1
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Gonzales Y Tucker RD, Addepalli A. Fever and Rash. Emerg Med Clin North Am 2024; 42:303-334. [PMID: 38641393 DOI: 10.1016/j.emc.2024.01.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Infectious causes of fever and rash pose a diagnostic challenge for the emergency provider. It is often difficult to discern rashes associated with rapidly progressive and life-threatening infections from benign exanthems, which comprise the majority of rashes seen in the emergency department. Physicians must also consider serious noninfectious causes of fever and rash. A correct diagnosis depends on an exhaustive history and head-to-toe skin examination as most emergent causes of fever and rash remain clinical diagnoses. A provisional diagnosis and immediate treatment with antimicrobials and supportive care are usually required prior to the return of confirmatory laboratory testing.
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Affiliation(s)
- Richard Diego Gonzales Y Tucker
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Emergency Medicine, Alameda Health System - Wilma Chan Highland Hospital, 1411 E 31st Street, Oakland, CA 94602, USA.
| | - Aravind Addepalli
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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2
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Klapproth H, Rauterberg J, Shabli S, Silling S, Böttcher S, von Stebut E, Fabri M. Papulovesikulöses Exanthem und ausgeprägter einseitiger Hörverlust bei einem 20‐jährigen Mann. J Dtsch Dermatol Ges 2024; 22:720-723. [PMID: 38730528 DOI: 10.1111/ddg.15363_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/06/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Henning Klapproth
- Klinik für Dermatologie und Venerologie, Medizinische Fakultät, Universität zu Köln und Uniklinik Köln
| | - Jonas Rauterberg
- Klinik für Dermatologie und Venerologie, Medizinische Fakultät, Universität zu Köln und Uniklinik Köln
| | - Sami Shabli
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät, Universität zu Köln und Uniklinik Köln
| | - Steffi Silling
- Institut für Virologie, Medizinische Fakultät, Universität zu Köln und Uniklinik Köln
| | - Sindy Böttcher
- Nationales Referenzzentrum für Poliomyelitis und Enteroviren, Robert Koch Institut, Berlin
| | - Esther von Stebut
- Klinik für Dermatologie und Venerologie, Medizinische Fakultät, Universität zu Köln und Uniklinik Köln
| | - Mario Fabri
- Klinik für Dermatologie und Venerologie, Medizinische Fakultät, Universität zu Köln und Uniklinik Köln
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln
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3
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Tahri NB, Gravdehaug B, Bahrami N, Reitsma L. A woman in her fifties with a post-operative infection, generalised rash and organ failure. Tidsskr Nor Laegeforen 2024; 144:23-0623. [PMID: 38651709 DOI: 10.4045/tidsskr.23.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Background Toxic shock syndrome (TSS) is a rare but potentially life-threatening disease caused by superantigen-producing Gram-positive bacteria such as Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS received special attention from 1978 to 1981, when an epidemic was observed associated with the use of hyper-absorbent tampons. Today the disease is rare and generally not related to menstruation, but can occur postpartum or in post-surgical wounds, intrauterine devices (IUDs), burns or other soft tissue injuries, mastitis or other focal infections. The annual incidence of staphylococcal TSS is around 0.5/100 000 and around 0.4/100 000 for streptococcal TSS. The mortality in menstrual-related cases is < 5 % and up to 22 % in non-menstrual related cases. Case presentation This article presents a case of a middle-aged woman who developed symptoms of toxic shock syndrome five days after elective breast cancer surgery, with high fever, multiorgan failure and a characteristic desquamation of the palms. Interpretation Toxic shock syndrome is a potentially lethal, toxin-mediated disease. Symptoms develop quickly, within hours. Early recognition and appropriate surgical management, intensive care and antibiotics are therefore important to reduce mortality and sequelae.
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Affiliation(s)
- Naima Borg Tahri
- Bryst- og endokrinkirurgisk avdeling, Akershus universitetssykehus
| | - Berit Gravdehaug
- Bryst- og endokrinkirurgisk avdeling, Akershus universitetssykehus
| | - Nazli Bahrami
- Bryst- og endokrinkirurgisk avdeling, Akershus universitetssykehus
| | - Laurens Reitsma
- Bryst- og endokrinkirurgisk avdeling, Akershus universitetssykehus
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4
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Hulshof MM, Starink MV, Lokin ASHJ, Hovius JW. [Cutaneous Lyme disease: not always a rash with a central clearing]. Ned Tijdschr Geneeskd 2024; 168:D7863. [PMID: 38568004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
During the past four decades the number of reported Lyme disease diagnoses in the Netherlands has increased to 27.000 a year, with a yearly incidence of Lyme disease between 111 (95% CI 106-115) to 131 (95% CI 126-136) per 100,000 person years. A large part of all Lyme disease diagnoses concern the skin; in the Netherlands, 77-89% erythema migrans, 2-3% borrelia lymfocytoom and 1-3% acrodermatitis chronica atrophicans. These skin manifestations have a variable clinical expression, reason why they can be difficult to diagnose. Early recognition and treatment is important to prevent the development of systemic manifestations.
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Affiliation(s)
| | | | | | - Joppe W Hovius
- Amsterdam UMC, Amsterdam. Afd. Inwendige Geneeskunde en Infectieziekten
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5
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Gupta A, de Menezes SL. Red in the face: Approach to diagnosis of red rashes on the face. Aust J Gen Pract 2024; 53:203-209. [PMID: 38575540 DOI: 10.31128/ajgp-08-23-6930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND A red rash on the face in an adult patient is a common presentation to general practice in Australia. Rashes on the face significantly affect quality of life because this is a cosmetically sensitive site. Ascertaining the correct diagnosis is therefore of utmost importance so that appropriate treatment can be initiated. OBJECTIVE This article discusses the assessment of red rashes on the face in an adult patient. DISCUSSION Diagnosing a red rash on the face requires assessment of symptomology, age of onset, rash morphology and 'clinical clues' that help delineate between differentials. Although the list of differential diagnoses is wide, many of the common diagnoses can be made clinically without the need for investigations. Investigations such as skin biopsy are useful if the diagnosis is unclear, if the rash is not responding to initial treatment and/or a referral to a dermatologist is being considered.
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Affiliation(s)
- Ankit Gupta
- MBBS (Hons), DipArts (Phil), FRACGP, General Practitioner, Aged Care GP, Melbourne, Vic; General Practitioner, Mole Check Clinic, Melbourne, Vic
| | - Sara Lee de Menezes
- MBBS (Hons), MPhil, FACD, Consultant Dermatologist, Dermatology Department, Northern Hospital, Melbourne, Vic; Consultant Dermatologist, Preston Dermatology and Specialist Centre, Melbourne, Vic
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6
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Gonzales DN, Punia JN, Patil MS. Neonate With a Diffuse Maculopapular and Nodular Rash. Neoreviews 2024; 25:e232-e236. [PMID: 38556494 DOI: 10.1542/neo.25-3-e232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Danielle N Gonzales
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
| | - Jyotinder Nain Punia
- Department of Pathology and Immunology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Monika S Patil
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
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7
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Gonzales DN, Punia JN, Patil MS. Neonate With a Diffuse Maculopapular and Nodular Rash. Neoreviews 2024; 25:e232-e236. [PMID: 38556503 DOI: 10.1542/neo.25-4-e232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Danielle N Gonzales
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
| | - Jyotinder Nain Punia
- Department of Pathology and Immunology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Monika S Patil
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
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8
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Koroneos G, Berry W, Sweeney N, Morgan V, Harun NS, Nicolopoulos J. Reactive infectious mucocutaneous eruption secondary to COVID-19 infection: A case report and review of the literature. J Eur Acad Dermatol Venereol 2024; 38:e204-e208. [PMID: 37907274 DOI: 10.1111/jdv.19590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023]
Affiliation(s)
| | - William Berry
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicola Sweeney
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Vanessa Morgan
- Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
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9
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Valbuena MC, Bravo C, Rolón-Cadena MC. Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Columbia. Actas Dermosifiliogr 2024; 115:288-292. [PMID: 37244395 DOI: 10.1016/j.ad.2023.04.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 05/29/2023] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
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Affiliation(s)
- M C Valbuena
- Hospital Universitario, Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatología, Pontificia Universidad Javeriana, Bogotá, Colombia
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10
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Fryc J, Naumnik B. The Case | A patient with skin rash, monoclonal gammopathy, and proteinuria. Kidney Int 2024; 105:643-644. [PMID: 38388153 DOI: 10.1016/j.kint.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Justyna Fryc
- 1st Department of Nephrology and Transplantation With Dialysis Unit, Medical University of Bialystok, Bialystok, Poland.
| | - Beata Naumnik
- 1st Department of Nephrology and Transplantation With Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Abstract
ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is rare but carries significant mortality and morbidity, making early identification and definitive management crucial. The diagnosis of DRESS is made clinically and involves consideration of a broad list of differential diagnoses. Given variable clinical presentations among patients with DRESS syndrome, clinicians should look for common findings and other hallmarks of the syndrome while monitoring for known complications. Additionally, clinicians should maintain a high index of suspicion to avoid missing more mild presentations, such as in this case patient with DRESS syndrome minor.
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Affiliation(s)
- James Beck
- James Beck practices in critical care at Emory University Hospital in Atlanta, Ga. The author has disclosed no potential conflicts of interest, financial or otherwise
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12
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Hofmeister N, Ames M, Lee A. Postprandial facial rash in an infant. JAAPA 2024; 37:31-32. [PMID: 38386930 DOI: 10.1097/01.jaa.0001005636.68497.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT This article describes an infant who developed a facial rash within minutes of eating certain foods. The rash resolved within 30 minutes. The patient was diagnosed with auriculotemporal syndrome or Frey syndrome, which is characterized by sweating or flushing in the preauricular area when the patient consumes certain foods, especially those that are acidic, sour, or spicy. Because most patients outgrow the syndrome, no treatment is needed.
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Affiliation(s)
- Nicole Hofmeister
- At the Mayo Clinic in Rochester, Minn., Nicole Hofmeister is a PA and instructor in family medicine, Michael Ames is an NP and instructor in family medicine, and Amanda Lee is an NP and instructor in family medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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13
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Snyder KAM, Voelckers AD. Newborn Skin: Part I. Common Rashes and Skin Changes. Am Fam Physician 2024; 109:212-216. [PMID: 38574210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Rashes in the newborn period are common and most are benign. Infections should be suspected in newborns with pustules or vesicles, especially in those who are not well-appearing or have risk factors for congenital infection. Congenital cytomegalovirus infection can cause sensorineural hearing loss and neurodevelopmental delay. Skin manifestations of cytomegalovirus may include petechiae due to thrombocytopenia. The most common skin manifestations of early congenital syphilis are small, copper-red, maculopapular lesions located primarily on the hands and feet that peel and crust over three weeks. Erythema toxicum neonatorum and neonatal pustular melanosis are transient pustular rashes with characteristic appearance and distribution. Neonatal acne is self-limited, whereas infantile acne may benefit from treatment. Milia can be differentiated from neonatal acne by their presence at birth. Cutis marmorata and harlequin color change are transient vascular phenomena resulting from inappropriate or exaggerated dilation of capillaries and venules in response to stimuli.
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Affiliation(s)
| | - Adam D Voelckers
- University of Pittsburgh Medical Center, Lititz Family Medicine Residency Program, Lititz, Pennsylvania
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14
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Xu J, Mahl E. A Violently Violaceous Rash of Infancy. Ann Emerg Med 2024; 83:276-277. [PMID: 38388081 DOI: 10.1016/j.annemergmed.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/06/2023] [Accepted: 09/26/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Jennie Xu
- Maimonides Medical Center, New York, NY
| | - Evan Mahl
- Maimonides Medical Center, New York, NY
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15
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Fraysse C, Picquendar V, Mannaioni L, Faivre d'Arcier M, Siaud M. [Pruritic rash caused by sandflies]. Rev Prat 2024; 74:306. [PMID: 38551876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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16
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García-Arellano G, Arvizu-Rivera RI, Castillo-de la Garza RDJ, Galarza-Delgado DÁ, Cardenas-de la Garza JA. Anti-Ku syndrome: A novel cause of fever, arthritis and rash. J Eur Acad Dermatol Venereol 2024; 38:e242-e243. [PMID: 37795671 DOI: 10.1111/jdv.19551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/29/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Gisela García-Arellano
- Rheumatology Department, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Rosa Icela Arvizu-Rivera
- Rheumatology Department, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | | | - Dionicio Ángel Galarza-Delgado
- Rheumatology Department, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Rheumatology Department, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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17
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Valbuena MC, Bravo C, Rolón-Cadena MC. [Translated article] Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Colombia. Actas Dermosifiliogr 2024; 115:T288-T292. [PMID: 38219907 DOI: 10.1016/j.ad.2024.01.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/02/2023] [Indexed: 01/16/2024] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
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Affiliation(s)
- M C Valbuena
- Dermatologist, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatology resident, Pontificia Universidad Javeriana, Bogotá, Colombia
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18
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Pasa Morgan MA, Muzzolon M, Abagge KT, Carvalho VO. The Challenge of a Strange Rash: Dermatitis Artefacta. J Pediatr 2024; 266:113881. [PMID: 38135029 DOI: 10.1016/j.jpeds.2023.113881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Mariana A Pasa Morgan
- Pediatric Dermatology Division, Department of Pediatrics, Federal University of Paraná, UFPR, Curitiba, Brazil; Postgraduate Program in Child and Adolescent Health, Complexo Hospital de Clínicas of the Federal University of Paraná, UFPR, Curitiba, Brazil
| | - Mariana Muzzolon
- Postgraduate Program in Child and Adolescent Health, Complexo Hospital de Clínicas of the Federal University of Paraná, UFPR, Curitiba, Brazil
| | - Kerstin T Abagge
- Pediatric Dermatology Division, Department of Pediatrics, Federal University of Paraná, UFPR, Curitiba, Brazil
| | - Vânia O Carvalho
- Pediatric Dermatology Division, Department of Pediatrics, Federal University of Paraná, UFPR, Curitiba, Brazil
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19
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Alves BR, Evanovich D, Mishra S, Cummins JM. A patient with jaundice and a rash. BMJ 2024; 384:e077368. [PMID: 38423567 DOI: 10.1136/bmj-2023-077368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
| | | | - Sandeep Mishra
- Faculty Internal Medicine, Mass General Brigham Salem Hospital, Salem, MA, USA
| | - Jordan M Cummins
- Department of Dermatology, Mass General Brigham Salem Hospital, Salem, MA, USA
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20
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Tiwari V, Miller AT. Fever, Rash, and Shortness of Breath in a 69-Year-Old. JAMA 2024; 331:698-699. [PMID: 38329771 DOI: 10.1001/jama.2023.25521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
A 69-year-old had fever, fatigue, rash, right periorbital swelling, and shortness of breath. Chest computed tomography revealed numerous small, bilateral pulmonary nodules; laboratory testing revealed mean corpuscular volume, 96.1 fL; hemoglobin level, 12.4 mg/dL; and leukopenia. What is the diagnosis and what would you do next?
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21
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Murdock BN, Lowe JB, Yoo MJ. Post-COVID-19 rash: An atypical manifestation of guttate psoriasis. Am J Emerg Med 2024; 76:271.e1-271.e3. [PMID: 38123421 DOI: 10.1016/j.ajem.2023.12.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Many complications are emerging from Coronavirus Disease 2019 (COVID-19), likely secondary to immune dysfunction and autoimmunity. While dermatologic changes have been reported, de novo guttate psoriasis, typically associated with streptococcal and other viral infections, secondary to COVID-19 infection has been minimally described. The authors report a case of a 34-year-old man who developed a diffuse rash 3 weeks following a COVID-19 infection found to have new onset guttate psoriasis who was responsive to topical corticosteroids and a vitamin D analog.
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Affiliation(s)
- Brandon N Murdock
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Joshua B Lowe
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Michael J Yoo
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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22
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Jayaraj D, Ramdas V, Al-Balushi AA, Al Asiry S, Al Yahmadi M, Malviya MN. A 3-day-old Neonate with Generalized Edema and a Bullous Rash. Neoreviews 2024; 25:e122-e126. [PMID: 38296793 DOI: 10.1542/neo.25-2-e122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
| | - Vidya Ramdas
- Department of Pediatrics, Khoula Hospital, Muscat, Oman
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23
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Mahoney MJ, Polcari IC. Infant with a widespread papulonodular rash. J Paediatr Child Health 2024; 60:79-80. [PMID: 37060243 DOI: 10.1111/jpc.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Matthew J Mahoney
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Ingrid C Polcari
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, United States
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24
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MacLean D, Shaw J. Petechial Rash Distal to a Radial Artery Compression Device. J Gen Intern Med 2024; 39:331-333. [PMID: 37940755 PMCID: PMC10853088 DOI: 10.1007/s11606-023-08521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Davis MacLean
- Department of Medicine, University of Calgary, Calgary, Canada.
| | - Jeffrey Shaw
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
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25
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Savarino JR, Lippmann MJ. Emergency Department Visit for Fever and Rash: DRESS Syndrome. R I Med J (2013) 2024; 107:28-29. [PMID: 38285749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Jeffrey R Savarino
- Resident Physician, Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
| | - Melanie J Lippmann
- Associate Professor of Emergency Medicine, Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
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26
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Mioso G, Naldi L, Sechi A. Photoexposed Rash in an Older Adult. Cutis 2024; 113:E23-E25. [PMID: 38593102 DOI: 10.12788/cutis.0964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Guido Mioso
- Dr. Mioso is from the Dermatology Unit, Department of Medicine, University of Padova, Italy. Drs. Naldi and Sechi are from the Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Luigi Naldi
- Dr. Mioso is from the Dermatology Unit, Department of Medicine, University of Padova, Italy. Drs. Naldi and Sechi are from the Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Andrea Sechi
- Dr. Mioso is from the Dermatology Unit, Department of Medicine, University of Padova, Italy. Drs. Naldi and Sechi are from the Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
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27
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Harper GM. Can You Please Take a Look at This Rash with Me? Clin Geriatr Med 2024; 40:xiii-xiv. [PMID: 38000865 DOI: 10.1016/j.cger.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Affiliation(s)
- G Michael Harper
- Geriatrics Department of Medicine, University of California, San Francisco, 4150 Clement Street, Rm 310B, San Francisco, CA 94121, USA.
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28
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Infant with a widespread papulonodular rash. J Paediatr Child Health 2024; 60:81-2. [PMID: 38623045 DOI: 10.1111/jpc.1_16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2024]
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29
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Akıncı B, Atay D, Yenigürbüz FD, Akçay A, Akar O, Öztürk G. Fatal disseminated Magnusiomyces clavatus infection with rash in pediatric acute lymphoblastic leukemia: A case report. Diagn Microbiol Infect Dis 2024; 108:116148. [PMID: 38128321 DOI: 10.1016/j.diagmicrobio.2023.116148] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023]
Abstract
Magnusiomyces clavatus is a rare yeast-like fungus that can cause opportunistic infections in immunocompromised patients. Here, we present a 14-year-old patient who was followed up with the diagnosis of acute lymphoblastic leukemia, developed skin rashes, and Magnusiomyces clavatus infection detected. The patient died shortly after the infection was diagnosed.
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Affiliation(s)
- Burcu Akıncı
- Department of Pediatric Hematology-Oncology, Acıbadem University School of Medicine, Kayışdağı Street. No:32, Ataşehir, İstanbul 34752, Turkey.
| | - Didem Atay
- Department of Pediatric Hematology-Oncology, Acıbadem University School of Medicine, Kayışdağı Street. No:32, Ataşehir, İstanbul 34752, Turkey
| | - Fatma Demir Yenigürbüz
- Department of Pediatric Hematology-Oncology, Acıbadem University School of Medicine, Kayışdağı Street. No:32, Ataşehir, İstanbul 34752, Turkey
| | - Arzu Akçay
- Department of Pediatric Hematology-Oncology, Acıbadem University School of Medicine, Kayışdağı Street. No:32, Ataşehir, İstanbul 34752, Turkey
| | - Oğuz Akar
- Department of Microbiology, Acıbadem Altunizade Hospital, İstanbul, Turkey
| | - Gülyüz Öztürk
- Department of Pediatric Hematology-Oncology, Acıbadem University School of Medicine, Kayışdağı Street. No:32, Ataşehir, İstanbul 34752, Turkey
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30
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Shen M, Liu D, Ye F, Zhang J, Wang J. Kawasaki disease in neonates: a case report and literature review. Pediatr Rheumatol Online J 2024; 22:23. [PMID: 38287358 PMCID: PMC10823709 DOI: 10.1186/s12969-024-00959-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that affects infants and young children but is extremely rare in neonates, especially afebrile KD. We present a case of KD without fever in a neonate and review the literature on KD in neonates. CASE PRESENTATION A newborn female was hospitalized because her peripheral blood leukocytes increased for half a day. The admission diagnosis was considered neonatal sepsis and bacterial meningitis. She had no fever since the admission, but a rash appeared on her face by the 7th day. On day 11 after admission, there was a desquamation on the distal extremities. On day 15 after admission, ultrasound showed non-suppurative cervical lymphadenopathy. Echocardiogram revealed coronary artery aneurysms in both sides. Finally, the patient was diagnosed with incomplete KD (IKD). The follow-up echocardiogram showed that the internal diameter of both coronary arteries returned to normal three months after birth. CONCLUSIONS Fever, rash, and distal extremity desquamation during the recovery phase are the most common symptoms of IKD. When newborns present with clinical manifestations such as rash, distal extremity desquamation and cervical lymph adenitis and with an increased peripheral blood leukocyte count and progressive increase in platelets simultaneously, the medical staff should be highly alert to the possibility of KD even without fever. The echocardiogram needs to be performed promptly. The incidence of coronary artery lesions is significantly higher if neonatal KD patients miss timely diagnosis and treatment.
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Affiliation(s)
- Mingjun Shen
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beisanhuan East Road, Chaoyang District, 100029, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China
| | - Die Liu
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China
| | - Fang Ye
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China.
| | - Jun Wang
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beisanhuan East Road, Chaoyang District, 100029, Beijing, China.
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China.
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31
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Lim SY, Jo HJ, Lee SY, Ahn M, Kim Y, Jeon J, Kim ES, Chin B, Choi JP, Kim NJ. Clinical Features of Mpox Patients in Korea: A Multicenter Retrospective Study. J Korean Med Sci 2024; 39:e19. [PMID: 38288533 PMCID: PMC10825456 DOI: 10.3346/jkms.2024.39.e19] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Mpox is a viral illness with a characteristic skin rash caused by the monkeypox virus. In 2022, Mpox spread throughout the world, and an epidemic through domestic transmission started in South Korea in early 2023. This study aimed to summarize the clinical features of Mpox patients in South Korea. METHODS This is a multicenter retrospective study conducted at four hospitals in South Korea. All adult patients diagnosed with Mpox who were admitted to the study hospitals between June 1, 2022 and May 26, 2023 and were discharged by June 30, 2023 were reviewed. RESULTS Sixty patients were included, accounting for 65.9% of Mpox cases reported in South Korea during the study period. Median age was 32 years and 97% (58/60) of patients were male. In total, 85% (51/60) of patients reported their sexual orientation as homosexual or bisexual. The most common route of transmission was sexual or close contact (55/60). Every patient had a skin rash and 88% (53/60) had constitutional symptoms. In total, 42% (25/60) of patients had human immunodeficiency virus and 25% (15/60) had concomitant sexually transmitted infections. Severe manifestations of Mpox were identified in only two patients. CONCLUSION Mpox patients in South Korea were mainly young adult males and were infected through sexual contact. The clinical outcomes were favorable.
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Affiliation(s)
- So Yun Lim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hyeon Jae Jo
- Department of Internal Medicine, Seoul National College of Medicine, Seoul, Korea
| | - Su-Yeon Lee
- Division of Emerging Infectious Disease Response, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Miyoung Ahn
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jaehyun Jeon
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Jae-Phil Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National College of Medicine, Seoul, Korea.
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32
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Hosseininasab A, MoradKasani S, Mostafavi E, Baseri N, Sadeghi M, Esmaeili S. Rickettsia conorii subsp. israelensis infection in a pediatric patient presenting skin rash and abdominal pain: a case report from Southeast Iran. BMC Infect Dis 2024; 24:114. [PMID: 38254000 PMCID: PMC10804630 DOI: 10.1186/s12879-024-09002-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The healthcare system in Iran appears to overlook Mediterranean spotted fever (MSF) as an endemic disease, particularly in pediatric cases, indicating the need for greater attention and awareness. CASE PRESENTATION A six-year-old patient with fever, abdominal pain, headache, skin rashes, diarrhea, vomiting, and black eschar (tache noire) from southeast Iran was identified as a rickettsiosis caused by Rickettsia conorii subsp. israelensis through clinical and laboratory assessments, including IFA and real-time PCR. The patient was successfully treated with doxycycline. CONCLUSIONS Symptoms like rash, edema, eschar, and abdominal pain may indicate the possibility of MSF during the assessment of acute febrile illness, IFA and real-time PCR are the primary diagnostic methods for this disease.
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Affiliation(s)
- Ali Hosseininasab
- Research Center of Tropical and Infectious Diseases, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Safoura MoradKasani
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran
| | - Ehsan Mostafavi
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Neda Baseri
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- , Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Iran
| | - Maryam Sadeghi
- Research Center of Tropical and Infectious Diseases, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Saber Esmaeili
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran.
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.
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Salih H, Ascott A, George S. Intensely itchy linear rash in a patient with Hodgkin's lymphoma. BMJ Case Rep 2024; 17:e258614. [PMID: 38199664 PMCID: PMC10806902 DOI: 10.1136/bcr-2023-258614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Hamisha Salih
- Dermatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Anna Ascott
- Dermatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Susannah George
- Dermatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Li Y, Lu M. Tocilizumab for treating mevalonate kinase deficiency and TNF receptor-associated periodic syndrome: a case series and literature review. Pediatr Rheumatol Online J 2024; 22:11. [PMID: 38183017 PMCID: PMC10768362 DOI: 10.1186/s12969-023-00952-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Mevalonate kinase deficiency (MKD) and TNF receptor-associated periodic syndrome (TRAPS) are categorized as systemic autoinflammatory diseases (SAIDs), which are rare diseases characterized by early onset, severe conditions, and challenging diagnosis and treatment. Although different SAIDs have varying standard treatments, some SAIDs are poorly controlled after routine treatment, seriously affecting the growth and development of children and their quality of life. This study aims to provide more treatment strategies for SAIDs. CASE PRESENTATION We present two Chinese patients with MKD and TRAPS who were resistant to TNF- (tumor necrosis factor-) α blockade. After using etanercept, baricitinib, and glucocorticoid, patients with MKD and TRAPS still had periodic fever and rash. Due to the unavailability of IL-1 antagonists in the Chinese Mainland, we started administering intravenous tocilizumab (TCZ) at a dosage of 240 mg every three weeks. They had not experienced fever or rash after receiving one or two doses of TCZ. Before treatment with TCZ in the MKD patient, white blood cell (WBC) count, and TNF-α level were normal, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased significantly, and IL-6 increased slightly. After treatment with TCZ, ESR and CRP levels returned to normal; however, IL-6 increased occasionally. In the TRAPS patient, ESR, CRP, WBC, IL-6, and TNF-α levels were increased significantly. After TCZ treatment, ESR, CRP, WBC, IL-6, and TNF-α levels returned to normal. The two patients were treated with TCZ for more than six months and achieved clinical and serological remission. Furthermore, they had no adverse reactions after injection of TCZ. CONCLUSION In the absence of IL-1 antagonists in mainland China, tocilizumab emerges as an alternative drug in SAIDs that are resistant to TNF-α blockade.
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Affiliation(s)
- Yandie Li
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Heath, NO.3333, Bin-sheng Road, 310052, Hangzhou, China
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Heath, NO.3333, Bin-sheng Road, 310052, Hangzhou, China.
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35
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Barman P, Nadig PL, Samynathan P, Jindal AK, Singh S. Malar rash in a febrile infant: is this Kawasaki disease? Rheumatology (Oxford) 2024; 63:e24-e25. [PMID: 37436704 DOI: 10.1093/rheumatology/kead338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Prabal Barman
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallavi L Nadig
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prasanna Samynathan
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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36
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Abstract
Background: During the height of the SARS CoV-2 (severe acutre respiratory syndrome coronavirus disease 2019 [COVID 19]) pandemic, there have been numerous case reports of cutaneous reactions shortly after COVID-19 vaccine administration. Most reported cases are local injection-site reactions, whereas persistent or delayed cutaneous reactions have not been as common. Methods: We present the case of an 82-year-old man with persistent rash after the second COVID-19 vaccination. Results: A specific diagnosis was confirmed after the third skin biopsy. Conclusion: Patients are frequently referred to an allergist for various cutaneous reactions that occurred after vaccination, concerned about a possible drug allergy. This case emphasizes the importance of keeping a broad differential diagnosis when encountering a persistent skin rash not resolved by oral antihistamines or steroids.
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37
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Garg S, Garg K, Thakur V, Behera B. Xeroderma pigmentosum group G with pellagroid rash: A rare presentation. Pediatr Dermatol 2024; 41:150-152. [PMID: 37667072 DOI: 10.1111/pde.15416] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/30/2023] [Indexed: 09/06/2023]
Abstract
Xeroderma pigmentosum (XP), a heterogeneous genodermatoses, has a variable clinical spectrum ranging from mild freckling and photosensitivity to severe skeletal and neurological abnormalities and cutaneous malignancies. Herein, we present the case of a 4-year-old boy with XP group G who presented with a pellagroid rash.
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Affiliation(s)
- Sonika Garg
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Kunal Garg
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vishal Thakur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Biswanath Behera
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
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38
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Wisco OJ, Diehl K, Clark MR, Gilson RT, Cohen LM. Pruritic Rash on the Shins. Am Fam Physician 2024; 109:Online. [PMID: 38227878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Oliver J Wisco
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kyra Diehl
- Western University of Health Sciences, Pomona, California
| | | | - Robert T Gilson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Lisa M Cohen
- Tufts University School of Medicine, Boston, Massachusetts
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Weisleder H, Valle A, Xie X, Mahmood S. Racial Disparities in Diagnosis and Treatment of Patients With Dermatomyositis of Different Skin Tones. J Clin Rheumatol 2024; 30:8-11. [PMID: 37747839 DOI: 10.1097/rhu.0000000000002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Delays in the diagnosis and treatment of dermatological conditions in minorities are a well-documented health disparity. We aimed to determine if there was a delay in detection and treatment initiation for dermatomyositis (DM) and amyopathic dermatomyositis (ADM) in patients of different skin tones. METHODS Patients from Montefiore Medical Center who met the criteria for DM and ADM were included in this cohort study. Records were reviewed for date of first documented rash, creatine kinase levels, muscle weakness complaints, and date of first steroid or disease-modifying antirheumatic drug initiation. The median number of days between rash documentation and therapy initiation was compared for patients of different races, including non-Hispanic White, non-Hispanic Black, Hispanic, and other (Asian and unknown). Data were compared in White versus non-White skin. RESULTS Sixty-three DM and 9 ADM patients met the inclusion criteria. There was a shorter time to treatment initiation in White versus non-White patients, with a median number of 8 days compared with 21 days, respectively ( p = 0.05). Kaplan-Meier curves showed prolonged time to diagnosis and treatment in all other races when compared with White patients ( p = 0.03). DISCUSSION It took clinicians longer to diagnose and treat DM and ADM in patients of color. The trends observed emphasize the importance of increasing dermatology education of non-White skin to improve detection and treatment of DM and ADM and minimize health disparities.
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Affiliation(s)
- Hillary Weisleder
- From the Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ana Valle
- Department of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA
| | - Xianhong Xie
- Departments of Epidemiology & Population Health (Biostatistics)
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40
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Lin RJ, Chung C, Wang CY, Wang PY, Sung WY, Tsai JJ. The cutaneous manifestation of dermatomyositis confounded with allergic rash might defer the diagnosis of malignancy. Int J Rheum Dis 2024; 27:e14945. [PMID: 37882482 DOI: 10.1111/1756-185x.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Ren-Jie Lin
- School of Post-Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiang Chung
- School of Post-Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yun Wang
- School of Post-Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pin-Yi Wang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Yu Sung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jih-Jin Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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41
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Krech L, Welkoborsky HJ. [Unexplained buccal swelling in a woman with exanthema, fever, and worsening of general condition]. Laryngorhinootologie 2024; 103:53-55. [PMID: 37500069 DOI: 10.1055/a-2123-4377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Lisa Krech
- Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, KRH Klinikum Nordstadt, Hannover, Germany
| | - H J Welkoborsky
- Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, KRH Klinikum Nordstadt, Hannover, Germany
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Shakhashiro M, McKay KM, Wilson CL. Linear rash in an 11-year-old girl. Int J Dermatol 2024; 63:41-42. [PMID: 37728149 DOI: 10.1111/ijd.16846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
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43
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Sakamoto T, Mizuta H, Amagai T. Persistent rash associated with multiple pulmonary nodules. Eur J Intern Med 2024; 119:127-128. [PMID: 37863701 DOI: 10.1016/j.ejim.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Takamitsu Sakamoto
- Department of General Medicine, Fukuoka Tokushukai Medical Center, Japan.
| | | | - Teruyoshi Amagai
- Faculty of Health Care Sciences, Department of Clinical Engineering, Jikei University of Health Care Sciences, Japan
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44
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Curry A, Khalsa A, Yi D. Facial Lesions and Rash in a 2-month-old Boy. Pediatr Rev 2024; 45:52-56. [PMID: 38161160 DOI: 10.1542/pir.2021-005372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Alexandra Curry
- Department of Pediatrics, University of California San Francisco-Fresno
| | - Anoop Khalsa
- Department of Pediatrics, University of California San Francisco-Fresno
| | - David Yi
- Department of Pediatrics, University of California San Francisco-Fresno
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45
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Miao J, Zhang J, Huang X, Wu N, Wu D, Shen M. NLRP12-associated autoinflammatory disease in Chinese adult patients: a single-centre study. RMD Open 2023; 9:e003598. [PMID: 38123482 DOI: 10.1136/rmdopen-2023-003598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND NLRP12-associated autoinflammatory disease (NLRP12-AID) is an autosomal dominant autoinflammatory disorder caused by variants of NLRP12 gene. We aimed to report a cohort of Chinese adult patients with NLRP12-AID and summarised phenotypes and genotypes. METHODS Twenty patients were diagnosed with NLRP12-AID after performing whole-exome sequencing and were included in our cohort. Demographic information, clinical data and treatment response were collected and evaluated. A literature review of NLRP12-AID was performed, and the clinical features and mutated sites were summarised and compared with our cohort. RESULTS Among the 20 NLRP12-AID patients, the main clinical features of NLRP12-AID included fever, cutaneous rash, arthralgia/arthritis, pharyngitis/tonsillitis, lymphadenopathy, myalgia and abdominal pain/diarrhoea. Thirteen NLRP12 variants were detected as F402L, G39V, R1030X, R7G, E24A, Q90X, A218V, A259V, W581X, G729R, R859W, c.-150T>C and c.*126G>C. Glucocorticoids were used in 14 patients, immunosuppressive agents in 13, and tocilizumab in 2. Seventeen patients had good responses to therapy. When compared with 50 NLRP12-AID patients from other countries, Chinese patients had fewer variants in exon 3, higher incidences of cutaneous rash, pharyngitis/tonsillitis and lymphadenopathy. Among all these 70 NLRP12-AID patients, patients carrying non-exon-3 variants had higher frequencies of ocular involvement, pharyngitis/tonsillitis, headache and lymphadenopathy than those with exon-3 variants. CONCLUSION This is the largest cohort of NLRP12-AID in the world and seven novel variants of NLRP12 were identified. Chinese adult patients of NLRP12-AID had more non-specific symptoms such as pharyngitis/tonsillitis and lymphadenopathy when compared with patients from other countries, for which the less occurrence of exon-3 variants might be one possible reason.
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Affiliation(s)
- Junke Miao
- Department of Rare Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyuan Zhang
- Department of Rare Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Huang
- Department of Rare Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Na Wu
- Department of Rare Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Wu
- Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Min Shen
- Department of Rare Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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46
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Phi DL, Dao TL, To MM, Nguyen TB, Nguyen DC, Gautret P, Hoang VT. Clinical and Laboratory Characteristics of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children. J Korean Med Sci 2023; 38:e410. [PMID: 38111281 PMCID: PMC10727921 DOI: 10.3346/jkms.2023.38.e410] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 12/20/2023] Open
Abstract
Geographical and racial factors constitute important distinctions between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C), but no study has been conducted in Vietnam. Forty-one children with KD from January 2018 to July 2020 and 42 with KD/MIS-C from August 2020 to December 2022 were included in this study. Of the patients, 52.3% were aged between 12 and 35 months. Only two were aged over 5 years, and both were belong to the KD/MIS-C group. A 59.5% of the patients were male. Apart from fever, all symptoms tended to be more frequent in patients with KD/MIS-C. The prevalence of diffuse skin rash, hand and foot edema or erythema and gastrointestinal signs was significantly higher in patients hospitalized with KD/MIS-C. There was no significant difference in laboratory findings between the two groups. Coronary artery dilation was more frequently observed in patients with KD/MIS-C compared to those with KD (40.5% vs. 14.6%, P = 0.009).
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Affiliation(s)
- Duc Long Phi
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi Loi Dao
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Minh Manh To
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Duy Cuong Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.
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Infant with a florid rash. J Paediatr Child Health 2023; 59:1336-7. [PMID: 38073248 DOI: 10.1111/jpc.1_16336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 12/18/2023]
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48
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Chawla S, Charan A, Tanwar GS. Widespread rash, leg pain and increased muscle bulk. Arch Dis Child Educ Pract Ed 2023; 108:467-468. [PMID: 37875325 DOI: 10.1136/archdischild-2023-326135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Siddhi Chawla
- Radiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Aditya Charan
- Radiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
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Muralidharan M, Hill AE, Onwuegbuchu E, Laycock KM, Treat J, Congdon M. A Tale of 2 Febrile Rashes: A Case Study. Clin Pediatr (Phila) 2023; 62:1583-1586. [PMID: 36964692 DOI: 10.1177/00099228231163938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
| | - Ann E Hill
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - James Treat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Morgan Congdon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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50
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Yamaguchi H, Hagino N. Heliotrope rash and puffy fingers due to Kikuchi-Fujimoto disease. Joint Bone Spine 2023; 90:105606. [PMID: 37414136 DOI: 10.1016/j.jbspin.2023.105606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Hiroyuki Yamaguchi
- Department of Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan.
| | - Noboru Hagino
- Department of Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
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