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Ha DL, Ha GU, Han MH, Lee SJ. A Case of Multiple Necrotic Dyskeratotic Cells within the Upper Epidermis and Horny Layer Revealing Persistent Papules and Plaques of Adult-Onset Still's Disease. Ann Dermatol 2023; 35:S84-S87. [PMID: 37853873 PMCID: PMC10608375 DOI: 10.5021/ad.21.163] [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: 08/10/2021] [Revised: 10/14/2021] [Accepted: 11/16/2021] [Indexed: 10/20/2023] Open
Abstract
It is important to differentiate violaceous to dusky red papules and plaques that widely persist on the trunk and extremities because there are dermatoses that could be fatal, such as lupus erythematosus, dermatomyositis, drug eruptions, and graft-versus-host disease. Dyskeratotic cells only in the upper epidermis and horny layer are not well known, but it is a distinctive histopathological pattern of atypical type of rash of adult-onset Still's disease (AOSD). AOSD rash is a transient salmon-colored rash that occurs and disappears with fever; however, an atypical type of rash called "persistent dermal plaque" or "persistent pruritic eruptions" has also been reported. It occurs and persists even after fever subsides. Herein, we describe a case with necrotic dyskeratotic cells in the upper epidermis and horny layer without AOSD symptoms lasting for five years.
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Affiliation(s)
- Dae-Lyong Ha
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gi Ung Ha
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea.
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Qiao J, Zhou S, Li S, Xue R, Pan Y, Tang S, Sun Q, Wu Y, Wang S, Wu Y, Bai J, Qu T, Zhang X, Sun C, Fang H. Histopathological diagnosis of persistent pruritic eruptions associated with adult-onset Still's disease. Histopathology 2019; 74:759-765. [PMID: 30408204 DOI: 10.1111/his.13785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/03/2018] [Indexed: 12/18/2022]
Abstract
AIMS Persistent pruritic eruptions (PPEs), presenting with dyskeratotic keratinocytes histologically, are characteristic skin rash in patients with adult-onset Still's disease (AOSD). The lesions may be histologically similar to other entities that present with dyskeratosis. In the present study, we compared the histopathological features between PPEs and other entities presenting with dyskeratosis. METHODS AND RESULTS To investigate whether histopathological findings can be used to discriminate among PPEs and other entities presenting with dyskeratotic keratinocytes, cutaneous histopathological changes of PPEs associated with AOSD (n = 26) were compared with those of systemic lupus erythematosus (SLE) (n = 16), dermatomyositis (n = 19), and drug eruption (n = 16). Dyskeratosis was observed in the upper one-third of the epidermal layer in all 26 PPEs. The rate of dyskeratosis for PPEs was higher than that for SLE (18.8%) and dermatomyositis (15.8%). In drug eruptions, the dyskeratotic cells were distributed in all levels of the epidermis. Variable densities of neutrophils were found in the dermis in all PPEs. CONCLUSIONS Although this was a retrospective study conducted at a single centre, presentation of dyskeratotic keratinocytes in the upper one-third of the epidermal layer is a distinctive histopathological reactive pattern of PPEs. This pattern may be a useful histopathological marker for early diagnosis of AOSD.
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Affiliation(s)
- Jianjun Qiao
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Sha Zhou
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ruzeng Xue
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Yunlei Pan
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qingmiao Sun
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanyan Wu
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Su Wang
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yinhua Wu
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Juan Bai
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tingting Qu
- Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiuming Zhang
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chuanyin Sun
- Department of Rheumatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Nassereddine H, Fite C, Kottler D, Descamps V, Couvelard A, Marot L, Deschamps L. An atypical persistent eruption of adult-onset Still's disease with neutrophilic urticarial dermatosis-like dermal features: A case report and review of the literature. J Cutan Pathol 2018; 45:793-799. [PMID: 29992610 DOI: 10.1111/cup.13320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/01/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Hussein Nassereddine
- AP-HP, Bichat-Hospital, Department of Pathology, Paris Descartes University, Paris, France
| | - Charlotte Fite
- AP-HP, Bichat-Hospital, Department of Dermatology, Paris Diderot University, Paris, France
| | - Diane Kottler
- AP-HP, Bichat-Hospital, Department of Dermatology, Paris Diderot University, Paris, France
| | - Vincent Descamps
- AP-HP, Bichat-Hospital, Department of Dermatology, Paris Diderot University, Paris, France
| | - Anne Couvelard
- AP-HP, Bichat-Hospital, Department of Pathology, Paris Diderot University, Paris, France
| | - Liliane Marot
- Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lydia Deschamps
- AP-HP, Bichat-Hospital, Department of Pathology, Paris Diderot University, Paris, France
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Narváez Garcia FJ, Pascual M, López de Recalde M, Juarez P, Morales-Ivorra I, Notario J, Jucglà A, Nolla JM. Adult-onset Still's disease with atypical cutaneous manifestations. Medicine (Baltimore) 2017; 96:e6318. [PMID: 28296747 PMCID: PMC5369902 DOI: 10.1097/md.0000000000006318] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests available, and diagnosis is usually based on a symptom complex and the well-described typical evanescent rash seen in the majority of patients. However, in recent years, other atypical cutaneous manifestations of AOSD have been reported. These atypical skin eruptions often present in addition to the typical evanescent rash but may also be the only skin manifestation, resulting in delayed diagnosis because of under-recognition.In this study, we present 3 new cases of AOSD with atypical cutaneous manifestations diagnosed during a 30-year period in our department and review 78 additional cases previously reported (PubMed 1990-2016). These 81 patients form the basis of the present analysis.The overall prevalence of atypical cutaneous manifestations in our AOSD population was 14%. These manifestations may appear at any time over the course of the disease, and usually occur in patients who have persistent and severe disease, with a considerable frequency of clinical complications (23%), including serositis, myopericarditis, lung involvement, abdominal pain, neurologic involvement, and reactive hemophagocytic syndrome.The most representative and frequent lesion among the nonclassical skin rashes is the development of persistent pruritic papules and/or plaques. Interestingly, these lesions show a distinctive histological pattern. Other, less frequently observed lesions include urticaria and urticaria-like eruptions, generalized or widespread non-pruritic persistent erythema, vesiculopustular eruptions, a widespread peau d'orange appearance of the skin, and edema of the eyelids mimicking dermatomyositis without any accompanying skin lesion.The great majority of these patients required medium or high doses of glucocorticoids (including intravenous methylprednisolone pulse therapy in some cases) and, in nearly 40%, a more potent or maintenance immunotherapy with immunosuppressant drugs and/or biologic agents (mainly anakinra or tocilizumab) to control or manage symptoms because of a polycyclic or chronic course. The development of atypical cutaneous manifestations seems to be associated with a potentially worse prognosis, with a mortality rate reaching 8% primarily because of infectious complications related to immunosuppressive therapy.In conclusion, the appearance of atypical cutaneous manifestations is not uncommon in AOSD. Recognition of this clinical variant is crucial for the early diagnosis of AOSD, as it might imply persistent disease activity and the need for more aggressive treatment.
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Affiliation(s)
| | | | | | | | | | - Jaime Notario
- Department of Dermatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Anna Jucglà
- Department of Dermatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
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