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Schaefer LS, Wampler Muskardin T, Tillema JM, Wieland C, Tollefson MM. A fatal case of malignant atrophic papulosis in a pediatric patient. Pediatr Dermatol 2022; 39:112-114. [PMID: 34935194 DOI: 10.1111/pde.14878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/26/2021] [Accepted: 11/14/2021] [Indexed: 12/01/2022]
Abstract
A 17-year-old Caucasian boy presented with progressive left-sided weakness, transient slurred speech, and skin lesions characterized by 3-5 mm, pink, asymptomatic papules with white atrophic centers on his central abdomen, back, and lower extremities. Skin biopsy confirmed the diagnosis of malignant atrophic papulosis, a rare vasculopathy that leads to the occlusion of small- and medium-sized arteries. He was treated with cyclophosphamide, eculizumab, treprostinil, pentoxifylline, heparin, and acetylsalicylic acid. Despite the aggressive immunosuppression, humanized monoclonal antibodies, and antiplatelet therapy, he died two months after presentation. We report this case to highlight diagnostic features, as well as to highlight the importance of early diagnosis and treatment.
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Affiliation(s)
| | - Theresa Wampler Muskardin
- NYU Grossman School of Medicine, New York, New York, USA.,Department of Medicine and Department of Pediatrics, Division of Rheumatology, NYU Colton Center for Autoimmunity, New York, New York, USA
| | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carilyn Wieland
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Megha M Tollefson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Kim PJ, Lytvyn Y, Kashetsky N, Bagit A, Mufti A, Yeung J. Clinical manifestations and treatment outcomes in degos disease: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:1655-1669. [PMID: 33914972 DOI: 10.1111/jdv.17311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
Degos disease (atrophic papulosis) is a rare vasculopathy with cutaneous and systemic manifestations. Although potentially fatal, the characteristics of and treatments for Degos disease variants are not adequately described. We conducted a systematic review to summarize cutaneous and systemic presentations, treatments and outcomes of malignant (MAP) and benign (BAP) variants of Degos disease. A comprehensive search was conducted on Embase, MEDLINE, CINAHL and CENTRAL on 27 October 2020, which yielded 254 original studies reporting cases of Degos disease. A total of 357 patients were included in the analysis. Mean age of onset was 33.9 years. MAP was most commonly reported (63.8%, n = 228/357), with 56.6% (n = 129/228) mortality. Cutaneous lesions were usually asymptomatic (26.3%, n = 81/308) and localized to the trunk (57.7%, n = 206/357) and extremities (56.8%, n = 203/357). Systemic involvement developed within 2 years on average, ranging from 0 to 28 years. Anti-platelet monotherapy had a complete resolution rate of 42.3% (n = 11/26) in BAP and 20.0% (n = 7/35) in MAP. Based on the findings of the study, most cases of Degos disease are malignant with high mortality, and even benign cutaneous cases may develop systemic disease in as late as 28 years. Anti-platelet monotherapies may prove effective against both variants. Further studies are needed to confirm these findings.
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Affiliation(s)
- P J Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Y Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Kashetsky
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - A Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - A Mufti
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
| | - J Yeung
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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Abstract
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital - University of Connecticut, Hartford CT, USA
| | - Jodi Speiser
- Section of Dermatopathology, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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4
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Guo YF, Pan WH, Cheng RH, Yu H, Liao WQ, Yao ZR. Successful treatment of neurological malignant atrophic papulosis in child by corticosteroid combined with intravenous immunoglobulin. CNS Neurosci Ther 2014; 20:88-91. [PMID: 24341936 DOI: 10.1111/cns.12196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 01/09/2023] Open
Affiliation(s)
- Yi-Feng Guo
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Karaoğlu P, Topçu Y, Bayram E, Yis U, Akarsu S, Atalay E, Koroğlu T, Cakmakçi H, Ozer E, Hız S. Severe neurologic involvement of Degos disease in a pediatric patient. J Child Neurol 2014; 29:550-4. [PMID: 23400246 DOI: 10.1177/0883073812474692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 14-year-old male presented with paresthesias on the right upper and lower extremities, headache, and vomiting. In addition to worsening paresthesia and weakness on the right side of his body, blurred vision, fever, and skin lesions developed. He also had skin lesions characterized with 3-10 mm papules with a white atrophic center surrounded by pink rim mostly on the trunk and lower extremities. Brain magnetic resonance imaging showed chronic subdural effusion and encephalomalacia of the left cerebral hemisphere. Cerebrospinal fluid (CSF) examination revealed increased protein levels. Electromyography was consistent with diffuse polyradiculoneuropathy. Skin biopsy confirmed the diagnosis of a rare vasculopathy: Degos disease. A case presenting with chronic subdural effusion, encephalomalacia, elevated CSF protein, and polyradiculopathy should be carefully examined for skin lesions, which may suggest the diagnosis of Degos disease.
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Affiliation(s)
- Pakize Karaoğlu
- 1Department of Pediatric Neurology, Dokuz Eylul University Medical School, Izmir, Turkey
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