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Mehta H, Bishnoi A, Singh C, Rajasekaran S, Chatterjee D, Kumaran MS, Handa S. A woman with leonine facies and monoclonal gammopathy. Clin Exp Dermatol 2024; 49:1094-1096. [PMID: 38619049 DOI: 10.1093/ced/llae136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
A 32-year-old woman presented with a 3-year history of progressive skin thickening. On examination, the skin of the glabella was thickened with longitudinal furrows, resulting in leonine facies. Skin-coloured to reddish-brown, firm, waxy, closely spaced papules partially coalescing to form sheets of induration with circular punched-out areas of sparing in between over the face, neck, trunk, abdomen, arms and thighs were seen. She additionally complained of a tingling sensation and occasional pain over the lateral side of her hands. Punch biopsy obtained from a papule over the nape of the neck revealed fibroblast proliferation with collagen and mucin deposition in the upper and midreticular dermis.
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Affiliation(s)
- Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Charanpreet Singh
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sangamitra Rajasekaran
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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2
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Bettolini L, Bighetti S, Maione V, Ghini I, Segala D, Calzavara-Pinton P. Successful treatment of scleromyxedema with daratumumab, lenalidomide and dexamethasone in a patient with multiple myeloma. Australas J Dermatol 2024; 65:e104-e107. [PMID: 38326991 DOI: 10.1111/ajd.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Luca Bettolini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Bighetti
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Vincenzo Maione
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Iacopo Ghini
- Pathology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Diego Segala
- Pathology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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3
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Burzi L, Rosset F, Senetta R, Conti L, Mastorino L, Dapavo P, Quaglino P, Ribero S. Rare scleromyxedema granuloma-annulare-like pattern successfully treated with intravenous immunoglobulins. Ital J Dermatol Venerol 2024; 159:80-81. [PMID: 38226941 DOI: 10.23736/s2784-8671.23.07816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Lorenza Burzi
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Francois Rosset
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy -
| | - Rebecca Senetta
- Department of Medical Sciences, Pathology Clinic, University of Turin, Turin, Italy
| | - Luca Conti
- Department of Medical Sciences, Pathology Clinic, University of Turin, Turin, Italy
| | - Luca Mastorino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
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4
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Zhang D, Sable K, Miller A, Hinshaw M, Schmidt T, Shields BE. Granulomatous variant of scleromyxedema successfully treated with topical ruxolitinib, dapsone and intravenous immunoglobulin. JAAD Case Rep 2023; 42:78-83. [PMID: 38156097 PMCID: PMC10753040 DOI: 10.1016/j.jdcr.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Donglin Zhang
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kimberly Sable
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Allison Miller
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Molly Hinshaw
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy Schmidt
- Department of Hematology and Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bridget E. Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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5
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Zhao P, Luu LA, Gish TJ, Raghavan SS, Gru AA, Zlotoff BJ. Widespread livedo racemosa. Clin Exp Dermatol 2023; 48:945-948. [PMID: 37052078 DOI: 10.1093/ced/llad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/14/2023]
Abstract
A 41-year-old woman with monoclonal gammopathy of undetermined significance presented with a 1-year history of livedo racemosa that started on one arm after receiving the Pfizer BioNTech COVID-19 vaccine. Her primary care physician initially thought it was a benign reaction to the COVID-19 vaccine as her symptoms were on the same arm as the site of injection. However, the livedo racemosa subsequently became more widespread after COVID-19 infection.
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Affiliation(s)
- Patricia Zhao
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Tappy J Gish
- Pathology, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Shyam S Raghavan
- Pathology, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Alejandro A Gru
- Pathology, University of Virginia Medical Center, Charlottesville, VA, USA
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6
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Huang H, Qian SX. Lichen myxedematosus associated with monoclonal gammopathy of undetermined significance: A case report and literature review. Front Med (Lausanne) 2023; 10:1118555. [PMID: 36968834 PMCID: PMC10032400 DOI: 10.3389/fmed.2023.1118555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
Lichen myxedematosus (LM) is an idiopathic cutaneous mucinosis disorder, and monoclonal gammopathy of undetermined significance (MGUS) is a preneoplastic plasma cell disease with a monoclonal increase in globulin. Patients with LM combined with monoclonal gammopathy are normally diagnosed with scleromyxedema. However, we report a case of generalized papules combined with MGUS in a 78-year-old man who was eventually diagnosed with atypical or intermediate forms of LM because it only involved the skin, and the pathological type was not consistent with scleromyxedema. Few cases of atypical or intermediate forms of LM have been reported, so the course of atypical or intermediate forms of LM is unpredictable. We report the diagnosis and treatment of a case of atypical forms of LM to discuss the current understanding of the disease, hoping to provide a reference for clinical research on this disease.
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7
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Wang SS, Chen QY, Xiang LH. Case report: Scleromyxedema associated with a monoclonal gammapathy: Successful treatment with intravenous immunoglobulins. Front Immunol 2023; 13:1099918. [PMID: 36713453 PMCID: PMC9880447 DOI: 10.3389/fimmu.2022.1099918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
Scleromyxedema is a rare idiopathic fibromucinous disorder characterized by a generalized papular and sclerodermoid cutaneous eruption. Patients often have praraproteinemia and extracutaneous, even lethal, manifestations. Yet the prognostic and therapeutic features of scleromyxedema are poorly documented. High-dose intravenous immunoglobulin (IVIG), used either alone or in conjunction with systemic steroids and/or thalidomide, has been suggested as a first-line treatment. We report the case of a 45-year-old woman diagnosed with scleromyxedema with paraproteinemia that initially did not respond to systemic steroids, retinoids, and thalidomide but greatly improvement in terms of systemic and cutaneous symptoms after treatment with IVIG.
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8
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Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases. An Bras Dermatol 2023; 98:141-158. [PMID: 36682966 PMCID: PMC9984718 DOI: 10.1016/j.abd.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.
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GALLO R, TRAVE I, COTZIA E, RUSSO R, PARODI A. Dermato-neuro Syndrome after COVID-19 Vaccination in a Patient with Scleromyxoedema Previously Controlled with Bortezomib and Intravenous Immunoglobulins. Acta Derm Venereol 2022; 102:adv00836. [PMID: 36511333 PMCID: PMC9811295 DOI: 10.2340/actadv.v102.4430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Rosella GALLO
- Section of Dermatology – Department of Health Sciences, University of Genoa, IRCCS – Ospedale Policlinico San Martino, Genoa
| | - Ilaria TRAVE
- Section of Dermatology – Department of Health Sciences, University of Genoa, IRCCS – Ospedale Policlinico San Martino, Genoa
| | - Emilia COTZIA
- Section of Hematology, Ospedale E. Muscatello-Augusta, Siracusa, Italy
| | - Roberto RUSSO
- Section of Dermatology – Department of Health Sciences, University of Genoa, IRCCS – Ospedale Policlinico San Martino, Genoa
| | - Aurora PARODI
- Section of Dermatology – Department of Health Sciences, University of Genoa, IRCCS – Ospedale Policlinico San Martino, Genoa
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Muacevic A, Adler JR, Berumen-Glinz C, Quijada-Ucelo Z, Hernandez-Ramirez H, De Anda-Juárez M, Vega-Memije E. Combination of Medical and Surgical Treatment in Scleromyxedema. Cureus 2022; 14:e32729. [PMID: 36686085 PMCID: PMC9850859 DOI: 10.7759/cureus.32729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Scleromyxedema is an uncommon and progressive fibromucinous disorder characterized by disseminated papular eruption with histological features of dermal mucin deposition. The skin changes associated with this disease are highly visible and they tend to affect the patient's quality of life. We report a case of a 50-year-old male patient that presented a 3-year-old history of disseminated asymptomatic firm papules-associated systemic symptoms. Medical treatment with oral corticosteroid and thalidomide was indicated and surgical treatment on residual facial folds was performed, with an excellent outcome.
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11
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Henrie R, Cherniawsky H, Marcon K, Zhao EJ, Marinkovic A, Pourshahnazari P, Parkin S, Chen LYC. Inflammatory diseases in hematology: a review. Am J Physiol Cell Physiol 2022; 323:C1121-C1136. [PMID: 35938681 DOI: 10.1152/ajpcell.00356.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hematopoietic cells are instrumental in generating and propagating protective inflammatory responses to infection or injury. However, excessive inflammation contributes to many diseases of the blood, bone marrow, and lymphatic system. We review three clinical categories of hematological inflammatory diseases in which recent clinical and translational advances have been made. The first category are monogenic inflammatory diseases. Genotype-driven research has revealed that previously mysterious diseases with protean manifestations are characterized by mutations which may be germline (e.g. deficiency of ADA2 or GATA2 deficiency) or somatic (e.g. VEXAS syndrome). The second category are the cytokine storm syndromes, including hemophagocytic lymphohistiocytosis and Castleman disease. Cytokine storm syndromes are characterized by excessive production of inflammatory cytokines including interleukin-6 and interferon-gamma, causing end-organ damage and high mortality. Finally, we review disorders associated with monoclonal and polyclonal hypergammaglobulinemia. The serum protein electrophoresis (SPEP) is typically ordered to screen for common diseases such as myeloma and humoral immunodeficiency. However, monoclonal and polyclonal hypergammaglobulinemia on SPEP can also provide important information in rare inflammatory diseases. For example, the autoinflammatory disease Schnitzler syndrome is notoriously difficult to diagnose. While this orphan disease has eluded precise genetic or histological characterization, the presence of a monoclonal paraprotein, typically IgM, is an obligate diagnostic criterion. Likewise, polyclonal hypergammaglobulinemia may be an important early, non-invasive diagnostic clue for patients presenting with rare neoplastic diseases such as Rosai-Dorfman disease and angioimmunoblastic T-cell lymphoma. Applying these three categories to patients with unexplained inflammatory syndromes can facilitate the diagnosis of rare and under-recognized diseases.
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Affiliation(s)
- Ryan Henrie
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hannah Cherniawsky
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Krista Marcon
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric J Zhao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Angelina Marinkovic
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Persia Pourshahnazari
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Stephen Parkin
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Luke Y C Chen
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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12
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Michelle L, Sabeti S, Yale K, Urso B, Lee B, Smith J. An unusual case of granulomatous scleromyxedema. JAAD Case Rep 2022; 26:66-69. [PMID: 35899146 PMCID: PMC9310074 DOI: 10.1016/j.jdcr.2022.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lauren Michelle
- School of Medicine, University of California, Irvine, Irvine, California
- Department of Dermatology, University of California Irvine Medical Center, Orange, California
| | - Sara Sabeti
- School of Medicine, University of California, Irvine, Irvine, California
- Department of Dermatology, University of California Irvine Medical Center, Orange, California
| | - Katerina Yale
- Department of Dermatology, University of California Irvine Medical Center, Orange, California
| | - Brittany Urso
- Department of Dermatology, University of California Irvine Medical Center, Orange, California
| | - Bonnie Lee
- Department of Dermatology, University of California Irvine Medical Center, Orange, California
| | - Janellen Smith
- Department of Dermatology, University of California Irvine Medical Center, Orange, California
- Correspondence to: Janellen Smith, MD, Department of Dermatology, University of California, Irvine, 1 Medical Plaza Dr, Irvine, CA 92697.
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13
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Marinkovic A, Zypchen LN, Chan J, Chen LY, Parkin S. Monoclonal gammopathy of clinical significance: what the rheumatologist needs to know. THE LANCET. RHEUMATOLOGY 2022; 4:e362-e373. [PMID: 38294033 DOI: 10.1016/s2665-9913(21)00348-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2024]
Abstract
Monoclonal proteins can provide important information on the diagnosis of several non-malignant systemic inflammatory disorders. At low concentration, they most commonly represent monoclonal gammopathy of undetermined significance (MGUS), whereas high concentrations often signify plasma cell myeloma or B-cell lymphoma. However, several rare inflammatory conditions associated with variable concentrations of monoclonal proteins, systemic symptoms, and organ dysfunction also exist. These conditions are termed monoclonal gammopathies of clinical significance (MGCS). Patients with MGCS might present to rheumatologists with undiagnosed systemic inflammatory disorders and the monoclonal protein provides an important, underappreciated clue for diagnosis. In this Review, we provide an approach to distinguishing MGCS from MGUS and lymphoid neoplasms, focusing on four rare MGCS that rheumatologists must recognise: scleromyxedema, Schnitzler's syndrome, idiopathic systemic capillary leak syndrome (also known as Clarkson's disease), and telangiectasias, elevated erythropoietin and erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intrapulmonary shunting (known as TEMPI) syndrome.
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Affiliation(s)
- Angelina Marinkovic
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Leslie N Zypchen
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Chan
- Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Luke Yc Chen
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada; Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
| | - Stephen Parkin
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.
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Çağdaş Akaslan T, Yıldız P, Onsun N. Clinical and Histopathological Improvement of Scleromyxedema Induced Microstomia after Hyaluronidase Injection. J Cosmet Dermatol 2022; 21:4319-4322. [PMID: 35441782 DOI: 10.1111/jocd.15007] [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: 11/19/2021] [Revised: 03/21/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Scleromyxedema is a rare primary cutaneous mucinosis characterized by numerous firm, waxy, confluent papules. Recently, intravenous immunoglobulin (IVIG) is accepted by many authors as the first-line treatment option for severe cases. We report a 69-year-old male patient who has been suffering from scleromyxedema, with reduced mouth opening. He has been on a high dose IVIG regime for 5 years. METHODS The patient stated that he had difficulty in wearing and removing his dentures because of reduced mouth opening lately. Before considering to add any other immunosuppressants to his regime, we injected 1500 IU of hyaluronidase in total in one session periorally. The patient has been told open his mouth maximum and photographs has been taken before injections and after one month. We used a photo measurement application when evaluating microstomia to increase accuracy. We also took punch biopsies in order to evaluate effect of hyaluronidase histopathologically before and one month after injections. RESULTS One month later, he was able to reattach and remove his dentures without adding any adjuvant immunosuppressants other than hyaluronidase. Mouth opening was increased in measurements and histopathologically, mucin deposition, fibroblastic proliferation and perivascular lymphocytic infiltration were decreased. CONCLUSIONS We think hyaluronidase is a safe, easily accessible and effective treatment option for microstomia caused by scleromyxedema.
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Affiliation(s)
| | - Pelin Yıldız
- Bezmialem Vakif University, Faculty of Medicine, Pathology Department
| | - Nahide Onsun
- Bezmialem Vakif University, Faculty of Medicine, Dermatology Department
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15
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Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
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16
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Maguire CA, Philippidou M, Schey S, Basu TN, Pembroke AC. Widespread, waxy, coalescing cutaneous papules. Clin Exp Dermatol 2021; 46:1626-1628. [PMID: 34490932 DOI: 10.1111/ced.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C A Maguire
- Departments of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - M Philippidou
- Histopathology, King's College Hospital NHS Foundation Trust, London, UK
| | - S Schey
- Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - T N Basu
- Departments of Dermatology, King's College Hospital NHS Foundation Trust, London, UK.,Haematology, King's College Hospital NHS Foundation Trust, London, UK
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18
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Larios JM, Ciuro J, Sam Varghese T, Lyons SE. Successful treatment of dermato-neuro syndrome with plasmapheresis. BMJ Case Rep 2020; 13:13/12/e237170. [PMID: 33376089 PMCID: PMC7778741 DOI: 10.1136/bcr-2020-237170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Altered mental status can have many causes ranging from emergent intracranial pathologies to more insidious, systemic toxic aetiologies. We report a rare case of dermato-neuro syndrome in a 71-year-old man with a known history of scleromyxoedema. The patient initially presented with encephalopathy which quickly progressed to generalised tonic-clonic seizures and coma. While his presentation fits with other, although rare, cases of dermato-neuro syndrome, it is imperative to rule out lethal, more common causes of altered mentation. Due to the rarity and difficulty in diagnosis of dermato-neuro syndrome, there is a significant debate regarding the optimal management as there are no standardised treatment protocols. In our case, the patient was successfully treated with plasmapheresis resulting in improved neurologic function.
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Affiliation(s)
- Jose Maciel Larios
- Department of Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, USA
| | - Jordan Ciuro
- Department of Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, USA
| | - Thomson Sam Varghese
- Department of Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, USA
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