1
|
Crichlow S, Alexandroff A, Simpson R, Saldanha G, Walker S, Harman K. Is IgA antineutrophil cytoplasmic antibody a marker for patients with erythema elevatum diutinum? A further three cases demonstrating this association. Br J Dermatol 2011; 164:675-7. [DOI: 10.1111/j.1365-2133.2010.10172.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
2
|
Madan S, Greipp PR. The incidental monoclonal protein: Current approach to management of monoclonal gammopathy of undetermined significance (MGUS). Blood Rev 2009; 23:257-65. [DOI: 10.1016/j.blre.2009.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
3
|
Hatzitolios A, Tzellos TG, Savopoulos C, Tzalokostas V, Kaiafa G, Psomas E, Apostolopoulou M, Papadopoulos A. Erythema elevatum diutinum with rare distribution as a first clinical sign of non-Hodgkin's lymphoma: a novel association? J Dermatol 2008; 35:297-300. [PMID: 18477231 DOI: 10.1111/j.1346-8138.2008.00470.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of a 78-year-old man with erythema elevatum diutinum as a first clinical sign of non-Hodgkin's lymphoma. The patient developed erythema elevatum diutinum with an unusual distribution involving the trunk. Erythema elevatum diutinum is a rare dermatosis that is considered to be a localized, low-grade form of leukocytoclastic vasculitis associated with neoplastic, autoimmune and infectious processes. It is probably mediated by immune complexes. Recent studies report hematological disease as the most common factor associated with erythema elevatum diutinum. Many hematological diseases, such as myeloma, myelodysplastic syndrome and immunoglobulin (Ig)A monoclonal gammopathy, have been reported in association with erythema elevatum diutinum, but none with IgM monoclonal gammopathy and only one with malignant lymphoma. We would like to add IgM monoclonal gammopathy and non-Hodgkin's lymphoma as one of the diseases associated with erythema elevatum diutinum considering that the activity of erythema elevatum diutinum and non-Hodgkin's lymphoma fluctuated in parallel in the present case.
Collapse
Affiliation(s)
- Apostolos Hatzitolios
- 1st Medical Propedeutic Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Rover PA, Bittencourt C, Discacciati MP, Zaniboni MC, Arruda LHDF, Cintra ML. Erythema elevatum diutinum as a first clinical manifestation for diagnosing HIV infection: case history. SAO PAULO MED J 2005; 123:201-3. [PMID: 16389420 DOI: 10.1590/s1516-31802005000400009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Erythema elevatum diutinum is a chronic and rare dermatosis that is considered to be a variant of leukocytoclastic vasculitis. It is probably mediated by immune complexes. It is generally associated with autoimmune, neoplastic and infectious processes. Recently, it has been added to the group of specific dermatoses that are associated with HIV. CASE REPORT We report on the case of a patient who had erythema elevatum diutinum as the first clinical evidence for diagnosing HIV infection. Dapsone was used in the treatment of this patient, and partial regression of the lesions was achieved within 15 days, even before anti-retroviral therapy was prescribed. CONCLUSION When there is a diagnosis of erythema elevatum diutinum, HIV infection should be investigated, especially in atypical and exacerbated clinical manifestations.
Collapse
Affiliation(s)
- Patrícia Accioni Rover
- Dermatology Department, Hospital Universitdrio Celso Pierro (HMCP), Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
5
|
Woody CM, Lane JE, Davis LS. Erythema Elevatum Diutinum in the Setting of Connective Tissue Disease and Chronic Bacterial Infection. J Clin Rheumatol 2005; 11:98-104. [PMID: 16357711 DOI: 10.1097/01.rhu.0000158540.57267.34] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Erythema elevatum diutinum (EED) is a rare and chronic cutaneous leukocytoclastic vasculitis. It is predominantly seen on the extensor surfaces of the extremities. Although a specific cause is largely unknown, EED has been noted to occur in association with a wide variety of diseases. A 28-year-old man with systemic lupus erythematosus (SLE) and a 53-year-old woman with an overlap syndrome of rheumatoid arthritis and polymyositis are presented. Both patients developed EED in the setting of chronic recurrent bacterial infections. Patients with a connective tissue disease are at increased risk for such infections secondary to immunosuppression, either from the disease itself or secondary to immunosuppressive therapy. EED has been independently reported to occur in the setting of connective tissue disease as well as in the setting of chronic infection. Our patients had both of these underlying conditions, which are known to predispose patients to immune complex-mediated vasculitides, in this case EED. One patient's EED responded to treatment of the SLE and the other improved, as has been previously reported with dapsone.
Collapse
Affiliation(s)
- Carol M Woody
- Section of Dermatology, Department of Internal Medicine, The Medical College of Georgia, 1004 Chafee Avenue, Augusta, GA 30912, USA
| | | | | |
Collapse
|
6
|
Abstract
Erythema elevatum diutinum (EED) is a rare chronic vasculitic process of unknown etiology that presents as bilateral, symmetrical, periarticular, red-brown papules and plaques, often over dorsa of joints. Early histologic changes are characterized by leukocytoclastic vasculitis. With chronicity, the lesions develop dense neutrophilic infiltrate and fibrosis. We describe an unusual case of late-stage nodular EED present for 35 years in a seronegative 75-year-old man. Asymptomatic papules and plaques measuring from 0.7 to 9.0 cm were seen over the interphalangeal joints, elbows, knees, and ankles. The histologic findings were characterized by predominant concentric fibrosis that formed well-circumscribed dermal and subcutaneous nodules. Awareness of this unusual presentation of EED helps to avoid misdiagnosis as cutaneous neoplasms.
Collapse
Affiliation(s)
- Whitney A High
- Department of Dermatology, University of texas Southewstern Medical Center, Dallas, Texas 75390-9073, USA
| | | | | | | |
Collapse
|
7
|
Chowdhury MMU, Serhat Inaloz H, Motley RJ, Knight AG. Erythema elevatum diutinum and IgA paraproteinaemia: 'a preclinical iceberg'. Int J Dermatol 2002. [DOI: 10.1111/j.1365-4632.2002.1432_4.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Affiliation(s)
- L E Gibson
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
| | | |
Collapse
|
9
|
Affiliation(s)
- C D Hensley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | |
Collapse
|
10
|
Daoud MS, Lust JA, Kyle RA, Pittelkow MR. Monoclonal gammopathies and associated skin disorders. J Am Acad Dermatol 1999; 40:507-35; quiz 536-8. [PMID: 10188670 DOI: 10.1016/s0190-9622(99)70434-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The monoclonal gammopathies are characterized by clonal proliferation of plasma cells and other clonally related cells in the B-cell lineage. These disorders include monoclonal gammopathy of undetermined significance, multiple myeloma, Waldenström macroglobulinemia, heavy chain diseases, plasmacytoma, and primary amyloidosis. Many skin disorders have been described in association with monoclonal gammopathies. This article provides an introduction to the definition, detection, natural course, and spectrum of monoclonal gammopathies and a brief discussion of pathogenesis. The article also reviews the skin disorders associated with monoclonal gammopathies, categorizes the association, and evaluates the strength of the association.
Collapse
Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
11
|
Avivi I, Rosenbaum H, Levy Y, Rowe J. Myelodysplastic syndrome and associated skin lesions: a review of the literature. Leuk Res 1999; 23:323-30. [PMID: 10229317 DOI: 10.1016/s0145-2126(98)00161-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The skin involvement of the myelodysplastic syndrome (MDS) can take the form of either a neoplastic infiltration or various non specific lesions. The occurrence of these lesions may be the presenting feature of the disease (MDS) or may herald its progression to acute leukemia. Recognition and early diagnosis have therapeutic and prognostic significance.
Collapse
Affiliation(s)
- I Avivi
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
| | | | | | | |
Collapse
|
12
|
Wayte JA, Rogers S, Powell FC. Pyoderma gangrenosum, erythema elevatum diutinum and IgA monoclonal gammopathy. Australas J Dermatol 1995; 36:21-3. [PMID: 7763217 DOI: 10.1111/j.1440-0960.1995.tb00919.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A patient with erythema elevatum diutinum (EED) developed pyoderma gangrenosum (PG). Investigation revealed an IgA kappa monoclonal gammopathy. Previous reports of PG in association with EED are reviewed and the spectrum of the neutrophilic dermatoses discussed.
Collapse
Affiliation(s)
- J A Wayte
- Regional Centre of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland
| | | | | |
Collapse
|
13
|
Aractingi S, Bachmeyer C, Dombret H, Vignon-Pennamen D, Degos L, Dubertret L. Simultaneous occurrence of two rare cutaneous markers of poor prognosis in myelodysplastic syndrome: erythema elevatum diutinum and specific lesions. Br J Dermatol 1994; 131:112-7. [PMID: 8043402 DOI: 10.1111/j.1365-2133.1994.tb08467.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report the concomitant occurrence of erythema elevatum diutinum and specific skin lesions in a patient with a myelodysplastic syndrome (MDS). This patient's course, and review of other reported cases, support the opinion that neutrophilic dermatoses are associated with a poor prognosis of MDS. The simultaneous appearance of these manifestations could be the consequence of a particular chemotactism of myeloid cells, expressed after acute transformation.
Collapse
Affiliation(s)
- S Aractingi
- Department of Dermatology, H pital Saint-Louis, Paris, France
| | | | | | | | | | | |
Collapse
|
14
|
Rodriguez-Serna M, Fortea JM, Perez A, Febrer I, Ribes C, Aliaga A. Erythema elevatum diutinum associated with celiac disease: response to a gluten-free diet. Pediatr Dermatol 1993; 10:125-8. [PMID: 8346102 DOI: 10.1111/j.1525-1470.1993.tb00036.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An 11-year-old girl with a history of insulin-dependent diabetes mellitus had erythema elevatum diutinum (EED) associated with a celiac disease related to a possible kidney disease. Dapsone did not improve the skin manifestations. However, the lesions disappeared after a gluten-free diet was begun. To our knowledge, this report describes the first case of EED in a patient with celiac disease.
Collapse
|
15
|
Miyagawa S, Kitamura W, Morita K, Saishin M, Shirai T. Association of hyperimmunoglobulinaemia D syndrome with erythema elevatum diutinum. Br J Dermatol 1993; 128:572-4. [PMID: 8504052 DOI: 10.1111/j.1365-2133.1993.tb00238.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hyperimmunoglobulinaemia D and periodic fever syndrome was observed in a female patient with erythema elevatum diutinum. The association of this skin disease with hyperimmunoglobulinaemia D may indicate a pathogenetic relationship. The skin lesions responded to dapsone therapy.
Collapse
Affiliation(s)
- S Miyagawa
- Department of Dermatology, Nara Medical University, Japan
| | | | | | | | | |
Collapse
|
16
|
Kavanagh GM, Colaco CB, Bradfield JW, Archer CB. Erythema elevatum diutinum associated with Wegener's granulomatosis and IgA paraproteinemia. J Am Acad Dermatol 1993; 28:846-9. [PMID: 8491878 DOI: 10.1016/0190-9622(93)70115-a] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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.
Collapse
Affiliation(s)
- G M Kavanagh
- Department of Dermatology, Bristol Royal Infirmary, University of Bristol, United Kingdom
| | | | | | | |
Collapse
|
17
|
Wilkinson SM, English JS, Smith NP, Wilson-Jones E, Winkelmann RK. Erythema elevatum diutinum: a clinicopathological study. Clin Exp Dermatol 1992; 17:87-93. [PMID: 1516248 DOI: 10.1111/j.1365-2230.1992.tb00171.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Erythema elevatum diutinum is a syndrome of vasculitis in which lesions, typically over the extensor surfaces, showed a mixed inflammatory infiltrate on biopsy. We describe a series of 13 patients. The most common association in our series was with hypergammaglobulinemia; both mono and polyclonal. Chronic infection, not streptococcal, was a less frequent finding although two of three patients had a positive reaction to the intradermal injection of streptococcal antigen. Dapsone remains the initial treatment of choice.
Collapse
Affiliation(s)
- S M Wilkinson
- Department of Dermatology, North Staffordshire Hospital Centre, Stoke-on-Trent, U.K
| | | | | | | | | |
Collapse
|
18
|
Asherson RA, Buchanan NM, d'Cruz D, Hughes GR. Urticarial vasculitis, IgA deficiency and C1 esterase inhibitor deficiency in the presence of an IgG monoclonal gammopathy--a case report. Clin Exp Dermatol 1992; 17:137-9. [PMID: 1516241 DOI: 10.1111/j.1365-2230.1992.tb00183.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A female patient, currently aged 40, has attended our Lupus Clinic for 8 years with a clinical picture of urticarial vasculitis, joint pains, severe myalgias and abdominal pain which has occurred in bouts at irregular intervals. She has been found to have consistently reduced C4 levels, C1-esterase inhibitor deficiency and a persistent monoclonal band in the gamma region on electrophoresis. Her serum IgA level has been continuously low. Her symptoms have failed to respond to antihistamines and a variety of other measures but have been partially alleviated by immunosuppressive therapy ('pulsed' cyclophosphamide). We believe that this is the first patient described showing this combination of clinical and laboratory features.
Collapse
Affiliation(s)
- R A Asherson
- Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London, UK
| | | | | | | |
Collapse
|
19
|
Bernard P, Bedane C, Delrous JL, Catanzano G, Bonnetblanc JM. Erythema elevatum diutinum in a patient with relapsing polychondritis. J Am Acad Dermatol 1992; 26:312-5. [PMID: 1569248 DOI: 10.1016/0190-9622(92)70043-f] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 69-year-old man with a history of relapsing polychondritis developed a widespread cutaneous eruption that was clinically and histologically typical of erythema elevatum diutinum. This eruption was accompanied by a recurrence of arthralgias. The significance of this association between relapsing polychondritis and erythema elevatum diutinum, which has not been previously reported, is discussed.
Collapse
Affiliation(s)
- P Bernard
- Department of Dermatology, CHRU Dupuytren, Limoges, France
| | | | | | | | | |
Collapse
|
20
|
Yiannias JA, el-Azhary RA, Gibson LE. Erythema elevatum diutinum: a clinical and histopathologic study of 13 patients. J Am Acad Dermatol 1992; 26:38-44. [PMID: 1732334 DOI: 10.1016/0190-9622(92)70003-x] [Citation(s) in RCA: 144] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Erythema elevatum diutinum is a rare condition representing a chronic leukocytoclastic vasculitis. OBJECTIVE Clinical and laboratory features of the disease were reviewed to better understand the disease. METHODS The medical records and histopathologic slides of 13 patients with erythema elevatum diutinum were studied. RESULTS The lesions were violaceous, deep red, or brown and typically were papules or plaques. Lesions were most often located on the extensor surfaces of the extremities. Associated medical problems included hematologic abnormalities in six patients: IgA clonal gammopathies (four), multiple myeloma (one), and myelodysplasia (one). Erythema elevatum diutinum preceded the myeloproliferative disorders by an average of 7.8 years. All patients showed vasculitis. Leukocytoclasia was present in 27 of 35 specimens. The predominant cell type in the inflammatory infiltrate was polymorphonuclear leukocytes or a mixture of polymorphonuclear leukocytes and lymphocytes. CONCLUSION The most significant finding of this study is the association of erythema elevatum diutinum with hematologic disease, most frequently an IgA monoclonal gammopathy.
Collapse
Affiliation(s)
- J A Yiannias
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
| | | | | |
Collapse
|
21
|
Abstract
A possible association between erythema elevatum diutinum and Crohn's disease is described. To our knowledge, erythema elevation diutinum has never been reported in a patient with Crohn's disease, nor has the disorder been considered one of the cutaneous manifestations of inflammatory bowel disease. Erythema elevatum diutinum is believed to be mediated by the deposition of circulating immune complexes in the dermal perivascular spaces. Our patient showed clinical and histopathologic findings typical of both erythema elevatum diutinum and Crohn's disease. The patient also had a positive Raji cell assay, which demonstrates the presence of a circulating immune complex. Increased levels of circulating immune complexes have been found in patients with inflammatory bowel disease, and the gastrointestinal inflammation in Crohn's disease could lead to enhanced antigenic exposure and increased formation of immune complexes. We contend that inflammatory bowel disease may have contributed to the development of erythema elevatum diutinum in our patient.
Collapse
Affiliation(s)
- K D Walker
- Department of Dermatology, Tulane University Medical School, New Orleans, LA 70112
| | | |
Collapse
|
22
|
Henriksson R, Hofer PA, Hörnqvist R. Erythema elevatum diutinum--a case successfully treated with colchicine. Clin Exp Dermatol 1989; 14:451-3. [PMID: 2605811 DOI: 10.1111/j.1365-2230.1989.tb02611.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A case of erythema elevatum diutinum, unresponsive to dapsone but successfully treated with colchicine, is described.
Collapse
|
23
|
|
24
|
|