Thalidomide-Then and Now: Case Report of a Woman With Thalidomide Embryopathy and Review of Current Thalidomide Uses

The Cutaneous Manifestations of Drug Reactions Can Mimic Traumatic Injuries: Case Reports and the Potential Role of Forensic Dermatology

The evaluation of the skin of the decedent is an essential component of the assessment by the forensic pathologist or the medical examiner. Age-associated cutaneous changes, primary diseases of the skin, and systemic conditions with mucocutaneous manifestations can be present. Importantly, several dermatoses can be misinterpreted for traumatic injuries; specifically, adverse reactions to medications can mimic assault, burns, elder abuse, and mutilation or torture. A male with corticosteroid-induced dermatitis mimicking an acute burn is described. A female with thalidomide embryopathy is reported with extensive deformities of her hands and feet with multiple absent digits mimicking a severe injury resulting from mutilation or torture. Another female is described who had hydroxychloroquine-associated hyperpigmentation; her physician misinterpreted the cutaneous hyperpigmentation as bruises and notified Adult Protective Services. Reactions to medications can also mimic assault, burns, and elder abuse. Drug reaction with eosinophilia and systemic symptoms (particularly when associated with phenytoin) can mimic assault. Albeit rarely, the antihypertensive irbesartan can result in dramatic edema of the face and eyelids similar to that observed following an assault. Drug-induced erythema multiforme can mimic a localized burn, and Stevens-Johnson syndrome or vancomycin infusion reaction can mimic an extensive burn. Several medications can mimic bruising observed in victims of elder abuse; they include amiodarone, arsenic, and tetracyclines (such as minocycline and doxycycline). In summary, an important aspect of the forensic evaluation during an autopsy includes a complete cutaneous examination; to aid in differentiating medication-associated dermatoses that can mimic traumatic injury, the evaluation of the decedent by a forensic dermatologist may be helpful to establish the etiology of observed skin changes.

Modeling the enigma of complex disease etiology

BACKGROUND

Complex diseases often present as a diagnosis riddle, further complicated by the combination of multiple phenotypes and diseases as features of other diseases. With the aim of enhancing the determination of key etiological factors, we developed and tested a complex disease model that encompasses diverse factors that in combination result in complex diseases. This model was developed to address the challenges of classifying complex diseases given the evolving nature of understanding of disease and interaction and contributions of genetic, environmental, and social factors.

METHODS

Here we present a new approach for modeling complex diseases that integrates the multiple contributing genetic, epigenetic, environmental, host and social pathogenic effects causing disease. The model was developed to provide a guide for capturing diverse mechanisms of complex diseases. Assessment of disease drivers for asthma, diabetes and fetal alcohol syndrome tested the model.

RESULTS

We provide a detailed rationale for a model representing the classification of complex disease using three test conditions of asthma, diabetes and fetal alcohol syndrome. Model assessment resulted in the reassessment of the three complex disease classifications and identified driving factors, thus improving the model. The model is robust and flexible to capture new information as the understanding of complex disease improves.

CONCLUSIONS

The Human Disease Ontology's Complex Disease model offers a mechanism for defining more accurate disease classification as a tool for more precise clinical diagnosis. This broader representation of complex disease, therefore, has implications for clinicians and researchers who are tasked with creating evidence-based and consensus-based recommendations and for public health tracking of complex disease. The new model facilitates the comparison of etiological factors between complex, common and rare diseases and is available at the Human Disease Ontology website.