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Hata Y, Tomita N, Shibata A, Yokoyama S, Fukahara K, Nishida N. An autopsy case of sudden unexpected death with Barlow's disease. Cardiovasc Pathol 2022;:107462. [PMID: 35952984 DOI: 10.1016/j.carpath.2022.107462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
A 45-year-old man was clinically diagnosed with mitral valve regurgitation 2 years before death. The autopsy showed left ventricular hypertrophy and mitral valve prolapse of the bileaflet with billowing valve and excessively thickened leaflet, the findings of which were consistent with Barlow's disease. Microscopically, destruction of the three-layer structure of the mitral valve and advanced interstitial fibrosis of the left ventricular wall were evident. Additionally, a marked but limited reduction in conduction fibers was found in the branching point of the left and right branches, as seen in cases of idiopathic complete atrioventricular block. Genetic investigation using whole-exome sequencing showed some genetic variants with uncertain significance. In patients with Barlow's disease, a marked reduction of conduction fibers might be a subtype of sudden cardiac death. The overlap of some arrhythmogenic substrate in the heart may increase the risk of sudden cardiac death with asymptomatic Barlow's disease.
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Esposito N, Polito MV, Mattiello G, Galderisi M. Cardiac Remodeling after Surgical Mitral Valvuloplasty for Barlow's Disease: Is it the Time to Look to the Load? J Cardiovasc Echogr 2021; 31:48-50. [PMID: 34221888 PMCID: PMC8230166 DOI: 10.4103/jcecho.jcecho_108_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022] Open
Abstract
We present the case of a 48-year-old man referred for a reduced exercise tolerance in whom a bileaflet mitral prolapse (Barlow's disease), associated with flail motion of posterior mitral leaflet and ruptured chordae tendineae and complicated by eccentric severe regurgitation, was incidentally diagnosed. Albeit paucisymptomatic, at echocardiography he showed the signs of LV dysfunction and, accordingly, was underwent surgical mitral valvuloplasty with implantation of the Memo 3D ReChord Ring without complications. We analyzed the changes of echocardiographic parameters of cardiac remodeling from baseline to post operative setting, highlighting the utility of modern imaging tools (strain and myocardial work) in grade to gauge with more sensitivity LV deformation and function in different conditions of pre and afterload and to overcome the limits of ancient ejection fraction. In conclusion, especially LV myocardial work may be a promising and accurate non load dipendent tool to quantify subclinical LV dysfunction, to guide therapeutic decisions and in post-surgical follow up.
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Affiliation(s)
- Nicolino Esposito
- Department of Internal Medicine, Evangelic Foundation, Naples, Italy
| | | | - Giacomo Mattiello
- Department of Internal Medicine, Evangelic Foundation, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Abstract
Mitral valve regurgitation (MR) is due primarily to either primary degeneration of the mitral valve with Barlow's or fibroelastic disease or is secondary to ischemic or nonischemic cardiomyopathies. Echocardiography is essential to assess MR etiology and severity, the remodeling of cardiac chambers and to characterize longitudinal chamber changes to determine optimal therapies. Surgery is recommended for severe primary MR if persistent symptoms are present or if left ventricle dysfunction is present with an EF <60% or a left ventricle end-systolic diameter ≥40 mm. For secondary MR, therapy of heart failure with vasodilators and diuretics improves forward cardiac output. Coronary artery bypass grafts (CABG) or percutaneous coronary intervention (PCI) should be considered for severe MR due to ischemia. This review summarizes the pathophysiology, the characteristics, the management and the different interventions for high risk patients with chronic primary and secondary MR.
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Affiliation(s)
- Robert J Henning
- University of South Florida, Tampa, FL 33612, USA.,James A Haley Hospital, Tampa, FL 33612, USA
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Feickert S, D'Ancona G, Neuhausen Abramkina A, Ince H. Treating Mitral Valve Prolapse in Barlow's Disease by Creation of a Medial MitraClip Bridge and a "New" Lateral Orifice: Rationale for MitraClip NTR Adoption. J Invasive Cardiol 2021; 33:E227-E228. [PMID: 33646968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Percutaneous mitral valve repair with MitraClip XTR (Abbott Vascular) has been proposed in patients with Barlow's disease, as the extended length of the MitraClip XTR may facilitate "grasping" and limit the number of clips. However, the design of the MitraClip XTR includes arms that 3 mm longer than the NTR device as well as 2 additional frictional elements, and requires a patient selection based mainly on mitral valve tissue quality. We summarize our rationale for using the shorter and smaller MitraClip NTR in patients with Barlow's disease.
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Affiliation(s)
- Sebastian Feickert
- Department of Cardiology, Vivantes Klinikum Urban, Dieffenbachstraße 1, 10967 Berlin, Germany.
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Kelley BP, Gazda C, Sivak JA, Vavalle JP, Weickert TT. Successful MitraClip Implantation in a Barlow's Valve: A Feasible Alternative? CASE (Phila) 2021; 5:73-77. [PMID: 33644518 PMCID: PMC7887515 DOI: 10.1016/j.case.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
•Barlow's disease is a degenerative mitral valvulopathy with highly complex anatomy. •Barlow's disease is classically unfavorable for TMVr using MitraClip. •Patients with Barlow's disease, SAM, and high surgical risk may be candidates for TMVr.
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Affiliation(s)
- Brian P Kelley
- Department of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Casey Gazda
- Division of Cardiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Joseph A Sivak
- Division of Cardiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - John P Vavalle
- Division of Cardiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Thelsa T Weickert
- Division of Cardiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
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Sakaguchi T, Totsugawa T, Hayashida A, Ryomoto M, Sekiya N, Tamura K, Hiraoka A, Yoshitaka H. Stepwise mitral valve repair for Barlow's disease via a minimally invasive approach. J Card Surg 2020; 35:1471-1476. [PMID: 32383283 DOI: 10.1111/jocs.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Mitral regurgitation (MR) in Barlow's disease is complicated because of its mixed pathophysiology, leaflet billowing with or without organic prolapse, and abnormal annular dynamics that cause functional prolapse. Complex repair techniques, including aggressive leaflet resection and implantation of multiple artificial chordae, are conventionally performed; nevertheless, these are technically demanding, especially when performed using a minimally invasive approach. We aimed to standardize the repair technique for Barlow's disease and developed stepwise repair techniques. METHODS Of 292 patients who underwent isolated minimally invasive mitral valve repair for MR, 29 patients (seven females, age 49 ± 10 years) were found to have Barlow's disease. Our repair technique consists of the following three steps: (a) stabilization of the mitral annulus by placing annuloplasty ring sutures; (b) distinction between organic and functional prolapse by a saline injection test; and (c) targeted repair for organic prolapse by leaflet resection or chordal replacement. RESULTS Surgical techniques included leaflet resection in 22 patients, chordal replacement in 19 patients, and ring annuloplasty only in one patient. These procedures were applied to the anterior leaflet in one, posterior leaflet in eight, and both leaflets in 19 patients. The median annuloplasty ring size was 34 mm. The repair success rate was 100%. No patients developed moderate or greater MR during a mean follow-up period of 36 ± 21 months. CONCLUSIONS A stepwise repair strategy facilitates mitral valve repair in patients with Barlow's disease and provides excellent outcomes even via a minimally invasive approach.
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Affiliation(s)
- Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Akihiro Hayashida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Masaaki Ryomoto
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Naosumi Sekiya
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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Imbrie-Moore AM, Paulsen MJ, Zhu Y, Wang H, Lucian HJ, Farry JM, MacArthur JW, Ma M, Woo YJ. A novel cross-species model of Barlow's disease to biomechanically analyze repair techniques in an ex vivo left heart simulator. J Thorac Cardiovasc Surg 2020; 161:1776-1783. [PMID: 32249088 DOI: 10.1016/j.jtcvs.2020.01.086] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Barlow's disease remains challenging to repair, given the complex valvular morphology and lack of quantitative data to compare techniques. Although there have been recent strides in ex vivo evaluation of cardiac mechanics, to our knowledge, there is no disease model that accurately simulates the morphology and pathophysiology of Barlow's disease. The purpose of this study was to design such a model. METHODS To simulate Barlow's disease, a cross-species ex vivo model was developed. Bovine mitral valves (n = 4) were sewn into a porcine annulus mount to create excess leaflet tissue and elongated chordae. A heart simulator generated physiologic conditions while hemodynamic data, high-speed videography, and chordal force measurements were collected. The regurgitant valves were repaired using nonresectional repair techniques such as neochord placement. RESULTS The model successfully imitated the complexities of Barlow's disease, including redundant, billowing bileaflet tissues with notable regurgitation. After repair, hemodynamic data confirmed reduction of mitral leakage volume (25.9 ± 2.9 vs 2.1 ± 1.8 mL, P < .001) and strain gauge analysis revealed lower primary chordae forces (0.51 ± 0.17 vs 0.10 ± 0.05 N, P < .001). In addition, the maximum rate of change of force was significantly lower postrepair for both primary (30.80 ± 11.38 vs 8.59 ± 4.83 N/s, P < .001) and secondary chordae (33.52 ± 10.59 vs 19.07 ± 7.00 N/s, P = .006). CONCLUSIONS This study provides insight into the biomechanics of Barlow's disease, including sharply fluctuating force profiles experienced by elongated chordae prerepair, as well as restoration of primary chordae forces postrepair. Our disease model facilitates further in-depth analyses to optimize the repair of Barlow's disease.
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Affiliation(s)
- Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Haley J Lucian
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Justin M Farry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif.
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Pang B, Wang Y, Liu S, Yang J, Gu T, Ma C. Three-dimensional echocardiography of mitral Barlow's disease with infective endocarditis: Perforations or cleft-like indentations? J Clin Ultrasound 2019; 47:376-379. [PMID: 30689215 DOI: 10.1002/jcu.22697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/30/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
Barlow's disease is a complicated form of degenerative mitral valve (MV) disease. Infective endocarditis (IE) often occurs on the basis of primary heart diseases and may be combined with valve perforations. Cleft-like indentations (CLIs) were suggested by Ring et al. in 2013. They are located at the inter-scallop position and involve at least one-half of the valve. Herein, we report a case of Barlow's disease combined with IE and CLIs, which was confirmed intra-operatively and by histopathological examination. The CLIs were misdiagnosed by two-dimensional transthoracic echocardiography as perforations, but rightly interpreted by preoperative three-dimensional echocardiography. The possibility of CLIs should be considered in the evaluation of mitral regurgitation caused by myxomatous MV diseases.
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Affiliation(s)
- Bo Pang
- The Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yonghuai Wang
- The Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- The Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jun Yang
- The Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Tianxiang Gu
- The Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- The Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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9
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Wilkins CS, McCabe K, Deobhakta A, Chelnis J. Central retinal artery occlusion secondary to Barlow's disease. Am J Ophthalmol Case Rep 2018; 10:249-252. [PMID: 29780944 PMCID: PMC5956717 DOI: 10.1016/j.ajoc.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/23/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a rare case of isolated, unilateral CRAO in a young patient with mitral valve prolapse secondary to Barlow's disease. OBSERVATIONS A 29-year-old woman with history of premature ventricular contractions and cardiac ablation presented to the emergency room after sudden onset painless visual loss in her left eye (OS). Her vision was 20/20 in her right eye and hand motion in the left. Fundus exam demonstrated a central retinal artery occlusion (CRAO) OS. Computerized tomography of head and neck were unremarkable. She underwent cerebral angiogram and local intra-arterial thrombolysis. Her vision remained stable post-procedure, with marked APD and stable fundus examination. Her cardiac work-up revealed a left atrial mass with calcified mitral valve, and small atrial septal defect. Rheumatologic, hematologic, and auto-immune work-up were unremarkable. She underwent resection of the mass with repair of mitral valve and ASD closure. Surgical pathology was compatible with diagnosis of Barlow's disease, a cause of mitral valve prolapse. The patient underwent intravitreal injection of anti-VEGF therapy at one month follow-up, with vision stable at hand motion and without neovascularization on subsequent evaluation. CONCLUSIONS In young patients presenting with CRAO, aggressive work-up for systemic disease or embolic source must be undertaken to avoid future sequelae.
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Affiliation(s)
- Carl S. Wilkins
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Katherine McCabe
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA
| | - Avnish Deobhakta
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA
| | - James Chelnis
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA
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Ishikawa N, Watanabe G, Tarui T, Horikawa T, Seguchi R, Kiuchi R, Tomita S, Ohtake H, Kawachi K. Robotic mitral valve plasty for mitral regurgitation after blunt chest trauma in Barlow's disease. Asian J Endosc Surg 2018; 11:35-38. [PMID: 28703435 DOI: 10.1111/ases.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 12/01/2022]
Abstract
We successfully treated a case of mitral regurgitation due to chest trauma in Barlow's disease. A 71-year-old man was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. Preoperative examination revealed wide chordae tendineae rupture and myxomatous changes to the bileaflets. Neo-chordae reconstruction of the anterior mitral leaflet using loop technique, triangular resection of the posterior mitral leaflet, and ring annuloplasty was performed via surgical robot. Robotic mitral valve plasty for severe mitral regurgitation due to chest trauma in Barlow's disease was achieved safely with good clinical and excellent cosmetic results.
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Affiliation(s)
- Norihiko Ishikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Tatsuya Tarui
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Takahumi Horikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Ryuta Seguchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Ryuta Kiuchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Shigeyuki Tomita
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Hiroshi Ohtake
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Kenji Kawachi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
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André R, Gabrielli A, Laffitte E, Kherad O. [Atypical scurvy associated with anorexia nervosa]. Ann Dermatol Venereol 2016; 144:125-129. [PMID: 27502755 DOI: 10.1016/j.annder.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/14/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Scurvy, or "Barlow's disease", is a widely described disease involving cutaneous and mucosal lesions resulting from vitamin C deficiency. Herein, we report a case of scurvy in a 48-year-old woman that was unusual in its atypical cutaneous-mucosal presentation as well as its association with anorexia nervosa. PATIENTS AND METHODS A 48-year-old woman treated for depression for several years was admitted to hospital for her impaired general state of health. Over the last year, she had presented palmoplantar rash and episodes of perimalleolar oedema. The clinical examination showed the patient to have wasting syndrome, with a BMI of 11.9kg/m2, lower-limb oedema, palmoplantar fissures, geographic tongue, telogen effluvium and purpuric petechiae on her right knee. However, no gingival bleeding was noted and there was no loss of tooth enamel. The remainder of the clinical examination was normal. Blood tests revealed extremely low vitamin C levels without any other associated deficiencies, as well as laboratory signs of cytolysis and anicteric cholestasis without inflammatory syndrome. The diagnosis of anorexia nervosa was made by psychiatrists, despite the unusual age of onset. Favorable clinical outcome was rapidly achieved via a one-month course of vitamin C supplements at a daily dose of 1g. DISCUSSION The absence of classical buccal-dental symptoms and the presence of keratotic dermatosis with fissures and ulcers on the hands and feet are atypical in scurvy; however, this diagnosis was confirmed by the existence of purpura evoking capillary fragility, the patient's drastically low vitamin C level and the rapid subsidence of symptoms following treatment with oral vitamin C alone. Anorexia nervosa was doubtless the cause of deficiency. This situation is rare and a systematic review of the literature in Medline via PubMed showed that only three reports of scurvy associated with mental anorexia have been published since 1975.
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Affiliation(s)
- R André
- Service de médecine interne générale, hôpitaux universitaires de Genève, 1206 Genève, Suisse.
| | - A Gabrielli
- Service de médecine interne générale, hôpitaux universitaires de Genève, 1206 Genève, Suisse
| | - E Laffitte
- Service de dermatologie et vénéréologie, hôpitaux universitaires de Genève, 1206 Genève, Suisse
| | - O Kherad
- Service de médecine interne générale, hôpitaux universitaires de Genève, 1206 Genève, Suisse; Service de médecine interne, hôpital de la Tour, 1217 Meyrin-Genève, Suisse
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12
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Roudil P, Jaffelin C, Gay C, Mory O, Stephan JL. [Infantile scurvy: Two cases]. Ann Dermatol Venereol 2015; 142:675-9. [PMID: 26363998 DOI: 10.1016/j.annder.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/12/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scurvy is the classic and most severe form of vitamin C deficiency. This condition has become extremely rare among children in the industrialized countries. PATIENTS AND METHODS We report the case of two boys presenting bone pain associated with haemorrhagic gingivitis, with perifollicular purpura of the lower limbs in one boy. The children had an unbalanced diet. Scurvy was associated with vitamin D and iron deficiency. The dermatological and radiological abnormalities seen were characteristic and a favourable outcome was rapidly obtained following supplementation. DISCUSSION The possibility of this forgotten historical illness should not be overlooked in the presence of these dermatological and rheumatologic signs, since this can help avoid unnecessary or excessively aggressive investigations.
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Affiliation(s)
- P Roudil
- Service de pédiatrie, hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France.
| | - C Jaffelin
- Service de dermatologie, hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - C Gay
- Service de pédiatrie, hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - O Mory
- Service des urgences médico-chirurgicales pédiatriques, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - J-L Stephan
- Service de pédiatrie, immuno-hématologie et oncologie pédiatrique, hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France
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