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Li Y, Wang H, Wang A, Zhao G. Dermato-neuro syndrome after COVID-19 infection in a patient with scleromyxoedema: Previously successful treatment with intravenous immunoglobulins. J Dermatol 2024; 51:140-144. [PMID: 37830263 DOI: 10.1111/1346-8138.16994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
Scleromyxedema (SMX) is a rare disease of unknown cause. It is a chronic, progressive, metabolic disorder characterized by a generalized papular and scleroderma-like rash, as well as a subtype of lichen myxedematosus. Dermato-neuro syndrome (DNS) is a rare neurological complication of SMX. It has flu-like prodromal symptoms; consists of a triad of fever, coma, and seizures; and can be life-threatening. We describe a patient with SMX complicated by DNS after infection with COVID-19. Her symptoms resolved after treatment with acyclovir and low-dose glucocorticoids, suggesting that DNS seizures may have a viral cause. Her skin lesions also improved after seven courses of intravenous immunoglobulin treatment, confirming that intravenous immunoglobulin is effective in these cases.
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Affiliation(s)
- Yan Li
- Department of Dermatology, ZiBo Central Hospital, Zibo, China
| | - Hui Wang
- Department of Dermatology, ZiBo Central Hospital, Zibo, China
| | - Aiqin Wang
- Department of Dermatology, ZiBo Central Hospital, Zibo, China
| | - Guowei Zhao
- Department of Dermatology, ZiBo Central Hospital, Zibo, China
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Linse KP, Enk A, Hoffmann J. [Dermato-neuro syndrome-an acute and life-threatening complication of scleromyxedema Arndt-Gottron]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05159-w. [PMID: 37284981 PMCID: PMC10244840 DOI: 10.1007/s00105-023-05159-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Scleromyxedema Arndt-Gottron is the systemic variant of lichen myxedematosus in which mucin accumulation occurs in the dermis. The disease is usually chronically progressive and extracutaneous manifestations or complications are possible. The pathogenesis is unknown and the disease is usually associated with monoclonal gammopathy. High-dose intravenous immunoglobulins (IVIg) are considered to be an effective therapy. We report the case of a patient who developed dermato-neuro syndrome following an interruption of IVIg treatment and a SARS-CoV‑2 infection. A similar episode occurred 2 years earlier in association with an influenza A infection. Dermato-neuro syndrome is a potentially lethal neurological complication which is characterized by fever, delirium, convulsions, and coma.
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Affiliation(s)
- Kai-Philipp Linse
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Alexander Enk
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Jochen Hoffmann
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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Fritz M, Tinker D, Wessel AW, Morris GM, Goldenberg L, Fesler M, Rukmangadachar L, Hurley MY. SARS-CoV-2: A potential trigger of dermato-neuro syndrome in a patient with scleromyxedema. JAAD Case Rep 2021; 18:99-102. [PMID: 34778497 PMCID: PMC8571101 DOI: 10.1016/j.jdcr.2021.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mike Fritz
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Daniel Tinker
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
| | - Alex W Wessel
- Washington University School of Medicine, St. Louis, Missouri
| | - Gabriela M Morris
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
| | - Linda Goldenberg
- Division of Hematology, Oncology, & Cellular Therapy, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri
| | - Mark Fesler
- Division of Hematology, Oncology, & Cellular Therapy, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri
| | | | - M Yadira Hurley
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
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Anguelova GV, Jellema K, Wagemakers S, Peters R. Two patients with dermatoneuro syndrome after influenza A infection. Eur J Neurol 2021; 28:e65-e66. [PMID: 33909318 DOI: 10.1111/ene.14886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Korné Jellema
- Neurology Department, Haaglanden Medical Centre, The Hague, The Netherlands
| | | | - Ron Peters
- Intensive Care Unit Department, Haaglanden Medical Centre, The Hague, The Netherlands
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Magira EE, Malouchou A, Karathanasi V, Mavropoulou N, Siempos II, Vourlakou C, Sykaras A, Anastasiadis G. Acute Encephalitic Syndrome Induced by Scleromyxedema. Am J Med Sci 2020; 360:192-195. [PMID: 32540147 DOI: 10.1016/j.amjms.2020.05.018] [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: 10/16/2019] [Revised: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
Dermato-neuro syndrome is a potentially fatal neurological complication of scleromyxedema consisting of fever, seizures, and coma. This is an overlooked scleromyxedema case of a 62-year-old female patient from 2-years ago. She was admitted to our ICU because of high fever, colloid speech, muscle ache, and nausea. Molecular methods in the cerebrospinal fluid for neurotropic viruses ruled out acute infectious encephalitis. Her thyroid hormones were within normal values while the serum protein electrophoresis confirmed the monoclonal gammopathy of immunoglobulin G lambda (IgG(λ)), known for the last 2 years. The subsequent bone-marrow biopsy excluded the development of multiple myeloma. The patient fulfilled fundamental diagnostic criteria of scleromyxedema (monoclonal gammopathy, normal thyroid function and the appearance of marked sclerosis and induration of the skin papules on the face, neck, extremities, and skin creases) presenting as dermato-neuro syndrome, which was histologically confirmed. She demonstrated a remarkable improvement after intravenous immunoglobulin treatment during the first 24 hours. Mimics of non-infectious acute encephalitis should include the clinical diagnosis of scleromyxedema, especially when patients present in the emergency department with acute fever, coma, and skin lesions of diffuse sclerodermoid and papular type.
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Affiliation(s)
- Eleni E Magira
- First Department of Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, University of Athens, Athens, Greece.
| | - Aikaterini Malouchou
- Dermatology Department, General Hospital of Athens, "Evangelismos", Athens, Greece
| | - Vasiliki Karathanasi
- Dermatology Department, General Hospital of Athens, "Evangelismos", Athens, Greece
| | - Niki Mavropoulou
- Dermatology Department, General Hospital of Athens, "Evangelismos", Athens, Greece
| | - Ilias I Siempos
- First Department of Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, University of Athens, Athens, Greece
| | - Christina Vourlakou
- Department of Pathology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Alexandros Sykaras
- Department of Pathology, General Hospital of Athens "Evangelismos", Athens, Greece
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Liu A, Suozzi K, Hwang DY, Moeller JJ, Lazova R, DiCapua D. Dermatoneuro syndrome: A full recovery after a second episode. Neurol Clin Pract 2016; 6:e27-e29. [PMID: 27347444 DOI: 10.1212/cpj.0000000000000221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrew Liu
- Andrew Liu, Yale-New Haven Hospital, Departments of Neurology (AL, DYH, JJM, DD), Dermatology (DYH), and Pathology (RL), Yale-New Haven Hospital, CT
| | - Kathleen Suozzi
- Andrew Liu, Yale-New Haven Hospital, Departments of Neurology (AL, DYH, JJM, DD), Dermatology (DYH), and Pathology (RL), Yale-New Haven Hospital, CT
| | - David Y Hwang
- Andrew Liu, Yale-New Haven Hospital, Departments of Neurology (AL, DYH, JJM, DD), Dermatology (DYH), and Pathology (RL), Yale-New Haven Hospital, CT
| | - Jeremy J Moeller
- Andrew Liu, Yale-New Haven Hospital, Departments of Neurology (AL, DYH, JJM, DD), Dermatology (DYH), and Pathology (RL), Yale-New Haven Hospital, CT
| | - Rossitza Lazova
- Andrew Liu, Yale-New Haven Hospital, Departments of Neurology (AL, DYH, JJM, DD), Dermatology (DYH), and Pathology (RL), Yale-New Haven Hospital, CT
| | - Daniel DiCapua
- Andrew Liu, Yale-New Haven Hospital, Departments of Neurology (AL, DYH, JJM, DD), Dermatology (DYH), and Pathology (RL), Yale-New Haven Hospital, CT
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