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Magro CM, Sanders S. Tumor necrosis factor ALPHA Inhibitor Associated Köhlmeier-Degos Disease as a Novel Iatrogenic Paradigm That Underscores Excessive Type I Interferon in Its Pathogenesis. Am J Dermatopathol 2024; 46:605-610. [PMID: 39150183 PMCID: PMC11328922 DOI: 10.1097/dad.0000000000002765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
ABSTRACT Malignant atrophic papulosis/Köhlmeier-Degos disease was first described in 1941 by Köhlmeier in an anecdotal case report that described a young man who presented with extensive multiple intestinal perforations and a papular skin rash. Köhlmeier-Degos disease represents a unique vasculopathy targeting both the microvasculature and the arterial system. One of its most characteristic features is reflected by the discrete multifocal depressed porcelain lesions involving the skin and gastrointestinal tract. The pathological findings are striking and can be broadly categorized into those that are vascular in nature versus extravascular matrix production in the context of extensive extravascular hyaluronic acid and collagen deposition. A dynamic evolutionary morphology is observed not only clinically but also histologically. The microvascular alterations are particularly evident in the skin and are characterized by endothelial cell necrosis with subsequent endothelial cell detachment accompanied by intraluminal fibrin deposition, defining a thrombogenic microangiopathy that in later stage lesions is typically pauci-inflammatory. The arterial lesions are very distinctive and include significant neointimal proliferation with vascular luminal occlusion by amorphous plugs of collagen intimately admixed with platelets. Pathogenetically enhanced type I interferon signaling and endothelial cell injury mediated by the membranolytic attack complex (ie, C5b-9) are key in the evolution of the thrombotic microvascular and obliterative fibrosing arteriopathic changes. We describe a case of Köhlmeier-Degos disease that developed in the setting of tumor necrosis factor (TNF)-alpha inhibitor therapy with the drug golimumab. The clinical features, light microscopic findings, and a pathophysiologic paradigm based on the critical role of TNF-alpha in controlling the type I interferon response are discussed.
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Affiliation(s)
- Cynthia M. Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; and
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2
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Zouboulis CC, Kaleta KP, Broniatowska E, Jarienė V, Nikolakis G. Atrophic papulosis (Köhlmeier-Degos disease) in children and adolescents-A cross-sectional study and literature review. J Eur Acad Dermatol Venereol 2023; 37:810-816. [PMID: 36606530 DOI: 10.1111/jdv.18844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Atrophic papulosis (Köhlmeier-Degos disease, Degos disease) is a rare thrombo-obliterative microangiopathy of unknown pathogenesis. It usually affects people between the ages of 20 and 50. However, it can occur at any age. The condition is considered uncommon in children. OBJECTIVE Clinical characterization of paediatric patients with atrophic papulosis. METHODS Single-centre prospective cohort study with data derived from the international Degos Disease Registry collected between 2000 and 2021. RESULTS Among 96 registered patients with atrophic papulosis fulfilling the criteria, 19 were aged 0 to completed 17 years at the time of onset. The median age at the time of onset was 5 years, ranging from 0 to 1 years for girls to 8 years for boys. In contrast to adult patients (male-to-female ratio 1:2.2), there was a male predominance in paediatric patients with a male-to-female ratio of 1.7:1. Systemic involvement, in particular gastrointestinal, central nervous system and cardiac, was more frequent in children than in adult patients. There were no statistically significant differences between family history, multisystem involvement, mortality and median survival time in the two groups. CONCLUSIONS Atrophic papulosis has some distinct features in the paediatric population. It presents an important and still under-recognized problem. Therefore, it is mandatory to pay attention to the typical skin lesions in combination with neurological or gastrointestinal symptoms in order to make a prompt and accurate diagnosis.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Katarzyna P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Broniatowska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Vaiva Jarienė
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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3
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GU X, JIANG X, CHEN M. Diffused Degos disease treated with rivaroxaban. Ital J Dermatol Venerol 2022; 157:294-295. [DOI: 10.23736/s2784-8671.21.07088-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Magro C, Shapiro L. Exploring the pathophysiologic basis of constrictive pericarditis of Kohlmeier Degos disease: A case series and review of the literature. Ann Diagn Pathol 2022; 59:151943. [DOI: 10.1016/j.anndiagpath.2022.151943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
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5
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Schaefer LS, Wampler Muskardin T, Tillema JM, Wieland C, Tollefson MM. A fatal case of malignant atrophic papulosis in a pediatric patient. Pediatr Dermatol 2022; 39:112-114. [PMID: 34935194 DOI: 10.1111/pde.14878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/26/2021] [Accepted: 11/14/2021] [Indexed: 12/01/2022]
Abstract
A 17-year-old Caucasian boy presented with progressive left-sided weakness, transient slurred speech, and skin lesions characterized by 3-5 mm, pink, asymptomatic papules with white atrophic centers on his central abdomen, back, and lower extremities. Skin biopsy confirmed the diagnosis of malignant atrophic papulosis, a rare vasculopathy that leads to the occlusion of small- and medium-sized arteries. He was treated with cyclophosphamide, eculizumab, treprostinil, pentoxifylline, heparin, and acetylsalicylic acid. Despite the aggressive immunosuppression, humanized monoclonal antibodies, and antiplatelet therapy, he died two months after presentation. We report this case to highlight diagnostic features, as well as to highlight the importance of early diagnosis and treatment.
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Affiliation(s)
| | - Theresa Wampler Muskardin
- NYU Grossman School of Medicine, New York, New York, USA.,Department of Medicine and Department of Pediatrics, Division of Rheumatology, NYU Colton Center for Autoimmunity, New York, New York, USA
| | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carilyn Wieland
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Megha M Tollefson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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6
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Narang I, Chohan B, Bleiker TO. Degos disease with renal cell carcinoma. Clin Exp Dermatol 2021; 46:1653-1655. [PMID: 34184287 DOI: 10.1111/ced.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- I Narang
- Department of Dermatology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Chohan
- Department of, Pathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - T O Bleiker
- Department of Dermatology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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7
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Abdel-Raouf HM, Ahmed AM, Touni AA. Asymptomatic skin lesions with bowel perforation and cerebrovascular stroke in a young adult male. Int J Dermatol 2020; 60:e176-e178. [PMID: 32710556 DOI: 10.1111/ijd.15074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hamza M Abdel-Raouf
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Almostafa M Ahmed
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed A Touni
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
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8
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Stavorn T, Chanprapaph K. Degos-Like Lesions In Association With Connective Tissue Diseases: A Report Of Three Cases And Literature Review. Clin Cosmet Investig Dermatol 2019; 12:815-822. [PMID: 31807047 PMCID: PMC6848981 DOI: 10.2147/ccid.s230081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/26/2019] [Indexed: 12/18/2022]
Abstract
Degos disease is characterized by atrophic porcelain-white papules with peripheral erythema. Degos-like lesions have been reported in association with several connective tissue diseases (CTDs), mostly systemic lupus erythematosus (SLE), and rarely in dermatomyositis and systemic sclerosis. Herein, we report three cases of Degos-like lesions in CTDs. Two cases had Degos-like lesions linked to dermatomyositis. Both cases presented with severe inflammatory myopathy without pathognomonic cutaneous signs for dermatomyositis and lacked myositis-specific autoantibodies. Our third case, to our knowledge, is the first case of Degos-like lesions in association with overlapping systemic sclerosis and SLE without major organ involvement. The clinical presentation and histopathology findings of our cases support that Degos-like lesions may not be a specific entity but can be considered as a unique clinical pattern expressed in patients with CTDs.
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Affiliation(s)
- Taptim Stavorn
- Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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9
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Khanna U, Semsarzadeh N, La Senna C, Ellis A, Galadari A, Fernandez AP. Disseminated discoid lupus erythematosus mimicking Degos disease. Australas J Dermatol 2019; 61:e114-e116. [PMID: 31429927 DOI: 10.1111/ajd.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nina Semsarzadeh
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ariana Ellis
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - AbdulAziz Galadari
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Dermatology, Cleveland Clinic, Abu Dhabi, UAE
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10
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Brown AE, Qiu CC, Drozd B, Sklover LR, Vickers CM, Hsu S. The color of skin: white diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:561-579. [PMID: 31896410 DOI: 10.1016/j.clindermatol.2019.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.
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Affiliation(s)
- Ashley E Brown
- McGovern Medical School, University of Texas Health Science Center at Houston,Houston, Texas, USA.
| | - Connie C Qiu
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Brandy Drozd
- McGovern Medical School, University of Texas Health Science Center at Houston,Houston, Texas, USA
| | - Lindsay R Sklover
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Conor M Vickers
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
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11
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Benign Atrophic Papulosis (Degos Disease) With Lymphocytic Vasculitis and Lichen Sclerosus-Like Features. Am J Dermatopathol 2018; 40:272-274. [DOI: 10.1097/dad.0000000000000847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Huang YC, Wang JD, Lee FY, Fu LS. Pediatric Malignant Atrophic Papulosis. Pediatrics 2018; 141:S481-S484. [PMID: 29610176 DOI: 10.1542/peds.2016-4206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/24/2022] Open
Abstract
Malignant atrophic papulosis (MAP), also known as Degos disease, is an extremely rare disease that is characterized by its unique skin presentation (namely, central, porcelain-white atrophic lesions with a telangiectatic rim). MAP has the following 2 variants: cutaneous MAP is manifested in the skin alone, whereas systemic MAP affects the gastrointestinal tract, central nervous system, lungs, and other internal organs. Some patients who presented with only cutaneous symptoms at first may develop systemic symptoms several years later. Although the exact pathologic mechanisms are unclear, Magro et al suggested in a recent study that MAP is a vascular injury syndrome that involves complement component C5b-9 complex deposition and high expression of interferon-α. The prognosis of systemic MAP is poor and typically fatal within a few years. Nonetheless, because the C5b-9 complex is detected in MAP, some researchers have suggested combined treatment with eculizumab (a humanized monoclonal antibody against C5) and treprostinil (a prostacyclin analog). Here, we report on a girl with systemic MAP who had severe central nervous system involvement and responded to eculizumab.
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Affiliation(s)
- Yung-Chieh Huang
- Departments of Pediatrics and.,Division of Pediatrics, Puli Branch, Taichung Veterans General Hospital, Nantou, Taiwan; and
| | | | - Fang-Yi Lee
- Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lin-Shien Fu
- Departments of Pediatrics and .,Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan
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13
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Hu P, Mao Z, Liu C, Hu X, Kang H, Zhou F. Malignant atrophic papulosis with motor aphasia and intestinal perforation: A case report and review of published works. J Dermatol 2018. [PMID: 29516548 PMCID: PMC6001538 DOI: 10.1111/1346-8138.14280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30‐year‐old female patient with systemic manifestation of MAP 10 days after delivery of a full‐term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.
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Affiliation(s)
- Pan Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chao Liu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongjun Kang
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Feihu Zhou
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
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14
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Choo SZ, Simpson I, Finlay MJ, Mulley WR. Multi-organ vaso-occlusive disease: Buerger's or Kohlmeier-Degos disease? Pathology 2017; 49:798-801. [PMID: 29096880 DOI: 10.1016/j.pathol.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Shi Z Choo
- Department of Nephrology, Monash Health, Melbourne, Australia.
| | - Ian Simpson
- Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Moira J Finlay
- Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Australia
| | - William R Mulley
- Department of Nephrology, Monash Health, Melbourne, Australia; Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Vic, Australia
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15
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Wallace MP, Thomas JM, Meligonis G, Ha T. Systemic lupus erythematosus, following prodromal idiopathic thrombocytopenic purpura, presenting with skin lesions resembling malignant atrophic papulosis. Clin Exp Dermatol 2017; 42:774-776. [DOI: 10.1111/ced.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. P. Wallace
- Department of Dermatology; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge Biomedical Campus; Cambridge UK
| | - J. M. Thomas
- Department of Dermatology; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge Biomedical Campus; Cambridge UK
| | - G. Meligonis
- Department of Dermatology; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge Biomedical Campus; Cambridge UK
| | - T. Ha
- Department of Dermatology; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge Biomedical Campus; Cambridge UK
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16
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Oliver B, Boehm M, Rosing DR, Shapiro LS, Dempsey DT, Merkel PA, Lee CCR, Cowen EW. Diffuse atrophic papules and plaques, intermittent abdominal pain, paresthesias, and cardiac abnormalities in a 55-year-old woman. J Am Acad Dermatol 2016; 75:1274-1277. [PMID: 27717619 DOI: 10.1016/j.jaad.2016.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 12/22/2022]
Abstract
KEY TEACHING POINTS.
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Affiliation(s)
| | - Manfred Boehm
- Center for Molecular Medicine, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Douglas R Rosing
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Daniel T Dempsey
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chyi-Chia Richard Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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17
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Mancl KA, Merrill BP, Johansen NG. Multiple umbilicated papules in a 51-year-old woman. J Am Acad Dermatol 2015; 73:894-6. [DOI: 10.1016/j.jaad.2013.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 01/11/2013] [Accepted: 01/25/2013] [Indexed: 11/25/2022]
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19
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Abstract
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital - University of Connecticut, Hartford CT, USA
| | - Jodi Speiser
- Section of Dermatopathology, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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20
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Guo YF, Pan WH, Cheng RH, Yu H, Liao WQ, Yao ZR. Successful treatment of neurological malignant atrophic papulosis in child by corticosteroid combined with intravenous immunoglobulin. CNS Neurosci Ther 2014; 20:88-91. [PMID: 24341936 DOI: 10.1111/cns.12196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 01/09/2023] Open
Affiliation(s)
- Yi-Feng Guo
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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21
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Karaoğlu P, Topçu Y, Bayram E, Yis U, Akarsu S, Atalay E, Koroğlu T, Cakmakçi H, Ozer E, Hız S. Severe neurologic involvement of Degos disease in a pediatric patient. J Child Neurol 2014; 29:550-4. [PMID: 23400246 DOI: 10.1177/0883073812474692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 14-year-old male presented with paresthesias on the right upper and lower extremities, headache, and vomiting. In addition to worsening paresthesia and weakness on the right side of his body, blurred vision, fever, and skin lesions developed. He also had skin lesions characterized with 3-10 mm papules with a white atrophic center surrounded by pink rim mostly on the trunk and lower extremities. Brain magnetic resonance imaging showed chronic subdural effusion and encephalomalacia of the left cerebral hemisphere. Cerebrospinal fluid (CSF) examination revealed increased protein levels. Electromyography was consistent with diffuse polyradiculoneuropathy. Skin biopsy confirmed the diagnosis of a rare vasculopathy: Degos disease. A case presenting with chronic subdural effusion, encephalomalacia, elevated CSF protein, and polyradiculopathy should be carefully examined for skin lesions, which may suggest the diagnosis of Degos disease.
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Affiliation(s)
- Pakize Karaoğlu
- 1Department of Pediatric Neurology, Dokuz Eylul University Medical School, Izmir, Turkey
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Su Z, Lu Y, Ge Y, Jiang J, Jia Z, Zhu F, Zhang M, Ji C, Tang Y, Wei J, Gao Q, Wang H. Central nervous system involvement in systemic malignant atrophic papulosis (Degos disease): a case report. Int J Dermatol 2013; 54:699-703. [PMID: 23786159 DOI: 10.1111/ijd.12123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/05/2012] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Zhonglan Su
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yan Lu
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yixin Ge
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jieyao Jiang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Zhenyu Jia
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Feng Zhu
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Meihua Zhang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Chao Ji
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yicheng Tang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jiwu Wei
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
| | - Qian Gao
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
| | - Hongwei Wang
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
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Shapiro LS, Toledo-Garcia AE, Farrell JF. Effective treatment of malignant atrophic papulosis (Köhlmeier-Degos disease) with treprostinil--early experience. Orphanet J Rare Dis 2013; 8:52. [PMID: 23557362 PMCID: PMC3636001 DOI: 10.1186/1750-1172-8-52] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/24/2013] [Indexed: 12/05/2022] Open
Abstract
Background Malignant atrophic papulosis (Köhlmeier-Degos disease; MAP) is an uncommon endotheliopathy with pathological findings similar to the vascular lesions of systemic sclerosis. These two disorders can overlap. When associated with visceral lesions, MAP has been considered almost universally and rapidly fatal. A recent report described dramatic response to treatment with eculizumab, but disease progression after initial response to therapy has occurred. Methods We describe the clinical and pathologic findings in two patients, one with MAP and the other with MAP like lesions, who received treatment with subcutaneous treprostinil. One patient had an overlap syndrome with features of systemic lupus erythematosus (SLE) and scleroderma and severe pulmonary hypertension. She also had very extensive MAP like cutaneous lesions. There was no evidence of central nervous system (CNS) disease and laparoscopy revealed no visible MAP lesions on the serosa of the small bowel. The second patient had experienced life-threatening disease progression despite ongoing eculizumab therapy. During this treatment, he had developed CNS and bladder involvement with neurologic symptoms and gross hematuria. Results Patient one was placed on therapy with treprostinil for her pulmonary hypertension, but in the months subsequent to initiation of treatment, dramatic and complete resolution of cutaneous MAP like lesions and disabling digital pain occurred. In patient two, therapy with treprostinil was temporally associated with clearing of hematuria, resolution of CNS symptoms and improvement in MRI findings. Conclusions Treprostinil may offer a second effective treatment approach to individuals with MAP or “rescue therapy” to those in whom eculizumab treatment has failed to maintain suppression of disease activity.
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Affiliation(s)
- Lee S Shapiro
- Steffens Scleroderma Center, Saratoga Springs, NY, USA.
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24
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Cutaneous manifestations of gastrointestinal disease: part II. J Am Acad Dermatol 2013; 68:211.e1-33; quiz 244-6. [PMID: 23317981 DOI: 10.1016/j.jaad.2012.10.036] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 02/07/2023]
Abstract
The gastrointestinal (GI) and cutaneous organ systems are closely linked. In part I of this continuing medical education article, the intricacies of this relationship were explored as they pertained to hereditary polyposis disorders, hamartomatous disorders, and paraneoplastic disease. Part II focuses on the cutaneous system's links to inflammatory bowel disease and vascular disorders. An in-depth analysis of inflammatory bowel disease skin findings is provided to aid dermatologists in recognizing and facilitating early consultation and intervention by gastroenterologists. Cutaneous signs of inflammatory bowel disease include fissures and fistulae, erythema nodosum, pyoderma gangrenosum, pyostomatitis vegetans, oral aphthous ulcers, cutaneous polyarteritis nodosa, necrotizing vasculitis, and epidermolysis bullosa acquisita. Additional immune-mediated conditions, such as diverticulitis, bowel-associated dermatosis-arthritis syndrome, Henoch-Schönlein purpura, dermatitis herpetiformis, and Degos disease, in which the skin and GI system are mutually involved, will also be discussed. Genodermatoses common to both the GI tract and the skin include Hermansky-Pudlak syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia, and blue rubber bleb nevus syndrome. Kaposi sarcoma is a neoplastic disease with lesions involving both the skin and the gastrointestinal tract. Acrodermatitis enteropathica, a condition of zinc deficiency, likewise affects both the GI and dermatologic systems. These conditions are reviewed with updates on the genetic basis, diagnostic and screening modalities, and therapeutic options. Finally, GI complications associated with vascular disorders will also be discussed.
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25
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Ahmadi M, Rafi SA, Faham Z, Azhough R, Rooy SB, Rahmani O. A fatal case of Degos’ disease which presented with recurrent intestinal perforation. World J Gastrointest Surg 2011; 3:156-8. [PMID: 22110848 PMCID: PMC3220729 DOI: 10.4240/wjgs.v3.i10.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 09/21/2011] [Accepted: 09/26/2011] [Indexed: 02/06/2023] Open
Abstract
Degos’ disease, otherwise known as “malignant atrophic papulosis” is a rare vasculopathy with an unknown etiology characterized by typical cutaneous lesions. Involvement of the gastrointestinal (GI) tract is observed in approximately half of patients and small infarctions in the mucosa can cause perforation and resulting peritonitis, the leading cause of death. We present a fatal case of Degos’ disease with skin and GI involvement, manifesting as recurrent intestinal perforations and peritonitis, in a 15-year-old Iranian boy.
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Affiliation(s)
- Mona Ahmadi
- Mona Ahmadi, Sevil Agabalaey Rafi, Zhale Faham, Ramin Azhough, Samad Beheshty Rooy, Omid Rahmani, Department of General Surgery and Pathology, Imam Reza Hospital, Azadi Street, Tabriz 5156975389, Iran
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26
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Passarini B, Balestri R, D’Errico A, Pinna AD, Infusino SD. Lack of recurrence of malignant atrophic papulosis of Degos in multivisceral transplant: Insights into possible pathogenesis? J Am Acad Dermatol 2011; 65:e49-e50. [DOI: 10.1016/j.jaad.2010.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 12/09/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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Gutiérrez-Pascual M, Hernández-Martín A, Colmenero I, García-Peñas JJ, López-Pino MA, Torrelo A. Malignant atrophic papulosis: a case report with severe visual and neurological impairment. Pediatr Dermatol 2011; 28:302-5. [PMID: 21133995 DOI: 10.1111/j.1525-1470.2010.01287.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Malignant atrophic papulosis, or Degos' disease, is a severe systemic vasculopathy extremely rare in children. The skin, gastrointestinal tract, and central nervous system are most frequently affected. We report a 5-year-old girl with malignant atrophic papulosis who presented with widespread skin lesions from early infancy and severe visual and neurological impairment.
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28
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Darwich E, Guilabert A, Mascaró JM, Malvehy J, Puig S, Fernandez-Figueras M, Herrero C. Dermoscopic description of a patient with thrombocythemia and factor V Leiden mutation-associated Degos’ disease. Int J Dermatol 2011; 50:604-6. [DOI: 10.1111/j.1365-4632.2010.04539.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Three unusual mimics of primary angiitis of the central nervous system. Rheumatol Int 2010; 32:737-42. [PMID: 21161532 DOI: 10.1007/s00296-010-1679-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/14/2010] [Indexed: 11/27/2022]
Abstract
To present three rare mimics of primary angiitis of the central nervous system (PACNS). We describe 3 patients with rare diseases that can mimic PACNS at clinical presentation and neuroimaging. We describe the clinical course of these patients and also present a review of the literature regarding these three diagnoses. All 3 patients presented with neurological symptoms and had abnormal findings on neuroimaging suggestive of PACNS. After detailed history, careful review of systems, thorough laboratory workup and consideration of lack of a response to immunosuppressive therapy, PACNS was ruled out with identification of an alternative diagnosis. PACNS is a rare disease and a diagnostic challenge with many differentials. A thorough investigation and awareness of unusual disorders is critical in avoiding misdiagnosis.
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30
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Zheng XY, Huang DY, Xin Y, Wang XF. Malignant Atrophic Papulosis with Severe Gastrointestinal Perforation and Omental Necrosis: A Case Report. J Int Med Res 2010; 38:1164-9. [PMID: 20819456 DOI: 10.1177/147323001003800346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Malignant atrophic papulosis (MAP) is a rare disease with an extremely grim prognosis, death being due to gastrointestinal perforation and neurological disorders. We report a severe case of MAP in a 37-year old woman. The patient had three emergent laparotomies in 3 months for recurrent acute peritonitis due to omental thrombosis resulting in necrosis, multiple intestinal and mesenteric lesions, and severe gastrointestinal perforations. Multiple papular skin lesions were present for 1 year prior to surgery. Pathological findings revealed MAP. Surgical intervention was successful and the patient recovered smoothly but later died of malnutrition and septicaemia.
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Affiliation(s)
- XY Zheng
- Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - DY Huang
- Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Y Xin
- Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - XF Wang
- Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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31
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Wobser M, Burger M, Trautmann A. Images in dermatology. The red flag. Am J Med 2010; 123:31-3. [PMID: 20102988 DOI: 10.1016/j.amjmed.2009.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Marion Wobser
- Department of Dermatology, University of Wuerzburg, Wuerzburg, Germany.
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32
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Moss C, Wassmer E, Debelle G, Hackett S, Goodyear H, Malcomson R, Ryder C, Sgouros S, Shahidullah H. Degos disease: a new simulator of non-accidental injury. Dev Med Child Neurol 2009; 51:647-50. [PMID: 19549203 DOI: 10.1111/j.1469-8749.2009.03349.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent high-profile cases have made paediatricians very aware of the serious implications of either missing or wrongly diagnosing non-accidental injury. Subdural fluid collections in non-mobile infants usually represent haemorrhage caused by non-accidental injury. We report a 6-month-old male who presented to the Accident and Emergency Department of Birmingham Heartlands Hospital with bilateral subdural fluid collections and skin ulcers resembling cigarette burns. Non-accidental injury was considered to be the most likely diagnosis. However, while under observation in hospital, the child's neurological condition deteriorated with progressive cerebral infarctions, and serial photographs of the skin lesions showed failure to heal. The revised diagnosis, confirmed histologically, was Degos disease, an extremely rare and often fatal occlusive vasculopathy. The child was treated palliatively and died 8 weeks after presentation. This report informs doctors of a new simulator of non-accidental injury to be considered in infants with otherwise unexplained subdural fluid collections.
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Affiliation(s)
- Celia Moss
- Department of Dermatology, Birmingham Children's Hospital, Birmingham, UK.
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33
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Degos’ disease: a rare condition simulating rheumatic diseases. Clin Rheumatol 2009; 28:861-3. [DOI: 10.1007/s10067-009-1164-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
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34
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Mydlarski PR, Barber DF, Robertson LH. Painless pink papules with central porcelain-white scars. CMAJ 2009; 179:1171-3. [PMID: 19015568 DOI: 10.1503/cmaj.080373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- P Régine Mydlarski
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alta
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Abstract
PURPOSE OF REVIEW The skin is often a mirror for matters of internal diseases including disorders of the gastrointestinal tract. Here we enumerate many cutaneous and gastrointestinal associations and focus closely on three of the lesser known cutaneous manifestations of colonic disorders. RECENT FINDINGS Muir-Torre syndrome involves cutaneous sebaceous adenomas and internal malignancy; screening of cutaneous lesions for microsatellite instability, and absence of mismatch repair genes provides an opportunity for diagnosis of the syndrome. Degos' disease is a vasoocclusive disorder involving the cutaneous and gastrointestinal systems; this disease affects all ages with significant mortality, yet a benign variant only affecting the skin is described. Anecdotally reported treatments are listed. Metastatic Crohn's disease is the development of noncaseating granulomas at skin sites not contiguous with the gastrointestinal tract; cutaneous lesions may precede the onset of colonic disease or appear in the absence of active bowel disease, and extensive surgical debridement of perineal lesions is often necessary. SUMMARY Knowledge of these cutaneous manifestations provides an insight into the state of colonic health. These clues alert the clinician to the potential for life-threatening consequences, which leads to vigilant screening and hopefully earlier diagnosis.
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Yamaguchi N, Isomoto H, Nakayama T. Clinical challenges and images in GI. Image 2: Malignant atrophic papulosis (Degos' disease) with systemic manifestations. Gastroenterology 2008; 135:1464, 1807. [PMID: 18851969 DOI: 10.1053/j.gastro.2008.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Naoyuki Yamaguchi
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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