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Somasundaram A, Gupta A, Sathishkumar D, Mathew L, George A, Thomas M. Rapid recovery in a child with febrile ulceronecrotic Mucha-Habermann disease following intravenous immunoglobulin administration. Pediatr Dermatol 2024; 41:518-522. [PMID: 38234081 DOI: 10.1111/pde.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024]
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a lymphocyte-mediated inflammatory skin disorder, is considered a severe variant of pityriasis lichenoides et varioliformis acuta that can lead to a fatal outcome if not managed in a timely fashion. Children with FUMHD can have systemic complications involving various organs. The scarcity of reported cases and the absence of well-designed studies or randomized clinical trials to evaluate different therapeutic modalities pose a major challenge in treating this potentially life-threatening disorder. We report a five-year-old child with FUMHD and seizures treated unsuccessfully with a combination of systemic steroids, methotrexate, dapsone, and oral erythromycin, who improved rapidly and achieved disease control with just a single infusion of low-dose intravenous immunoglobulin.
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Affiliation(s)
- Arun Somasundaram
- Department of Dermatology, Venereology & Leprosy, Christian Medical College and Hospital, Vellore, India
| | - Ankan Gupta
- Department of Dermatology, Venereology & Leprosy, Christian Medical College and Hospital, Vellore, India
| | - Dharshini Sathishkumar
- Department of Dermatology, Venereology & Leprosy, Christian Medical College and Hospital, Vellore, India
| | - Lydia Mathew
- Department of Dermatology, Venereology & Leprosy, Christian Medical College and Hospital, Vellore, India
| | - Anju George
- Department of Dermatology, Venereology & Leprosy, Christian Medical College and Hospital, Vellore, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, India
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2
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Rai E, Kamzan A, Boozalis E, Hogeling M, Fong K. A case of febrile ulceronecrotic Mucha-Habermann disease responsive to systemic corticosteroids. Pediatr Dermatol 2022; 40:573-575. [PMID: 36573550 DOI: 10.1111/pde.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a rare, potentially fatal subtype of pityriasis lichenoides et varioliformis acuta (PLEVA). Herein, we present a rare case of a 14-year-old male without significant past medical history who was diagnosed with FUMHD without a clear inciting factor. He was effectively treated with systemic corticosteroids with complete resolution of symptoms.
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Affiliation(s)
- Ekra Rai
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, UCLA, Los Angeles, California, USA
| | - Audrey Kamzan
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, UCLA, Los Angeles, California, USA
| | - Emily Boozalis
- Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, UCLA, Los Angeles, California, USA
| | - Marcia Hogeling
- Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, UCLA, Los Angeles, California, USA
| | - Kelly Fong
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, UCLA, Los Angeles, California, USA
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3
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Blohm ME, Ebenebe CU, Rau C, Escherich C, Johannsen J, Escherich G, Driemeyer J, Nagel PD, Kobbe R, Lütgehetmann M, Lennartz M, Booken N, Schneider SW, Singer D. Mucha-Habermann disease: a pediatric case report and proposal of a risk score. Int J Dermatol 2021; 61:401-409. [PMID: 34287852 DOI: 10.1111/ijd.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/31/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a rare inflammatory dermatological disease. A case of a 13-year-old boy with FUMHD possibly triggered by mycoplasma infection is presented. Based on FUMHD cases identified in a MEDLINE literature search, demographic, treatment, and outcome data were analyzed. An FUMHD mortality risk score is proposed based on the likelihood ratios of risk factors for a fatal outcome. Our FUMHD case had marked leukopenia and thrombocytopenia at admission. He recovered without systemic immunosuppressive treatment. Literature review revealed 119 FUMHD cases. Overall lethality was 14/119 (12%, CI 6-17%), and lethality in children was lower (1/54, 2%, CI 0-6%) compared to adults (13/65, 20%, CI 11-31%). Risk factors for a fatal outcome (likelihood ratio; P) were sepsis (24.97, P < 0.001), adult vs. pediatric patient age (11.19; P = 0.001), systemic involvement (19.97, P < 0.001), and mucosal involvement (4.58; P = 0.032). The proposed FUMHD mortality risk score = Age/10 + 4 + 4 (if systemic involvement) + 1 (if mucosal involvement) was discriminative (sensitivity 93%, specificity 77%). In FUMHD, immune-suppressive treatment intensity should be balanced against the mortality risk, as infectious complications are a frequent cause of death.
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Affiliation(s)
- Martin Ernst Blohm
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chinedu Ulrich Ebenebe
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cornelius Rau
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Escherich
- Department of Paediatric Oncology, Haematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jessika Johannsen
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joenna Driemeyer
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Daniel Nagel
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Kobbe
- Division of Infectious Diseases, First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Booken
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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4
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Chin LD, Parvinnejad N, Haber RM. Pityriasis in dermatology: an updated review. Int J Dermatol 2020; 60:141-158. [PMID: 32783190 DOI: 10.1111/ijd.15097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/30/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Dermatology has a very distinctive lexicon. The term pityriasis refers to several dermatologic conditions which all feature scaling of the skin. According to the Merriam-Webster dictionary, the term pityriasis was first used in print in 1684. Although the diseases beginning with the name pityriasis are of diverse causation, they do represent important dermatologic diseases, with some common and others quite rare. It is important for dermatologists to be aware and updated on all pityriasis conditions in dermatology.
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Affiliation(s)
- Laura D Chin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nikoo Parvinnejad
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard M Haber
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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5
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Fongue J, Amatore F, Benzaquen M, Spadari M, Granel B, Berbis P. Febrile ulceronecrotic Mucha-Habermann disease after levamisole-adulterated cocaine use: an unusual case. Clin Exp Dermatol 2018; 43:846-848. [DOI: 10.1111/ced.13651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- J. Fongue
- Dermatology Service; Hôpital Nord, Assistance Publique Hôpitaux de Marseille; Aix Marseille Université; Marseille France
| | - F. Amatore
- Dermatology Service; Hôpital Nord, Assistance Publique Hôpitaux de Marseille; Aix Marseille Université; Marseille France
| | - M. Benzaquen
- Dermatology Service; Hôpital Nord, Assistance Publique Hôpitaux de Marseille; Aix Marseille Université; Marseille France
| | - M. Spadari
- Addictovigilance Service; Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille; Marseille France
| | - B. Granel
- Internal Medicine Service; Hôpital Nord, Assistance Publique Hôpitaux de Marseille; Aix Marseille Université; Marseille France
| | - P. Berbis
- Dermatology Service; Hôpital Nord, Assistance Publique Hôpitaux de Marseille; Aix Marseille Université; Marseille France
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6
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Orenstein LAV, Coughlin CC, Flynn AT, Pillai V, Boos MD, Wertheim GB, Treat JR, Teachey DT. Severe Mucha-Habermann-Like Ulceronecrotic Skin Disease in T-Cell Acute Lymphoblastic Leukemia Responsive to Basiliximab and Stem Cell Transplant. Pediatr Dermatol 2017; 34:e265-e270. [PMID: 28884915 DOI: 10.1111/pde.13235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A 5-year-old girl with T-cell acute lymphoblastic leukemia (T-ALL) developed a progressive eruption of crusted papules and ulcerative plaques involving 80% of her body surface area with histopathology consistent with febrile ulceronecrotic Mucha-Habermann disease (FUMHD), although multiple specimens also contained clonal leukemic cells. Her skin disease was refractory to many classic treatments for FUMHD, including methotrexate, and became so severe that concern about superinfection prevented intensification of chemotherapy for her malignancy. The addition of basiliximab promoted gradual improvement of the skin, allowing for chemotherapy intensification and subsequent bone marrow transplantation, after which the eruption resolved completely. This report describes a severe case of FUMHD-like eruption associated with clonal leukemic cells that improved with basiliximab, suggesting anti-CD25 therapy as a novel treatment for ulceronecrotic skin disease in the setting of high interleukin-2 levels.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie C Coughlin
- Division of Dermatology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Andrea T Flynn
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vinodh Pillai
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Gerald B Wertheim
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James R Treat
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David T Teachey
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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7
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Alratrout J, Alshammasi F, Ansari N. Febrile ulceronecrotic Mucha-Habermann disease in an 8-year-old boy responding to methotrexate. Int J Dermatol 2016; 55:1205-1209. [DOI: 10.1111/ijd.13323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/16/2016] [Accepted: 02/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jehad Alratrout
- Department of Dermatology; Qatif Central Hospital; Kingdom of Saudi Arabia
| | - Fatima Alshammasi
- Department of Dermatology; Qatif Central Hospital; Kingdom of Saudi Arabia
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8
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Liu ZH, Shen H. Young Male With Painful Skin Necrosis. Ann Emerg Med 2016; 68:276-311. [PMID: 27568417 DOI: 10.1016/j.annemergmed.2016.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ze-Hu Liu
- Department of Dermatology, Affiliated Third Hospital of Hangzhou, Anhui Medical University, Hangzhou, China
| | - Hong Shen
- Department of Dermatology, Affiliated Third Hospital of Hangzhou, Anhui Medical University, Hangzhou, China
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10
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Nofal A, Assaf M, Alakad R, Amer H, Nofal E, Yosef A. Febrile ulceronecrotic Mucha-Habermann disease: proposed diagnostic criteria and therapeutic evaluation. Int J Dermatol 2015; 55:729-38. [DOI: 10.1111/ijd.13195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/13/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Magda Assaf
- Department of Pathology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Rania Alakad
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
| | - Eman Nofal
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Yosef
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
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11
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Methotrexate Treatment in Children with Febrile Ulceronecrotic Mucha-Habermann Disease: Case Report and Literature Review. Case Rep Dermatol Med 2015; 2015:357973. [PMID: 26413356 PMCID: PMC4564610 DOI: 10.1155/2015/357973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022] Open
Abstract
Febrile Ulceronecrotic Mucha-Habermann disease is a rare and potentially fatal variant of pityriasis lichenoides et varioliformis acuta and is characterized by high fever, constitutional symptoms, and acute oncet of ulceronecrotic lesions. We present an 11-year-old male with Febrile Ulceronecrotic Mucha-Habermann disease who was cured with methotrexate and review the use of methotrexate for this disorder in the pediatric age group with the relevant literature.
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Lode HN, Döring P, Lauenstein P, Hoeger P, Dombrowski F, Bruns R. Febrile ulceronecrotic Mucha–Habermann disease following suspected hemorrhagic chickenpox infection in a 20-month-old boy. Infection 2015; 43:583-8. [DOI: 10.1007/s15010-015-0726-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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[Off-label use of infliximab]. Hautarzt 2013; 64:757-61. [PMID: 24150825 DOI: 10.1007/s00105-013-2596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tumor necrosis factor α (TNFα) is a pro-inflammatory cytokine and a key mediator of inflammation. Several TNFα antagonists have been used therapeutically. One of them, infliximab, is a chimeric monoclonal antibody with anti-TNFα activity. Numerous studies have shown TNFα antagonists to be effective in treating psoriasis--particularly severe resistant forms--and arthritis. Additionally, several case reports and studies showing the effects of TNFα on new dermatologic indications have been published. The intention of this review is to summarize the new off-label uses of infliximab according to published data.
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Pityriasis Lichenoides and Cutaneous T Cell Lymphoma: An Update on the Diagnosis and Management of the Most Common Benign and Malignant Cutaneous Lymphoproliferative Diseases in Children. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0054-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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