RESUMO
BACKGROUND: The development of persistent subcutaneous nodules at the injection sites of aluminium-adsorbed hyposensitization solutions is rare. These nodules have been interpreted as a delayed, granulomatous hypersensitivity reaction to aluminium. We report for the first time a case of persistent intradermal granulomas that developed at the sites of inaccurate intradermal, instead of subcutaneous, hyposensitization injections. METHODS: An intradermal nodule was excised and processed for histopathology, scanning electron microscopy, and X-ray microanalysis. Intradermal and patch tests with aluminium hydroxide were performed. RESULTS: Histologically, the nodule presented a pattern of granulomatous inflammatory reaction surrounding foci of necrotic tissue. Scanning electron microscopy and X-ray microanalysis revealed deposits of aluminium within the granulomas. Patch tests with aluminium hydroxide were negative, and intradermal tests caused persistent intradermal granulomas. Subsequent hyposensitization therapy in our department with the usual subcutaneous injections of aluminium-adsorbed allergen extracts was well tolerated by the patient. CONCLUSIONS: Local toxic effects of aluminium may be crucial in the development of persistent intradermal injection-site granulomas. Such intradermal nodules may develop even if the subcutaneous route is well tolerated. We conclude that inaccurate intradermal injections of aluminium-containing solutions have to be strictly avoided.
Assuntos
Hidróxido de Alumínio/administração & dosagem , Hidróxido de Alumínio/efeitos adversos , Dessensibilização Imunológica , Granuloma de Corpo Estranho/etiologia , Venenos de Vespas/administração & dosagem , Feminino , Granuloma de Corpo Estranho/patologia , Humanos , Hipersensibilidade Imediata/terapia , Injeções Intradérmicas , Injeções Subcutâneas , Pessoa de Meia-Idade , Venenos de Vespas/efeitos adversos , Venenos de Vespas/imunologiaAssuntos
Atitude Frente a Saúde , Tomada de Decisões , Família/psicologia , Doadores de Tecidos , Adolescente , Adulto , Idoso , Morte Encefálica , Feminino , Culpa , Humanos , Masculino , Pessoa de Meia-Idade , Obtenção de Tecidos e ÓrgãosAssuntos
Morte Encefálica , Família , Doadores de Tecidos , Adolescente , Adulto , Fatores Etários , Idoso , Causas de Morte , Criança , Demografia , Feminino , França , Humanos , Consentimento Livre e Esclarecido , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
Annexins/lipocortins are a group of structurally related calcium and lipid binding proteins which have been implicated as mediators of the anti-inflammatory action of corticosteroids. Autoantibodies against annexin-1 have been reported in association with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis and their presence has been hypothesized as the reason for the steroid resistance phenomenon. In this study we investigated IgG- and IgM-autoantibodies against annexin-1,-2,-3,-4,-5 and -6 in sera of 221 patients with skin disorders and 114 healthy blood donors with newly established ELISAs. Patients were clustered into 5 groups according to their diagnosis: autoimmune diseases, psoriasis, leg ulcer, malignant melanoma, and miscellaneous diseases. Autoantibodies directed against each annexin were detectable in all investigated groups, in the control group as well as in the disease groups, without displaying any significant correlation to any of the disease states. The homogenous distribution of annexin-autoantibodies throughout the control group and all the disease groups studied, do not support the implication of annexin-autoantibodies in pathophysiological states and make them an unlikely candidate for use as a diagnostic marker.
