201
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Jura E, Palasik W, Meurer M, Palester-Chlebowczyk M, Czlonkowska A. Sneddon's syndrome (livedo reticularis and cerebrovascular lesions) with antiphospholipid antibodies and severe dementia in young man: a case report. Acta Neurol Scand 1994; 89:143-6. [PMID: 8191878 DOI: 10.1111/j.1600-0404.1994.tb01650.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present the case of 37-year-old man with Sneddon's syndrome and antiphospholipid antibodies. His chief neurological manifestation was rapidly progressive dementia, which developed 6 years after the appearance of livedo reticularis.
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Affiliation(s)
- E Jura
- Institute of Psychiatry and Neurology, Warsaw, Poland
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202
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Bircher AJ, Koo JY, Frieden IJ, Berger TG. Angiodysplastic syndrome with capillary and venous malformation associated with soft tissue hypotrophy. Dermatology 1994; 189:292-6. [PMID: 7949488 DOI: 10.1159/000246865] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Angiodysplastic syndromes include a vascular malformation which may often be associated with secondary changes such as further vascular abnormalities, soft tissue and bone hypertrophy. One of the best known is the syndrome triad originally described by Klippel and Trenaunay, which includes a unilateral capillary malformation, ectatic veins and osseous and soft tissue hypertrophy. A female patient is reported who had an extensive capillary malformation, discrete ectatic veins overlying an extensive venous malformation and soft tissue hypotrophy without bone involvement. Our patient and cases from the literature illustrate the occurrence of 'atypical', hypotrophic variants of angiodysplastic syndromes. Discrete superficial angiodysplasias may overlie deep, extensive malformations, and identification of such cases is important with regard to management and prognosis. The current classification of angiodysplasias is based on the primary vascular malformation. The use of eponyms should be avoided, because they do not contribute to the diagnosis and management of such cases.
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Affiliation(s)
- A J Bircher
- Department of Dermatology, University of Basel, Switzerland
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203
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Woods PR, Helman RG, Schmitz DG. Granulomatous enteritis and cutaneous arteritis in a horse. J Am Vet Med Assoc 1993; 203:1573-5. [PMID: 8288481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 5-year-old Quarter Horse mare was examined because of weight loss of 2 months' duration. The horse was anemic and in poor body condition, and had several areas of cutaneous ulceration, including areas on the muzzle and distal portion of the limbs. Histologic examination of a rectal mucosa biopsy specimen revealed a lymphoplasmacytic infiltrate in the lamina propria mucosa. Results of a glucose absorption test were suggestive of malabsorption. Histologic examination of a biopsy specimen from the cutaneous lesions revealed pronounced arteritis, and weak, patchy immunofluorescent staining for immunoglobulins at the basement membrane. The horse was treated with prednisone, but did not improve, so the horse was humanely destroyed. Necropsy revealed granulomatous enteritis. This case identified an unusual combination of clinical problems and suggests further evidence for similarities between equine granulomatous enteritis and regional enteritis in human beings.
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Affiliation(s)
- P R Woods
- Department of Large Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University, College Station 77843
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204
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Sheehan MG, Condemi JJ, Rosenfeld SI. Position dependent livedo reticularis in cholesterol emboli syndrome. J Rheumatol 1993; 20:1973-4. [PMID: 8308790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe a case of a 64-year-old Filipino man who presented with cholesterol emboli syndrome manifesting as worsening hypertension, renal failure and livedo reticularis involving the upper legs and lower abdomen. The livedo reticularis became very prominent with the patient standing, but completely vanished after several minutes of lying supine. Deep cutaneous biopsy of an area of skin that was found to be consistently involved with livedo reticularis demonstrated cholesterol clefts in several vessels, thus establishing the diagnosis in this patient, and avoiding the more problematic option of biopsying an involved visceral organ.
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Affiliation(s)
- M G Sheehan
- Allergy and Rheumatology Unit, University of Rochester School of Medicine and Dentistry, NY
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205
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Vázquez-Doval FJ, Ruiz de Erenchun F, Páramo JA, Quintanilla E. Malignant atrophic papulosis. A report of two cases with altered fibrinolysis and platelet function. Clin Exp Dermatol 1993; 18:441-4. [PMID: 8252767 DOI: 10.1111/j.1365-2230.1993.tb02246.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Malignant atrophic papulosis is a systemic vaso-occlusive disorder characterized by typical skin lesions. We report two new cases with impairment of blood fibrinolytic activity and alterations in platelet function. The first case showed an increase in plasminogen activator inhibitor-1 (PAI-1) activity, and the second case had a decrease in platelet aggregation induced by adenosine diphosphate and adrenaline but normal with collagen. The impairment of blood fibrinolytic activity and platelet aggregation may have pathogenic and therapeutic implications in malignant atrophic papulosis.
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Affiliation(s)
- F J Vázquez-Doval
- Department of Dermatology, University Clinic of Navarra, University of Navarra, Pamplona, Spain
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206
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Lotz BP, Schutte CM, Colin PF, Biermann LD. Sneddon's syndrome with anticardiolipin antibodies--complications and treatment. S Afr Med J 1993; 83:663-4. [PMID: 8310361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We investigated 2 patients with Sneddon's syndrome, elevated anticardiolipin antibodies and systemic complications, which included stroke, habitual abortions, cardiac valvular lesions, acrocyanosis, hypertension and renal insufficiency. Treatment with a combination of immunosuppressive agents and warfarin or aspirin prevented further complications and improved renal function. It is important for those in different specialties to be aware of this potentially treatable disorder.
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Affiliation(s)
- B P Lotz
- Department of Neurology, University of Pretoria
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207
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Abstract
A large number of diseases can eventuate in cutaneous ulceration. This article will review inflammatory disorders which by their nature can directly produce cutaneous breakdown and ulcer formation. Major emphasis is given to those disorders where recent knowledge has improved our understanding of the condition or where new therapeutic agents or maneuvers have become available. This later group consists of vasculitis, disorders caused by small vessel thrombi or embolus and pyoderma gangrenosum.
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Affiliation(s)
- F A Kerdel
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida
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208
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Abstract
Malignant atrophic papulosis (Degos disease) is a rare disorder characterized by a vasculopathy of unknown origin. The cutaneous manifestations comprise erythematous papules, which heal to leave scars with a pathognomonic central porcelain-white atrophic area and a peripheral telangiectatic rim. There is usually involvement of the gastrointestinal tract but other organ systems can also be affected, the central nervous system being involved in 20% of cases. It is frequently fatal within 2 or 3 years from onset of systemic involvement, the cause of death usually being intestinal perforation. Our patient is of interest as she has survived an unusually long time despite florid cutaneous and neurological manifestations.
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Affiliation(s)
- T A Leslie
- Department of Dermatology, University College and Middlesex School of Medicine, London, UK
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209
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Abstract
BACKGROUND Erythema elevatum diutinum (EED) is a rare, chronic form of cutaneous vasculitis that can result in fibrosis. Four patients infected with the human immunodeficiency virus (HIV) had unusual nodular lesions of EED. OBJECTIVE Our purpose was to document the occurrence of these lesions in HIV-infected patients and to characterize the histopathologic and immunophenotypic features of nodular EED. METHODS Clinicopathologic studies were supplemented by special stains of biopsy specimens. RESULTS EED may be a complication of HIV infection. Nodules of EED are composed of small aggregates of Mac-387+ spindled cells. Within the aggregates can be seen neutrophils, nuclear dust, and fibrin. The marked fibrosis of the lesions may account for the lack of response to dapsone. CONCLUSION EED should be considered in the differential diagnosis of juxta-articular nodules in HIV-infected patients; its diagnosis can be confirmed by biopsy.
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Affiliation(s)
- P E LeBoit
- Department of Pathology, School of Medicine, University of California, San Francisco 94143-0506
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210
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Abstract
We present a case of Sneddon's syndrome with high titers of antiphospholipid antibodies (APLA), in which the leading symptom was an incapacitating memory defect. MRI revealed vasculitic lesions of the central nervous system (CNS). Therefore immunosuppressive therapy was started with steroids and cyclophosphamide pulses. The transient beneficial effects of such a therapy will be discussed.
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Affiliation(s)
- H A Mesa
- Department of Rheumatology and Clinical Immunology, University of Freiburg Medical Center, Freiburg, Germany
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211
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Abstract
A 69-year-old man had erythema elevatum diutinum for several years before he developed IgA paraproteinemia and a limited form of Wegener's granulomatosis. This is the first report of an association between erythema elevatum diutinum and Wegener's granulomatosis. IgA paraproteinemia has been reported in association with erythema elevatum diutinum but not with Wegener's granulomatosis.
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Affiliation(s)
- G M Kavanagh
- Department of Dermatology, Bristol Royal Infirmary, University of Bristol, United Kingdom
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212
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Zelger B, Sepp N, Stockhammer G, Dosch E, Hilty E, Ofner D, Aichner F, Fritsch PO. Sneddon's syndrome. A long-term follow-up of 21 patients. Arch Dermatol 1993; 129:437-47. [PMID: 8466214 DOI: 10.1001/archderm.129.4.437] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND DESIGN Twenty-one patients with histologically proven Sneddon's syndrome were followed up in a retrospective study. We report on their detailed clinical courses and extensive follow-up examinations. RESULTS Incidence is estimated at four cases per million population per year. Nonspecific prodromal symptoms (headache, dizziness) frequently (80%) precede livedo racemosa for 3.5 and (multi)focal neurological symptoms of fully developed disease for 9 years followed by progressive cognitive impairment (60%) 10 years later. Involvement of fundi, peripheral nerves, heart, and kidneys is frequent (50% to 70%) yet usually asymptomatic. Some symptoms prove irreversible (livedo racemosa, multifocal cerebral lesions on imaging, or creatinine clearance), whereas other symptoms tend to resolve after days to years (many focal neurological symptoms, some electrocardiographic changes, or hypertension). Mortality is calculated at 9.5% within an average observation time of 6.2 years. Laboratory findings, including antiphospholipid antibodies, are normal except for elevated erythrocyte sedimentation rates and complement consumption at times of disease progression and increased cholesterol levels parallel to disease extent. Skin biopsy specimens reveal inflammatory findings ("endothelitis") of small- to medium-sized arteries followed by subendothelial proliferation and fibrosis. Hypertension is the only risk factor significantly associated with a more severe course of the disease; no medication proved effective. CONCLUSIONS Sneddon's syndrome is an often unrecognized, slowly progressive, systemic disease with evidence of vasculitic origin.
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Affiliation(s)
- B Zelger
- Department of Dermatology, University of Innsbruck, Australia
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213
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Pehr K, Moroz B. Cutis marmorata telangiectatica congenita: long-term follow-up, review of the literature, and report of a case in conjunction with congenital hypothyroidism. Pediatr Dermatol 1993; 10:6-11. [PMID: 8493172 DOI: 10.1111/j.1525-1470.1993.tb00002.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cutis marmorata telangiectatica congenita is an uncommon, generally congenital, cutaneous condition. The major skin findings are persistent, fixed cutis marmorata, telangiectasia, and phlebectasia; often, there is associated skin atrophy and ulceration as well. Significantly, two-thirds of patients have other congenital anomalies, although often minor ones. We report a series of eight children with cutis marmorata telangiectatica congenita, including one with associated congenital hypothyroidism, a relationship that has never before been noted.
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Affiliation(s)
- K Pehr
- Division of Dermatology, McGill University, Montreal Children's Hospital
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214
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Simon MW, Moore AM. Cutis marmorata telangiectatica congenita. J Ky Med Assoc 1993; 91:20-2. [PMID: 8436874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cutis marmorata telangiectatica congenita (CMTC) is an uncommon benign condition presenting at birth with levido reticularis, telangiectasia, phlebectasia, and possible ulceration of the involved skin. Diagnosis is made through the clinical picture and supported by characteristic histopathologic changes when present. This condition should not be confused with manifestations of serious system disease and aggressive treatment is not indicated. We describe in this report a case of CMTC.
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215
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Martini A, Ravelli A, Albani S, Viola S, Scotta MS, Magrini U, Burgio GR. Recurrent juvenile dermatomyositis and cutaneous necrotizing arteritis with molecular mimicry between streptococcal type 5 M protein and human skeletal myosin. J Pediatr 1992; 121:739-42. [PMID: 1359045 DOI: 10.1016/s0022-3476(05)81905-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An adult patient had a syndrome associating the features of juvenile dermatomyositis and cutaneous polyarteritis nodosa that followed a cyclic course from childhood; recurrences were always associated with a rise of serum antistreptococcal antibodies. Regions of homology between streptococcal type 5 M protein and skeletal myosin were found. These findings suggest that streptococcal infection, possibly through a molecular mimicry mechanism, played a role in the pathogenesis of the disease in our patient.
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Affiliation(s)
- A Martini
- Clinica Pediatrica Università di Pavia, Italy
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216
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Abe Y, Tada J, Akiyama H, Arata J. Primary systemic pustular vasculitis with severe intestinal involvement. Arch Dermatol 1992; 128:1408-10. [PMID: 1417040 DOI: 10.1001/archderm.1992.01680200120030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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217
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Merino Angulo J, Arenzana J. [Primary antiphospholipid syndrome associated with Sneddon syndrome]. Rev Clin Esp 1992; 191:226. [PMID: 1439046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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218
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Stephens CJ. Sneddon's syndrome. Clin Exp Rheumatol 1992; 10:489-92. [PMID: 1458702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sneddon's syndrome refers to the rare association of extensive livedo reticularis with multiple ischaemic cerebrovascular episodes. Endarteritis obliterans is the most common cutaneous pathology. It is likely that several pathogenic mechanisms may give rise to Sneddon's syndrome, as the condition is associated with a high incidence of generalised atherosclerosis, hypertension, valvular heart disease and the presence of antiphospholipid antibodies.
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Affiliation(s)
- C J Stephens
- St. John's Dermatology Centre, St. Thomas' Hospital, London, U.K
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219
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Carella F, Fetoni V, Pollo B, Testa D, Tagliavini F, Girotti F. Sneddon's syndrome and renal carcinoma. Case report. Funct Neurol 1992; 7:395-400. [PMID: 1292961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A patient with Sneddon's syndrome in association with renal neoplasm is discussed. The association has not been reported before and raises questions concerning the pathogenesis of vascular proliferation in Sneddon's syndrome.
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Affiliation(s)
- F Carella
- Department of Neurology, National Neurological Institute C. Besta, Milan, Italy
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220
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Leese GP, Jung RT, Morley KD. Astrocytoma presenting with vasculitis. Scott Med J 1992; 37:117-8. [PMID: 1411481 DOI: 10.1177/003693309203700408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A cerebral astrocytoma which had remained quiescent possibly for 12 years, presented with blackout, vasculitis and a lupus-like (L-E like) syndrome. The association between tumours and "L-E like" syndromes is reviewed briefly.
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Affiliation(s)
- G P Leese
- Department of Medicine, Ninewells Hospital and Medical School, Dundee
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221
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Florczak E, Dobrogowska-Kunicka J, Paschalis-Purtak K, Puciłowska B. [2 cases of Sneddon syndrome]. Pol Arch Med Wewn 1992; 87:393-8. [PMID: 1408998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two cases of Sneddon syndrome (S.s.) in a 33 and 53-year-old women who developed arterial hypertension, cerebral ischaemic signs and who have livedo reticularis or livedo racemosa, are reported. The authors describe clinical, radiological and biological features of this rare disease, as well as diagnostic investigations including the measurements of the antiphospholipid antibodies (APA). The possible role of APA in the pathogenesis of S.s. is discussed.
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Affiliation(s)
- E Florczak
- Kliniki Nadciśnienia Tetniczego Instytutu Kardiologii, Warszawie
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222
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Sinisi L, Palma V, Di Girolamo C, Scarpa R, Faccenda F, Rubba P, Cirillo S, Mansi D. Sneddon's syndrome, anticardiolipin antibodies and anticardiolipin cofactor. A case report. Acta Neurol (Napoli) 1992; 14:134-9. [PMID: 1414558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sneddon's syndrome is a rare entity characterized by idiopathic livedo reticularis and cerebrovascular lesions. A case of a young woman with livedo reticularis and progressive cerebral arteriopathy is described. Abnormalities of sexual and gonadotropic hormones were present. Anticardiolipin and anticardiolipin-cofactor complex antibodies were not found.
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Affiliation(s)
- L Sinisi
- Department of Neurology, Second School of Medicine, University of Naples, Italy
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223
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Requena L, Sánchez Yus E, Martín L, Barat A, Arias D. Erythema elevatum diutinum in a patient with acquired immunodeficiency syndrome. Another clinical simulator of Kaposi's sarcoma. Arch Dermatol 1991; 127:1819-22. [PMID: 1845281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Several types of vasculitis have been described in patients with human immunodeficiency virus infection. Erythema elevatum diutinum is a rare variant of cutaneous leukocytoclastic vasculitis which, with the exception of the case reported herein, has been described only once in human immunodeficiency virus-infected patients. Our male patient, a longtime intravenous drug abuser, had cutaneous lesions, closely resembling Kaposi's sarcoma, on the extensor surfaces of the lower extremities. Cutaneous biopsy specimens, however, demonstrated leukocytoclastic vasculitis with fibrinoid necrosis of the vessel walls and areas of basophilic degeneration of collagen bundles in early lesions, whereas late lesions showed dense diffuse fibrosis with proliferation of dermal spindle cells and some foci of residual leukocytoclastic vasculitis. Oral therapy with dapsone resulted in marked clearing of the cutaneous lesions within few days. This case raises the necessity of histologic confirmation for all cases of suspected Kaposi's sarcoma in patients with acquired immunodeficiency syndrome. We discuss the possible pathogenesis of leukocytoclastic vasculitis in human immunodeficiency virus-infected patients.
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Affiliation(s)
- L Requena
- Department of Dermatology, Jiménez Díaz Foundation, Nuestra Señora de la Concepción Clinic, Universidad Autónoma, Madrid, Spain
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