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Chieosilapatham P, Prinyaroj N, Jamjanya S, Kiratikanon S, Thinrungroj N, Kaewpoowat Q, Kongkarnka S, Mahanupab P, Tovanabutra N, Chiewchanvit S, Chuamanochan M. Degos-like lesions as a cutaneous manifestation of cytomegalovirus infection: A rare and serious complication in a patient with drug-induced hypersensitivity syndrome. J Dermatol 2020; 48:533-536. [PMID: 33305840 DOI: 10.1111/1346-8138.15717] [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: 08/26/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022]
Abstract
Cytomegalovirus causes a myriad of clinical features, potentially affecting any organ system, significantly increasing morbidity and even mortality. Vascular endothelial cell infection by cytomegalovirus has been implicated in the development of vasculopathy, possibly accounting for the clinical association between cytomegalovirus and vascular thrombosis. In contrast with visceral organ involvement, the cutaneous manifestations of cytomegalovirus are variable and rarely described. Malignant atrophic papulosis, commonly known as Degos disease, is an unusual small vessel arteriopathy with a pathognomonic clinical appearance of atrophic porcelain-white central papules surrounded by telangiectatic erythema. As with the arterial occlusive process, Degos disease may be idiopathic or secondary to autoimmune disorders or viral infection. All in all, cytomegalovirus-related Degos-like presentation has never been described. This report describes a case in which disseminated cytomegalovirus disease developed 4 weeks after the onset of drug-induced hypersensitivity syndrome with prominent Degos-like skin lesions. Our case highlights a rare example of Degos-like lesions occurring due to cytomegalovirus disease and emphasizes the importance of early recognition of the characteristic cutaneous eruption as a diagnostic clue leading to the prompt management of this life-threatening infection.
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Affiliation(s)
- Panjit Chieosilapatham
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nayanunt Prinyaroj
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinda Jamjanya
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Salin Kiratikanon
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nithi Thinrungroj
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Quanhathai Kaewpoowat
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsak Mahanupab
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napatra Tovanabutra
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siri Chiewchanvit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Dhar S, Ganjoo S, Dhar S, Srinivas SM, Parikh D. Neonate with white macules and mild erosions. Pediatr Dermatol 2020; 37:e57-e59. [PMID: 32981171 DOI: 10.1111/pde.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sandipan Dhar
- Department of Paediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Shikhar Ganjoo
- Department of Dermatology & STD, SGT Medical College, Hospital & Research Institute, Gurugram, India
| | | | - Sahana M Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Deepak Parikh
- Department of Paediatric Dermatology, Wadia Children Hospital, Mumbai, India
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3
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Razanamahery J, Payet‐Revest C, Mareschal A, Saizonou I, Bonnet L, Gil H, Humbert S, Magy‐Bertrand N. Early failure of eculizumab in a patient with malignant atrophic papulosis: Is it time for initial combination therapy of eculizumab and treprostinil? J Dermatol 2019; 47:e22-e23. [DOI: 10.1111/1346-8138.15120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jerome Razanamahery
- Department of Internal Medicine Besancon University Hospital Besancon France
| | | | - Adrien Mareschal
- Department of Dermatology Besancon University Hospital Besancon France
| | - Ines Saizonou
- Department of Pathology Besancon University Hospital Besancon France
| | - Louise Bonnet
- Department of Neurology Besancon University Hospital Besancon France
| | - Helder Gil
- Department of Internal Medicine Besancon University Hospital Besancon France
| | - Sebastien Humbert
- Department of Internal Medicine Besancon University Hospital Besancon France
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Sun S, Chai S, Zhang F, Lu L. Overexpressed microRNA-103a-3p inhibits acute lower-extremity deep venous thrombosis via inhibition of CXCL12. IUBMB Life 2019; 72:492-504. [PMID: 31613419 DOI: 10.1002/iub.2168] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/30/2019] [Indexed: 01/02/2023]
Abstract
Studies have shown that microRNAs (miRNAs) participate in almost all pathological and physiological processes including acute lower-extremity deep venous thrombosis (LEDVT). Here, this study was designed to elucidate the possible function of miR-103a-3p in acute LEDVT. Expression of miR-103a-3p and chemokine C-X-C motif ligand 12 (CXCL12) was initially quantified in plasma collected from 81 LEDVT patients. Then LEDVT mouse models were established by injection with 3% sodium pentobarbital. The interaction between miR-103a-3p and CXCL12 was identified by dual-luciferase reporter gene assay. After gain- and loss-of-function studies, interleukin-6 (IL-6) and IL-8 and tissue factor (TF) levels, and expression of plasminogen activator inhibitors (PAIs), von Willebrand factor (vWF), thromboxane A2 (TH-A2), F4/80, IL-12, Arginase-1 (Arg-1) and CD206 were determined using enzyme-linked immunosorbent assay (ELISA), reverse transcription quantitative polymerase chain reaction (RT-qPCR) and western blot analysis, respectively. miR-103a-3p was downregulated, while CXCL12 was upregulated in patients and mice with LEDVT. miR-103a-3p targets CXCL12 and inhibited its expression. Overexpressed miR-103a-3p or downregulated CXCL12 decreased expression of IL-6, IL-8, TF, PAIs, vWF, TH-A2, M1 markers (IL-6 and IL-12), yet increased expression of M2 markers (Arg-1 and CD206) in LEDVT mice. Additionally, upregulated miR-103a-3p or silencing CXCL12 suppressed thrombosis in LEDVT mice. However, overexpression of CXCL12 reversed the tendency mentioned above. Altogether, miR-103a-3p can potentially downregulate CXCL12 expression to disrupt inflammatory response and thrombosis, ultimately preventing the development of LEDVT. Our findings underscore a possible alternative therapeutic strategy to limit LEDVT.
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Affiliation(s)
- Shaoliang Sun
- Department of Vascular Surgery, Liaocheng People's Hospital, Liaocheng, People's Republic of China
| | - Shanyi Chai
- Department of General Surgery, Liaocheng Dongchangfu People's Hospital, Liaocheng, People's Republic of China
| | - Feng Zhang
- Department of Vascular Surgery, Liaocheng People's Hospital, Liaocheng, People's Republic of China
| | - Lu Lu
- Department of Chest Cardiovascular Surgery, Liaocheng Gaotang People's Hospital, Liaocheng, People's Republic of China
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Benign Atrophic Papulosis (Degos Disease) With Lymphocytic Vasculitis and Lichen Sclerosus-Like Features. Am J Dermatopathol 2018; 40:272-274. [DOI: 10.1097/dad.0000000000000847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Murthy AS, Kinsler V. White scarlike lesions in a female infant with bilious emesis and sixth nerve palsy. Pediatr Dermatol 2018; 35:242-243. [PMID: 29575076 DOI: 10.1111/pde.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aditi S Murthy
- Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Veronica Kinsler
- Pediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.,Genetics and Genomic Medicine, Institute of Child Health, University College of London, London, UK
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Affiliation(s)
- Vishalakshi Viswanath
- Department of Dermatology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India. E-mail:
| | - Jinal Lakhamshi Gada
- Department of Dermatology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India. E-mail:
| | - Ronak Jagdeep Shah
- Department of Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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Pirolla E, Fregni F, Miura IK, Misiara AC, Almeida F, Zanoni E. Degos disease - malignant atrophic papulosis or cutaneointestinal lethal syndrome: rarity of the disease. Clin Exp Gastroenterol 2015; 8:141-7. [PMID: 25926751 PMCID: PMC4403817 DOI: 10.2147/ceg.s59794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Degos disease is a very rare syndrome with a rare type of multisystem vasculopathy of unknown cause that affects the skin, gastrointestinal tract, and central nervous system. Other organs such as the kidneys, lungs, pleura, liver, heart, and eyes, can also be involved. OBJECTIVE To highlight the incidence of Degos disease with regard to age and sex, discuss the necessity of its accurate and early diagnosis, and demonstrate the most current techniques for its diagnosis; to discuss whether early therapeutic intervention can impact patient prognosis; and to present a literature review about this disease. DESIGN With a retrospective, observational, nonrandomized trial, we described the evolution of the different forms of Degos disease and referenced the literature. DATA SOURCES Research on rare documented cases in the literature, including two cases of potentially lethal form of the disease involving the skin and gastrointestinal system and, possibly, the lungs, kidneys, and central nervous system. A case of the benign form of the disease involving the skin was observed by the authors. MAIN OUTCOME MEASURES Differences between outcomes in patients with the cutaneointestinal form and skin-only form of the disease. There was one fatal outcome. We reviewed possible new approaches to diagnosis and treatment. RESULTS The study demonstrated the rapid evolution of the aggressive and malignant form of the disease. It also described newly accessible Phase I diagnostic tools being currently researched as well as new therapeutic approaches. LIMITATION The rarity of the disease, with only eleven cases throughout the literature. CONCLUSION The gastrointestinal form of Degos disease can be lethal. Its vascular etiology has finally been confirmed; however, new and more accurate early diagnostic modalities need to be developed. There are new therapeutic possibilities, but the studies of them are still in the early stages and have not yet shown the full effectiveness of these new therapies.
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Affiliation(s)
- Eduardo Pirolla
- Spaulding Rehabilitation Network Research Laboratory, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Spaulding Rehabilitation Network Research Laboratory, Harvard Medical School, Boston, MA, USA
| | - Irene K Miura
- University of São Paulo, Sirio Libanes Hospital, São Paulo, Brazil
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Daggett RN, Kurata M, Abe S, Onishi I, Miura K, Sawada Y, Tanizawa T, Kitagawa M. Expression dynamics of CXCL12 and CXCR4 during the progression of mycosis fungoides. Br J Dermatol 2014; 171:722-31. [PMID: 24725174 DOI: 10.1111/bjd.13054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) classically presents from patch stage to plaque stage over a number of years and finally progresses to tumour stage with nodal or visceral involvement. The mechanism of progression remains incompletely elucidated. Chemokines and their receptors are known to be involved in disease mechanisms, with CXCL12 and CXCR4 playing a critical role in carcinogenesis, invasion and cancer cell migration in various carcinomas. OBJECTIVES To investigate the expression of CXCL12 and CXCR4 in different cutaneous stages of MF. METHODS Formalin-fixed, paraffin-embedded skin samples from 40 patients with MF (21 patch stage, 10 plaque stage, nine tumour stage) and 30 non-neoplastic control skin samples were analysed. CXCL12 and CXCR4 were assessed by quantitative reverse-transcription polymerase chain reaction and immunohistochemical staining. RESULTS The expression level of mRNA for CXCL12 in plaque-stage MF was significantly higher than in control skin (P = 0.0035), or patch-stage (P = 0.0108) or tumour-stage disease (P = 0.0089). The CXCR4 mRNA expression level in plaque-stage disease was significantly higher than in control skin (P = 0.0090) or patch-stage disease (P = 0.0387). CXCL12- and CXCR4-positive cell rates in patch-stage and plaque-stage MF were significantly higher than those in control skin (P < 0.0001). CXCL12- and CXCR4-positive cell rates in tumour-stage MF were significantly lower than those in patch- and plaque-stage disease (P = 0.0274 and P = 0.0492, respectively). CONCLUSIONS Our data suggest that neoplastic T cells in MF are exposed to the microenvironment, given the abundance of CXCL12 during its progression, and also that neoplastic T cells express CXCR4, especially in the pretumour stage. We reveal that the CXCL12-CXCR4 axis plays a critical role in MF progression.
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Affiliation(s)
- R N Daggett
- Department of Comprehensive Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Zaharia D, Truchot F, Ronger-Savle S, Balme B, Thomas L. Benign form of atrophic papulosis developed at injection sites of pegylated-alpha-interferon: is there a pathophysiological link? Br J Dermatol 2014; 170:992-4. [DOI: 10.1111/bjd.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Zaharia
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - F. Truchot
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - S. Ronger-Savle
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - B. Balme
- Department of Pathology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - L. Thomas
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
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Theodoridis A, Makrantonaki E, Zouboulis CC. Malignant atrophic papulosis (Köhlmeier-Degos disease) - a review. Orphanet J Rare Dis 2013; 8:10. [PMID: 23316694 PMCID: PMC3566938 DOI: 10.1186/1750-1172-8-10] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/09/2013] [Indexed: 12/14/2022] Open
Abstract
Definition of the disease Malignant atrophic papulosis (MAP), described independently by Köhlmeier and Degos et al., is a rare, chronic, thrombo-obliterative vasculopathy characterized by papular skin lesions with central porcelain-white atrophy and surrounding teleangiectatic rim. Epidemiology Less than 200 cases have been described in the literature. The first manifestation of MAP usually occurs between the 20th and 50th year of life. Clinical description The cutaneous clinical picture is almost pathognomonic. The histology is not consistent but in most cases it shows a wedge-shaped connective tissue necrosis in the deep corium due to a thrombotic occlusion of the small arteries. In the systemic variant, manifestations mostly occur at the intestine and central nervous system. Etiology The etiopathogenesis of the disease remains unknown, a genetic predisposition may occur. Vasculitis, coagulopathy or primary dysfunction of the endothelial cells have been implicated. Diagnostic methods Diagnosis is only based on the characteristic skin lesions. Differrential diagnosis It depends on the clinical presentation of MAP, but systemic lupus erythematosus and other connective tissue diseases need to be considered. Management No effective treatment exists for the systemic manifestations, while compounds that facilitate blood perfusion have achieved a partial regression of the skin lesions in single cases. Prognosis An apparently idiopathic, monosymptomatic, cutaneous, benign variant and a progressive, visceral one with approx. 50% lethality within 2–3 years have been reported. Systemic manifestations can develop years after the occurrence of skin lesions leading to bowel perforation and peritonitis, thrombosis of the cerebral arteries or massive intracerebral hemorrhage, meningitis, encephalitis, radiculopathy, myelitis.
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Affiliation(s)
- Athanasios Theodoridis
- Departments of Dermatology, Venerology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, Dessau, 06847, Germany
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