.53 [1.09-1.79]; P < 0.001). CONCLUSIONS: Cutaneous manifestations are common in type 1 diabetic patients, and some of them, like acquired ichthyosis and keratosis pilaris, develop early in the course of the disease. Diabetic hand and rubeosis faciei are related to disease duration.

[Ocular rosacea]. / Okularna rozacea.

Five cases of ocular rosacea (one male and four females) are reported in this paper. Two of the patients were with keratoconjunctivitis sicca, one with conjunctivitis chronica and blepharitis, one with conjunctivitis chronica and meibomitis, and one with reccurent corneal erosions with meibomitis and chordeloum. In four patients ocular symptoms preceded the occurence of skin lesions. The treatment with oral tetracyclines significantly improved the state of ocular rosacea in four patients, while in one case the changes of the anterior eye segment progressed in more severe state of ulcerative keratitis. It is considered that in almost 20% of the patients with rosacea ocular lesions may precede the skin changes, representing a diagnostic problem. Thus, in those cases multidisciplinary approach is suggested. Such approach is particularly important because of the decrease of morbidity and the prevention of the onset of the eye complications such as drastic worsening of visual acuity, i.e., the blindness.