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Ashchyan HJ, Nelson CA, Stephen S, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pyoderma gangrenosum and other bowel- and arthritis-associated neutrophilic dermatoses. J Am Acad Dermatol 2018; 79:1009-1022. [PMID: 29653213 DOI: 10.1016/j.jaad.2017.11.063] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 01/27/2023]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The second article in this continuing medical education series reviews the epidemiology, clinical characteristics, histopathologic features, diagnosis, and management of pyoderma gangrenosum as well as bowel-associated dermatosis-arthritis syndrome and the arthritis-associated neutrophilic dermatoses rheumatoid neutrophilic dermatitis and adult Still disease.
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Affiliation(s)
- Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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2
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Yamamoto T. Pyoderma gangrenosum: An important dermatologic condition occasionally associated with rheumatic diseases. World J Rheumatol 2015; 5:101-107. [DOI: 10.5499/wjr.v5.i2.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Pyoderma gangrenosum (PG) presents with refractory, sterile, deep ulcers most often on the lower legs. Clinically, PG exhibits four types, i.e., ulcerative, bullous, pustular, and vegetative types. PG may be triggered by surgical operation or even by minor iatrogenic procedures such as needle prick or catheter insertion, which is well-known as pathergy. PG is sometimes seen in association with several systemic diseases including rheumatoid arthritis (RA), inflammatory bowel disease, hematologic malignancy, and Takayasu’s arteritis. In particular, various cutaneous manifestations are induced in association with RA by virtue of the activation of inflammatory cells (neutrophils, lymphocytes, macrophages), vasculopathy, vasculitis, drugs, and so on. Clinical appearances of ulcerative PG mimic rheumatoid vasculitis or leg ulcers due to impaired circulation in patients with RA. In addition, patients with PG sometimes develop joint manifestations as well. Therefore, it is necessary for not only dermatologists but also rheumatologists to understand PG.
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3
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Abstract
Cutaneous blastomycosis (CB) is associated with a variety of skin manifestations. Among other entities, CB may be mistaken for pyoderma gangrenosum due to overlap of findings on histopathologic examination. We report a case of CB, initially diagnosed as pyoderma gangrenosum and treated with steroids, leading to disseminated blastomycosis and acute respiratory distress syndrome (ARDS).
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4
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Chen LP, Li J, Huang MF, Chen QS, Xia B. Cryptococcus neoformans infection in ulcerative colitis with immunosuppressants. Inflamm Bowel Dis 2011; 17:2023-4. [PMID: 21287669 DOI: 10.1002/ibd.21619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 12/06/2010] [Indexed: 12/09/2022]
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5
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[Necrotizing cellulitis as the first manifestation of disseminated cryptococcosis]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:297-9. [PMID: 21334585 DOI: 10.1016/j.ad.2010.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/21/2010] [Accepted: 08/01/2010] [Indexed: 11/24/2022] Open
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6
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Bordel-Gómez M, Zafra-Cobo M, Cardeñoso-Álvarez M, Sánchez-Estella J, Martín-Arribas M. Necrotizing Cellulitis as the First Manifestation of Disseminated Cryptococcosis. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/s1578-2190(11)70808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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7
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Orsini J, Nowakowski J, Delaney V, Sakoulas G, Wormser G. Cryptococcal infection presenting as cellulitis in a renal transplant recipient. Transpl Infect Dis 2009; 11:68-71. [DOI: 10.1111/j.1399-3062.2008.00352.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Ramdial PK, Calonje E, Sing Y, Chotey NA, Aboobaker J. Molluscum-like cutaneous cryptococcosis: a histopathological and pathogenetic appraisal. J Cutan Pathol 2008; 35:1007-13. [DOI: 10.1111/j.1600-0560.2007.00952.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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SANDLER B, POTTER TS, HASHIMOTO K. Cutaneous Pneumocystis carinii
and Cryptococcus neoformans
in AIDS. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-753.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Abstract
The incidence of invasive fungal infections has increased dramatically over the past two decades, mostly due to an increase in the number of immunocompromised patients.1–4 Patients who undergo chemotherapy for a variety of diseases, patients with organ transplants, and patients with the acquired immune deficiency syndrome have contributed most to the increase in fungal infections.5 The actual incidence of invasive fungal infections in transplant patients ranges from 15% to 25% in bone marrow transplant recipients to 5% to 42% in solid organ transplant recipients.6,7 The most frequently encountered are Aspergillus species, followed by Cryptococcus and Candida species. Fungal infections are also associated with a higher mortality than either bacterial or viral infections in these patient populations. This is because of the limited number of available therapies, dose-limiting toxicities of the antifungal drugs, fewer symptoms due to lack of inflammatory response, and the lack of sensitive tests to aid in the diagnosis of invasive fungal infections.1 A study of patients with fungal infections admitted to a university-affiliated hospital indicated that community-acquired infections are becoming a serious problem; 67% of the 140 patients had community-acquired fungal pneumonia.8
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11
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Su WPD, Davis MDP, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2005; 43:790-800. [PMID: 15533059 DOI: 10.1111/j.1365-4632.2004.02128.x] [Citation(s) in RCA: 338] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pyoderma gangrenosum is a rare but significant cause of ulcerations. It is a diagnosis of exclusion. Herein, we suggest diagnostic criteria and some historical perspectives on the diagnosis of pyoderma gangrenosum.
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Affiliation(s)
- W P Daniel Su
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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12
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Christianson JC, Engber W, Andes D. Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts. Med Mycol 2003; 41:177-88. [PMID: 12964709 DOI: 10.1080/1369378031000137224] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A case of primary cutaneous cryptococcal infection is presented and cases of primary cutaneous cryptococcosis in normal and immunocompromised hosts are reviewed. Cutaneous cryptococcosis can occur from local inoculation or dissemination from a distant site of infection. Risk factors associated with development of primary cutaneous cryptococcosis are those which affect cell-mediated immunity, such as corticosteroid usage, solid organ transplantation, sarcoidosis and immunosuppression. The cutaneous manifestations of cryptococcosis are protean and may mimic other cutaneous diseases. Patients with a diagnosis of cryptococcosis from a skin biopsy or culture should undergo evaluation to exclude disseminated disease and an evaluation of cell-mediated immunity. Although some patients do well without antifungal therapy, these patients cannot be discerned prospectively and therefore antifungal therapy appears warranted in all patients with localized disease. Choice of therapy depends on the extent of disease and immunocompetence of the host.
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Affiliation(s)
- John C Christianson
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792-5158, USA
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13
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Neuville S, Dromer F, Morin O, Dupont B, Ronin O, Lortholary O. Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis 2003; 36:337-47. [PMID: 12539076 DOI: 10.1086/345956] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2002] [Accepted: 10/22/2002] [Indexed: 11/03/2022] Open
Abstract
Cryptococcus neoformans is an encapsulated yeast responsible for disseminated meningitis in immunocompromised hosts. Controversies persist on the existence of primary cutaneous cryptococcosis (PCC) versus cutaneous cryptococcosis being only secondary to hematogenous dissemination. Thus, we reviewed cryptococcosis cases associated with skin lesions reported in the French National Registry. Patients with PCC (n=28) differed significantly from those with secondary cutaneous cryptococcosis (n=80) or other forms of the disease (n=1866) by living area (mostly rural), age (older), ratio of men to women (approximately 1:1), and the lack of underlying disease. Evidence of PCC included the absence of dissemination and, predominantly, a solitary skin lesion on unclothed areas presenting as a whitlow or phlegmon, a history of skin injury, participation in outdoor activities, or exposure to bird droppings, and isolation of C. neoformans serotype D. Therefore, PCC is a distinct epidemiological and clinical entity with a favorable prognosis even for immunocompromised hosts.
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Affiliation(s)
- Ségolène Neuville
- Centre National de Référence des Mycoses et des Antifongiques, Unité de Mycologie Moléculaire, Institut Pasteur, 75724 Paris cedex 15, France
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14
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Abstract
Pyoderma gangrenosum (PG) is a rare, ulcerative skin disease. Diseases with cutaneous manifestations resembling PG may lead to the misdiagnosis of PG. We discuss two patients presenting with cutaneous ulcers originally thought to be PG, and review the literature on the clinical and pathologic characteristics of PG ulcers compared to PG-like ulcers in order to determine possible distinguishing features.
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Affiliation(s)
- Kari H Nguyen
- Division of Dermatology, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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15
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Abstract
BACKGROUND Pyoderma gangrenosum is a diagnosis of exclusion, and the misdiagnosis of pyoderma gangrenosum can result in substantial complications in patients who have other causes of severe cutaneous ulceration. METHODS We reviewed the charts of 240 patients with a diagnosis of pyoderma gangrenosum who were evaluated at our institution from 1975 through 2000, including 157 consecutive patients treated for presumed pyoderma gangrenosum from 1984 through 1992. We also reviewed the English-language literature. RESULTS Ninety-five patients (49 from our institution and 46 described in the literature) had skin ulcers with a clinical resemblance to pyoderma gangrenosum. The final diagnoses were vascular occlusive or venous disease, vasculitis, cancer, primary infection, drug-induced or exogenous tissue injury, and other inflammatory disorders. Of the 95 patients studied, 64 had been treated for pyoderma gangrenosum for a median of 10 months (range, 3 to 180). These 64 included 15 of the 157 consecutive patients treated for pyoderma gangrenosum at our institution (10 percent). Of the ulcers in the 64 patients treated for pyoderma gangrenosum, it was clear that those in 23 patients (36 percent) did not respond to treatment directed at pyoderma gangrenosum, those in 8 (12 percent) were exacerbated by such treatment, and those in 15 (23 percent) improved with such treatment. CONCLUSIONS The misdiagnosis of pyoderma gangrenosum is not uncommon and exposes patients to risks associated with its treatment. A thorough evaluation is required in all patients suspected of having pyoderma gangrenosum in order to rule out alternative diagnoses.
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Affiliation(s)
- Roger H Weenig
- Department of Dermatology, Mayo Clinic, 200 First St., SW, Rochester, MN 55905, USA
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16
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Affiliation(s)
- D E Manthey
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA.
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17
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Tomasini C, Caliendo V, Puiatti P, Bernengo MG. Granulomatous-ulcerative vulvar cryptococcosis in a patient with advanced HIV disease. J Am Acad Dermatol 1997; 37:116-7. [PMID: 9216534 DOI: 10.1016/s0190-9622(97)70222-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C Tomasini
- Department of Dermatology, University of Turin, Italy
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18
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Calista D, Stagno A, Landi C. Cutaneous lesions of disseminated cryptococcosis as the initial presentation of advanced HIV infection. J Eur Acad Dermatol Venereol 1997. [DOI: 10.1111/j.1468-3083.1997.tb00203.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Castano-Molina C, Cockerell CJ. Diagnosis and treatment of infectious diseases in HIV-infected hosts. Dermatol Clin 1997; 15:267-83. [PMID: 9098636 DOI: 10.1016/s0733-8635(05)70435-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Treatment of infectious diseases in patients with HIV infection is of primary importance in patient care. Viral, bacterial, parasitic, and fungal pathogens all may affect these patients. It is essential that accurate diagnoses be made and appropriate therapy be administered as early as possible.
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20
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Sanchez-Albisua B, Rodriguez-Peralto JL, Romero G, Alonso J, Vanaclocha F, Iglesias L. Cryptococcal cellulitis in an immunocompetent host. J Am Acad Dermatol 1997; 36:109-12. [PMID: 8996275 DOI: 10.1016/s0190-9622(97)70340-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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21
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Affiliation(s)
- S W Wright
- Division of Dermatology, Harvard Medical School, Deaconess Hospital, Boston, MA 02215, USA
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22
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Myers SA, Kamino H. Cutaneous cryptococcosis and histoplasmosis coinfection in a patient with AIDS. J Am Acad Dermatol 1996; 34:898-900. [PMID: 8621824 DOI: 10.1016/s0190-9622(96)90075-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients with AIDS may have multiple infections at one time, and skin lesions resulting from simultaneous infections with more than one organism have been described. We report a case of disseminated cryptococcal and histoplasmosis infections with cutaneous lesions in a patient with AIDS. In addition, we demonstrate the first case of two coexisting fungal infections in a unique skin lesion. The cutaneous presentation of infectious disorders in HIV-infected patients is often nondescript and not diagnosed by clinical observation alone. Biopsies and cultures are essential for making accurate diagnoses in immunocompromised patients with unusual skin lesions.
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Affiliation(s)
- S A Myers
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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23
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Abstract
Pyoderma gangrenosum (PG) has four distinctive clinical and histologic variants. Some have morphologic and histologic overlapping features with other reactive neutrophilic skin conditions. PG often occurs in association with a systemic disease, and the specific clinical features of the skin lesion may provide a clue to the associated disease. Management of PG depends on its type and severity and usually requires aggressive local and systemic treatment.
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Affiliation(s)
- F C Powell
- Regional Centre of Dermatology, Mater Misericordiae, Dublin, Ireland
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24
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SANDLER B, POTTER TS, HASHIMOTO K. Cutaneous Pneumocystis carinii and Cryptococcus neoformans in AIDS. Br J Dermatol 1996. [DOI: 10.1111/j.1365-2133.1996.tb07859.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Glassman SJ, Hale MJ. Cutaneous cryptococcosis and Kaposi's sarcoma occurring in the same lesions in a patient with the acquired immunodeficiency syndrome. Clin Exp Dermatol 1995; 20:480-6. [PMID: 8857342 DOI: 10.1111/j.1365-2230.1995.tb01383.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 34-year-old woman presented with a history of fever, malaise and skin lesions. A diagnosis of Kaposi's sarcoma and acquired immunodeficiency syndrome (AIDS) was established, and in addition, the skin lesion which was biopsied also demonstrated cryptococcal infection. Disseminated cryptococcosis was later confirmed and the disease ran a florid course. The co-existence of different diseases within the same lesion is a feature of human immunodeficiency virus (HIV) infection, this being the third documented case of simultaneous Kaposi's sarcoma and cutaneous cryptococcosis occurring at the same site in a patient with AIDS. The nature of this co-existence is discussed with reference to the pathogenesis of Kaposi's sarcoma.
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Affiliation(s)
- S J Glassman
- Division of Dermatology, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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26
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Abstract
Patients infected with HIV are susceptible to many opportunistic fungal infections. Cryptococcus neoformans infection is particularly common in patients with AIDS. We describe a patient with disseminated cryptococcosis resembling molluscum contagiosum and review the typical cutaneous manifestations of disseminated cryptococcosis. A synopsis of case reports in the English literature is also presented.
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Affiliation(s)
- F M Durden
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH
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27
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Gordon PM, Ormerod AD, Harvey G, Atkinson P, Best PV. Cutaneous cryptococcal infection without immunodeficiency. Clin Exp Dermatol 1994; 19:181-4. [PMID: 8050156 DOI: 10.1111/j.1365-2230.1994.tb01155.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of cutaneous cryptococcosis (encapsulated strain) in a 67-year-old female, with no evidence of immune suppression (normal cell surface marker analysis and mitogen proliferation studies) and which responded to treatment with oral fluconazole is reported. To date her clinical progress remains satisfactory after 12 months of follow-up.
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Affiliation(s)
- P M Gordon
- Department of Dermatology, University of Aberdeen, UK
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Abstract
A case of pyoderma gangrenosum (PG) in a 14-year-old boy with acute myelogenous leukemia (AML) is described. The onset of pyoderma gangrenosum coincided with the relapse of AML. The lesions responded dramatically to treatment with oral prednisone despite the persistence of leukemia. Pyoderma gangrenosum should be included in the differential diagnosis of any nodular, pustular, or necrotic cutaneous eruption in children with leukemia.
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MESH Headings
- Adolescent
- Gangrene
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/complications
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/diagnosis
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/drug therapy
- Male
- Necrosis
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Pyoderma/complications
- Pyoderma/drug therapy
- Pyoderma/pathology
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Affiliation(s)
- A Hayani
- Department of Pediatrics, Texas Children's Hospital, Houston
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30
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Barfield L, Iacobelli D, Hashimoto K. Secondary cutaneous cryptococcosis: case report and review of 22 cases. J Cutan Pathol 1988; 15:385-92. [PMID: 2975676 DOI: 10.1111/j.1600-0560.1988.tb00570.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 51-year-old immunosuppressed man presented with ulcerations of the abdominal wall. Biopsy of the ulcer margin was necessary for the diagnosis of cutaneous cryptococcosis. Since a variety of opportunistic organisms can present with non-specific cutaneous lesions, these infections must be ruled out by tissue diagnosis of all immunosuppressed patients. A review of 22 additional cases is included together with electron microscopic findings.
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Affiliation(s)
- L Barfield
- Department of Dermatology and Syphilogy, Wayne State University School of Medicine, Detroit, MI 48201
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31
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Granier F, Kanitakis J, Hermier C, Zhu YY, Thivolet J. Localized cutaneous cryptococcosis successfully treated with ketoconazole. J Am Acad Dermatol 1987; 16:243-9. [PMID: 3546413 DOI: 10.1016/s0190-9622(87)80073-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A 27-year-old female recipient of a renal allograft, treated with systemic steroids and azathioprine, developed progressive cutaneous lesions (an ulcer, a nodule, and an abscess). Histopathologic and tissue-culture examination of the skin lesions led to the diagnosis of cutaneous cryptococcosis. A description of the light and electron microscopic features of the cutaneous lesions is reported. A thorough visceral investigation failed to detect systemic involvement. The patient was treated with oral ketoconazole (400 mg daily) for 6 months. A gradual healing of the lesions was obtained, and cultures performed 3 months after the onset of treatment failed to show Cryptococcus neoformans. No relapse or dissemination has so far been observed.
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32
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-1986. An 18-year-old man with cutaneous ulcers and bilateral pulmonary infiltrates. N Engl J Med 1986; 314:1170-84. [PMID: 2938008 DOI: 10.1056/nejm198605013141808] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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34
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Borton LK, Wintroub BU. Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome. J Am Acad Dermatol 1984; 10:387-90. [PMID: 6707261 DOI: 10.1016/s0190-9622(84)80013-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 31-year-old homosexual man with acquired immunodeficiency syndrome (AIDS) had cutaneous herpetiform lesions that showed numerous encapsulated organisms on Tzanck preparation. Subsequent cultures of cerebrospinal fluid and skin biopsy specimens substantiated a diagnosis of disseminated cryptococcosis. Cutaneous cryptococcosis should be considered in the differential diagnosis for skin lesions in the population with AIDS.
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Abstract
Since its description 50 years ago, pyoderma gangrenosum has continued to capture the attention and imagination of all those who see its dramatic presentation. Clinical observation still provides the only reliable diagnosis. As investigative techniques increase, more and more intriguing immunologic abnormalities associated with this disorder are discovered, but understanding of the pathogenesis remains elusive. It is now recognized as an independent condition as well as a co-condition with many systemic disorders. Many new treatment options are available, allowing much individualization of treatment. For now, pyoderma gangrenosum remains an impressive, relatively easily recognized, but poorly understood disease.
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