726
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Rashes linked to Carter's baby and infant clothing. CHILD HEALTH ALERT 2008; 26:3. [PMID: 19244595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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727
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Sielaff T. The telltale rash: a man with pretibial erythema. MINNESOTA MEDICINE 2008; 91:45-46. [PMID: 19108548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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728
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Léger D. Scurvy: reemergence of nutritional deficiencies. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2008; 54:1403-1406. [PMID: 18854467 PMCID: PMC2567249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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729
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Aisa Y, Mori T, Tanikawa A, Takae Y, Kato J, Ikeda Y, Okamoto S. Demodicidosis as a cause of facial eruption developing early after allogeneic hematopoietic stem cell transplantation. Transpl Int 2008; 21:1192-3. [PMID: 18783387 DOI: 10.1111/j.1432-2277.2008.00749.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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730
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Fukushima S, Kidou M, Ihn H. Fixed food eruption caused by cashew nut. Allergol Int 2008; 57:285-7. [PMID: 18566551 DOI: 10.2332/allergolint.c-07-58] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 02/04/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diagnosis of fixed 'drug' eruption is not difficult for dermatologists, but it is difficult to identify the causative agent when the patient denies ingestion of any drugs. There have been some reported cases of fixed 'food' eruption. CASE SUMMARY A 71-year-old woman experienced repeated erythema and tense bulla with a burning sensation and pruritus on the right ankle. The eruption remitted leaving pigmentation. The patient denied previous ingestion of any drug. We suspected cashew nut as the causative agent. Oral challenge and patch tests with cashew nut were positive. DISCUSSION A fixed eruption without any antecedent drug ingestion should alert us to think of food as a causative agent.
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731
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Lam A, Randhawa I, Klaustermeyer W. Cephalosporin induced toxic epidermal necrolysis and subsequent penicillin drug exanthem. Allergol Int 2008; 57:281-4. [PMID: 18566552 DOI: 10.2332/allergolint.c-07-55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 01/10/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Drug hypersensitivity is classically divided into IgE mediated and non-IgE mediated disease. We report a rare case of consequent IgE mediated and non-IgE mediated reactions within the beta lactam class of antibiotics. CASE SUMMARY An 84-year-old man developed toxic epidermal necrolysis (TEN) due to ceftriaxone, a third generation cephalosporin, involving 72% of the body surface area. The patient recovered but within weeks subsequently developed an acute IgE mediated allergic reaction to piperacillin/tazobactam, an extended spectrum penicillin. Further IgE RAST revealed positive results to penicillin major determinant. DISCUSSION This case demonstrates the complexity of drug hypersensitivity reactions. While it is accepted that IgE mediated penicillin allergy is a predisposition to cephalosporin allergy, this case displays an unusual correlation between drug hypersensitivity and drug class. There have been few studies that evaluate the cross reactivity with penicillin or other beta-lactams in subjects with primary hypersensitivity to cephalosporins. This clinical scenario emphasizes the need of more studies on cephalosporin allergy in particular as shown by this case of sequential non-IgE mediated cephalosporin induced TEN reaction pursuant by an IgE mediated penicillin allergy.
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732
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Fazili T, James O. Twenty-eight-year-old male with gastrointestinal symptoms and a skin rash. THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 2008; 101:208-209. [PMID: 18856049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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733
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Gopaluni S, Perzova R, Abbott L, Farah R, Shrimpton A, Hutchison R, Poiesz BJ. CD8+ cutaneous T-cell lymphoma successfully treated with bexarotene: a case report and review of the literature. Am J Hematol 2008; 83:744-6. [PMID: 18615708 DOI: 10.1002/ajh.21231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CD8+ cutaneous T-cell lymphoma (CTCL) is a relatively rare subset of the non-Hodgkins lymphomas. Bexarotene has been FDA-approved for the treatment of CTCL, but previous studies have been conducted on CD4+ CTL and there have been no reports about its use in CD8+ CTCL. Herein, we report on a patient whose CD8+ CTCL completely responded to treatment with bexarotene.
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734
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Band RA, Gaieski DF, Goyal M, Perrone J. A 52-year-old man with malaise and a petechial rash. J Emerg Med 2008; 41:39-42. [PMID: 18722741 DOI: 10.1016/j.jemermed.2007.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/14/2007] [Accepted: 12/23/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Capnocytophaga canimorsus is a Gram-negative, fusiform, rod-shaped organism that is part of the normal oral flora of dogs, cats, and other animals. A significant number of Emergency Department (ED) patients are surgically or functionally asplenic and may be at marked risk for overwhelming post-splenectomy infection (OPSI). OPSI has a mortality rate estimated to be up to 70%. The risk of sepsis is estimated to be 30-60 times greater after splenectomy, and C. canimorsus is one of the organisms that can cause catastrophic OPSI. OBJECTIVES To describe a case of C. canimorsus septic shock in a post-splenectomy patient and review the epidemiology of OPSI, the role of the spleen in protecting the body from infection, and the potential role of early goal-directed therapy in the resuscitation of patients with OPSI. CASE REPORT A 52 year-old man with a past medical history significant for idiopathic thrombocytopenic purpura (status post-splenectomy), and non-Hodgkin lymphoma (treated for cure), was brought to the ED with the chief complaints of light-headedness, malaise, and a rapidly spreading rash. He was found to be hypotensive, tachycardic, and tachypneic, and had a marked lactic acidosis. He was aggressively resuscitated with large volume fluid resuscitation and treated empirically with broad-spectrum antibiotics for septic shock of unclear etiology. His clinical course was complicated by acute lung injury and renal failure. Blood cultures grew C. canimorsus; he was extubated on hospital day 7 and discharged home several days later in good condition. CONCLUSIONS Patients status-post-splenectomy are at greatly increased risk for infection from encapsulated organisms and other organisms, including C. canimorsus, which is part of the normal oral flora of dogs, cats, and other animals. It can be spread to humans by bites, scratches, or less invasive forms of animal-human contact. C. canimorsus infection can lead to OPSI. Early recognition and aggressive clinical management, including early goal-directed therapy and rapid administration of antibiotics, may minimize the morbidity and mortality of this condition and other etiologies of severe sepsis and septic shock.
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735
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Zhang JL, Chen X, Li J, Xie HF. [Clinical analysis of childhood acute generalized exanthematous pustulosis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2008; 10:497-499. [PMID: 18706172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To describe the etiology, clinical features and treatment of childhood acute generalized exanthematous pustulosis (AGEP). METHODS Clinical data from 20 cases of childhood acute generalized exanthematous pustulosis from 1990 to 2008 were retrospectively reviewed. RESULTS Eighteen cases had a history of medication, including the use of penicillin (n=6), cephalosporins (n=3), sulphonamides (n=2), algopyrin (n=2), vaccines (n=2 ) and anti-cold drugs (n=3). Fever and generalized erythematous pustules were observed in all 20 cases. Histopathologic examination revealed spongiform superficial pustules and papillary edema. The patients were asked to stop taking suspected sensitizing drugs and received glucocorticoid treatment (1-2 mg/kg daily). After 3-5 days of the treatment, symptoms were improved and the dosage of glucocorticoid was gradually reduced. All patients were healed within 20 days after treatment. CONCLUSIONS The cause of AGEP is mainly attributed to the use of antibiotics, sulphonamides, antipyretic analgesics and vaccines in children. AGEP is characterized by fever and widespread pustular eruption of the skin. Removal of sensitizing factors and glucocorticoid administration is important in the treatment of AGEP in children.
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736
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Nehemya M. [Brown recluse bite]. HAREFUAH 2008; 147:672-752. [PMID: 18935751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Spider bites are not uncommon in our warm climate. The most prevalent species of venomous spiders in Israel are the brown recluse and the black widow. Although the black widow is more notorious than the recluse, for every bite by a black widow there are hundreds of recluse bites reported. Despite the numerous bites, there is little awareness amongst physicians with regard to the clinical signs of recluse bites, and very often the wrong diagnosis is made, resulting in complex and unnecessary treatments. The basis of this error stems from the numerous clinical diagnoses which closely imitate a recluse bite, the relative scarceness of documented recluse bites and the fact that in most cases the spider is not witnessed by the victim. The following article describes three cases of children admitted to our department, presenting with high fever, a necrotic lesion and an extensive maculopapular rash. The children were eventually diagnosed with brown recluse bites. Furthermore, the article summarizes the literature regarding the clinical signs of recluse bites, possible complications and treatment options. The objective of this review is to increase awareness towards recluse bites, thereby preventing misdiagnoses and unnecessary treatments.
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737
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Godoy P, Picco G, Clotet C, Gómez F, Peralba MA. [Outbreak of Mediterranean exanthematic fever due to tick bites in a public square]. Aten Primaria 2008; 40:371-3. [PMID: 18620641 DOI: 10.1157/13124133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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738
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739
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Bed bug re-emergence--what you should know. THE ALABAMA NURSE 2008; 35:20. [PMID: 18634233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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740
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Maza A, Renard L, Monestier S, Grob JJ, Richard MA. [Fever with skin rash and polyarthralgia in a genetically black-skinned woman]. MEDECINE TROPICALE : REVUE DU CORPS DE SANTE COLONIAL 2008; 68:297-299. [PMID: 18689326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adult onset Still's disease (AOSD) is a systemic disorder characterized by intermittent fever, evanescent rash, polyarthralgia or arthritis, and neutrophilic leucocytoclasis. Appearance of skin rash during fever episodes is the characteristic feature. An atypical form of AOSD with a fixed pigmented skin rash was described in 1994. Prognosis of the atypical form is thought to be more severe than that of the classic form. The purpose of this report is to describe the first case of atypical AOSD in a genetically black-skinned woman. Treatment required administration of high-dose systemic corticosteroids.
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741
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Mooney RL. You're the flight surgeon: neurologic decompression sickness. AVIATION, SPACE, AND ENVIRONMENTAL MEDICINE 2008; 79:539-540. [PMID: 18697276 DOI: 10.3357/asem.86087.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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742
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Walther B. [Exanthema, high fever, joint pain]. MMW Fortschr Med 2008; 150:4. [PMID: 18533598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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743
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Escher R. [What is your diagnosis? Vaccine-induced measles]. PRAXIS 2008; 97:417-418. [PMID: 18551909 DOI: 10.1024/1661-8157.97.8.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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744
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Puzenat E, Humbert P. [Exanthem, erythrodermia]. LA REVUE DU PRATICIEN 2008; 58:783-788. [PMID: 18546653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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745
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Hamilton E. Itching and rashes on contact with latex among patients attending community contraceptive clinics. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008; 34:129-130. [PMID: 18413032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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746
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747
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Simpson T. Rash in a 15-year-old female. PEDIATRIC NURSING 2008; 34:148-149. [PMID: 18543840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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748
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Bingham A, Mamyrova G, Rother KI, Oral E, Cochran E, Premkumar A, Kleiner D, James-Newton L, Targoff IN, Pandey JP, Carrick DM, Sebring N, O’Hanlon TP, Ruiz-Hidalgo M, Turner M, Gordon LB, Laborda J, Bauer SR, Blackshear PJ, Imundo L, Miller FW, Rider LG. Predictors of acquired lipodystrophy in juvenile-onset dermatomyositis and a gradient of severity. Medicine (Baltimore) 2008; 87:70-86. [PMID: 18344805 PMCID: PMC2674585 DOI: 10.1097/md.0b013e31816bc604] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We describe the clinical features of 28 patients with juvenile dermatomyositis (JDM) and 1 patient with adult-onset dermatomyositis (DM), all of whom developed lipodystrophy (LD) that could be categorized into 1 of 3 phenotypes, generalized, partial, or focal, based on the pattern of fat loss distribution. LD onset was often delayed, beginning a median of 4.6 years after diagnosis of DM. Calcinosis, muscle atrophy, joint contractures, and facial rash were DM disease features found to be associated with LD. Panniculitis was associated with focal lipoatrophy while the anti-p155 autoantibody, a newly described myositis-associated autoantibody, was more associated with generalized LD. Specific LD features such as acanthosis nigricans, hirsutism, fat redistribution, and steatosis/nonalcoholic steatohepatitis were frequent in patients with LD, in a gradient of frequency and severity among the 3 sub-phenotypes. Metabolic studies frequently revealed insulin resistance and hypertriglyceridemia in patients with generalized and partial LD. Regional fat loss from the thighs, with relative sparing of fat loss from the medial thighs, was more frequent in generalized than in partial LD and absent from DM patients without LD. Cytokine polymorphisms, the C3 nephritic factor, insulin receptor antibodies, and lamin mutations did not appear to play a pathogenic role in the development of LD in our patients. LD is an under-recognized sequela of JDM, and certain DM patients with a severe, prolonged clinical course and a high frequency of calcinosis appear to be at greater risk for the development of this complication. High-risk JDM patients should be screened for metabolic abnormalities, which are common in generalized and partial LD and result in much of the LD-associated morbidity. Further study is warranted to investigate the pathogenesis of acquired LD in patients with DM.
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749
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Gioseffi ML, Giardelli M, González M, Martino C, Guerdile MJ, Boer M, Ruiz E. [Exanthema, fever and adenopathies: make your diagnosis]. ARCH ARGENT PEDIATR 2008; 106:54-56. [PMID: 18636136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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750
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Abstract
The clinical findings of fever and skin rash with or without evidence of fluid retention, which mimic engraftment syndrome, have been observed during the pre-engraftment period in patients undergoing hematopoietic stem cell transplantation. In order to characterize this newly observed clinical syndrome called pre-engraftment syndrome (pES), we retrospectively analyzed the clinical records of 50 patients. Three out of 14 patients (23.1%) who underwent cord blood stem cell transplantation developed non-infectious fever, skin rash, and tachypnea 4-15 days prior to neutrophil engraftment. Two patients spontaneously recovered with fluid restriction and oxygen inhalation. One patient died of a complicated pulmonary hemorrhage in spite of aggressive supportive therapy and steroid treatment. Four out of 23 patients (17.4%) who underwent allogeneic bone marrow transplantation developed non-infectious fever and skin rash 4 to 5 days prior to neutrophil engraftment. All four of these patients recovered with only steroid treatment. These characteristic findings were not observed in patients who had undergone autologous peripheral blood stem cell transplantation. Interestingly, the speed of neutrophil engraftment was significantly faster for the patients suffering from pre-engraftment syndrome. The close observation and further pathophysiological research are required to better understand this syndrome.
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