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Hiraoka S, Kawasumi M. A case of diabetic ketoacidosis with prurigo pigmentosa as a dermadrome. Diabetol Int 2024; 15:594-599. [PMID: 39101194 PMCID: PMC11291841 DOI: 10.1007/s13340-024-00711-y] [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] [Received: 10/21/2023] [Accepted: 03/02/2024] [Indexed: 08/06/2024]
Abstract
Hyperketonemia is a risk factor for prurigo pigmentosa; therefore, diabetic ketosis and ketoacidosis as background diseases are more frequent in prurigo pigmentosa. However, it is underrecognized by clinicians and easily missed. Herein, we present a case of diabetic ketoacidosis in which prurigo pigmentosa was recognized as a dermadrome. A 37-year-old woman with no medical history presented with thirst, polydipsia, and polyuria approximately 1 month prior to transport. and a pruritic skin rash on both shoulders 1 week later. After no diagnosis by a local dermatologist, the patient was diagnosed with diabetic ketoacidosis, and insulin therapy was initiated at our hospital. Based on the patient's history, post-hospitalization course, and pathological findings, the pruritic skin rash was diagnosed as prurigo pigmentosa. The clinical course suggested that prurigo pigmentosa is a dermadrome of diabetic ketosis and ketoacidosis. The medical clinicians' awareness of its relevance is crucial for designing therapeutic interventions for diabetic ketosis and ketoacidosis.
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Affiliation(s)
- Sachiko Hiraoka
- Department of Endocrinology and Diabetology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1, Kameyamaminami, Asakita-ku, Hiroshima, 731-0293 Japan
| | - Muneo Kawasumi
- Department of Endocrinology and Diabetology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1, Kameyamaminami, Asakita-ku, Hiroshima, 731-0293 Japan
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Yang J, Jiao S, Zhang M. Use of minocycline for the treatment of prurigo pigmentosa with intraepidermal vesiculation: a case report. J Int Med Res 2021; 49:3000605211015593. [PMID: 34038199 PMCID: PMC8161857 DOI: 10.1177/03000605211015593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pruritus pigmentosa is a skin disease mainly characterized by pruritus, inflammatory rash and reticular and macular pigmentation. The disease more commonly affects young women and may persist for several years. In this article, we report a case of a 20-year-old female patient who presented with erythema and blisters on the neck and trunk with pruritus for 20 days. Dermatological examination revealed a reticular distribution of erythema on the chest and abdomen and some areas of erythema covered with crusts. Additionally, blisters and bullae with clear fluid and negative Nikolsky's sign were noted. On the neck and back, erythema was also in a reticular distribution, and erythema secondary to erosion and/or crusts was present. In addition, histopathological analysis of the lesions showed hyperkeratosis and intraepidermal multilocular vesiculation and confirmed increased migration of inflammatory cells into the epidermis and infiltration of inflammatory cells, including lymphocytes, histiocytes and eosinophils, in the superficial dermis. The expression levels of IgG, IgM, IgA and C3 were all negative. This patient was diagnosed with prurigo pigmentosa, and the condition improved after treatment with minocycline.
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Affiliation(s)
- Jie Yang
- The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China
| | | | - Min Zhang
- The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China
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3
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Multiple Pruriginous Reticular Plaques With Spontaneous Resolution in a Young Woman: Answer. Am J Dermatopathol 2020; 42:1006-1007. [DOI: 10.1097/dad.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Testerman TL, Semino-Mora C, Cann JA, Qiang B, Peña EA, Liu H, Olsen CH, Chen H, Appt SE, Kaplan JR, Register TC, Merrell DS, Dubois A. Both diet and Helicobacter pylori infection contribute to atherosclerosis in pre- and postmenopausal cynomolgus monkeys. PLoS One 2019; 14:e0222001. [PMID: 31490998 PMCID: PMC6730863 DOI: 10.1371/journal.pone.0222001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/20/2019] [Indexed: 02/07/2023] Open
Abstract
A number of viruses and bacterial species have been implicated as contributors to atherosclerosis, potentially providing novel pathways for prevention. Epidemiological studies examining the association between Helicobacter pylori and cardiovascular disease have yielded variable results and no studies have been conducted in nonhuman primates. In this investigation, we examined the relationship between H. pylori infection and atherosclerosis development in socially housed, pre- and postmenopausal cynomolgus macaques consuming human-like diets. Ninety-four premenopausal cynomolgus monkeys (Macaca fascicularis) were fed for 36 months an atherogenic diet deriving its protein from either casein lactalbumin(CL) or high isoflavone soy (SOY). Animals were then ovariectomized and fed either the same or the alternate diet for an additional 36 months. Iliac artery biopsies were obtained at the time of ovariectomy and iliac and coronary artery sections were examined at the end of the study. Evidence of H. pylori infection was found in 64% of the monkeys and 46% of animals had live H. pylori within coronary atheromas as determined by mRNA-specific in situ hybridization. There was a significant linear relationship between the densities of gastric and atheroma organisms. Helicobactor pylori infection correlated with increased intimal plaque area and thickness at both the premenopausal and postmenopausal time points and regardless of diet (p< 0.01), although animals consuming the SOY diet throughout had the least amount of atherosclerosis. Additionally, plasma lipid profiles, intimal collagen accumulation, ICAM-1, and plaque macrophage densities were adversely affected by H. pylori infection among animals consuming the CL diet, while the SOY diet had the opposite effect. Plaque measurements were more highly associated with the densities of cagA-positive H. pylori within coronary atheromas than with the densities of gastric organisms, whereas plasma lipid changes were associated with H. pylori infection, but not cagA status. This study provides strong evidence that live H. pylori infects atheromas, exacerbates atherosclerotic plaque development, and alters plasma lipid profiles independently of diet or hormonal status. Finally, socially subordinate animals relative to their dominant counterparts had a greater prevalence of H. pylori, suggesting a stress effect. The results indicate that early H. pylori eradication could prevent or delay development of cardiovascular disease.
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Affiliation(s)
- Traci L. Testerman
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States of America
| | - Cristina Semino-Mora
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | | | - Beidi Qiang
- Department of Mathematics and Statistics, Southern Illinois University at Edwardsville, Edwardsville, IL, United States of America
| | - Edsel A. Peña
- Department of Statistics, University of South Carolina, Columbia, SC, United States of America
| | - Hui Liu
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Cara H. Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Haiying Chen
- Wake Forest University Primate Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Susan E. Appt
- Wake Forest University Primate Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Jay R. Kaplan
- Wake Forest University Primate Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Thomas C. Register
- Wake Forest University Primate Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - D. Scott Merrell
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Andre Dubois
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
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Jeunon de Sousa Vargas T, Abreu Raposo CM, Lima RB, Sampaio AL, Bordin AB, Jeunon Sousa MA. Prurigo Pigmentosa-Report of 3 Cases From Brazil and Literature Review. Am J Dermatopathol 2017; 39:267-274. [PMID: 27533074 DOI: 10.1097/dad.0000000000000643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prurigo pigmentosa (PP) is a rare inflammatory disease of the skin of uncertain etiology first reported in Japan. It is typified by recurrent eruptions of itching urticarial macules, papules, vesicopapules, and plaques with a reticular arrangement that quickly resolve leaving a net-like pigmentation. The disease presents specific histopathological features. Herein, 3 cases of PP in Brazilians with no Japanese ancestry are reported and a revision of all previous English-language case reports indexed on PubMed is provided. Two articles with original case reports not listed on PubMed were also included. Our patients are 2 women and 1 man at the ages of 39, 33, and 22 years, respectively. All 3 presented findings in consonance with previous cases of PP and were diagnosed based on clinicopathological correlation. They were successfully treated with oral minocycline or doxycycline. In our literature review, a total of 210 previously reported cases were included. Although PP seemed to be restricted to Japanese patients in the first years after its recognition, the geographic boundaries of the disease are continuously expanding. Korea responded for 83 previous cases and Japan for 53. The mean age was 24.4 years, with 84.3% of the cases occurring between 11 and 30 years of age. The female/male rate was 2.6 and the most affected anatomical sites were back, chest, and neck. We do believe that the rarity of case reports in western countries may represent lack of awareness about the disease by dermatologists and dermatopathologists in these regions.
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Affiliation(s)
- Thiago Jeunon de Sousa Vargas
- *Departments of Dermatology and Pathology, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; †Department of Dermatology, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; ‡Department of Dermatology, Hospital Universitário Gafrée e Guinle, Rio de Janeiro, Brazil; §Detartment of Dermatology, Hospital Federal Servidores do Estado, Rio de Janeiro, Brazil; and ¶ID-Investigação em Dermatologia, dermatopathology consultive services, Rio de Janeiro, Brazil
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Lewinska A, Wnuk M. Helicobacter pylori-induced premature senescence of extragastric cells may contribute to chronic skin diseases. Biogerontology 2017; 18:293-299. [PMID: 28074309 PMCID: PMC5350214 DOI: 10.1007/s10522-017-9676-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/02/2017] [Indexed: 02/06/2023]
Abstract
Helicobacter pylori, one of the most frequently observed bacterium in the human intestinal flora, has been widely studied since Marshall and Warren documented a link between the presence of H. pylori in the gastrointestinal tract and gastritis and gastric ulcers. Interestingly, H. pylori has also been found in several other epithelial tissues, including the eyes, ears, nose and skin that may have direct or indirect effects on host physiology and may contribute to extragastric diseases, e.g. chronic skin diseases. More recently, it has been shown that H. pylori cytotoxin CagA expression induces cellular senescence of human gastric nonpolarized epithelial cells that may lead to gastrointestinal disorders and systemic inflammation. Here, we hypothesize that also chronic skin diseases may be promoted by stress-induced premature senescence (SIPS) of skin cells, namely fibroblasts and keratinocytes, stimulated with H. pylori cytotoxins. Future studies involving cell culture models and clinical specimens are needed to verify the involvement of H. pylori in SIPS-based chronic skin diseases.
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Affiliation(s)
- Anna Lewinska
- Department of Genetics, University of Rzeszow, Werynia 502, 36-100, Kolbuszowa, Poland.
| | - Maciej Wnuk
- Department of Genetics, University of Rzeszow, Werynia 502, 36-100, Kolbuszowa, Poland.
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Abstract
Prurigo pigmentosa, also referred to as Nagashima's disease, is a rare inflammatory skin condition of unknown etiology. It typically presents as pruritic erythematous papules, papulovesicles, and vesicles appearing in a reticular pattern on the back, chest, or neck. The histological features of prurigo pigmentosa vary according to the stage of the disease. Early-stage disease is characterized by a superficial perivascular infiltrate of neutrophils; spongiosis and necrotic keratinocytes commonly appear in later stages. The etiology of prurigo pigmentosa has yet to be determined. Oral minocycline is usually the first-line therapy for prurigo pigmentosa. However, doxycycline, macrolide antibiotics, and/or dapsone (diaminodiphenyl sulfone) may be indicated for some patients. We describe the key features of prurigo pigmentosa, including the epidemiology, clinical and histologic presentation, differential diagnosis, postulated pathogenesis, and treatment options for this condition.
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Affiliation(s)
- Bryce D Beutler
- University of Nevada School of Medicine, 1060 Wiegand Road, Encinitas, CA, 92024, USA.
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
| | - Robert A Lee
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
- Dermatopathology, University of California San Diego, San Diego, CA, USA.
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Immunohistochemistry in the diagnosis of cutaneous bacterial infections. Am J Dermatopathol 2015; 37:179-93; quiz 194-6. [PMID: 25699977 DOI: 10.1097/dad.0000000000000227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The identification of pathogens is of vital importance for the adequate treatment of infections. During the past 2 decades, the approach to histopathologic diagnosis has been dramatically transformed by immunohistochemistry (IHC) specifically in the diagnosis and classification of tumors and more recently in the diagnosis of infectious diseases in tissue samples. The main goals of this article were to: (1) identify by IHC the cutaneous structures where bacterial pathogens are expressed in the course of infection, (2) identify the specific cells in which bacterial pathogens are expressed in positive cases, and (3) describe the pattern of distribution of the bacterial antigens within these cells (nuclear, cytoplasmatic, or membranous). This article is an up-to-date overview of the potential uses and limitations of IHC in the histopathologic diagnosis of cutaneous bacterial infections. In conclusion, IHC is especially useful in the identification of microorganisms that are present in low numbers, stain poorly, are fastidious to grow, culture is not possible, or exhibit an atypical morphology.
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Testerman TL, Morris J. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol 2014; 20:12781-12808. [PMID: 25278678 PMCID: PMC4177463 DOI: 10.3748/wjg.v20.i36.12781] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/17/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is an extremely common, yet underappreciated, pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host. H. pylori is the primary cause of peptic ulcers and gastric cancer. In the United States, the annual cost associated with peptic ulcer disease is estimated to be $6 billion and gastric cancer kills over 700000 people per year globally. The prevalence of H. pylori infection remains high (> 50%) in much of the world, although the infection rates are dropping in some developed nations. The drop in H. pylori prevalence could be a double-edged sword, reducing the incidence of gastric diseases while increasing the risk of allergies and esophageal diseases. The list of diseases potentially caused by H. pylori continues to grow; however, mechanistic explanations of how H. pylori could contribute to extragastric diseases lag far behind clinical studies. A number of host factors and H. pylori virulence factors act in concert to determine which individuals are at the highest risk of disease. These include bacterial cytotoxins and polymorphisms in host genes responsible for directing the immune response. This review discusses the latest advances in H. pylori pathogenesis, diagnosis, and treatment. Up-to-date information on correlations between H. pylori and extragastric diseases is also provided.
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Petit A. [What's new in clinical dermatology?]. Ann Dermatol Venereol 2013; 139 Suppl 5:S177-87. [PMID: 23522704 DOI: 10.1016/s0151-9638(12)70132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Medical articles published between September 2011 and September 2012 were selected based on themes related to clinical dermatology. Therapeutics, pediatrics, oncology, sexually transmitted diseases, and major system diseases such as sarcoidosis and connective tissue disease were not retained. The subjects reviewed were: (i) epidemiology, particularly the risks of exposure to infectious agents; (ii) diagnostic tools, dominated by dermoscopy and teledermatology; (iii) the description of new disorders and the reassessment of older diseases; (iv) complementary tests in certain types of dermatosis; (v) a few large "works in progress" in dermatology, where clinical aspects and biological research intertwine and contribute one to the other.
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Affiliation(s)
- A Petit
- Service de Dermatologie, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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Kim JK, Chung WK, Chang SE, Ko JY, Lee JH, Won CH, Lee MW, Choi JH, Moon KC. Prurigo pigmentosa: Clinicopathological study and analysis of 50 cases in Korea. J Dermatol 2012; 39:891-7. [DOI: 10.1111/j.1346-8138.2012.01640.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 06/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Jae Kyung Kim
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - Woon Kyong Chung
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - Sung Eun Chang
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - Joo Yeon Ko
- Department of Dermatology; Hanyang University College of Medicine; Seoul; Korea
| | - Jong Hee Lee
- Department of Dermatology; Seoul National University, Boramae Medical Center; Seoul; Korea
| | - Chong Hyun Won
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - Mi Woo Lee
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - Jee Ho Choi
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
| | - Kee Chan Moon
- Department of Dermatology; University of Ulsan College of Medicine, Asan Medical Center; Seoul; Korea
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Abstract
The complex and fascinating spectrum of inflammatory skin disease, and the comprehension of it, is ever expanding and evolving. During the first decade of the 21st century, numerous advances in the understanding of inflammatory disease mechanisms have occurred, particularly in psoriasis and atopic dermatitis. Continuation of this trend will assure a future in which molecular tests for biomarkers of immediate clinical relevance are used in routine patient care, not only for diagnosis but also for prognosis and management. This article focuses on selected recent or noteworthy developments that are clinically relevant for the histologic diagnosis of inflammatory skin diseases.
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Affiliation(s)
- Maxwell A Fung
- UC Davis Dermatopathology Service, Department of Dermatology, University of California Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA.
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