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Yu L, Wang Y, Tang X, Zhao X, Song Z. Malignant atrophic papulosis treated with eculizumab and hirudin: a fatal case report and literature review. Front Cardiovasc Med 2024; 11:1347587. [PMID: 38606375 PMCID: PMC11007069 DOI: 10.3389/fcvm.2024.1347587] [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: 12/01/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
Background Malignant atrophic papulosis (MAP) is a rare obliterative vasculopathy whose etiology and pathophysiological mechanisms remain unknown, and the treatment is still empirical. It can involve multiple systems, especially the gastrointestinal tract and central nervous system, and has a poor prognosis. Case presentation A 20-year-old Chinese male appeared to have Widespread atrophic papules and plaques, intermittent abdominal pain, recurrent bowel perforation, and psoas abscess. The clinical diagnosis of MAP was supported by skin biopsy. He was then treated with anticoagulants, antiplatelets, glucocorticoids, and immunosuppressants and started on eculizumab and hirudin after the first surgical interventions. Despite the aggressive immunosuppression, anticoagulant, antiplatelet, humanized monoclonal antibodies, and surgery therapy, he died five months after presentation. Conclusions MAP is an extremely rare obliterative vasculopathy manifesting as benign cutaneous involvement or potentially malignant systemic involvement. MAP patients who exhibit any abdominal symptoms should undergo laparoscopy and evaluation in time and start on eculizumab and treprostinil as soon as possible, as the combination of them is presently the most effective treatment option for gastrointestinal MAP and hopefully reduce mortality.
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Affiliation(s)
- Linna Yu
- Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yun Wang
- Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiaodan Tang
- Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xueru Zhao
- Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Zhengji Song
- Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
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2
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Song P, Li S, Lewis MA, Fiorentino DF, Chung L. Clinical Associations of Degos-Like Lesions in Patients With Systemic Sclerosis. JAMA Dermatol 2023; 159:308-313. [PMID: 36753129 PMCID: PMC9909573 DOI: 10.1001/jamadermatol.2022.6330] [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: 08/18/2022] [Accepted: 12/11/2022] [Indexed: 02/09/2023]
Abstract
Importance Degos-like lesions are cutaneous manifestations of a small-vessel vasculopathy that appear as atrophic, porcelain-white papules with red, telangiectatic borders. No study has adequately examined Degos-like lesions in patients with systemic sclerosis (SSc). Objective To characterize the serologic, cutaneous, and internal organ manifestations associated with Degos-like lesions in a large cohort of patients with SSc. Design, Settings, and Participants This retrospective cohort study involved adult patients with SSc who were seen at Stanford Rheumatologic Dermatology Clinic between January 1, 1998, and December 31, 2018. Participants fulfilled the 2013 classification criteria for SSc. Data analysis was conducted from February 1 to June 1, 2019. Main Outcomes and Measures Data on demographic characteristics; autoantibody status; clinical characteristics, including cutaneous and systemic manifestations of SSc; and presence of Degos-like lesions were collected. Results The cohort comprised 506 patients with SSc (447 females [88.3%]; mean [SD] age at first non-Raynaud disease symptoms, 46.1 [15.2] years). Twenty-seven patients (5.3%) had Degos-like lesions, of whom 24 (89.0%) had lesions affecting the fingers. Patients with Degos-like lesions were more likely to have diffuse cutaneous SSc compared with patients without lesions (15 [55.6%] vs 181 [37.8%]; P = .04). Degos-like lesions were also associated with acro-osteolysis (10 [37.0%] vs 62 [12.9%]; P < .01), digital ulcers (15 [55.6%] vs 173 [36.1%]; P = .04), and calcinosis (15 [55.6%] vs 115 [24.0%]; P < .01). While Degos-like lesions were not associated with internal organ manifestations, such as scleroderma renal crisis, interstitial lung disease, or pulmonary arterial hypertension, there was P < .10 for the association with gastric antral vascular ectasia. Conclusions and Relevance Results of this study suggest an association of Degos-like lesions with diffuse cutaneous SSc and other cutaneous manifestations of vasculopathy, including acro-osteolysis, calcinosis, and digital ulcers. A prospective longitudinal study is warranted to examine the onset of Degos-like lesions and to elucidate whether these lesions play a role in SSc.
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Affiliation(s)
- Paula Song
- Division of Rheumatology, Columbia University School of Medicine, New York, New York
| | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
- Department of Urology, Stanford University School of Medicine, Palo Alto, California
| | - Matthew A. Lewis
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - David F. Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California
- Division of Immunology and Rheumatology, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California
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3
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Ai W, Liang Z, Li F, Yu H. Degos disease with multiple intestinal perforations: A missed-opportunity case report and literature review. Front Cardiovasc Med 2022; 9:910288. [PMID: 36324742 PMCID: PMC9618646 DOI: 10.3389/fcvm.2022.910288] [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] [Received: 04/24/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Degos disease, also known as malignant atrophic papulosis (MAP), is a rare systemic obstructive vascular disease with unknown pathophysiology, which can affect multiple systems, especially gastrointestinal tract and central nervous system. Intestinal perforations with MAP is associated with high mortality rate and ambiguous treatment outcomes. Case presentation Here we report a missed-opportunity case of Degos disease characterized by generalized skin eruption and multiple intestinal perforations. Definite diagnosis of Degos disease was finally concluded after two exploratory laparotomy operations and skin biopsies. Due to the delayed diagnosis and treatment, the patient died after being discharged automatically in spite of application of aspirin and low-dose subcutaneous heparin. In view of such circumstances, we searched the Pubmed using “Degos [Title] OR Malignant Atrophic Papulosis [Title]” AND “perforation [Title] OR perforations [Title]” and make a detailed analysis of the result. Conclusions Degos disease is a rare systemic obstructive vascular disease with unknown pathologic mechanism and unavailable treatment methods. Diagnosis is usually based on the presence of pathognomonic skin lesions and tissue biopsy. Gastrointestinal involvement can cause serious and lethal conditions with high mortality. Currently, how to achieve a satisfying prognosis of MAP with intestinal perforations becomes the most urgent problem in front of medical staff.
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4
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Sattler SS, Magro CM, Shapiro L, Merves JF, Levy R, Veenstra J, Patel P. Gastrointestinal Kohlmeier-Degos disease: a narrative review. Orphanet J Rare Dis 2022; 17:172. [PMID: 35443671 PMCID: PMC9022239 DOI: 10.1186/s13023-022-02322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. Body Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K–D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K–D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells. Conclusion Prompt laparoscopic evaluation is necessary in any K–D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K–D should start on eculizumab as soon as possible, as onset of action is immediate. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02322-9.
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Affiliation(s)
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical College, 6 Medical Park Drive, Malta, NY, 12020, USA.
| | - Jamie F Merves
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Levy
- Division of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Puraj Patel
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
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5
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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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6
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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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7
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Leyens J, Bender TTA, Mücke M, Stieber C, Kravchenko D, Dernbach C, Seidel MF. The combined prevalence of classified rare rheumatic diseases is almost double that of ankylosing spondylitis. Orphanet J Rare Dis 2021; 16:326. [PMID: 34294115 PMCID: PMC8296612 DOI: 10.1186/s13023-021-01945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences. RESULTS A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000. CONCLUSIONS RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology.
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Affiliation(s)
- Judith Leyens
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Neonatology and Pediatric Care, Children's University Hospital, Bonn, Germany
| | - Tim Th A Bender
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Institute of Human Genetics, University Hospital, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
| | - Christiane Stieber
- Institute of General Practice and Family Medicine, University Hospital, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Radiology, University Hospital, Bonn, Germany
| | - Christian Dernbach
- Division of Medical Psychology and Department of Psychiatry, University Hospital, Bonn, Germany
| | - Matthias F Seidel
- Department of Rheumatology, Spitalzentrum-Centre hospitalier, Biel-Bienne, Switzerland.
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8
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Kim PJ, Lytvyn Y, Kashetsky N, Bagit A, Mufti A, Yeung J. Clinical manifestations and treatment outcomes in degos disease: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:1655-1669. [PMID: 33914972 DOI: 10.1111/jdv.17311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
Degos disease (atrophic papulosis) is a rare vasculopathy with cutaneous and systemic manifestations. Although potentially fatal, the characteristics of and treatments for Degos disease variants are not adequately described. We conducted a systematic review to summarize cutaneous and systemic presentations, treatments and outcomes of malignant (MAP) and benign (BAP) variants of Degos disease. A comprehensive search was conducted on Embase, MEDLINE, CINAHL and CENTRAL on 27 October 2020, which yielded 254 original studies reporting cases of Degos disease. A total of 357 patients were included in the analysis. Mean age of onset was 33.9 years. MAP was most commonly reported (63.8%, n = 228/357), with 56.6% (n = 129/228) mortality. Cutaneous lesions were usually asymptomatic (26.3%, n = 81/308) and localized to the trunk (57.7%, n = 206/357) and extremities (56.8%, n = 203/357). Systemic involvement developed within 2 years on average, ranging from 0 to 28 years. Anti-platelet monotherapy had a complete resolution rate of 42.3% (n = 11/26) in BAP and 20.0% (n = 7/35) in MAP. Based on the findings of the study, most cases of Degos disease are malignant with high mortality, and even benign cutaneous cases may develop systemic disease in as late as 28 years. Anti-platelet monotherapies may prove effective against both variants. Further studies are needed to confirm these findings.
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Affiliation(s)
- P J Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Y Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Kashetsky
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - A Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - A Mufti
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
| | - J Yeung
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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Lu JD, Sachdeva M, Silverberg OM, Shapiro L, Croitoru D, Levy R. Clinical and laboratory prognosticators of atrophic papulosis (Degos disease): a systematic review. Orphanet J Rare Dis 2021; 16:203. [PMID: 33957947 PMCID: PMC8101154 DOI: 10.1186/s13023-021-01819-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Degos disease is a rare vascular disorder with a cutaneous-limited form, benign atrophic papulosis (BAP), and a systemic variant, malignant atrophic papulosis (MAP). Despite the poor prognosis of MAP, no study has established features associated with systemic disease. Objectives The aims of this systematic review were to: (1) summarize clinical features and treatments implemented for patients with MAP and BAP (2) identify clinical and laboratory factors associated with the development of MAP, compared to BAP. Methods We systematically searched MEDLINE and Embase from inception to April 2020. Demographic and clinical features of Degos patients were presented descriptively; multivariable logistic regression was performed to identify associations with MAP. Results We identified 99 case studies, comprising 105 patients. MAP (64%) had a 2.15 year median survival time from cutaneous onset, most often with gastrointestinal or central nervous system involvement. We found that elevations in either of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) were associated with systemic involvement (OR 2.27, p = 0.023). Degos secondary to an autoimmune connective tissue disease was found to be inversely associated with MAP (OR 0.08, p = 0.048). Conclusions Elevated ESR or CRP is associated with MAP and may be a predictor of systemic involvement for patients with Degos disease. In addition, secondary Degos disease is associated with a favourable prognosis. Clinicians should be aware of the differences between primary and secondary Degos and the utility of ESR or CRP in identifying disease evolution to systemic involvement. The utility of ESR and CRP to identify systemic involvement should be further explored. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01819-z.
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Affiliation(s)
- Justin D Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Lee Shapiro
- Department of Medicine, Division of Rheumatology, Albany Medical College, Albany, NY, USA
| | - David Croitoru
- Division of Dermatology, Department of Medicine, Women's College Hospital, 76 Grenville St, 3rd Floor, Toronto, ON, M5S 1B2, Canada.
| | - Rebecca Levy
- Department of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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10
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Wang HQ, Guan Y, Gong XP, Chen YT, Ji C. Case Report: Pediatric Malignant Atrophic Papulosis With Small Bowel Perforation and Positivity of Anticardiolipin Antibody. Front Pediatr 2021; 9:764797. [PMID: 34956979 PMCID: PMC8703221 DOI: 10.3389/fped.2021.764797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Malignant atrophic papulosis (MAP) is a life-threatening vasculopathy affecting the skin, gastrointestinal tract, central nervous system, pleural membrane, and pericardium. MAP carries a poor prognosis primarily because of its systemic involvement. It is extremely rare in children. Herein, we report a pediatric case of MAP with small bowel perforation and anticardiolipin antibody positivity.
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Affiliation(s)
- Hai-Qing Wang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu Guan
- Department of Dermatology, Fujian Children's Hospital, Fuzhou, China
| | - Xiao-Pan Gong
- Department of Dermatology, Dermatology Hospital of Fuzhou, Fuzhou, China
| | - You-Tao Chen
- Department of Pediatrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Chao Ji
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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11
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Sathiyaraj A, Jayakumar P, McGlennon MR, Eckford JF, Anne SI. Bowel perforation from malignant atrophic papulosis treated with eculizumab. Proc (Bayl Univ Med Cent) 2020; 34:111-113. [PMID: 33456165 DOI: 10.1080/08998280.2020.1809942] [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: 10/23/2022] Open
Abstract
We present the case of a 57-year-old man with known cutaneous manifestations of malignant atrophic papulosis, also known as Köhlmeier-Degos disease, who developed an almost-fatal small bowel perforation following a parathyroidectomy. He required two surgical interventions during his initial hospitalization and was started on eculizumab. Despite these therapies, the patient developed recurrent bowel perforations and ultimately died.
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Affiliation(s)
- Ajithraj Sathiyaraj
- Department of Internal Medicine, Baylor Scott and White Medical Center - Round Rock, Texas
| | - Priyanga Jayakumar
- Department of Family Medicine, Baylor Scott and White Medical Center - Round Rock, Texas
| | - Matthew R McGlennon
- Department of Internal Medicine, Baylor Scott and White Medical Center - Round Rock, Texas
| | - John F Eckford
- Department of General Surgery, Baylor Scott and White Medical Center - Round Rock, Texas
| | - Sandy Itwaru Anne
- Department of General Surgery, Baylor Scott and White Medical Center - Round Rock, Texas.,Department of Hematology and Oncology, Baylor Scott and White Cancer Center - Round Rock, Texas
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12
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Affiliation(s)
- Adrien Mareschal
- Department of Dermatology, University Hospital of Besançon, Besançon, France
| | - Jérôme Razanamahery
- Department of Internal Medicine, University Hospital of Besançon, Besançon, France
| | - François Aubin
- Department of Dermatology, University Hospital of Besançon, Besançon, France
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13
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Saha BK, Beegle S. Chronic pleuritis leading to severe pulmonary restriction: a rare complication of Degos disease. BMJ Case Rep 2019; 12:12/12/e232759. [PMID: 31818897 DOI: 10.1136/bcr-2019-232759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This case demonstrates chronic fibrosing pleuritis, as a rare pulmonary aetiology for mortality in patients with Degos disease or malignant atrophic papulosis (MAP). Knowledge of this unusual complication will help physicians identify this entity early and provide appropriate treatment.Patients with MAP die from gastrointestinal and brain involvement within 2-3 years of diagnosis. This case is unique as the patient survived for 9 years and died secondary to respiratory failure, which had not been reported before. Our patient was a young man, diagnosed with MAP at the age of 17. His skin and gastrointestinal disease were controlled with eculizumab and parenteral treprostinil. The patient developed severe restrictive pulmonary disease, required ventilatory support, and died from respiratory failure. An autopsy revealed chronic fibrosis pleuritis. Longer surviving patients with MAP might suffer from significant respiratory disease. Pulmonary function test should be obtained to identify subclinical respiratory limitation.
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Affiliation(s)
- Biplab Kumar Saha
- Pulmonary and Critical Care Medicine, Albany Medical Center Hospital, Albany, New York, USA
| | - Scott Beegle
- Pulmonary and Critical Care Medicine, Albany Medical Center Hospital, Albany, New York, USA
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14
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Razanamahery J, Payet‐Revest C, Mareschal A, Saizonou I, Bonnet L, Gil H, Humbert S, Magy‐Bertrand N. Early failure of eculizumab in a patient with malignant atrophic papulosis: Is it time for initial combination therapy of eculizumab and treprostinil? J Dermatol 2019; 47:e22-e23. [DOI: 10.1111/1346-8138.15120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jerome Razanamahery
- Department of Internal Medicine Besancon University Hospital Besancon France
| | | | - Adrien Mareschal
- Department of Dermatology Besancon University Hospital Besancon France
| | - Ines Saizonou
- Department of Pathology Besancon University Hospital Besancon France
| | - Louise Bonnet
- Department of Neurology Besancon University Hospital Besancon France
| | - Helder Gil
- Department of Internal Medicine Besancon University Hospital Besancon France
| | - Sebastien Humbert
- Department of Internal Medicine Besancon University Hospital Besancon France
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15
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Wang SC, Patel H, Shapiro LS, Mookherjee S. Kohlmeier–Degos disease with constrictive pericarditis and atrial fibrillation. J Echocardiogr 2018; 16:192-193. [DOI: 10.1007/s12574-018-0386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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16
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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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17
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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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18
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Murthy AS, Kinsler V. White scarlike lesions in a female infant with bilious emesis and sixth nerve palsy. Pediatr Dermatol 2018; 35:242-243. [PMID: 29575076 DOI: 10.1111/pde.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aditi S Murthy
- Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Veronica Kinsler
- Pediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.,Genetics and Genomic Medicine, Institute of Child Health, University College of London, London, UK
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19
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Vision Loss, Rash, and Abnormal Brain Magnetic Resonance Imaging in a 17 Year Old. J Neuroophthalmol 2017; 37:303-308. [DOI: 10.1097/wno.0000000000000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Calderón-Castrat X, Yuste-Chaves M, Hernández A, Santos-Briz A, Fernández-López E. Degos disease, not just a scar: lethal outcome in spite of immunomodulatory therapy. J Eur Acad Dermatol Venereol 2017; 31:e435-e438. [DOI: 10.1111/jdv.14245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- X. Calderón-Castrat
- Department of Dermatology; University Hospital of Salamanca; Salamanca Spain
| | - M. Yuste-Chaves
- Department of Dermatology; University Hospital of Salamanca; Salamanca Spain
| | - A. Hernández
- Department of Neuropediatrics; University Hospital of Salamanca; Salamanca Spain
| | - A. Santos-Briz
- Department of Pathology; University Hospital of Salamanca; Salamanca Spain
| | - E. Fernández-López
- Department of Dermatology; University Hospital of Salamanca; Salamanca Spain
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21
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Calderón-Castrat X, Castro R, Peceros-Escalante J, Villate Caballero M, Chian C, Ballona R. Congenital Degos Disease: Case Report and Dermoscopic Findings. Pediatr Dermatol 2017; 34:e109-e115. [PMID: 28317162 DOI: 10.1111/pde.13096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric Degos disease is rare, with only 36 cases reported in the medical literature. Classically the diagnosis has been established according to pathognomonic histopathologic findings, but when these features are not present, there may be a delay in diagnosis. We report the second congenital case of Degos disease, highlighting the clinical and dermoscopic findings.
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Affiliation(s)
| | - Rosa Castro
- Department of Dermatology, Instituto Nacional de Salud del Niño, Lima, Perú
| | | | | | - Cesar Chian
- Department of Pathology, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Rosalía Ballona
- Department of Dermatology, Instituto Nacional de Salud del Niño, Lima, Perú
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22
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Affiliation(s)
- Vishalakshi Viswanath
- Department of Dermatology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India. E-mail:
| | - Jinal Lakhamshi Gada
- Department of Dermatology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India. E-mail:
| | - Ronak Jagdeep Shah
- Department of Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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23
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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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24
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Sharma S, Brennan B, Naden R, Whelan P. A case of Degos disease in pregnancy. Obstet Med 2016; 9:167-168. [PMID: 27829877 DOI: 10.1177/1753495x16652006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/06/2016] [Indexed: 11/15/2022] Open
Abstract
Degos disease is characterized as a rare systemic vaso-occlusive disorder, although the exact pathophysiology is uncertain. Fewer than 200 patients have been reported in the literature, and only two reports describe the course of the disease during pregnancy. Here, we present the first reported case of the course of pregnancy in a woman with the systemic form of Degos disease. The patient had been diagnosed with Degos prior to pregnancy and was monitored throughout the duration of the pregnancy. Her presentation and treatment are described. There was no further exacerbation secondary to the pregnancy itself; the pregnancy course was uncomplicated and the baby unaffected to date.
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Affiliation(s)
- Sapna Sharma
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McMaster University, Hamilton, ON, Canada
| | - Barbara Brennan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McMaster University, Hamilton, ON, Canada
| | - Ray Naden
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Whelan
- Division of Rheumatology, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA, USA; Heritage Provider Network, Los Angeles, CA, USA
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25
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Gmuca S, Boos MD, Treece A, Narula S, Billinghurst L, Bhatti T, Laje P, Perman MJ, Vossough A, Harding B, Burnham J, Banwell B. Degos disease mimicking primary vasculitis of the CNS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e206. [PMID: 26894208 PMCID: PMC4747475 DOI: 10.1212/nxi.0000000000000206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Sabrina Gmuca
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Markus D Boos
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Amanda Treece
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Sona Narula
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Lori Billinghurst
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Tricia Bhatti
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Pablo Laje
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Marissa J Perman
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Arastoo Vossough
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Brian Harding
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Jon Burnham
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
| | - Brenda Banwell
- Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA
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26
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Toledo AE, Shapiro LS, Farrell JF, Magro CM, Polito J. Laparoscopy shows superiority over endoscopy for early detection of malignant atrophic papulosis gastrointestinal complications: a case report and review of literature. BMC Gastroenterol 2015; 15:156. [PMID: 26527039 PMCID: PMC4630896 DOI: 10.1186/s12876-015-0387-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/22/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The malignant form of atrophic papulosis (Köhlmeier-Degos disease) is a rare thrombo-occlusive vasculopathy that can affect multiple organ systems. Patients typically present with distinctive skin lesions reflective of vascular drop out. The small bowel is the most common internal organ involved, resulting in considerable morbidity and mortality attributable to ischemic microperforations. Determination of the presence of gastrointestinal lesions is critical in distinguishing systemic from the benign, cutaneous only disease and in identifying candidates for treatment. CASE PRESENTATION We describe an 18 year old male who first presented with cutaneous atrophic papulosis but became critically ill from small bowel microperforations. He had an almost immediate and dramatic response to treatment. Prior to his presentation with acute abdomen he had upper and lower endoscopy showing areas of nonspecific patchy erythema. At laparotomy, innumerable characteristic lesions with central pearly hue and erythematous border were seen. PubMed was used for a literature search using the keywords malignant atrophic papulosis, Degos disease, endoscopy, laparoscopy and laparotomy. This search yielded 200 articles which were further analyzed for diagnostic procedures and findings. Among the 200 articles we identified only 11 cases in which endoscopy was performed. Results of endoscopy and laparotomy in our patient with malignant atrophic papulosis were compared to those in the literature. Endoscopy of the gastrointestinal tract has shown gastritis and non-specific inflammation whereas laparoscopy shows white plaques with red borders on the serosal surface of the small bowel and the peritoneum. From personal communications with other physicians worldwide, we identified three additional unpublished cases in which endoscopy revealed only minimal changes while laparoscopy showed dramatic lesions. From our experience the endoscopic findings are often subtle and nonspecific, whereas laparascopy or laparotomy will reveal pathognomic lesions on the serosal surface of the intestine. CONCLUSION Our report contrasts the endoscopic and laparoscopic findings in malignant atrophic papulosis which suggest laparoscopy is the more powerful means of detecting gastrointestinal involvement. Imaging studies may serve as a key indicator of systemic progression. Based on our experience, laparoscopy should be performed when there is a high index of suspicion for gastrointestinal malignant atrophic papulosis, even if endoscopic examination is non-diagnostic or normal.
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Affiliation(s)
- A E Toledo
- Steffens Scleroderma Center, Saratoga Springs, NY, USA. .,The Center for Rheumatology, Albany and Saratoga Springs, NY, USA.
| | - L S Shapiro
- Steffens Scleroderma Center, Saratoga Springs, NY, USA. .,The Center for Rheumatology, Albany and Saratoga Springs, NY, USA. .,Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
| | - J F Farrell
- Steffens Scleroderma Center, Saratoga Springs, NY, USA. .,The Center for Rheumatology, Albany and Saratoga Springs, NY, USA. .,Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
| | - C M Magro
- Weill Cornell College of Cornell University, New York, NY, USA.
| | - J Polito
- Gastroenterology Consultants, Albany, NY, USA.
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27
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Pirolla E, Fregni F, Miura IK, Misiara AC, Almeida F, Zanoni E. Degos disease - malignant atrophic papulosis or cutaneointestinal lethal syndrome: rarity of the disease. Clin Exp Gastroenterol 2015; 8:141-7. [PMID: 25926751 PMCID: PMC4403817 DOI: 10.2147/ceg.s59794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Degos disease is a very rare syndrome with a rare type of multisystem vasculopathy of unknown cause that affects the skin, gastrointestinal tract, and central nervous system. Other organs such as the kidneys, lungs, pleura, liver, heart, and eyes, can also be involved. OBJECTIVE To highlight the incidence of Degos disease with regard to age and sex, discuss the necessity of its accurate and early diagnosis, and demonstrate the most current techniques for its diagnosis; to discuss whether early therapeutic intervention can impact patient prognosis; and to present a literature review about this disease. DESIGN With a retrospective, observational, nonrandomized trial, we described the evolution of the different forms of Degos disease and referenced the literature. DATA SOURCES Research on rare documented cases in the literature, including two cases of potentially lethal form of the disease involving the skin and gastrointestinal system and, possibly, the lungs, kidneys, and central nervous system. A case of the benign form of the disease involving the skin was observed by the authors. MAIN OUTCOME MEASURES Differences between outcomes in patients with the cutaneointestinal form and skin-only form of the disease. There was one fatal outcome. We reviewed possible new approaches to diagnosis and treatment. RESULTS The study demonstrated the rapid evolution of the aggressive and malignant form of the disease. It also described newly accessible Phase I diagnostic tools being currently researched as well as new therapeutic approaches. LIMITATION The rarity of the disease, with only eleven cases throughout the literature. CONCLUSION The gastrointestinal form of Degos disease can be lethal. Its vascular etiology has finally been confirmed; however, new and more accurate early diagnostic modalities need to be developed. There are new therapeutic possibilities, but the studies of them are still in the early stages and have not yet shown the full effectiveness of these new therapies.
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Affiliation(s)
- Eduardo Pirolla
- Spaulding Rehabilitation Network Research Laboratory, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Spaulding Rehabilitation Network Research Laboratory, Harvard Medical School, Boston, MA, USA
| | - Irene K Miura
- University of São Paulo, Sirio Libanes Hospital, São Paulo, Brazil
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29
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Flühler C, Stinco G, di Meo N, Bonin S, Degrassi F, Bussani R, Cova M, Trevisan G. Malignant form of atrophic papulosis with lethal abdominal involvement. J Eur Acad Dermatol Venereol 2014; 30:126-8. [DOI: 10.1111/jdv.12612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Flühler
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
| | - G. Stinco
- Institute of Dermatology; Department of Experimental and Clinical Medicine; University of Udine; Gemona del Friuli Italy
| | - N. di Meo
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
| | - S. Bonin
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
| | - F. Degrassi
- Department of Radiology; Cattinara Hospital; University of Trieste; Trieste Italy
| | - R. Bussani
- Department of Histopathology; Ospedale di Cattinara di Trieste; University of Trieste; Strada di Fiume Trieste Italy
| | - M.A. Cova
- Department of Radiology; Cattinara Hospital; University of Trieste; Trieste Italy
| | - G. Trevisan
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
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