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Sidiki S, Fatima R, Hernández NC, Altorok N. Atezolizumab-Associated Retiform Purpura. Am J Ther 2024; 31:e455-e458. [PMID: 38335060 DOI: 10.1097/mjt.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Sabeen Sidiki
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Rawish Fatima
- Division of Rheumatology, University of Toledo Medical Center, Toledo, OH
| | | | - Nezam Altorok
- Division of Rheumatology, University of Toledo Medical Center, Toledo, OH
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2
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Lenga M, Erickson T, Nguyen CV. Retiform Ulceration and Bullae on the Bilateral Thighs. JAMA Dermatol 2024; 160:773-774. [PMID: 38691375 DOI: 10.1001/jamadermatol.2024.0486] [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: 05/03/2024]
Abstract
A man with a history of polysubstance use presents with new bullae on his bilateral lower extremities. What is your diagnosis?
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Affiliation(s)
- Marisa Lenga
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Taylor Erickson
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Assistant Section Editor, JAMA Dermatology
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3
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King HL, Benedetti GB, Keller JJ, DeLoughery TG, Shatzel JJ, Martens KL. Dermatologic manifestations of hematologic disorders. Ann Hematol 2024:10.1007/s00277-024-05761-5. [PMID: 38662204 DOI: 10.1007/s00277-024-05761-5] [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: 02/13/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.
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Affiliation(s)
- Hannah L King
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Jesse J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Kylee L Martens
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA.
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4
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Gupta A, Arasu A, Landgren A, Howard A. A sheep in wolf's clothing: a rare case of erythema ab igne mimicking vasculitis. Intern Emerg Med 2024:10.1007/s11739-024-03575-x. [PMID: 38446369 DOI: 10.1007/s11739-024-03575-x] [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: 12/21/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Ankit Gupta
- Department of Dermatology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
| | - Alexis Arasu
- Department of Dermatology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Anthony Landgren
- Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Anne Howard
- Department of Dermatology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
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5
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Chaudhry S, Lee K. Diagnosing and Managing Venous Stasis Disease and Leg Ulcers. Clin Geriatr Med 2024; 40:75-90. [PMID: 38000863 DOI: 10.1016/j.cger.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Venous insufficiency is a common medical condition that affects many individuals, especially those with advanced age. Chronic venous insufficiency can lead to secondary cutaneous changes that most commonly present as stasis dermatitis but can progress to more serious venous ulcers. Although venous ulcers are the most common cause of lower extremity ulcers, the differential diagnosis of leg ulcers is broad. This article will discuss clinical clues to help guide patient workup and will review basic clinical evaluation and management of common leg ulcers.
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Affiliation(s)
- Sofia Chaudhry
- Department of Dermatology, Saint Louis University School of Medicine, 1225 South Grand Boulevard, 3rd Floor, Saint Louis, MO 63104, USA.
| | - Kathryn Lee
- Saint Louis University School of Medicine, 1402 South Grand Boulevard, Saint Louis, MO 63104, USA
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6
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Hosseini NS, Babaei S, Rahimi H, Gheissari A, Sedaghat B, Pourmahdi-Boroujeni M, Abtahi-Naeini B. Cutaneous microvascular occlusion syndrome as the first manifestation of catastrophic lupus-associated antiphospholipid antibody syndrome: a case report. J Med Case Rep 2023; 17:375. [PMID: 37605287 PMCID: PMC10464427 DOI: 10.1186/s13256-023-04068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/19/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Antiphospholipid syndrome (APS), defined by thrombotic events or obstetric complications in the presence of persistently high antiphospholipid antibodies, is characterized by a wide variety of clinical presentations and the effects of vascular occlusion can impact almost any organ system or tissue. Since adult-onset APS classification criteria are not well verified in pediatrics (where pregnancy-related problems are rare), estimating childhood prevalence is challenging. Stroke and pulmonary embolism are thromboembolic events occurring in children that can cause considerable long-term morbidity. Children with APS are more prone to recurrent thromboembolism than adults. Cutaneous symptoms are prominent and typically represent the first clue of APS. Although dermatologic findings are exceedingly heterogeneous, it is essential to consider which dermatological symptoms justify the investigation of antiphospholipid syndrome and the required further management. CASE PRESENTATION We describe a seven-year-old Iranian boy with retiform purpura and acral cutaneous ischemic lesions as the first clinical presentation of antiphospholipid syndrome in the setting of systemic lupus erythematous. CONCLUSION APS in pediatrics, is associated with a variety of neurologic, dermatologic, and hematologic symptoms. Therefore, it is essential for pediatricians to be aware of the rare appearance of Catastrophic APS as an initial indication of APS.
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Affiliation(s)
| | - Sharareh Babaei
- Department of Pediatric Intensive Care Unit, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Rahimi
- Department of Pediatric Infectious Diseases, School of Medicine, Pediatric Cardiovascular Research Center, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alaleh Gheissari
- Isfahan Kidney Diseases Research Center and Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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7
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Zhang Y, Yu Y, Gao AT. Systemic lupus erythematosus and antiphospholipid syndrome with retiform purpura as the initial skin lesion: A case study. Lupus 2023; 32:583-585. [PMID: 36888900 DOI: 10.1177/09612033231162199] [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: 03/10/2023]
Abstract
Retiform purpura-like lesions are rarely seen clinically and can be induced by cutaneous vascular wall damage or a lumen-occlusive disease arising from a broad range of triggers, including infection, drugs, emboli, cryoglobulinemia, disseminated intravascular coagulation, and autoimmune disease. Here, we present the case of a patient suffering from both systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), with retiform purpura as the first lesion and lacking other typical symptoms of SLE, such as photosensitivity, malar rash, ulceration of the mouth and nose, alopecia, and joint pain.
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Affiliation(s)
- Ying Zhang
- Department of Dermatology, 117933Chongqing Traditional Chinese Medicine Hospital, Chongqing Clinical Research Center for Dermatology, Chongqing, China
| | - Yin Yu
- Department of Dermatology, 117933Chongqing Traditional Chinese Medicine Hospital, Chongqing Clinical Research Center for Dermatology, Chongqing, China
| | - And Tao Gao
- Department of Dermatology, 117933Chongqing Traditional Chinese Medicine Hospital, Chongqing Clinical Research Center for Dermatology, Chongqing, China
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8
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Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity. Adv Skin Wound Care 2023; 36:137-141. [PMID: 36812078 DOI: 10.1097/01.asw.0000911988.75204.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To describe the observed patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process. METHODS This retrospective observational cohort study included adults who were COVID-19 positive with purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury. Patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were compiled by review of the electronic health record. The wounds were described by location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and periwound condition (intact). RESULTS A total of 26 patients were included in the study. Purpuric/violaceous wounds were found predominantly on White (92.3%) men (88.0%) aged 60 to 89 years (76.9%) with a body mass index 30 kg/m2 or higher (46.1%). The majority of wounds were located on the sacrococcygeal (42.3%) and fleshy gluteal regions (46.1%). CONCLUSIONS Wounds were heterogeneous in appearance (poorly defined violaceous skin discoloration of acute onset), and the patient population had clinical characteristics similar to acute skin failure (eg, concomitant organ failures and hemodynamic instability). Additional larger population-based studies with biopsies may assist in finding patterns related to these dermatologic changes.
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9
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Gallo Marin B, Aghagoli G, Hu SL, Massoud CM, Robinson-Bostom L. Calciphylaxis and Kidney Disease: A Review. Am J Kidney Dis 2023; 81:232-239. [PMID: 35970430 DOI: 10.1053/j.ajkd.2022.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
Calciphylaxis is a life-threatening complication most often associated with chronic kidney disease that occurs as a result of the deposition of calcium in dermal and adipose microvasculature. However, this condition may also be seen in patients with acute kidney injury. The high morbidity and mortality rates associated with calciphylaxis highlight the importance to correctly diagnose and treat this condition. However, calciphylaxis remains a diagnosis that may be clinically challenging to make. Here, we review the literature on uremic calciphylaxis with a focus on its pathophysiology, clinical presentation, advances in diagnostic tools, and treatment strategies. We also discuss the unique histopathological features of calciphylaxis and contrast it with those of other forms of general vessel calcification. This review emphasizes the need for multidisciplinary collaboration including nephrology, dermatology, and palliative care to ultimately provide the best possible care to patients with calciphylaxis.
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Affiliation(s)
- Benjamin Gallo Marin
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ghazal Aghagoli
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cathy M Massoud
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
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10
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Keim CK, Schwartz RA, Kapila R. Levamisole-induced and COVID-19-induced retiform purpura: two overlapping, emerging clinical syndromes. Arch Dermatol Res 2023; 315:265-273. [PMID: 34807290 PMCID: PMC8607060 DOI: 10.1007/s00403-021-02303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/11/2021] [Indexed: 10/28/2022]
Abstract
Levamisole exposure in cocaine users is a well-recognized cause of retiform purpura, a distinctive net-like maculopapular patch. Prolonged exposure to levamisole can lead to a serious systemic syndrome known as levamisole-induced vasculitis, most commonly involving the kidneys and lungs. More recently, retiform purpura has been observed in patients with the novel coronavirus disease of 2019 (COVID-19). Due to their overlapping dermatologic and systemic manifestations, levamisole-induced and COVID-19-induced retiform purpura may mimic one another in clinical presentation. The possibility that patients may present with one or both syndromes creates a diagnostic challenge. This review of levamisole-induced and COVID-19-induced retiform purpura highlights their corresponding and distinctive features. Additionally, we propose a unique staging system for levamisole-induced retiform purpura that may be valid for future classification of COVID-19-induced retiform purpura.
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Affiliation(s)
- Catherine K. Keim
- grid.430387.b0000 0004 1936 8796Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Robert A. Schwartz
- grid.430387.b0000 0004 1936 8796Dermatology and Pathology, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Rajendra Kapila
- grid.430387.b0000 0004 1936 8796Infectious Diseases, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
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11
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Eswaran H, Googe P, Vedak P, Marston WA, Moll S. Livedoid vasculopathy: A review with focus on terminology and pathogenesis. Vasc Med 2022; 27:593-603. [PMID: 36285834 PMCID: PMC9732787 DOI: 10.1177/1358863x221130380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Livedoid vasculopathy (LV) is a rare thrombotic vasculopathy of the dermis characterized by painful, relapsing ulcers over the lower extremities. Diagnosis is challenging due to the overlap in clinical appearance and nomenclature with other skin disorders. Treatment selection is complicated by poor understanding of the pathogenesis of LV and lack of robust clinical trials evaluating therapy efficacy. The terminology and pathophysiology of LV are reviewed here, along with its epidemiology, clinical and histologic features, and treatment options. A diagnostic pathway is suggested to guide providers in evaluating for comorbidities, referring to appropriate specialists, and choosing from the available classes of therapy.
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Affiliation(s)
- Harish Eswaran
- Department of Medicine, Division of
Hematology, University of North Carolina School of Medicine, Chapel Hill, NC,
USA
| | - Paul Googe
- Department of Dermatology, University
of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Priyanka Vedak
- Department of Dermatology, University
of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - William A Marston
- Department of Surgery, University of
North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Stephan Moll
- Department of Medicine, Division of
Hematology, University of North Carolina School of Medicine, Chapel Hill, NC,
USA
- Blood Research Center, University of
North Carolina School of Medicine, Chapel Hill, NC, USA
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12
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Cutaneous Oxalosis Due to Primary Hyperoxaluria. Am J Dermatopathol 2022; 44:981-983. [DOI: 10.1097/dad.0000000000002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Kang BY, Han J, Peterson EJ, Konstantinov NK. Rapidly progressing dyspnea and retiform purpura. JAAD Case Rep 2022; 30:66-69. [DOI: 10.1016/j.jdcr.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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14
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Quinn LA, Plost GR, Siegele B, Feldman AG, de Zoeten E. Inflammatory Bowel Disease Presenting With Retiform Purpura. JPGN REPORTS 2022; 3:e232. [PMID: 37168649 PMCID: PMC10158265 DOI: 10.1097/pg9.0000000000000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 05/13/2023]
Affiliation(s)
- Laura A. Quinn
- From the Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Grant R. Plost
- Department of Pediatric Dermatology, University of Colorado School of Medicine, Aurora, CO
| | - Bradford Siegele
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - Amy G. Feldman
- From the Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Edwin de Zoeten
- From the Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO
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15
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Rick J, Strowd L, Pasieka HB, Saardi K, Micheletti R, Zhao M, Kroshinsky D, Shinohara MM, Ortega-Loayza AG. Calciphylaxis: Part I. Diagnosis and pathology. J Am Acad Dermatol 2022; 86:973-982. [PMID: 35114300 DOI: 10.1016/j.jaad.2021.10.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022]
Abstract
Calciphylaxis is an uncommon but devastating disorder characterized by vascular calcification and subsequent cutaneous tissue necrosis. This results in exquisitely painful and slow healing wounds that portend exceptionally high morbidity and mortality. The diagnosis of this condition can be complicated because there are no conclusive serologic, radiographic or visual signs that this disease is manifesting. The differential of tissue necrosis is broad, and identifying calciphylaxis requires an adroit understanding of the risk factors and physical signs that should raise suspicion of this condition. Reviews on this subject are uncommon and lack directed commentary from disease experts on the best diagnostic approach for patients suffering from this disease. The goal of this article is to update practicing dermatologists on the current standard of care for calciphylaxis.
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Affiliation(s)
- Jonathan Rick
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Lindsay Strowd
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Helena B Pasieka
- Georgetown University School of Medicine, Washington, DC; Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Karl Saardi
- Georgetown University School of Medicine, Washington, DC
| | - Robert Micheletti
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Megan Zhao
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Michi M Shinohara
- University of Washington Division of Dermatology, Seattle, Washington
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16
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Carmona-Rocha E, Iznardo H, Puig L. Retiform purpura in an 80-year-old woman. Int J Dermatol 2022; 61:1225-1226. [PMID: 35106756 DOI: 10.1111/ijd.16120] [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: 12/27/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Helena Iznardo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Lluís Puig
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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17
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Livedoid vasculopathy: A multidisciplinary clinical approach to diagnosis and management. Int J Womens Dermatol 2022; 7:588-599. [PMID: 35024414 PMCID: PMC8721056 DOI: 10.1016/j.ijwd.2021.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/15/2021] [Accepted: 08/26/2021] [Indexed: 12/05/2022] Open
Abstract
Livedoid vasculopathy (LV) is a rare, chronic, and occlusive disease of the veins supplying the upper parts of the skin. The pathogenesis of the disease is not precisely understood, and its attacks are often unpredictable but tend to worsen during the summer. LV affects women more often. This increased risk for LV in women might be related to sex-specific physiological conditions, such as pregnancy, or a higher incidence of LV-associated conditions, such as connective tissue diseases, hypercoagulable states, and venous stasis in women. The typical clinical appearance of LV consists of three main findings: livedo racemose, atrophie blanche, and skin ulcers. The purpose of this comprehensive review was to analyze LV in all aspects and mainly focus on early diagnosis for successful clinical management with a holistic and multidisciplinary approach. A detailed history, dermatological examination, and laboratory testing are essential for a diagnosis of LV. When LV is clinically suspected, a skin biopsy should be taken to confirm the diagnosis. Another critical step is to investigate the underlying associated conditions, such as connective tissue diseases, hypercoagulable states, thrombophilia, and malignancy. Unfortunately, no associated conditions can be detected in approximately 20% of all cases (idiopathic LV) despite all efforts. The diagnosis of the disease is delayed in most patients. Thus, irreversible, permanent scars appear. Early and appropriate treatment reduces pain and prevents the development of scars and other complications. Antiplatelet drugs and anticoagulants can be preferred as the first-line treatments along with general supportive measures. Other therapeutic options might be considered in unresponsive cases. Preference for refractory cases is based on availability, clinical experience, and patient-related factors (comorbidities, age, sex, and compliance). These include anabolic steroids, intravenous immunoglobulin, hyperbaric oxygen therapy, psoralen-ultraviolet A, vasodilators, fibrinolytics, immunomodulators, and immunosuppressives.
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18
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19
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Berríos-Hernández M, Abou-Jokh Casas C, Sainz-Gaspar L, Ginarte-Val J, Fernández Redondo V, López-Otero D, Aliste C, Suárez-Peñaranda JM. Cutaneous Polymer-Coating Embolism After Endovascular Procedures: Report of Two Cases and a Literature Review. Am J Dermatopathol 2021; 43:662-666. [PMID: 33606376 DOI: 10.1097/dad.0000000000001920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Different hydrophilic and hydrophobic polymers are used as lubricious coatings to reduce vascular traumas in minimally invasive percutaneous procedures. Although they are usually very safe, there is still a risk of serious complications in patients undergoing such procedures, mostly derived from the devices' coating detachment and systemic embolization. The lungs are the most common organ involved, followed by the central nervous system. Yet, cutaneous embolization is unusual, and only 19 cases are available in the literature. Most commonly, they present as asymptomatic retiform purpura on the lower legs, which tends to involve spontaneously. Correct clinical diagnosis is not suspected in most cases, being cholesterol emboly or vasculitis the preferred options. Time interval since surgical procedure and appearance of lesions vary widely but they generally start in the first few days. Histopathological identification of the embolus as bluish, amorphous intraluminal material in dermal vessels is diagnostic, but vasculitic signs are not present. We report 2 cases of skin lesions as the main manifestation of polymer embolization after endovascular surgical procedures. In both cases, biopsy allowed identification of embolized foreign material and lesions resolved without specific treatment.
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Affiliation(s)
| | | | - Laura Sainz-Gaspar
- Dermatology, Clinical University Hospital, Santiago de Compostela, Spain ; and
| | - Javier Ginarte-Val
- Dermatology, Clinical University Hospital, Santiago de Compostela, Spain ; and
| | - Virginia Fernández Redondo
- Dermatology, Clinical University Hospital, Santiago de Compostela, Spain ; and
- Departments of Dermatology, and
| | | | | | - Jose M Suárez-Peñaranda
- Departments of Pathology
- Forensic Sciences and Pathology, Faculty of Medicine, University of Santiago de Compostela
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20
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Ali SN, Kauffman A, Syed M. Purpura fulminans. Postgrad Med J 2021; 98:e6. [PMID: 37066566 DOI: 10.1136/postgradmedj-2021-140510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Syed Noaman Ali
- University of South Florida College of Medicine, Tampa, Florida, USA
| | - Amanda Kauffman
- Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Misbahuddin Syed
- Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida, USA
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21
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Light chain amyloidosis presenting as retiform purpura. JAAD Case Rep 2021; 12:34-36. [PMID: 34026991 PMCID: PMC8121765 DOI: 10.1016/j.jdcr.2021.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Mateos-Mayo A, Anderson-Vildósola J, Morón-Nozaleda MG, Camarneiro R, Escribano E, Colmenero I, Torrelo A, Hernández-Martín Á. Diffuse reticulate purpura in two adolescents with anorexia nervosa and severe malnutrition. Pediatr Dermatol 2021; 38:667-669. [PMID: 33856062 DOI: 10.1111/pde.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anorexia nervosa is an eating disorder frequently associated with cutaneous manifestations. A rare type of purpura, known as diffuse reticulate purpura, has been described in patients with anorexia nervosa and severe malnutrition. Typical characteristics of this condition include a purpuric reticulate rash predominantly affecting the trunk that rapidly resolves with adequate feeding. We report two male adolescent patients with anorexia nervosa and severe malnutrition who developed diffuse reticulate purpura.
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Affiliation(s)
- Ana Mateos-Mayo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Ricardo Camarneiro
- Department of Psychiatry, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eva Escribano
- Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Isabel Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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23
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Santiesteban-Lores LE, Amamura TA, da Silva TF, Midon LM, Carneiro MC, Isaac L, Bavia L. A double edged-sword - The Complement System during SARS-CoV-2 infection. Life Sci 2021; 272:119245. [PMID: 33609539 PMCID: PMC7889033 DOI: 10.1016/j.lfs.2021.119245] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
In the past 20 years, infections caused by coronaviruses SARS-CoV, MERS-CoV and SARS-CoV-2 have posed a threat to public health since they may cause severe acute respiratory syndrome (SARS) in humans. The Complement System is activated during viral infection, being a central protagonist of innate and acquired immunity. Here, we report some interactions between these three coronaviruses and the Complement System, highlighting the central role of C3 with the severity of these infections. Although it can be protective, its role during coronavirus infections seems to be contradictory. For example, during SARS-CoV-2 infection, Complement System can control the viral infection in asymptomatic or mild cases; however, it can also intensify local and systemic damage in some of severe COVID-19 patients, due to its potent proinflammatory effect. In this last condition, the activation of the Complement System also amplifies the cytokine storm and the pathogenicity of coronavirus infection. Experimental treatment with Complement inhibitors has been an enthusiastic field of intense investigation in search of a promising additional therapy in severe COVID-19 patients.
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Affiliation(s)
| | | | | | | | | | - Lourdes Isaac
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Brazil.
| | - Lorena Bavia
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Brazil.
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24
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Santiago MB, Paz A. Acute Peripheral and/or Cutaneous Ischemic Syndrome: What Rheumatologists Should Know. J Clin Rheumatol 2021; 27:73-79. [PMID: 33315786 DOI: 10.1097/rhu.0000000000001609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In daily practice, the frequent appearance of limb and/or skin necrosis, which we term "acute peripheral and/or cutaneous ischemic syndrome" (APCIS), can be a manifestation of numerous underlying diseases, or it can sometimes be a clinical phenomenon whose etiology is undefined even after a wide investigation. The mechanisms for the development of APCIS include vessel wall abnormalities (atherosclerosis, vasculitis, and calciphylaxis), embolic processes (infectious endocarditis, atrial myxoma, and cholesterol emboli), local thrombotic injuries (genetic or acquired thrombophilias and heparin- and warfarin-induced ischemia), dysproteinemias (cryoglobulinemia and cryofibrinogenemia), or venous limb gangrene. Here, we report 5 illustrative cases of APCIS with different pathogenetic mechanisms, thereby highlighting some clinical conditions that cause APCIS that may be of special interest for rheumatologists, such as antiphospholipid syndrome, primary and secondary vasculitis, and cryoproteinemias. Furthermore, we describe a large spectrum of other causes of APCIS beyond the scope of rheumatology. Because there are no validated guidelines for APCIS, we tentatively propose an initial diagnostic workup and a therapeutic approach based on full-dose anticoagulation and immunosuppressive therapy.
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Affiliation(s)
| | - Adriane Paz
- From the Hospital Universitário Professor Edgard Santos
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25
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Ferreli C, Atzori L, Rongioletti F. Glomeruloid reactive angioendotheliomatosis in a woman with systemic lupus erythematosus and antiphospholipid syndrome mimicking reticular erythematous mucinosis. JAAD Case Rep 2021; 8:56-59. [PMID: 33506085 PMCID: PMC7814103 DOI: 10.1016/j.jdcr.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Caterina Ferreli
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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26
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Inglis JM, Tan J. Scurvy presenting as lower limb ecchymoses in the setting of metastatic colorectal cancer. BMJ Case Rep 2020; 13:13/12/e237507. [PMID: 33370932 DOI: 10.1136/bcr-2020-237507] [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: 11/04/2022] Open
Abstract
A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have Klebsiella bacteraemia secondary to urinary source. Skin biopsy showed dermal haemorrhage without vessel inflammation. Vitamin C levels were low confirming the diagnosis of scurvy.
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Affiliation(s)
- Joshua M Inglis
- Royal Adelaide Hospital, Adelaide, South Australia, Australia .,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jia Tan
- Flinders Medical Centre, Bedford Park, South Australia, Australia
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27
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28
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Calciphylaxis: Diagnostic and Treatment Advances for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Korman AM, Grant-Kels JM. The ethics of navigating an inappropriately canceled inpatient dermatology consultation. J Am Acad Dermatol 2020; 84:585. [PMID: 33011315 DOI: 10.1016/j.jaad.2020.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Abraham M Korman
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
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30
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MacGibeny MA, John AM, Milgraum DM, Wassef C, Milgraum SS. Early cutis marmorata telangiectatica congenita masquerading as ulcerated retiform purpura: a diagnostic trap. Pediatr Dermatol 2020; 37:979-980. [PMID: 32749028 DOI: 10.1111/pde.14293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital cutaneous vascular anomaly with a reticular marbled erythematous pattern, which can result in isolated benign skin lesions or less commonly be associated with systemic anomalies. Occasionally, the characteristic pattern of CMTC lesions is masked on initial presentation, creating a diagnostic conundrum that can result in unnecessary workups to rule out vasculopathy. We present the case of a female newborn with a red-blue ulcerated skin lesion on the right leg and foot, which initially appeared as retiform purpura but evolved to exhibit the mottled pattern of CMTC by 5 days of age. Clinicians must be made aware of this potential diagnostic trap in early CMTC to avoid invasive skin biopsies and unnecessary laboratory testing in neonates.
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Affiliation(s)
| | - Ann M John
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - David M Milgraum
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Cindy Wassef
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Sandy S Milgraum
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
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31
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Gehlhausen JR, Wetter DA, Nelson C, Ramachandran S, McNiff JM, Ko CJ. A detailed analysis of the distribution, morphology, and histopathology of complex purpura in hospitalized patients: A case series of 68 patients. J Am Acad Dermatol 2020; 84:1188-1196. [PMID: 32376433 DOI: 10.1016/j.jaad.2020.04.149] [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] [Received: 02/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Purpura in inpatients commonly leads to dermatologic consultation. The differential diagnosis is broad and algorithms are intricate. OBJECTIVE We evaluated inpatient consultations for complex purpura to document the most common diagnoses and to validate the true diagnostic utility of histopathology, clinical morphology, and distribution. METHODS We reviewed a case series of 68 inpatients during a 4-year period with a dermatologic consultation for purpura and biopsy findings of vasculitis or microvascular occlusion. RESULTS Key features of complex purpura are nonbranching (round) versus branching (retiform) morphology, dependent versus acral or generalized distribution, and leukocytoclastic vasculitis versus microvascular occlusion (with emphasis on depth of involvement). Dependent nonbranching purpura with only superficial vessels involved by leukocytoclastic vasculitis was most often due to IgA vasculitis or cutaneous single-organ small-vessel vasculitis. In contrast, deeper involvement by leukocytoclastic vasculitis was suggestive of systemic disease (eg, antineutrophil cytoplasmic antibody-associated vasculitis). Branching purpura was concerning, with greater than 90% sensitivity and specificity for microvascular occlusion and associated high mortality (≈50%). The majority of patients who died had acral branching lesions. LIMITATIONS Small sample size, inpatients at a tertiary care center, and retrospective nature are some limitations. CONCLUSION Nonbranching dependent purpura corresponded to leukocytoclastic vasculitis, with the most common diagnoses being IgA vasculitis or skin-limited small-vessel vasculitis; patients with deep involvement often had systemic diseases. In this series, branching purpura was due to microvascular occlusion rather than medium-vessel vasculitis, and had associated high mortality.
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Affiliation(s)
- Jeff R Gehlhausen
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut
| | - David A Wetter
- Mayo Clinic Department of Dermatology, Rochester, Minnesota
| | - Caroline Nelson
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut
| | | | - Jennifer M McNiff
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut; Department of Pathology, New Haven, Connecticut
| | - Christine J Ko
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut; Department of Pathology, New Haven, Connecticut.
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32
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Calado R, Relvas M, Brites MM, Cardoso JC. Acute retiform purpura caused by Morganella morganii. BMJ Case Rep 2019; 12:12/12/e233344. [PMID: 31874851 DOI: 10.1136/bcr-2019-233344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rebeca Calado
- Dermatology, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Maria Relvas
- Dermatology, Hospital and University Centre of Coimbra, Coimbra, Portugal
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