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Alonso JV, McKeown S, Montoro E. Degos disease: A rare disease with a fatal outcome. Med Clin (Barc) 2024:S0025-7753(24)00195-7. [PMID: 38692989 DOI: 10.1016/j.medcli.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 05/03/2024]
Affiliation(s)
| | - Samuel McKeown
- Emergency Physician, Royal Bournemouth Hospital, Bournemouth, UK
| | - Esther Montoro
- Emergency Physician, Hospital Santa Lucia, Cartagena, Spain
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2
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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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3
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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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Li ZG, Zhou JM, Li L, Wang XD. Malignant atrophic papulosis: Two case reports. World J Clin Cases 2022; 10:12971-12979. [PMID: 36569027 PMCID: PMC9782946 DOI: 10.12998/wjcc.v10.i35.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Malignant atrophic papulosis is a rare and potentially lethal thrombo-occlusive microvasculopathy characterized by cutaneous papules and gastrointestinal perforation. The precise pathogenesis of this disease remains obscure.
CASE SUMMARY We describe the case of a 67-year-old male patient who initially presented with cutaneous aubergine papules and dull pain in the epigastrium. One week after symptom onset, he was admitted to the hospital for worsening abdominal pain. Exploratory laparotomy showed patchy necrosis and subserosal white plaque lesions on the small intestinal wall, along with multiple perforations. Histological examination of the small intestine showed extensive hyperemia, edema, necrosis with varying degrees of inflammatory reactions in the small bowel wall, small vasculitis with fibrinoid necrosis and intraluminal thrombosis in the mesothelium. Based on the mentioned evidence, a diagnosis of malignant atrophic papulosis was made. We also present the case of a 46-year-old man with known cutaneous manifestations, abdominal pain, nausea and vomiting. His physical examination showed positive rebound tenderness. A computed tomography scan revealed free intraperitoneal air. He required surgical intervention on admission and then developed an esophageal perforation. He ultimately died of a massive hemorrhage.
CONCLUSION In previously published cases of this disease, the cutaneous lesions initially appeared as small erythematous papules. Subsequently, the papules became porcelain-white atrophic depression lesions with a pink, telangiectatic peripheral rim. In one of the patients, the cutaneous lesions appeared as aubergine papules. The other patient developed multiple perforations in the gastrointestinal tract. Due to malignant atrophic papulosis affecting multiple organs, many authors speculated that it is not a specific entity. This case series serves as additional evidence for our hypothesis.
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Affiliation(s)
- Zhi-Gui Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Ming Zhou
- Department of Clinical Medicine, West China School of Medicine, Sichuan University, Chengdu 610207, Sichuan Province, China
| | - Li Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Dong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Croitoru D, Lu JD, Ling SC, Wales P, Levy R. Laparoscopic Detection of Malignant Atrophic Papulosis (MAP) in a Pediatric Patient. J Eur Acad Dermatol Venereol 2022; 36:e1052-e1054. [PMID: 35857385 DOI: 10.1111/jdv.18446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto Ontario, Canada
| | - Justin D Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simon C Ling
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Wales
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rebecca Levy
- Division of Dermatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Section of Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Zouboulis CC, Theodoridis A, Makrantonaki E. Inflammation and thrombo-occlusive vessel signalling in benign atrophic papulosis (Köhlmeier-Degos disease). J Eur Acad Dermatol Venereol 2022; 36:2195-2198. [PMID: 35748122 DOI: 10.1111/jdv.18362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the merely cutaneous, benign form of the extremely rare disease atrophic papulosis (Köhlmeier-Degos disease) may occasionally develop into the systemic, malignant form with time, it is unclear whether it itself exhibits any systemic characteristics. OBJECTIVE To determine whether benign atrophic papulosis exhibits inflammatory and thrombo-occlusive signals and to classify it according to the Chapel-Hill classification of vasculitis. METHODS In a monocentric, controlled study, levels of cytokines (IL-1β, IL-6, IL-8, IFNγ, MCP-1, VEGF, TNFα, TGF-β1), antiphospholipid antibodies (cardiolipin IgG/A/M, cardiolipin IgG, cardiolipin IgM, β2-glycoprotein IgG/A/M, phosphatidyl choline, phosphatidyl serine, phosphatidyl inositol, phosphatidyl ethanolamine and sphingomyelin A), antibodies against proteinase-3 IgG and myeloperoxidase IgG, antinuclear antibodies and extractable nuclear antigen were assessed in blood samples of six benign atrophic papulosis patients and six age- and sex-matched healthy controls. RESULTS IL-8 was only detectable in patients' serum. VEGF was reduced and cardiolipin IgG/A/M and β2-glycoprotein antibodies were increased in the patients' group. ANA were only detected in three patients, ENA were throughout negative. No differences were detected between the other investigated markers. CONCLUSIONS This is the first study evaluating systemic inflammatory and thrombo-occlusive vessel signalling in benign atrophic papulosis and provide evidence of a non-antineutrophil cytoplasmatic antibodies immune-complex small vessel vasculitis according to the Chapel-Hill classification. These findings corroborate its systemic character despite the apparent missing involvement of systemic organs.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - A Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - E Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
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7
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Kaleta KP, Jarienė V, Theodoridis A, Nikolakis G, Zouboulis CC. Atrophic papulosis (Köhlmeier-Degos disease) revisited. A cross-sectional study on 105 patients. J Eur Acad Dermatol Venereol 2022; 36:2190-2194. [PMID: 35610757 DOI: 10.1111/jdv.18260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrophic papulosis is a very rare vascular disease of unknown pathogenesis, mostly described by case reports. OBJECTIVE To assess demographic data and prognosis in patients with atrophic papulosis. METHODS Single-centre study on a series of 105 patients with atrophic papulosis, diagnosed 2000-2021. Patients referred and diagnosed at the evaluation centre and patients' clinical data provided by the Degos Support Network and evaluated by the authors for confirming diagnosis for skin lesions and fulfilling the diagnostic criteria for a malignant subset. A unique set of variables was collected from all patients. RESULTS The mean age of disease onset was 33.3±18.3 years and the male-to-female ratio 1:1.6. The family history rate was 8.1%. The classification into a benign, merely cutaneous one (benign atrophic papulosis), and malignant atrophic papulosis, associating cutaneous and visceral lesions was confirmed due to their striking prognostic difference. Benign atrophic papulosis was detected in 41% of the patients with no deaths occurring throughout the follow-up period (median 3.00 years; range 0.13-23). Malignant atrophic papulosis was reported in 59% of patients with 47.5% multisystemic involvement and a median skin lesion onset to systemic symptoms duration of 0.54 years (-6 to 20). Gastrointestinal tract and central nervous system were equally involved; however, the neurological sign-caused death rate was slightly higher. The disease-specific mortality rate of malignant atrophic papulosis was 22.6%. CONCLUSIONS Atrophic papulosis presents with striking prognostic difference of benign - merely cutaneous - involvement or quickly developing - into less than one year - malignant subset, associating cutaneous and visceral lesions and multiorgan involvement in 1/2 of the patients, which leads to premature, disease-specific mortality in 1/4 of the cases. Central nervous system and gastrointestinal tract involvement complications are the major reasons for disease-specific death. Over the years the diagnosis of severe nervous system involvement has become more common.
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Affiliation(s)
- K P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - V Jarienė
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - A Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
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