1
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Qian Y, Zhao X, Liu D, Liu J, Yue Z, Liu W. Adverse events of direct factor Xa inhibitors: a disproportionality analysis of the FAERS database. Expert Opin Drug Saf 2024:1-10. [PMID: 38889295 DOI: 10.1080/14740338.2024.2368815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, commonly used direct oral anticoagulant (DOAC), are widely used to prevent and treat stroke and venous thromboembolic events in patients with atrial fibrillation (AF). This study aimed to assess and compare reports of adverse events associated with rivaroxaban, apixaban, and edoxaban, including hemorrhagic and non-hemorrhagic events. METHODS Reporting odds ratio (ROR), proportional reporting ratio (PRR), Medications and Health Care Products Regulatory Agency (MHRA), and the information component (IC) were used to perform a risk assessment of adverse event reports in the FDA Adverse Event Reporting System (FAERS) database for the years 2018-2022. RESULTS Combined with disproportionality analysis in different backgrounds, the salient risks of the three-factor Xa inhibitors varied. Rivaroxaban had the most significant risk of hemorrhage, apixaban had a higher incidence and risk of death, cardiac and cerebral adverse events, and edoxaban showed a more prominent risk in the kidneys and urinary system. CONCLUSION Hemorrhage is a common risk with factor Xa inhibitors, with rivaroxaban being the most significant. Apixaban and edoxaban also showed significant association with non-hemorrhagic adverse events, and increased attention to non-hemorrhagic adverse events is needed in clinical use.
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Affiliation(s)
- Yating Qian
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Xinxia Zhao
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Danyi Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Junting Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhongsheng Yue
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
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2
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Suoniemi L, Salmi T, Huhtala H, Kaartinen I, Kiiski J, Kimpimäki T. The role of split-thickness skin grafting in the treatment of vasculitic and pyoderma gangrenosum ulcers in a multidisciplinary wound centre. Int Wound J 2024; 21:e14943. [PMID: 38899689 PMCID: PMC11187742 DOI: 10.1111/iwj.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Vasculitic and pyoderma gangrenosum ulcers are traditionally treated with immunosuppressants, and the role of surgery in the treatment of these atypical ulcers remains unclear. This study aimed to investigate the need for surgical intervention as well as the outcome and safety of skin grafting in the treatment of 46 patients with vasculitic ulcers and 34 with pyoderma gangrenosum ulcers using data recorded in the validated Wound Registry. Of the 80 patients with atypical ulcers, 14% (n = 11) were treated surgically; these patients were older (p = 0.039), had lower mobility status (p = 0.002), and more often pulmonary diseases, rheumatoid arthritis, and previous arterial procedures (p = 0.007; p = 0.031; p = 0.031, respectively) than those treated conservatively. Of 181 ulcers, 15% (n = 27) were surgically treated, 78% once and 22% multiple times. During follow-up, 92.3% of both surgically and conservatively treated ulcers with available data healed. Of the surgically treated ulcers, median healing time after first surgical procedure was 96 days, and post-surgical complications were considered mild or unrelated to surgery. Our results suggest that if surgery is indicated, skin grafting is a safe and efficient treatment method provided that multidisciplinary approach is applied.
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Affiliation(s)
- Laura Suoniemi
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Teea Salmi
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Heini Huhtala
- Faculty of Social SciencesTampere UniversityTampereFinland
| | - Ilkka Kaartinen
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of Musculoskeletal Surgery and DiseasesTampere University HospitalTampereFinland
| | - Juha Kiiski
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of Musculoskeletal Surgery and DiseasesTampere University HospitalTampereFinland
| | - Teija Kimpimäki
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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3
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Wang HY, Robson DC, Kim SJ. Annular vasculitic lesions. Clin Dermatol 2023; 41:326-339. [PMID: 37423264 DOI: 10.1016/j.clindermatol.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Vasculitic skin findings may present with annular morphologies. This group of conditions consists of capillaritis, such as pigmented purpuric dermatoses, and vasculitis, which is often classified by the affected vessel size. Annular vasculitic lesions may be the presenting sign of systemic disease, thus requiring thorough exploration to reach an accurate diagnosis and guide proper disease management. Herein we review the clinical presentation, histopathology, and treatments for cutaneous vasculitic disease that may present with annular lesions.
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Affiliation(s)
| | | | - Soo Jung Kim
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
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4
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Ertekin SS, Koku Aksu AE, Leblebici C, Erdemir VA, Erdem O, Bal Avcı E, Gürel MS. Systemic disease in leukocytoclastic vasculitis: a focus on direct immunofluorescence findings. An Bras Dermatol 2023; 98:59-67. [PMID: 36369199 PMCID: PMC9837647 DOI: 10.1016/j.abd.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Direct immunofluorescence (DIF) panels are usually ordered for clinically suspected cutaneous vasculitis, but their positivity rate is variable, and their prognostic significance is not clear to date. OBJECTIVE The study aims to investigate the systemic involvement rate in leukocytoclastic vasculitis (LCV) patients and the potential clinical and laboratory associations with systemic involvement, including DIF findings. METHODS A retrospective study of patients with histopathologically proven cutaneous LCV examined in the dermatology department between 2013 and 2017 was performed. RESULTS Of the 81 patients (mean age, 50.6 years), 42 (52%) were male. The mean time between the appearance of skin lesions and biopsy was 23.1 days, ranging from 2 to 180 days. DIF showed overall positivity of 90.1%, and C3 was the most frequent immunoreactant (82.7%). Any kind of extracutaneous involvement was present in 47 (58%) of patients, with renal involvement being the most frequent (53.1%), followed by articular (18.5%) and gastrointestinal (11.1%) involvement. The presence of renal disease was associated with the detection of IgG in the lesional skin (p = 0.017), and with the absence of IgM in the lesional skin (p = 0.032). There was a significant association between C3 deposition and joint involvement (p = 0.05). STUDY LIMITATIONS This is a single-center study with a retrospective design. CONCLUSION DIF seems to be a useful ancillary diagnostic tool in the evaluation of cutaneous vasculitis, but the relationship between DIF findings and systemic involvement needs to be further elucidated due to contradictory data in the current literature.
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Affiliation(s)
- Sümeyre Seda Ertekin
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey,Corresponding author.
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Vefa Aslı Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ozan Erdem
- Department of Dermatology, Başakşehir Çam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Bal Avcı
- Department of Dermatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Salih Gürel
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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5
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Micheletti RG. Cutaneous Small Vessel Vasculitis: A Practical Guide to Diagnosis and Management. Am J Clin Dermatol 2023; 24:89-95. [PMID: 36308673 DOI: 10.1007/s40257-022-00736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/28/2023]
Abstract
Cutaneous vasculitis may be a cutaneous manifestation of systemic vasculitis, a skin-limited variant of systemic vasculitis, or a type of single-organ vasculitis limited to the skin. Careful evaluation is necessary to distinguish these possibilities, differentiate skin-limited from systemic disease, and identify important underlying conditions, if present. Appropriate management depends on disease type and severity. In the case of cutaneous small vessel vasculitis (CSVV), treatment is primarily based on case reports and expert opinion, using a range of immunomodulatory or immunosuppressive therapies. This manuscript presents a systematic and stepwise approach to the evaluation of patients presenting with cutaneous vasculitis, as well as the management of those diagnosed with CSVV, using best available evidence. Studies relevant to the classification, evaluation, and management of skin vasculitis are ongoing.
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Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, PCAM 7 South, Room 724, Philadelphia, PA, 19104, USA.
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6
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DeHoratius DM. Cutaneous small vessel vasculitis. Postgrad Med 2022; 135:44-51. [PMID: 36524408 DOI: 10.1080/00325481.2022.2159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This review discusses the clinical manifestations of cutaneous small vessel vasculitis. The etiologies and work up will be explored as well as the treatment considerations. This entity is multifactorial and usually involves multiple specialties. The presentation can range from self-limited to life threatening, multi-organ failure. It is essential to be able to diagnose vasculitis and proceed with the appropriate laboratory studies and work-up. Finally, investigation of associated etiologies such as infection and drugs will guide additional diagnostic studies.
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Affiliation(s)
- Danielle M. DeHoratius
- Bryn Mawr Hospital – Dermatology, 825 Old Lancaster Road Suite 450 Bryn Mawr Pennsylvania, Pennsylvania, United States
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7
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Rahmanian E, Alikhani M, Loghman M, Beikmohamadi Hezaveh S, Zangeneh S, Shahriarirad R, Faezi ST, Nejadhosseinian M. COVID
‐19
vaccine‐induced
vasculitis in a patient with sarcoidosis: A case report. Clin Case Rep 2022; 10:e6501. [DOI: 10.1002/ccr3.6501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ehsan Rahmanian
- Department of Rheumatology Hormozgan University of Medical Sciences Bandar Abbas Iran
| | - Majid Alikhani
- Department of Internal Medicine, School of Medicine, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Maryam Loghman
- Department of Internal Medicine, School of Medicine, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Sara Beikmohamadi Hezaveh
- Resident of Neurology, Department of Neurology, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Saba Zangeneh
- School of Medicine Fasa University of Medical Sciences Shiraz Iran
| | - Reza Shahriarirad
- School of Medicine Shiraz University of Medical Sciences Shiraz Iran
- Thoracic and Vascular Surgery Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Seyedeh Tahereh Faezi
- Department of Internal Medicine, School of Medicine, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences Tehran Iran
| | - Mohammad Nejadhosseinian
- Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran
- Rheumatology Research Center Tehran University of Medical Sciences Tehran Iran
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8
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Ajao A, Cosgrove A, Eworuke E, Mohamoud M, Zhang R, Shapira O, Kolonoski J, Connolly JG. A cohort study to assess risk of cutaneous small vessel vasculitis among users of different oral anticoagulants. Pharmacoepidemiol Drug Saf 2022; 31:1164-1173. [PMID: 35909259 PMCID: PMC9872093 DOI: 10.1002/pds.5514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Cutaneous small vessel vasculitis (CSVV) was identified as a safety signal among patients treated with direct oral anticoagulants (DOAC). This study aimed to determine if CSVV risk differed among patients with atrial fibrillation (Afib) who newly initiated warfarin or a DOAC. METHODS We identified enrollees aged ≥21 years diagnosed with Afib who newly initiated rivaroxaban, dabigatran, apixaban, and warfarin in the Sentinel Distributed Database from October 19, 2010 to February 29, 2020. We selected and followed patients who did not have evidence of the following in the 183 days prior to initiating treatment: CSVV diagnosis, dispensing of other study drugs, select autoimmune diseases or autoimmune medications, cancer diagnoses or chemotherapeutic treatment, kidney dialysis or transplant, alternative anticoagulation indications, or an institutional (nursing home, hospice, hospital) stay on the treatment initiation date (index date) until CSVV outcome or pre-specified censoring. We conducted 1:1 propensity score matching in six comparisons. RESULTS CSVV incidence rates for DOACs and warfarin ranged from 3.3 to 5.6 per 10 000-person years in our matched Afib population. The adjusted CSVV hazard ratio (HR) and 95% confidence interval (CI) was 0.94 (0.64, 1.39) for rivaroxaban versus warfarin; 1.17 (0.67, 2.06) for dabigatran vs. warfarin; 0.85 (0.62, 1.16) for apixaban vs. warfarin; 0.86 (0.49, 1.50) for rivaroxaban vs. dabigatran; 0.99 (0.68, 1.45) for rivaroxaban versus apixaban; and 1.70 (0.90, 3.21) for dabigatran versus apixaban. CONCLUSION We did not find significant evidence of differential CSVV risk in pair-wise comparisons of DOACs and warfarin.
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Affiliation(s)
- Adebola Ajao
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Austin Cosgrove
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Efe Eworuke
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mohamed Mohamoud
- Division of Pharmacovigilance, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rongmei Zhang
- Division of Biometrics VII, Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Oren Shapira
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Joy Kolonoski
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - John G Connolly
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
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9
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Martín Guerra JM, Moreta Rodríguez M. Contestación a las consideraciones realizadas al manuscrito «Vasculitis leucocitoclástica secundaria a vacunación frente a SARS-CoV-2». Semergen 2022; 48:101830. [PMID: 36155988 PMCID: PMC9424514 DOI: 10.1016/j.semerg.2022.101830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
- J M Martín Guerra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - M Moreta Rodríguez
- Servicio de Aparato Digestivo, Hospital Universitario Río Hortega de Valladolid, Valladolid, España
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10
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Alpsoy E. Cutaneous vasculitis; An algorithmic approach to diagnosis. Front Med (Lausanne) 2022; 9:1012554. [PMID: 36213632 PMCID: PMC9532537 DOI: 10.3389/fmed.2022.1012554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Vasculitides, characterized by inflammation and damage of blood vessels, encompass a broad spectrum of diseases. They can occur with different pathophysiological mechanisms and have a rich clinical heterogeneity depending on the vessel diameters they affect. Vasculitides may also present with a broad spectrum of severity, ranging from a mild self-limiting to a potentially life-threatening disease. The high prevalence of skin involvement in vasculitis, visible character and, finally, the easy accessibility of the skin for both physical examination and biopsy offers important advantages for prompt disease recognition and diagnosis. Thus, dermatologists are privileged to diagnose the disease earlier and more effectively than any other discipline. As a consequence, a detailed clinical and histopathological evaluation of the skin is one of the most critical steps in diagnosing vasculitis. Besides obtaining a good medical history, laboratory and radiological evaluation methods are used in the diagnosis. In this review, a practical and algorithmic approach is aimed to assist in the diagnosis of vasculitis. However, this approach should not be seen as strict rules. This stepwise algorithmic diagnostic approach for vasculitis was developed by combining the current literature knowledge and the author's experience in this field to provide a rational framework for selecting the most appropriate among various diagnostic approaches.
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11
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Leukocytoclastic Vasculitis following the First Dose of the Elasomeran COVID-19 Vaccination. Case Rep Dermatol Med 2022; 2022:1469410. [PMID: 35968197 PMCID: PMC9371881 DOI: 10.1155/2022/1469410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/17/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022] Open
Abstract
Our case highlights leukocytoclastic vasculitis as a potential side effect of the elasomeran COVID-19 vaccine. As the elasomeran vaccine becomes more widely available to the public, cutaneous reactions should be noted and looked for as potential side effects of the vaccine. Our patient had a history of immune thrombocytopenic purpura, making this a potential predisposing condition to the development of vasculitis following elasomeran administration. The case of vasculitis in our patient, although diffuse in distribution, was self-resolving. Our patient was counseled of the potential risk of worsening reaction to the second dose of the vaccine and instructed to proceed at their own risk. He elected to receive the second vaccination dose without any further reaction or side effects. Primary teaching points from this case include the potential of developing leukocytoclastic vasculitis following the elasomeran vaccination. Patients who develop LCV following the first dose should be counseled of the risks associated with receiving the second dose, including progression to systemic organ involvement.
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12
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Lehr S, Meiss F, Kiritsi D, Tsakiris L. Small-Vessel Vasculitis After ST-Segment Elevation Myocardial Infarction. JACC Case Rep 2022; 4:967-971. [PMID: 35935157 PMCID: PMC9350893 DOI: 10.1016/j.jaccas.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 10/31/2022]
Abstract
We report a case of cutaneous small-vessel vasculitis in a patient treated with clopidogrel after an ST-segment elevation myocardial infarction and with amiodarone caused by persistent atrial fibrillation 6 weeks before. (Level of Difficulty: Intermediate.)
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13
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Martín Guerra JM, Moreta Rodríguez M. Vasculitis leucocitoclástica secundaria a vacunación frente a SARS-CoV-2. Semergen 2022; 48:e33-e34. [PMID: 35491375 PMCID: PMC8853828 DOI: 10.1016/j.semerg.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/30/2022] [Accepted: 02/13/2022] [Indexed: 01/07/2023]
Affiliation(s)
- J M Martín Guerra
- Servicio de Medicina Interna, Hospital clínico Universitario de Valladolid, Valladolid, España.
| | - M Moreta Rodríguez
- Servicio de Medicina Interna, Hospital clínico Universitario de Valladolid, Valladolid, España
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14
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Gnesotto L, Mioso G, Alaibac M. Use of granulocyte and monocyte adsorption apheresis in dermatology (Review). Exp Ther Med 2022; 24:536. [PMID: 35837066 PMCID: PMC9257973 DOI: 10.3892/etm.2022.11463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet's disease, Sweet's syndrome, adult-onset Still's disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.
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Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
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15
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Wallace CE, Sharma A. Adult Onset Immunoglobulin A (IgA) Vasculitis Secondary to Group A Streptococcus Infection. Cureus 2022; 14:e23987. [PMID: 35541301 PMCID: PMC9084608 DOI: 10.7759/cureus.23987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Immunoglobulin A (IgA) vasculitis is a small blood vessel vasculitis that is mediated by immune complex deposition. While it is the most common cause of childhood vasculitis, the disease is uncommon in adults with variable clinical manifestations. A 65-year-old female presented with a diffuse erythematous, pruritic, painful rash across her legs, back, and arms of 12 days’ duration. Associated symptoms included fatigue, lower extremity swelling, and migratory arthralgias of the knees and ankles. Skin examination revealed edematous, blanchable, erythematous, annular papules and plaques on the legs, back, and arms with pitting edema of the lower legs. Laboratory testing revealed an elevated erythrocyte sedimentation rate, hypoalbuminemia, proteinuria, hematuria, and a positive antistreptolysin O titer, indicative of recent group A Streptococcus infection. Treatment with systemic corticosteroids led to a resolution of all her symptoms. Adult onset IgA vasculitis differs in clinical manifestation and treatment from that of the pediatric population. This case demonstrates the importance of considering IgA vasculitis as a differential diagnosis in adults presenting with small vessel vasculitis.
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16
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Wu S, Smith CJ, Miedema JR, Googe PB. Updates in Inflammatory Dermatopathology. Semin Diagn Pathol 2022; 39:288-297. [DOI: 10.1053/j.semdp.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
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17
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Alabbadi A, Alalwi S, Alkhalifah R, Alfaraj D, Albreiki S, Bin Rubaian N, Alsagheer M. Scabies-Associated Leukocytoclastic Vasculitis: A Case Report and Review of Literature. Cureus 2021; 13:e20725. [PMID: 34976550 PMCID: PMC8711789 DOI: 10.7759/cureus.20725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
Scabies is a common contagious ectoparasitosis. The association of scabies and leukocytoclastic vasculitis (LCV) is unclear, and only a few cases of scabies-related LCV have been documented. Here, we report a case of scabies complicated by LCV in an 86-year-old woman diagnosed with scabies and treated accordingly. The patient presented to our hospital with a one-day history of fever, increased rash, and itchiness. Histologic examination of a purpuric lesion revealed signs of LCV. Although histologic examination did not identify the scabies mite in the purpuric lesion, the LCV was likely a post-scabetic presentation following infestation based on other case reports, despite this being a rare occurrence.
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Yap BJM, Lai-Foenander AS, Goh BH, Ong YS, Duangjai A, Saokaew S, Chua CLL, Phisalprapa P, Yap WH. Unraveling the Immunopathogenesis and Genetic Variants in Vasculitis Toward Development of Personalized Medicine. Front Cardiovasc Med 2021; 8:732369. [PMID: 34621800 PMCID: PMC8491767 DOI: 10.3389/fcvm.2021.732369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022] Open
Abstract
Leukocytoclastic vasculitis (LCV) is a systemic autoimmune disease characterized by the inflammation of the vascular endothelium. Cutaneous small vessel vasculitis (CSVV) and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) are two examples of LCV. Advancements in genomic technologies have identified risk haplotypes, genetic variants, susceptibility loci and pathways that are associated with vasculitis immunopathogenesis. The discovery of these genetic factors and their corresponding cellular signaling aberrations have enabled the development and use of novel therapeutic strategies for vasculitis. Personalized medicine aims to provide targeted therapies to individuals who show poor response to conventional interventions. For example, monoclonal antibody therapies have shown remarkable efficacy in achieving disease remission. Here, we discuss pathways involved in disease pathogenesis and the underlying genetic associations in different populations worldwide. Understanding the immunopathogenic pathways in vasculitis and identifying associated genetic variations will facilitate the development of novel and targeted personalized therapies for patients.
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Affiliation(s)
- Bryan Ju Min Yap
- School of Biosciences, Taylor's University, Subang Jaya, Malaysia
| | | | - Bey Hing Goh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yong Sze Ong
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Acharaporn Duangjai
- Unit of Excellence in Research and Product Development of Coffee, Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, Thailand.,Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Surasak Saokaew
- Unit of Excellence in Research and Product Development of Coffee, Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, Thailand.,Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | | | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wei Hsum Yap
- School of Biosciences, Taylor's University, Subang Jaya, Malaysia.,Centre for Drug Discovery and Molecular Pharmacology (CDDMP), Faculty of Health and Medical Sciences (FHMS), Taylor's University, Subang Jaya, Malaysia
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19
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Mutua V, Gershwin LJ. A Review of Neutrophil Extracellular Traps (NETs) in Disease: Potential Anti-NETs Therapeutics. Clin Rev Allergy Immunol 2021; 61:194-211. [PMID: 32740860 PMCID: PMC7395212 DOI: 10.1007/s12016-020-08804-7] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Activated neutrophils release neutrophil extracellular traps (NETs) in response to a variety of stimuli. NETosis is driven by protein-arginine deiminase type 4, with the release of intracellular granule components that function by capturing and destroying microbes, including viral, fungal, bacterial, and protozoal pathogens. The positive effects of pathogen control are countered by pro-inflammatory effects as demonstrated in a variety of diseases. Components of NETS are non-specific, and other than controlling microbes, they cause injury to surrounding tissue by themselves or by increasing the pro-inflammatory response. NETs can play a role in enhancement of the inflammation seen in autoimmune diseases including psoriasis, rheumatoid arthritis, and systemic lupus erythematosis. In addition, autoinflammatory diseases such as gout have been associated with NETosis. Inhibition of NETs may decrease the severity of many diseases improving survival. Herein, we describe NETosis in different diseases focusing on the detrimental effect of NETs and outline possible therapeutics that can be used to mitigate netosis. There is a need for more studies and clinical trials on these and other compounds that could prevent or destroy NETs, thereby decreasing damage to patients.
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Affiliation(s)
- Victoria Mutua
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California Davis, 1 Shields Ave, Davis, CA, USA.
| | - Laurel J Gershwin
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California Davis, 1 Shields Ave, Davis, CA, USA
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20
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Mücke VT, Knop V, Mücke MM, Ochsendorf F, Zeuzem S. First description of immune complex vasculitis after COVID-19 vaccination with BNT162b2: a case report. BMC Infect Dis 2021; 21:958. [PMID: 34530771 PMCID: PMC8443965 DOI: 10.1186/s12879-021-06655-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cases of immune complex vasculitis have been reported following COVID-19 infections; so far none in association with novel mRNA-based COVID-19 vaccination. This case report describes a cutaneous immune complex vasculitis after vaccination with BNT162b2. CASE PRESENTATION A 76-year old male with liver cirrhosis developed an immune complex vasculitis 12 days after the second injection of BNT162b2. On physical examination, the patient presented with pruritic purpuric macules on hands and feet, flexor and extensor parts of both legs and thighs and lower abdomen, and bloody diarrhoea. Laboratory testing showed elevated inflammatory markers. After short treatment with oral steroids all clinical manifestations and laboratory findings resolved. CONCLUSIONS An increasing number of clinical manifestations have been attributed to COVID-19 infection and vaccination. This is the first written report of immune complex vasculitis after vaccination with BNT162b2. We present our case report and a discussion in the light of type three hypersensitivity reaction.
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Affiliation(s)
- Victoria Therese Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Viola Knop
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Marcus Maximilian Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Falk Ochsendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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21
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Affiliation(s)
| | | | - Daniel Lozeau
- Pathology, Stony Brook University Hospital, Stony Brook, NY
| | - Qingping Yao
- From the Division of Rheumatology, Allergy, and Immunology
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22
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To Trap a Pathogen: Neutrophil Extracellular Traps and Their Role in Mucosal Epithelial and Skin Diseases. Cells 2021; 10:cells10061469. [PMID: 34208037 PMCID: PMC8230648 DOI: 10.3390/cells10061469] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
Neutrophils are the most abundant circulating innate immune cells and comprise the first immune defense line, as they are the most rapidly recruited cells at sites of infection or inflammation. Their main microbicidal mechanisms are degranulation, phagocytosis, cytokine secretion and the formation of extracellular traps. Neutrophil extracellular traps (NETs) are a microbicidal mechanism that involves neutrophil death. Since their discovery, in vitro and in vivo neutrophils have been challenged with a range of stimuli capable of inducing or inhibiting NET formation, with the objective to understand its function and regulation in health and disease. These networks composed of DNA and granular components are capable of immobilizing and killing pathogens. They comprise enzymes such as myeloperoxidase, elastase, cathepsin G, acid hydrolases and cationic peptides, all with antimicrobial and antifungal activity. Therefore, the excessive formation of NETs can also lead to tissue damage and promote local and systemic inflammation. Based on this concept, in this review, we focus on the role of NETs in different infectious and inflammatory diseases of the mucosal epithelia and skin.
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23
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Moreta-Rodríguez M, Miramontes-González JP, Solera Arroyo JC, Martín Guerra JM. Apixaban-Induced Skin Purpura. Ann Geriatr Med Res 2021; 25:226-228. [PMID: 33975419 PMCID: PMC8497939 DOI: 10.4235/agmr.21.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022] Open
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24
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Mohammed ET, Patel T. Asymptomatic Purpuric Eruption on the Scalp of a Middle-aged Man. JAMA Oncol 2021; 7:771-772. [PMID: 33599695 DOI: 10.1001/jamaoncol.2020.6773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Tejesh Patel
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis
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25
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Yoon D, Byun HJ, Oh SJ, Park JH, Lee DY. A Case of Cutaneous Leukocytoclastic Vasculitis Associated with Granulocyte Colony-Stimulating Factor: An Unusual Presentation. Ann Dermatol 2021; 32:164-167. [PMID: 33911730 PMCID: PMC7992539 DOI: 10.5021/ad.2020.32.2.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022] Open
Abstract
Drug-induced vasculitis is an inflammation of small-sized blood vessel caused by the use of drugs. It accounts for approximately 10% of acute cutaneous vasculitis. Propylthiouracil, hydralazine, and allopurinol have been widely known as causative agents. The most common clinical feature of drug-induced vasculitis is palpable purpura on lower extremities. A 66-year-old Korean female presented with erythematous nodules on upper chest and back. She had been on medication for multiple myeloma. Laboratory results showed neutropenia. After a single injection of filgrastim (recombinant granulocyte colony-stimulating factor), she developed cutaneous lesions with concurrent increase in absolute neutrophil count. A skin biopsy revealed leukocytoclastic vasculitis. After discontinuation of filgrastim injection, her skin lesions disappeared spontaneously.
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Affiliation(s)
- Dokyoung Yoon
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jeong Byun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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26
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Ko CJ, Gehlhausen JR, McNiff JM. Leukocytoclastic Vasculitis and Microvascular Occlusion: Key Concepts for the Working Pathologist. Surg Pathol Clin 2021; 14:309-325. [PMID: 34023108 DOI: 10.1016/j.path.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although clinicians often put vasculitis and microvascular occlusion in the same differential diagnosis, biopsy findings often are either vasculitis or occlusion. However, both vasculitis and occlusion are present in some cases of levamisole-associated vasculopathy and certain infections. Depth of dermal involvement and vessel size should be reported, because superficial and deep small vessel leukocytoclastic vasculitis and/or involvement of medium-sized vessels may be associated with systemic disease. Microvascular occlusion of vessels in the fat should prompt consideration of calciphylaxis. Clues to ultimate clinical diagnosis can be garnered from depth of involvement, size of vessels affected, and presence of both vasculitis and occlusion.
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Affiliation(s)
- Christine J Ko
- Department of Dermatology, Yale University, 333 Cedar Street, PO Box 208059, New Haven, CT 06520, USA; Department of Pathology, Yale University, 310 Cedar St, New Haven, CT 06511, USA.
| | - Jeff R Gehlhausen
- Department of Dermatology, Yale University, 333 Cedar Street, PO Box 208059, New Haven, CT 06520, USA
| | - Jennifer M McNiff
- Department of Dermatology, Yale University, 333 Cedar Street, PO Box 208059, New Haven, CT 06520, USA; Department of Pathology, Yale University, 310 Cedar St, New Haven, CT 06511, USA
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27
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Schattner A, Dubin I. Mediterranean spotted fever associated with leucocytoclastic vasculitis and acute pancraeatitis. BMJ Case Rep 2021; 14:14/2/e238440. [PMID: 33622746 PMCID: PMC7907886 DOI: 10.1136/bcr-2020-238440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A young healthy gardener became febrile with abdominal pain, nausea, vomiting and diarrhoea followed by palpable purpura, mostly on the legs and buttocks with associated arthralgia. Dehydration, azotemia and hyponatraemia resolved with fluid replacement. Tests demonstrated acute pancreatitis, hepatitis, thrombocytopenia, microscopic haematuria and proteinuria. He improved with doxycycline, but bipedal pitting oedema and punctate rash involving the soles/hands appeared. Microbiological tests revealed positive IgM and IgG serology for rickettsiae spotted fever. Skin biopsy of the purpura confirmed leucocytoclastic vasculitis, positive for Rickettsiae conorii by PCR amplification. Palpable purpura is a rare important manifestation of Mediterranean spotted fever (MSF), due to either secondary leucocytoclastic vasculitis or associated Henoch-Schonlein purpura (HSP), which best explains the distribution of the rash, arthralgia, gastrointestinal symptoms, and microhaematuria not usually seen in R. conorii infections. Likewise, the patient's acute pancreatitis may be interpreted as a rare presentation of HSP or a seldom-encountered feature of MSF.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University Hadassah, Jerusalem, Israel .,Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | - Ina Dubin
- Laniado Hospital, Sanz Medical Centre, Netanya, Israel
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28
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Iraji F, Galehdari H, Siadat AH, Bokaei Jazi S. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: A case report. Clin Case Rep 2021; 9:830-834. [PMID: 33598253 PMCID: PMC7869328 DOI: 10.1002/ccr3.3596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
COVID-19 is a novel disease that mostly affects the respiratory system but as the number of cases is rising significantly around the world, more extra-respiratory manifestations are being reported among which are various dermatologic manifestations.
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Affiliation(s)
- Fariba Iraji
- Dermatology DepartmentIsfahan University of Medical SciencesIsfahanIran
| | - Hamid Galehdari
- Dermatology DepartmentIsfahan University of Medical SciencesIsfahanIran
| | | | - Safoura Bokaei Jazi
- Faculty of Pharmaceutical SciencesIsfahan University of Medical SciencesIsfahanIran
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29
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Toader MP, Esanu IM, Taranu T, Mocanu M, Toader S. Colchicine in the treatment of refractory aphthous ulcerations: Review of the literature and two case reports. Exp Ther Med 2021; 21:281. [PMID: 33603888 DOI: 10.3892/etm.2021.9712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022] Open
Abstract
Colchicine has been known and used for over a millennium for its anti-inflammatory properties, being the treatment of choice for gout and familial Mediterranean fever. A tricyclic alkaloid extracted from the herbaceous plant, Colchicum autumnale, colchicine blocks multiple inflammatory pathways, and has antimitotic and antifibrotic action. Although there are insufficient data on the beneficial mechanism of action, colchicine is a widely used treatment in dermatology, one of the morbid conditions with more evidence of efficacy being recurrent aphthous stomatitis (RAS), a disorder with incompletely known etiopathogenesis and, consequently, with poorly defined treatment. Colchicine is considered as the first therapeutic line in complex or severe aphthoses, significantly relieving pain, decreasing the number of lesions, increasing the free interval between eruptive episodes, without inducing noticeable side effects. We examined the treatment efficacy of colchicine in two cases of chronic, severe RAS, evolving in different morbid contexts, who did not respond to other therapeutic measures. The two cases presented with recurrent aphthous stomatitis with herpetiform aphthae; one patient with Turner syndrome and one patient with major Sutton ulcers.
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Affiliation(s)
- Mihaela Paula Toader
- Department of Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Irina Mihaela Esanu
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Tatiana Taranu
- Department of Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Madalina Mocanu
- Department of Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Stefan Toader
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
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30
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Antony T, Hiya F, Vazquez T, Zaiac M. A case of fish venom‐induced leukocytoclastic vasculitis. Int J Dermatol 2020; 59:e476-e477. [DOI: 10.1111/ijd.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Thompson Antony
- Florida International UniversityHerbert Wertheim College of Medicine Miami FL USA
| | - Farhan Hiya
- Florida International UniversityHerbert Wertheim College of Medicine Miami FL USA
| | - Thomas Vazquez
- Florida International UniversityHerbert Wertheim College of Medicine Miami FL USA
| | - Martin Zaiac
- Florida International UniversityHerbert Wertheim College of Medicine Miami FL USA
- Greater Miami Skin and Laser CenterMount Sinai Medical Center Miami Beach FL USA
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31
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Mohamoud M, Horgan C, Eworuke E, Dee E, Bohn J, Shapira O, Munoz MA, Stojanovic D, Sansing-Foster V, Ajao A, La Grenade L. Complementary Use of U.S. FDA's Adverse Event Reporting System and Sentinel System to Characterize Direct Oral Anticoagulants-Associated Cutaneous Small Vessel Vasculitis. Pharmacotherapy 2020; 40:1099-1107. [PMID: 33090530 DOI: 10.1002/phar.2468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cutaneous small vessel vasculitis (CSVV) has been reported after exposure to direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban. OBJECTIVE We used the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) to describe clinical characteristics associated with CSVV among DOAC-exposed patients. Furthermore, we characterized this signal in the Sentinel System to relate the clinical data from the individual FAERS cases to population-based electronic healthcare data. METHODS We queried FAERS for all cases of CSVV associated with DOACs from U.S. approval date of each DOAC through March 16, 2018. Within the Sentinel System, we identified incident CSVV cases using ICD-9 and ICD-10 diagnosis codes among adults aged ≥ 30 years who received a DOAC in the prior 90 days between January 1, 2010, and June 30, 2018. We excluded patients with evidence of select autoimmune diagnoses in the 183 days prior to their CSVV diagnoses and reported patient characteristics in the 183-day period prior to CSVV diagnoses. RESULTS In FAERS, we identified 50 cases of CSVV reported with rivaroxaban (n=26), apixaban (n=14), dabigatran (n=9), and edoxaban (n=1). Approximately 50% of the cases reported time to onset within 10 days after DOAC exposure. When specified, the predominant type of CSVV reported was leukocytoclastic vasculitis (n=31), followed by Henoch-Schonlein purpura (n=4). Hospitalization occurred in most of the cases (n=37). Switching of the offending agent after the development of CSVV was reported (n=26). Three rivaroxaban (n=3) cases and one dabigatran case (n=1) reported positive rechallenge. In the Sentinel system, we identified 3659 CSVV cases with prior DOAC exposure, with 85% of events occurring within 10 days. CONCLUSIONS The assessment of FAERS cases, combined with the temporal clustering of the Sentinel System cases suggest a possible causal relationship of DOACs and CSVV. Future efforts should characterize the risk of CSVV among the various DOAC users.
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Affiliation(s)
- Mohamed Mohamoud
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Casie Horgan
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Efe Eworuke
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elizabeth Dee
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Justin Bohn
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Oren Shapira
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Monica A Munoz
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danijela Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Veronica Sansing-Foster
- Division of Epidemiology, Office of Clinical Evaluation and Analysis, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Adebola Ajao
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lois La Grenade
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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32
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Dermatological Manifestations in the Intensive Care Unit: A Practical Approach. Crit Care Res Pract 2020; 2020:9729814. [PMID: 33062328 PMCID: PMC7533796 DOI: 10.1155/2020/9729814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/23/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022] Open
Abstract
Dermatological problems are not usually related to intensive medicine because they are considered to have a low impact on the evolution of critical patients. Despite this, dermatological manifestations (DMs) are relatively frequent in critically ill patients. In rare cases, DMs will be the main diagnosis and will require intensive treatment due to acute skin failure. In contrast, DMs can be a reflection of underlying systemic diseases, and their identification may be key to their diagnosis. On other occasions, DMs are lesions that appear in the evolution of critical patients and are due to factors derived from the stay or intensive treatment. Lastly, DMs can accompany patients and must be taken into account in the comprehensive pathology management. Several factors must be considered when addressing DMs: on the one hand, the moment of appearance, morphology, location, and associated treatment and, on the other hand, aetiopathogenesis and classification of the cutaneous lesion. DMs can be classified into 4 groups: life-threatening DMs (uncommon but compromise the patient's life); DMs associated with systemic diseases where skin lesions accompany the pathology that requires admission to the intensive care unit (ICU); DMs secondary to the management of the critical patient that considers the cutaneous manifestations that appear in the evolution mainly of infectious or allergic origin; and DMs previously present in the patient and unrelated to the critical process. This review provides a characterization of DMs in ICU patients to establish a better identification and classification and to understand their interrelation with critical illnesses.
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33
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Akhavanrezayat A, Hien DL, Pham BH, Nguyen HV, Tuong Ngoc TT, Al-Moujahed A, Uludag G, Karkhur S, Doan HL, Nguyen QD. Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis. Am J Ophthalmol Case Rep 2020; 20:100934. [PMID: 33015410 PMCID: PMC7522751 DOI: 10.1016/j.ajoc.2020.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone. Observations A 27-year-old man presented to a tertiary Uveitis Clinic with a five-day history of blurry vision in the right eye (OD). He had a history of a purpuric rash and arthralgias five years ago and a biopsy-confirmed diagnosis of LCV controlled with colchicine two years ago in India. Recently, he presented with a recurrent rash and severe abdominal pain. After being evaluated by rheumatology and gastroenterology, he was placed on Helicobacter pylori treatment and high dose oral prednisone, which improved his skin and gastrointestinal symptoms. At the first ophthalmic exam, his systemic findings included lower extremity purpura. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU). Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed mild enlarged, tortuous veins, optic nerve hemorrhage, and intraretinal hemorrhages temporal to the macula in OD. Spectral-domain optical coherence tomography (SD-OCT) demonstrated multiple hyper-reflective, plaque-like lesions involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). The patient was diagnosed with impending central retinal vein occlusion (CRVO) in OD. Laboratory evaluations were unremarkable. Aspirin was initially started for the patient but was later held due to the worsening of retinal hemorrhage and retinal vein tortuosity at the one-week follow-up. The patient then received three doses of intravenous methylprednisolone, followed by systemic oral prednisone and mycophenolate mofetil. One month later, retinal hemorrhages, venous stasis, and skin manifestations resolved. Conclusion and importance Ocular involvement in LCV is rare and may present with different manifestations. The index case is the first report of impending CRVO in a patient with idiopathic LCV and without any other known risk factors for CRVO. Our report not only describes the unique course of LCV-related ocular involvement, but also introduces and underscores a potentially effective therapeutic plan.
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Affiliation(s)
| | - Doan Luong Hien
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | - Brandon H Pham
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Huy Vu Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Than Trong Tuong Ngoc
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | | | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Huy Luong Doan
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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34
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Arsanios DM, Cabezas DF, Barragán AF, Estupiñán MF, Calderón CM, Quintero-Muñoz E. Tercer caso de vasculitis leucocitoclástica cutánea secundaria al uso de oxacilina: reporte de caso. INFECTIO 2020. [DOI: 10.22354/in.v25i1.908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
La vasculitis leucocitoclastica es una patologìa que compromete los vasos pequeños y cuya causa predominantemente se ha descrito como idiopatica. Se presenta el caso de una mujer de 78 años hipertensa, diabética y con enfermedad renal crónica en estadio 5, que presentó lesiones limitadas a la piel posterior a la administración de oxacilina para manejo de bacteremia por SAMS. La presentación clínica se basó en purpuras palpables predominantemente en miembros inferiores y lesiones dolorosas coalescentes que formaban ampollas de contenido hemorrágico. Estas lesiones resolvieron gradualmente después del cambio de la terapia mencionada anteriormente. La biopsia fue compatible con vasculitis leucocitoclástica, con paraclínicos que descartaron causas infecciosas y autoinmunes.
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35
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Ye R, Tian X, Zhang X. Efficacy of cyclosporine treatment on severe recalcitrant nodular vasculitis. Dermatol Ther 2020; 33:e13870. [PMID: 32558046 DOI: 10.1111/dth.13870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- RuiXian Ye
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Xin Tian
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - XiBao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
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36
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Micheletti RG, Pagnoux C. Management of cutaneous vasculitis. Presse Med 2020; 49:104033. [PMID: 32645416 DOI: 10.1016/j.lpm.2020.104033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
Cutaneous vasculitis encompasses cutaneous components of systemic vasculitides, skin-limited variants of systemic vasculitides, such as IgA vasculitis or cutaneous polyarteritis nodosa, and single-organ cutaneous vasculitis, as individualized in 2012 in the Chapel Hill Consensus Conference Nomenclature. In this article, we focus on the management of skin-limited and single-organ vasculitides, often referred to, in clinical practice, as isolated "cutaneous leukocyctoclastic vasculitis", terms which may correspond to histological findings or descriptions, but are imprecise and not specific. Since most cases of isolated cutaneous vasculitis are self-limited and resolve spontaneously over 3 to 4 weeks, most patients require no systemic treatment. For those with severe, intractable, or chronic and recurring vasculitis, systemic therapy can be indicated and should be tailored to the severity of the disease. High-quality literature is lacking to guide management. Oral glucocorticoids may be required for a short period of time for painful, ulcerative, or otherwise severe disease in order to speed resolution. Among drugs which are reasonable longer-term options are colchicine, dapsone, azathioprine or hydroxychloroquine. Additional studies, including an ongoing multicenter randomized trial, are needed to determine the most effective therapies for skin-limited vasculitis.
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Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 7 South, Room 724, Philadelphia, PA 19104, United States
| | - Christian Pagnoux
- Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, 60 Murray Street, Ste 2-220, Toronto, Ontario, M5T 3L9, Canada.
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37
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Guzman AK, Balagula Y. Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment. Clin Dermatol 2020; 38:613-628. [PMID: 33341196 DOI: 10.1016/j.clindermatol.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed.
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Affiliation(s)
- Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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38
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Martín Guerra JM, Martín Asenjo M, Novoa Fernandez C, Prieto de Paula JM. [Cotrimoxazole-induced leukocytoclastic vasculitis]. Rev Esp Geriatr Gerontol 2020; 55:181-182. [PMID: 31882161 DOI: 10.1016/j.regg.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - Miguel Martín Asenjo
- Servicio de Medicina Interna, Hospital clínico Universitario de Valladolid, Valladolid, España
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39
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Retiform purpura: A diagnostic approach. J Am Acad Dermatol 2020; 82:783-796. [DOI: 10.1016/j.jaad.2019.07.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 12/28/2022]
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40
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Martín Guerra JM, Martín Asenjo M, Prieto de Paula JM. [Leucocitoclastic vasculitis and lymphoma]. Rev Esp Geriatr Gerontol 2020; 55:182-183. [PMID: 32035788 DOI: 10.1016/j.regg.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Miguel Martín Asenjo
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
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41
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Yu Z, Xue Y, Foreman R, Kroshinsky D. A 67-Year-Old Male with Diffuse Purpuric Vesicles and Bullae. Dermatopathology (Basel) 2020; 6:251-254. [PMID: 32083063 PMCID: PMC7011730 DOI: 10.1159/000503662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 02/01/2023] Open
Abstract
Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that most commonly affects the postcapillary venules in the skin. It classically presents with purpuric macules that progress to palpable purpura on the bilateral shins 7–10 days after an inciting medication or infection, or in the setting of connective tissue disease, malignancy, or inflammatory bowel disease. Up to 50% of cases have no identifiable cause. Lesions on the buttocks, abdomen, upper extremities, and face are uncommon, as are bullae and ulcers. We present a rare case of bullous LCV manifesting as grouped vesicles on the face and body mimicking varicella-zoster infection.
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Affiliation(s)
- Zizi Yu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yun Xue
- Harvard Combined Dermatology Residency Training Program and Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth Foreman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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42
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Abstract
PURPOSE OF REVIEW Cutaneous vasculitis reflects a spectrum ranging from skin limited to severe systemic forms. To date, there is still no generally acknowledged nomenclature for cutaneous vasculitis. This review aims to summarize the recent advances in the nomenclature of cutaneous vasculitis. RECENT FINDINGS The most widely adopted vasculitis classification system is the one of 2012 Revised Chapel Hill Consensus Conference (CHCC) which represent not such a classification but a nomenclature system that name vasculitis on the basis of the size of the vessel affected. The CHCC 2012 did not deal with the special features of cutaneous vasculitis and did not explicitly discuss the presence of skin-limited or skin-dominant forms of vasculitis. Therefore, a consensus group was formed to propose an Addendum to CHCC 2012, focusing on cutaneous vasculitis. The Addendum better clarify the main aspects of some single-organ vasculitis, including IgM/IgG vasculitis, nodular vasculitis, erythema elevatum et diutinum and recurrent macular vasculitis in hypergammaglobulinemia. Moreover, it differentiated normocomplementemic from hypocomplementemic urticarial vasculitis. Finally, it recognized cutaneous polyarteritis nodosa as a distinct subtype of polyarteritis nodosa. SUMMARY Classification criteria are useful tools to standardize names and definitions for cutaneous vasculitis; however, they do not represent diagnostic criteria. Collaborative efforts are still needed to get a shared classification and valid diagnostic criteria for cutaneous vasculitis.
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43
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Demographic, etiological and clinical characteristics of patients with leukocytoclastic vasculitis single center experience. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.572537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Viallard J, Vergier B, Lazaro E, Greib C, Pellegrin J. Cutaneous necrotizing small-vessel vasculitis induced by acute hepatitis E. Clin Case Rep 2019; 7:1539-1541. [PMID: 31428384 PMCID: PMC6693053 DOI: 10.1002/ccr3.2167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/14/2019] [Indexed: 12/26/2022] Open
Abstract
Hepatitis E virus is a new emergent virus causing acute self-limiting hepatitis, but may also cause extrahepatic manifestations. Hepatitis E virus should be systematically considered in patients with cutaneous small-vessel vasculitis and cytolytic hepatitis.
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Affiliation(s)
- Jean‐François Viallard
- Clinique de Médecine Interne et Maladies InfectieusesCHU of bordeaux and University of BordeauxPessacFrance
| | - Béatrice Vergier
- Laboratoire d’AnatomopathologieHôpital Haut‐Lévêque, CHU bordeaux, University of BordeauxAvenue de MagellanPessacFrance
| | - Estibaliz Lazaro
- Clinique de Médecine Interne et Maladies InfectieusesCHU of bordeaux and University of BordeauxPessacFrance
| | - Carine Greib
- Clinique de Médecine Interne et Maladies InfectieusesCHU of bordeaux and University of BordeauxPessacFrance
| | - Jean‐Luc Pellegrin
- Clinique de Médecine Interne et Maladies InfectieusesCHU of bordeaux and University of BordeauxPessacFrance
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45
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Sheoran A, Mahto SK, Verma P, War GA, Agarwal N, Singh A. Leukocytoclastic vasculitis: An uncommon adverse effect of a common drug. J Family Med Prim Care 2019; 8:2137-2139. [PMID: 31334194 PMCID: PMC6618195 DOI: 10.4103/jfmpc.jfmpc_338_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A hypertensive elderly male on amlodipine presented with a palpable purpuric rash on both legs followed by shoulder, buttocks, and back with foot ulcer, which was found to be leukocytoclastic vasculitis on skin biopsy. The patient recovered completely on discontinuation of amlodipine and short-term steroid.
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Affiliation(s)
- Ankita Sheoran
- Department of Medicine, PGIMER, Dr. RML Hospital, New Delhi, India
| | | | - Pooja Verma
- Department of Medicine, Smt. Sucheta Kriplani Hospital and LHMC, New Delhi, India
| | - Gwenette A War
- Department of Medicine, Smt. Sucheta Kriplani Hospital and LHMC, New Delhi, India
| | - Nagina Agarwal
- Department of Medicine, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Anu Singh
- Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India
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46
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Abstract
The color purple can be seen in several types of eruptions including inflammatory dermatoses like lichen planus, infectious dermatoses like ecthyma gangrenosum, neoplasms like Kaposi sarcoma, and vasculitis and vasculopathy. The current review focuses on the clinical appearance, pathophysiology, and treatment of several vasculitides and vasculopathies including capillaritis, cutaneous small-vessel vasculitis, immunoglobulin A (IgA) vasculitis, cryoglobulinemia, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, polyarteritis nodosum, warfarin-induced skin necrosis, heparin-induced thrombocytopenia, purpura fulminans, antiphospholipid antibody syndrome, calciphylaxis, levamisole-induced vasculopathy, and thrombotic thrombocytopenic purpura. Dermatologists play a central role in treating patients with cutaneous vasculitis and vasculopathy and may have the opportunity to facilitate identification of systemic disease by diagnosing cutaneous vasculitis and vasculopathy.
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Affiliation(s)
- Alexa B Steuer
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Jeffrey M Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
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47
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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48
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Mericliler M, Shnawa A, Al-Qaysi D, Fleisher J, Moraco A. Oxacillin-induced leukocytoclastic vasculitis. IDCases 2019; 17:e00539. [PMID: 31384556 PMCID: PMC6667486 DOI: 10.1016/j.idcr.2019.e00539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 12/03/2022] Open
Abstract
Leukocytoclastic vasculitis (LCV) refers to a histopathological pattern of neutrophil predominant inflammatory process of small vessels associated with fibrinoid necrosis. Cutaneous LCV usually presents as symmetrically distributed palpable purpuric nodules of the lower extremities with or without systemic involvement. Although 50% of LCV cases are idiopathic, it can be secondary to identifiable causes such as malignancy, autoimmune conditions, infections, and medications. Medications have been implicated in up to 25% of cases; sulfonamides, NSAIDs, and beta-lactams have the most frequent association. We herein present a 32-year-old female who developed palpable purpura over hands and lower limbs 12 days after exposure to oxacillin administered for infective endocarditis. Punch biopsy from the skin lesions confirmed the diagnosis of LCV. Given the temporal relationship between oxacillin administration and development of skin findings, the diagnosis of oxacillin-associated LCV was suspected. Discontinuation of drug resulted in resolution of the lesions confirming the diagnosis. To our knowledge, this is the second case of oxacillin-induced cutaneous LCV described in literature.
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Affiliation(s)
- Meric Mericliler
- St. Elizabeth's Medical Center, Department of Medicine, Brighton, MA 02135.,Tufts University School of Medicine, Boston, MA 02111
| | - Aya Shnawa
- Tufts University School of Medicine, Boston, MA 02111.,Tufts Medical Center, Department of Medicine, Boston, MA 02111.,Harvard University Medical School, Boston, MA 02115
| | - Dalya Al-Qaysi
- St. Elizabeth's Medical Center, Department of Medicine, Brighton, MA 02135.,Tufts University School of Medicine, Boston, MA 02111
| | - Jorge Fleisher
- Tufts University School of Medicine, Boston, MA 02111.,St. Elizabeth's Medical Center, Department of Infectious Disease, Brighton, MA 02135
| | - Andrew Moraco
- Tufts University School of Medicine, Boston, MA 02111.,St. Elizabeth's Medical Center, Department of Pulmonary and Critical Care, Brighton, MA 02135
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49
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Haehn DA, Patel A, Youngberg G, Gonzalez-Estrada A. Ceftriaxone-induced leucocytoclastic vasculitis. BMJ Case Rep 2019; 12:12/4/e229411. [PMID: 30988110 DOI: 10.1136/bcr-2019-229411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Archi Patel
- Department of Pathology, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
| | - George Youngberg
- Department of Pathology, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
| | - Alexei Gonzalez-Estrada
- Division of Allergy and Clinical Immunology, Department of Medicine, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
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50
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Abate MS, Battle LR, Emerson AN, Gardner JM, Shalin SC. Dermatologic Urgencies and Emergencies: What Every Pathologist Should Know. Arch Pathol Lab Med 2019; 143:919-942. [PMID: 30785787 DOI: 10.5858/arpa.2018-0239-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Fatal dermatologic diseases and ones with high morbidity can occur in the inpatient setting. In such cases, prompt and accurate assessment of a bedside skin biopsy is required. This may be challenging for many pathologists who are not familiar with the complexity of skin pathology and skin terminology within the fields of dermatopathology and dermatology. OBJECTIVE.— To provide the pathologist with a practical, up-to-date, and "must-know" reference guide on dermatologic urgencies and emergencies from a real-world perspective, highlighting diagnostic pearls, diagnostic pitfalls, and commonly encountered practice gaps. This review will focus on key diseases with which every pathologist should be familiar, including angioinvasive fungal infections, Stevens-Johnson syndrome/toxic epidermal necrolysis, staph-scalded-skin syndrome, acute graft-versus-host disease, bullous pemphigoid, calciphylaxis, Sweet syndrome and its histiocytoid variant, pyoderma gangrenosum, and leukocytoclastic vasculitis, as well as those in their clinical and histopathologic differential. DATA SOURCES.— This review is based on peer-reviewed literature and our personal experiences with these diseases at major academic institutions, including one where a large number of stem cell transplants are performed. This review is unique as it represents collaborative expert opinion from both a dermatopathology and a dermatology standpoint. CONCLUSIONS.— This review outlines the critical role that the pathologist plays in the outcomes of patients with dermatologic urgencies and emergencies. Improved patient care will result from prompt and accurate histopathologic diagnoses as well as an open line of communication with the dermatologist.
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Affiliation(s)
- Mallory S Abate
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Laura R Battle
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Ashley N Emerson
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Jerad M Gardner
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Sara C Shalin
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
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