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Charakida A, Kubba F, Cintra ML, Teixeira F. Verrucous nodules on distal limbs. Int J Dermatol 2021; 60:1363-1365. [PMID: 33951181 DOI: 10.1111/ijd.15651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Aikaterini Charakida
- Department of Dermatology, Ealing Hospital, London Northwest University Healthcare NHS Trust, Southall, UK
| | - Faris Kubba
- Department of Pathology, Ealing Hospital, London Northwest University Healthcare NHS Trust, Southall, UK
| | - Maria L Cintra
- Faculty of Medical Sciences, State University of Campinas, Sao Paulo, Brazil
| | - F Teixeira
- Department of Dermatology, Ealing Hospital, London Northwest University Healthcare NHS Trust, Southall, UK.,Dermateixeira Consultants, Miami, FL, USA
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2
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Multiple Lobulated Nodules: Answer. Am J Dermatopathol 2020; 42:61-62. [PMID: 31880635 DOI: 10.1097/dad.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Hirayama SA, Pinheiro CAT, Guarenti IM, Oliveira DS. Exuberant case of erythema elevatum diutinum in a patient infected with HIV and hepatitis B virus. An Bras Dermatol 2020; 95:200-202. [PMID: 32173140 PMCID: PMC7175035 DOI: 10.1016/j.abd.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/27/2019] [Indexed: 11/30/2022] Open
Abstract
Erythema elevatum diutinum is a small vessel vasculitis which is benign, rare, and chronic. It is clinically characterized by violaceous, brown, or yellowish plaques, nodules, and papules. It has been associated with autoimmune, infectious, and neoplastic processes. The following case describes a patient with hepatitis B virus and human immunodeficiency virus with CD4 count<200mm3, HIV-seropositive for 16 years, and diagnosed with hepatitis B virus at the hospital. The patient was treated with oral dapsone 100mg/day, showing regression after seven months of treatment. The authors found three cases in the literature of association of erythema elevatum diutinum, human immunodeficiency virus, and hepatitis B virus.
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Affiliation(s)
- Sayuri Aparecida Hirayama
- Department of General Medicine, Teaching Hospital, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | | | - Isabelle Maffei Guarenti
- Empresa Brasileira de Serviços Hospitalares, Teaching Hospital, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Danise Senna Oliveira
- Department of General Medicine, Teaching Hospital, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Kaur M, Sahoo AK, Gupta S. Unusual presentation of erythema elevatum diutinum in an HIV-positive man with dramatic response to dapsone. Int J STD AIDS 2019; 30:1337-1339. [PMID: 31726928 DOI: 10.1177/0956462419874985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Erythema elevatum diutinum (EED) is a form of chronic leukocytoclastic vasculitis, which is known to occur in human immunodeficiency virus (HIV)-positive patients. Mostly, in the setting of HIV, it presents as plaques, nodules and occasionally as vesicles. We present a case of EED manifesting as annular plaques in an HIV-positive man, which was predominantly acral in distribution, involving the face also. After starting on dapsone, it disappeared completely in three days.
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Affiliation(s)
- Maninder Kaur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok K Sahoo
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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5
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Doktor V, Hadi A, Hadi A, Phelps R, Goodheart H. Erythema elevatum diutinum: a case report and review of literature. Int J Dermatol 2018; 58:408-415. [PMID: 30074624 DOI: 10.1111/ijd.14169] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 01/19/2023]
Abstract
Erythema elevatum diutinum (EED) is a rare cutaneous leukocytoclastic vasculitis thought to be related to increased levels of circulating antibodies. It has been shown to be associated with HIV infection, tuberculosis, as well as various autoimmune diseases. A retrospective review of all cases of EED indexed in PubMed between 1990 and 2014 was performed. Inclusion criteria for articles was availability of full text in English and a biopsy-confirmed diagnosis of EED. All other articles were excluded. Cases were stratified by age and anatomic location of the lesions. Treatment response was coded as "complete," "partial," and "none." A total of 133 cases of EED with 381 lesions detailed in case reports and case series were included. Twenty-one cases were associated with HIV. Of 47 patients with reported paraproteinemias, IgA paraproteinemia was found in 57.45%, IgG paraproteinemia in 29.8%, IgM paraproteinemia in 10.6%, and IgD paraproteinemia in 2.1% of cases. Of 40 (30.1%) patients with reported comorbid autoimmune disease, rheumatoid arthritis was associated with 10 cases. Cancer was found to be associated with 9.77% of cases. Seventy-five patients were treated with dapsone, with 36 (48%) achieving complete treatment response, 24 (32%) achieving partial response, and seven (9.3%) achieving no response. Keeping the clinical associations of EED in mind, especially malignancy, is critical in management of the disease. More structured studies need to take place in order to fully define the mechanisms and strength of these associations.
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Affiliation(s)
- Vladyslava Doktor
- Dermatology Department, St. John's Episcopal Hospital, Far Rockaway, NY, USA
| | - Ahmed Hadi
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali Hadi
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Phelps
- The Kimberly and Eric J. Waldman Department of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Herbert Goodheart
- The Kimberly and Eric J. Waldman Department of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jose SK, Marfatia YS. Erythema elevatum diutinum in acquired immune deficiency syndrome: Can it be an immune reconstitution inflammatory syndrome? Indian J Sex Transm Dis AIDS 2016; 37:81-4. [PMID: 27190420 DOI: 10.4103/0253-7184.180287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old male with acquired immune deficiency syndrome (AIDS) presented with multiple hyperpigmented papules and nodules on both ankles, dorsum of bilateral feet and soles. It was associated with mild itching and pain. The patient was diagnosed with human immunodeficiency virus (HIV) in 2007. First-line antiretroviral therapy (ART) was started in 2009 to which he responded initially. He was shifted to second-line ART 11 months ago in March 2015 due to treatment failure as suggested by CD4 count of 50 cells/mm(3). The present skin lesions started 2 months after the initiation of second-line ART. Differential diagnoses considered were Kaposi's sarcoma and immune reconstitution inflammatory syndrome (IRIS) related infections, but biopsy was suggestive of erythema elevatum diutinum (EED). Patient was started on oral dapsone 100 mg/day and increased to 200 mg/day to which he is responding gradually. In the present case, appearance of the lesions after initiation of second-line ART coupled with increase in CD4 count and decrease of viral load below undetectable level suggest that EED could be an IRIS.
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Affiliation(s)
- Sheethal K Jose
- Department of Skin-VD, SSG Hospital, Vadodara, Gujarat, India
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Cirvidiu DC, Elias BLF, Jorge JCF, Lira MLDA, Mandelbaum SH. Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship? An Bras Dermatol 2016; 90:561-3. [PMID: 26375227 PMCID: PMC4560547 DOI: 10.1590/abd1806-4841.20153284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Erythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology. It is believed to be due to deposition of immune complexes in the vessels. Clinically it is manifested as erythematous violaceous papules and nodules, isolated or confluent with hardened consistency, symmetrical, usually located on the extensor surface of the extremities, particularly over the joints. Diagnosis is based on clinical and histological findings. We report the case of a woman, 71 years old, with erythematous violaceous nodules on the hands, elbows, back and legs, beginning two years ago, with pain and itching. Histopathological analysis revealed leukocytoclastic vasculitis, confirming the clinical suspicion. Laboratory tests revealed hypothyroidism. We report the case because of its rarity, with subsequent review of the literature.
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Yıldız F, Karakaş T, Açıkalın A, Taş DA, Erken E. Erythema elevatum diutinum coexisting with ankylosing spondylitis. Eur J Rheumatol 2015; 2:73-75. [PMID: 27708930 DOI: 10.5152/eurjrheum.2015.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/04/2014] [Indexed: 11/22/2022] Open
Abstract
A 43-year-old woman presented to our hospital with the complaint of a reddish-purple rash on the extensor sides of her forearms. She had been diagnosed with ankylosing spondylitis 7 years ago. On physical examination, reddish-purple nodules were detected on the pretibial areas of both legs and extensor sides of both hands and forearms. Neutrophil, eosinophil, lymphocyte, and mixed-type leukocyte infiltration and erythrocyte extravasation were observed in skin biopsy. Erythema elevatum diutinum (EED) was diagnosed. For treatment, sulphasalazine, colchicine, and diclofenac were started. After 3 months of treatment, the lesions were healed. To the best of our knowledge, this is the first report of EED coexisting with ankylosing spondylitis.
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Affiliation(s)
- Fatih Yıldız
- Department of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Tuğba Karakaş
- Department of Dermatology, Sütcü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Arbil Açıkalın
- Department of Pathology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Didem Arslan Taş
- Department of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Eren Erken
- Department of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
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Rao GR, Joshi R, Phaneendra Prasad AK, Amareswar A, Sandhya S, Sridevi M. Nodular Erythema Elevatum Diutinum Mimicking Kaposi's Sarcoma in a Human Immunodeficiency Virus Infected Patient. Indian J Dermatol 2014; 59:592-4. [PMID: 25484391 PMCID: PMC4248498 DOI: 10.4103/0019-5154.143527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Erythema elevatum diutinum (EED) has been emerging as a specific Human Immunodeficiency Virus (HIV) associated dermatosis in recent times. It is an extremely rare chronic disease of unknown origin and part of the spectrum of leukocytoclastic vasculitis. We describe a case of EED simulating Kaposi's sarcoma in a 52-year-old HIV infected female patient with no previous opportunistic infections and CD4+ count of 164/mm(3). Therapy with oral dapsone (100 mg/day) for two weeks resulted in resolution of some lesions.
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Affiliation(s)
- G Raghurama Rao
- Department of DVL, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - Rajiv Joshi
- Department of Dermatopathology, Hinduja Hospitals, Mumbai, Maharashtra, India
| | | | - A Amareswar
- Surya Skin Care and Research Center, Visakhapatnam, Andhra Pradesh, India
| | - S Sandhya
- Surya Skin Care and Research Center, Visakhapatnam, Andhra Pradesh, India
| | - M Sridevi
- Surya Skin Care and Research Center, Visakhapatnam, Andhra Pradesh, India
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Momen S, Jorizzo J, Al-Niaimi F. Erythema elevatum diutinum: a review of presentation and treatment. J Eur Acad Dermatol Venereol 2014; 28:1594-602. [DOI: 10.1111/jdv.12566] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/29/2014] [Indexed: 01/19/2023]
Affiliation(s)
- S.E. Momen
- St John's Institute of Dermatology; London UK
| | - J. Jorizzo
- Wake Forest Baptist Health; Winstom Salem North Carolina USA
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11
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Kim JM, Song SH, Park Y, Eom M, Kim HS, Choi EH, Choi HK, Kim HY, Kim YK. Erythema Elevatum Diutinum in Human Immunodeficiency Virus Infected Patient. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.4.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Min Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Shin Han Song
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yumi Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Minseob Eom
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Kyoung Choi
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Smitha P, Sathish P, Mohan K, Sripathi H, Sachi G. A case of extensive erosive and bullous erythema elevatum diutinum in a patient diagnosed with human immunodeficiency virus (HIV). Int J Dermatol 2011; 50:989-91. [DOI: 10.1111/j.1365-4632.2010.04616.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lekhanont K, Patarakittam T, Mantachote K, Waiyawatjamai P, Vongthongsri A. Progressive Keratolysis with Pseudopterygium Associated with Erythema Elevatum Diutinum. Ophthalmology 2011; 118:927-33. [DOI: 10.1016/j.ophtha.2010.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 08/11/2010] [Accepted: 09/14/2010] [Indexed: 11/30/2022] Open
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Hatzitolios A, Tzellos TG, Savopoulos C, Tzalokostas V, Kaiafa G, Psomas E, Apostolopoulou M, Papadopoulos A. Erythema elevatum diutinum with rare distribution as a first clinical sign of non-Hodgkin's lymphoma: a novel association? J Dermatol 2008; 35:297-300. [PMID: 18477231 DOI: 10.1111/j.1346-8138.2008.00470.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of a 78-year-old man with erythema elevatum diutinum as a first clinical sign of non-Hodgkin's lymphoma. The patient developed erythema elevatum diutinum with an unusual distribution involving the trunk. Erythema elevatum diutinum is a rare dermatosis that is considered to be a localized, low-grade form of leukocytoclastic vasculitis associated with neoplastic, autoimmune and infectious processes. It is probably mediated by immune complexes. Recent studies report hematological disease as the most common factor associated with erythema elevatum diutinum. Many hematological diseases, such as myeloma, myelodysplastic syndrome and immunoglobulin (Ig)A monoclonal gammopathy, have been reported in association with erythema elevatum diutinum, but none with IgM monoclonal gammopathy and only one with malignant lymphoma. We would like to add IgM monoclonal gammopathy and non-Hodgkin's lymphoma as one of the diseases associated with erythema elevatum diutinum considering that the activity of erythema elevatum diutinum and non-Hodgkin's lymphoma fluctuated in parallel in the present case.
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Affiliation(s)
- Apostolos Hatzitolios
- 1st Medical Propedeutic Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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