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Si H, Li S, Wen Q, Yu Y. Erythema elevatum diutinum associated with severe ocular complications and lung tuberculosis. Indian J Dermatol Venereol Leprol 2024; 0:1-3. [PMID: 38899418 DOI: 10.25259/ijdvl_1291_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/15/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Henan Si
- Department of Dermatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shanshan Li
- Department of Dermatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Quan Wen
- Department of Dermatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yan Yu
- Department of Dermatology, The First Hospital of Jilin University, Changchun, Jilin, China
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Feng H, Li S, Jie Y. Leucocytoclastic Vasculitis Presenting as Bilateral Ulcerative Keratitis: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231204358. [PMID: 37808226 PMCID: PMC10559690 DOI: 10.1177/11795476231204358] [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: 03/08/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
Introduction Small artery disease caused by neutrophils and immune-mediated is known as leucocytoclastic vasculitis (LCV). Clinically, it manifests as palpable, asymptomatic purpuric papules on the limbs. Ocular manifestation is rare. Here, we describe a case of peripheral ulcerative keratitis (PUK) associated with LCV. Case presentation A 59-year-old man was referred to the hospital with blurred vision due to corneal perforation in his left eye. He complained of itchy nodules on his hands and lower legs for 15 years and the skin biopsy of the back of his hand revealed LCV 6 years ago, which suggested erythema elevatum diutinum. The patient was under treatment with anti-inflammatory and immunosuppressive drugs and physical features of LCV seen in him included erythema on his hands and legs. After receiving conjunctival flap covering surgery, the corneal perforation was resolved. Conjunctival flaps covered cornea that limited his vision to hand motion. Six months later, he was referred to our clinic again because of pain, redness, photophobia, and tearing in the right eye, presenting with PUK. Necrotic tissue was removed during surgery, which also included a conjunctival flap covering procedure. Following surgery, the symptoms were reduced, and the postoperative eye condition remained stable. Conclusion To our knowledge, it is the first case of PUK secondary to LCV which was diagnosed 6 years ago. This case demonstrates that PUK associated with LCV can be successfully treated by surgical interventions.
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Affiliation(s)
| | | | - Ying Jie
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Wang J, Cao K, Li S, Su B, Jin Z, Pan Z, Tian L, Shi W, Jie Y. Epidemiologic characteristics and the change of surgical methods of pterygium and pseudopterygium from 2013 to 2019 in China: A retrospective analysis. Heliyon 2023; 9:e15046. [PMID: 37082637 PMCID: PMC10112034 DOI: 10.1016/j.heliyon.2023.e15046] [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: 08/26/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
Introduction Pterygium is a common multifactorial external eye disease, which causes various ocular symptoms and negatively affects appearance. The aim of this study was to analyze the epidemiological characteristics and the change of surgical methods of pterygium and pseudopterygium in China from 2013 to 2019. Materials and methods This study was a hospital-based nationwide retrospective study to estimate the epidemiologic characteristics and the change of surgical methods of pterygium and pseudopteygium in China from 2013 to 2019. The data was extracted from the Hospital Quality Monitoring System (HQMS) database. The diagnosis was based on the tenth revision of the International Classification of Diseases (ICD-10) code. Results Our study included 1,007,800 pterygium and 2,681 pseudopteygium inpatients. From 2013 to 2019, the proportion of pterygium and pseudopterygium patients who underwent surgery, among all ophthalmology inpatients, increased from 3.3% in 2013 to 7.84% in 2019. The male-female ratio of surgically treated pterygium and pseudopterygium is 1:1.8 and 1.6:1 respectively. Among all age groups, the hospitalized pterygium patients who received surgery were mainly 60-69 years old, accounting for 36.53%. The pseudopterygium patients who received surgery were mostly 50-59 years old, accounting for 24.02%. Among the 31 provinces of mainland China, Yunnan Province has the highest proportion of pterygium patients treated surgically (6.40%), while Shanghai has the highest proportion of pseudopterygium patients treated surgically (12.98%). The most common occupation of participants in the study was farmer, accounting for 47.62% and 28.53%, respectively. During the study period, the application of autologous stem cell transplantation increased year by year, and became the first choice for pterygium and pseudopterygium surgery. Discussion This study was the first to describe the epidemiological characteristics and surgical methods of hospitalized pterygium and pseudopterygium patients in China. This study provides important information for better diagnosis, treatment and prevention of pterygium and pseudopterygium.
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Affiliation(s)
- Jingyi Wang
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shang Li
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Bingnan Su
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zibing Jin
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhiqiang Pan
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Tian
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innocation Center Fot Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
| | - Weiyun Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
- Shandong Eye Hospital, Jinan, China
- Corresponding author. No.5, Yanerdao Road, Shinan District, 250004, Qingdao, China.
| | - Ying Jie
- National Center for Quality Control of Ophthalmic Care, WHO Collaborating Center for the Prevention of Blindness, Dongjiaomin Lane, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Corresponding author. No.17, Hougou alley, Dongcheng District, Beijing 100730, China.
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Abstract
PURPOSE OF REVIEW To discuss peripheral ulcerative keratitis, with a focus on the evaluation and management of associated systemic diseases. RECENT FINDINGS Peripheral ulcerative keratitis (PUK) is a sight-threatening condition that is often defined by the presence of a crescent-shaped area of peripheral corneal thinning, an epithelial defect, and an inflammatory corneal infiltrate. It is highly associated with rheumatoid arthritis, systemic necrotizing vasculitides like granulomatosis with polyangiitis, and collagen vascular diseases like systemic lupus erythematosus. Undertreated PUK carries a risk of vision loss and premature death. SUMMARY Multidisciplinary collaboration between the ophthalmologist, rheumatologist, and other consultants is required. Early and aggressive steroid-sparing therapy should be considered in cases due to noninfectious systemic disease.
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Affiliation(s)
| | - Rex M McCallum
- Department of Medicine, Division of Rheumatology, Duke University, Durham, North Carolina, USA
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Pseudopterygium: An Algorithm Approach Based on the Current Evidence. Diagnostics (Basel) 2022; 12:diagnostics12081843. [PMID: 36010195 PMCID: PMC9406874 DOI: 10.3390/diagnostics12081843] [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: 06/28/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Pseudopterygium is a non-progressive conjunctival adhesion to the peripheral cornea secondary to a corneal-limbus damage. According to the literature, the main etiology is a previous eye trauma. Nevertheless, this could be biased by the existence of other underdiagnosed causes of pseudopterygium, some of which may have severe consequences for the integrity of the eye and patient’s life. This comprehensive literature review was performed based on a search on the PubMed and Google Scholar databases of relevant pseudopterygium published papers according to our current knowledge and seeks to gather the existing evidence about its diverse etiologies and clinical features, as well as to propose a diagnostic algorithm to simplify its correct approach.
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Multiple Lobulated Nodules: Answer. Am J Dermatopathol 2020; 42:61-62. [PMID: 31880635 DOI: 10.1097/dad.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sandhu JK, Albrecht J, Agnihotri G, Tsoukas MM. Erythema elevatum et diutinum as a systemic disease. Clin Dermatol 2019; 37:679-683. [PMID: 31864448 DOI: 10.1016/j.clindermatol.2019.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Erythema elevatum et diutinum (EED) is a rare, chronic dermatosis. It has been associated with extracutaneous findings, including arthralgias, scleritis, panuveitis, peripheral ulcerative keratitis, oral and penile ulcers, and neuropathy. Additionally, EED is connected with various systemic diseases, including HIV, IgA paraproteinemia, myelomas, neutrophilic dermatoses, and inflammatory bowel diseases. The presence of such extracutaneous manifestations in EED patients suggests that EED may be a multiorgan entity. Extracutaneous manifestations in EED may involve deposition of circulating immune complexes; thus, patients with EED should be evaluated for systemic manifestations to ensure targeted management.
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Affiliation(s)
- Jeena K Sandhu
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Joerg Albrecht
- Department of Dermatology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Gaurav Agnihotri
- University of Illinois-Chicago College of Medicine Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois-Chicago School of Medicine, Chicago, Illinois, USA.
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Doktor V, Hadi A, Hadi A, Phelps R, Goodheart H. Erythema elevatum diutinum: a case report and review of literature. Int J Dermatol 2018; 58:408-415. [PMID: 30074624 DOI: 10.1111/ijd.14169] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 01/19/2023]
Abstract
Erythema elevatum diutinum (EED) is a rare cutaneous leukocytoclastic vasculitis thought to be related to increased levels of circulating antibodies. It has been shown to be associated with HIV infection, tuberculosis, as well as various autoimmune diseases. A retrospective review of all cases of EED indexed in PubMed between 1990 and 2014 was performed. Inclusion criteria for articles was availability of full text in English and a biopsy-confirmed diagnosis of EED. All other articles were excluded. Cases were stratified by age and anatomic location of the lesions. Treatment response was coded as "complete," "partial," and "none." A total of 133 cases of EED with 381 lesions detailed in case reports and case series were included. Twenty-one cases were associated with HIV. Of 47 patients with reported paraproteinemias, IgA paraproteinemia was found in 57.45%, IgG paraproteinemia in 29.8%, IgM paraproteinemia in 10.6%, and IgD paraproteinemia in 2.1% of cases. Of 40 (30.1%) patients with reported comorbid autoimmune disease, rheumatoid arthritis was associated with 10 cases. Cancer was found to be associated with 9.77% of cases. Seventy-five patients were treated with dapsone, with 36 (48%) achieving complete treatment response, 24 (32%) achieving partial response, and seven (9.3%) achieving no response. Keeping the clinical associations of EED in mind, especially malignancy, is critical in management of the disease. More structured studies need to take place in order to fully define the mechanisms and strength of these associations.
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Affiliation(s)
- Vladyslava Doktor
- Dermatology Department, St. John's Episcopal Hospital, Far Rockaway, NY, USA
| | - Ahmed Hadi
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali Hadi
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Phelps
- The Kimberly and Eric J. Waldman Department of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Herbert Goodheart
- The Kimberly and Eric J. Waldman Department of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hwang SH, Kim DH. A Case of Spontaneous Corneal Perforation Combined with Primary Pterygium. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.6.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Ha Hwang
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
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Momen S, Jorizzo J, Al-Niaimi F. Erythema elevatum diutinum: a review of presentation and treatment. J Eur Acad Dermatol Venereol 2014; 28:1594-602. [DOI: 10.1111/jdv.12566] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/29/2014] [Indexed: 01/19/2023]
Affiliation(s)
- S.E. Momen
- St John's Institute of Dermatology; London UK
| | - J. Jorizzo
- Wake Forest Baptist Health; Winstom Salem North Carolina USA
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Abstract
OBJECTIVES The aim of this study is to report a case of conjunctival lymphangiectasia simulating a pediatric pterygium. METHODS A 10-year-old girl with Turner syndrome and familial history of pterygia presented because of a conjunctival growing lesion clinically consistent with pterygium in her left eye. Visual acuity (VA) was 20/20 in the right eye and 20/40 in the left eye. Cycloplegic refraction was +1.50sph -0.50cyl×93° and +9.00sph -9.00cyl×180° in the right and left eyes, respectively. RESULTS Resection of the lesion with amniotic membrane implantation and conjunctival autograft was performed. The histologic examination revealed conjunctival lymphangiectasia. Ten months later, the patient did not show any signs of recurrence. Refraction in the left eye was +0.5sph -1.5cyl×70°, and spontaneous VA was 20/20 in both eyes. CONCLUSIONS Pediatric pseudopterygium may be the clinical presentation of several ocular surface disorders. Thus, pathologic analysis of this lesion should be considered to determine its exact nature. Surgery lessens the refractive defect and hastens visual recovery.
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[Erythema elevatum et diutinum]. Hautarzt 2011; 62:252-5. [PMID: 21424891 DOI: 10.1007/s00105-011-2149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Erythema elevatum et diutinum (EED) is a rare, chronic, cutaneous, leukocytoclastic vasculitis. It is characterized by symmetric, plaques, papules and nodules occurring preferentially on the extensor aspects of the arms. An association with chronic infections, neoplasms, especially myeloproliferative diseases and paraproteinemia, as well as autoimmune disorders (rheumatoid arthritis, Crohn disease) has been described. An 83-year-old woman with EED presented with symmetric, skin colored, firm nodules on the extensor surfaces of her fingers for two years. This case report summarizes the central clinical aspects and differential diagnosis of EED as well as its therapeutic options.
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