Eosinophilic fasciitis in a 57-year-old Japanese-American woman.

Eosinophilic fasciitis (EF) is a rare connective tissue disorder characterized by symmetrical sclerodermatous skin changes primarily affecting the extremities and histologically, by thickening of the fascia with chronic inflammatory infiltrate containing eosinophils. EF is associated with peripheral eosinophilia, hypergammaglobulinemia, and an elevated ESR. Reported is a case of EF in a 57-year-old Japanese-American woman who refused treatment with prednisone, review of other treatment options, and discussion of key differences between this disease and scleroderma.

Treatment of acne conglobata with infliximab.

Acne conglobata is an uncommon nodulocystic condition that is often resistant to therapy. This disorder typically begins in adulthood and presents as numerous comedones, papules, pustules, nodules, abscesses, and draining sinus tracts involving the chest, back, and buttocks. These lesions frequently become secondarily infected with gram-positive bacteria and often heal with scarring. Pathology usually reveals inflammatory infiltrate around follicles, which can often disrupt the normal dermal architecture. Acne conglobata is particularly disfiguring and socially detrimental to patients because of its chronicity, severity, and treatment challenge.

T-cell lymphopenia associated with infliximab and cyclophosphamide.

We report the first case of T-cell lymphopenia in a woman with rheumatoid arthritis who developed molluscum contagiosum with infliximab and cyclophosphamide. She presented in July 2000 with optic neuropathy and arthritis refractory to nonsteroidal anti-inflammatory drugs. After starting prednisone and cyclophosphamide, she became leukopenic (1.8x10 cells/microL), a condition that resolved with decreasing of the cyclophosphamide dose. In June 2002, the patient continued to have synovitis despite treatment with prednisone, cyclophosphamide, gabapentin, and celecoxib; blood counts were normal and infliximab was started. Her symptoms improved, but leukocyte counts declined (nadir of 1.5x10 cells/microL) despite discontinuing cyclophosphamide. She developed molluscum contagiosum after 8 months on infliximab (CD4 count, 492; HIV enzyme-linked immunosorbent assay and Western blot negative). Her symptoms flared after 10 months on infliximab; after the dose of infliximab was increased, her CD4 count fell to 114. Infliximab was discontinued and her leukocyte and CD4 count increased. This is the first reported case of leukopenia and T-cell suppression associated with infliximab and cyclophosphamide.

Risk factors for the development of psoriatic arthritis: a population based nested case control study.

OBJECTIVE: To identify factors influencing the development of psoriatic arthritis (PsA) in a population-based, inception cohort of psoriasis (PS) patients. METHODS: Using the population-based data resources of the Rochester Epidemiology Project. which ensures virtually complete ascertainment of all clinically defined conditions, we previously identified all incident cases of PsA and prevalent cases with PS from 1/1/1982 to 12/21/1991. In this nested case-control study, we assessed potential factors influencing the development of PsA in this cohort using medical record and patient survey information. Each case of PsA was matched with 2 PS controls on age, gender and PS duration/date of onset. Factors influencing the development of PsA were identified, adjusting for the influence of other variables using conditional logistic regression for medical record data and logistic regression for survey data. RESULTS: Sixty incident PsA cases were matched with 120 controls with PS. The median age at onset of PS was 31.7 (3.0-78.3) years, and 49% of subjects were male. There were 67% (n = 40) survey responders among cases and 48% (n = 58) among controls. Corticosteroids were used by 10 cases and 6 controls in the 2 years prior to onset of PS through to the development of PsA, and increased the risk of developing PsA (odds ratio 4.33, 95% CI = 1.34-14.02). Pregnancy occurred in 2 cases and 12 controls in the same period, and decreased the risk of developing PsA (odds ratio 0.19, 95% CI = 0.04-0.95). These associations remained significant after adjusting for the influence of gender, age, and duration of psoriasis. CONCLUSION: Corticosteroid use and pregnancy, both of which modulate the immune response, may influence the development of PsA in patients with PS.