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Lopes S, Nogueira A, Gullo I, Pardal J, Lopes JM, Azevedo F. Perianal purpuric plaques revealing an amyloid light-chain amyloidosis: case report and review of the literature. Dermatol Online J 2019; 25:13030/qt9n84p8k5. [PMID: 30710905] [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] [Received: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 06/09/2023] Open
Abstract
Systemic immunoglobulin light chain amyloidosis is the most common and severe type of amyloidosis. There is an abnormal fibrillary protein deposition in tissues that leads to progressive and irreversible organ dysfunction. The most commonly affected organs are kidney and heart. Although rare, cutaneous manifestations may be the first clinical sign of the disease and usually present as hemorrhagic lesions, such as purpura, petechiae, and ecchymosis. We present a 71-year-old man that presented to our department because of exuberant purpuric plaques in the anogenital area as the first manifestation of an amyloid light-chain (AL) amyloidosis. The multi-organ involvement in addition to rapid clinical deterioration precipitated the patient's death four months later.
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Affiliation(s)
- Sofia Lopes
- Department of Dermatology and Venereology, Centro Hospitalar São João, Porto.
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Dennin MH, Dulmage BO, Yazdan P, Keimig E. Metastatic calcinosis cutis in a patient with Hodgkin's lymphoma. Dermatol Online J 2018; 24:13030/qt7z73b3kk. [PMID: 30695977] [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] [Received: 12/16/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023] Open
Abstract
Calcinosis cutis results from the deposition of insoluble calcium salts in the skin and subcutaneous tissue. Herein, we report a case of extensive metastatic calcinosis cutis in an 18-year-old woman with stage IV Hodgkin lymphoma with skeletal involvement. With combination therapy including radiation directed at her lymphoma and diltiazem, her lesions improved dramatically. This case demonstrates the previously unreported association between calcinosis cutis and Hodgkin lymphoma.
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Affiliation(s)
| | | | | | - Emily Keimig
- Northwestern University, Department of Dermatology, Chicago, Illinois.
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3
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Stiefelhagen P. [The skin is a mirror of glucose metabolism]. MMW Fortschr Med 2016; 158:22. [PMID: 27221411 DOI: 10.1007/s15006-016-8252-7] [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: 06/05/2023]
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Yoneyama K, Tochigi N, Oikawa A, Shinkai H, Utani A. Primary Localized Cutaneous Nodular Amyloidosis in a Patient with Sjögren's Syndrome: A Review of the Literature. J Dermatol 2014; 32:120-3. [PMID: 15906542 DOI: 10.1111/j.1346-8138.2005.tb00728.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 11/27/2022]
Abstract
We report a 53-year-old Japanese woman with multiple, red, and elastic soft nodules on the left waist, left thigh, and right lower leg. She had had polyclonal hyperglobulinemia for one year, rheumatoid arthritis for 13 years, and Sjögren's syndrome (SjS) for 18 years. Histochemical examination of the nodule on the left thigh revealed a deposition of amyloid by Congo red staining. It was also positively stained with both anti-kappa and -lambda light chain antibodies. Moreover, the cytoplasm of the infiltrating plasma cells also positively reacted to both antibodies. The major amyloid proteins of primary localized cutaneous nodular amyloidosis (PLCNA) generally consist of monoclonal immunoglobulin light chains. A review of literature demonstrates 13 cases of PLCNA with SjS, in which immunoglobulin light chains were demonstrated in the amyloid in 5 cases. Amyloid in the 3 cases was composed of a single class immunoglobulin light chain and that in the 2 cases was composed of both kappa and lambda light chains. Polyclonal immunoglobulin amyloid has been reported only in PLCNA with SjS, which may be related to the fact that a certain population of SjS develops polyclonal B cell proliferation and hyperglobulinemia.
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Affiliation(s)
- Kei Yoneyama
- Department of Dermatology, School of Medicine, Chiba University, Japan
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5
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Abstract
Calciphylaxis represents a dermatological emergency with a mortality of up to 80%. The disease is characterized by a triad of arteriolar medial calcification, thrombotic cutaneous ischemia and necrotic ulcerations. Recently several mechanisms of vascular calcification have been identified. This may led to preventive measures in the future. Early diagnosis is important to avoid complications such as sepsis. The dermatologist plays an important role in early diagnosis based on the recognition of clinical presentation and histopathology. Patients with end-stage renal disease are most commonly affected by calciphylaxis. The most frequent non-uremic predisposing conditions are primary hyperparathyroidism, malignancies, alcohol-induced liver disease, and autoimmune connective tissue diseases. Medical treatment aims to normalize mineral metabolism to reduce the serum concentration of sodium phosphate and thus to prevent precipitation and calcification. Newer compounds are bisphosphonates, non-sodium/non-aluminium phosphate binders, cinacalcet, paricalcitrol, and sodium thiosulfate. Among the surgical procedures parathyroidectomy did not result in a significant survival benefit. An aggressive surgical debridement of necrotic ulcerations, on the other hand, improved survival. Early diagnosis and a multidisciplinary treatment approach including re-vascularization by the vascular surgeon, repeated surgical debridement and split skin transplantation support wound healing and insure limb conservation.
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Affiliation(s)
- U Wollina
- Klinik für Dermatologie und Allergologie, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Friedrichstr. 41, 01067, Dresden.
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Khoudri I, Marcil T, Elmeknassi I, Kzadri M, Ismaili N, Afifi Y, Senouci K, Hassam B. Oto-Rhino-Laryngology (ORL) tumor presentation in a case of systemic AA amyloidosis. Dermatol Online J 2009; 15:6. [PMID: 19951642] [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: 05/28/2023] Open
Abstract
A 64-year-old male with no underlying disease presented with the development of multiple skin nodules, loss of sensation in the extremities, hoarseness, macroglossia, and pain in the oral cavity. Direct laryngoscopy showed nodules involving the oral cavity, oropharynx, supraglottic region, and vocal cords. Biopsy from skin nodules showed amyloid deposits staining with Congo red. Immunohistochemical staining was used for AA protein and was positive. Biopsy from the oral floor was also positive for amyloid. Oto-Rhino-Laryngology (ORL) involvement has been reported in approximately 40 percent of AL amyloidosis patients, but does not appear to be frequent in AA amyloidosis. Cutaneous manifestations in AA amyloidosis are rare, although cases with lesions presenting as purpura are reported occasionally; we are not aware of other cases of ORL nodular involvement in systemic AA.
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Affiliation(s)
- I Khoudri
- Department of Dermatology, Ibn Sina University Hospital, Rabat, Morocco.
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Leonard D, Koca R, Acun C, Cinar S, Estürk E, Ustündag G, Herron S, Butterfly MM, Zenel JA. Visual diagnosis: three infants who have perioral and acral skin lesions. Pediatr Rev 2007; 28:312-8. [PMID: 17670956 DOI: 10.1542/pir.28-8-312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/24/2022]
Affiliation(s)
- Douglas Leonard
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore, USA
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8
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Abstract
OBJECTIVE To report a case of calciphylaxis in the absence of renal failure in a patient with secondary hyperparathyroidism and low calcium/phosphorus product, in whom total parathyroidectomy resulted in relief of pain and healing of ulcerations. METHODS We present the clinical, laboratory, and pathologic findings in a 62-year-old woman with calciphylaxis in the absence of end-stage renal disease. RESULTS A 62-year-old woman presented with painful nonhealing bilateral calf ulcerations. Pathology examination of tissue specimens from surgical débridement revealed intravascular calcification, consistent with calciphylaxis. Laboratory investigation revealed normal renal function; however, hypocalcemia and hypophosphatemia were present--a corrected serum calcium level of 7.5 mg/dL (normal, 8.5 to 10.2) and a serum phosphorus value of 1.0 mg/dL (normal, 2.5 to 4.5). These abnormalities were likely due to vitamin D deficiency, evidenced by a 25-hydroxyvitamin D level of 14 ng/mL, which provoked an elevation of the serum parathyroid hormone (PTH) concentration, documented by an intact PTH of 213 pg/mL (normal, 15 to 65) and a whole PTH (1-84 PTH) of 70.6 pg/mL (normal, 7 to 36). Her quality of life was severely impaired, not only by the ulcerations but also by intractable pain that necessitated epidural analgesia during the hospitalization. The patient underwent total parathyroidectomy and transcervical thymectomy, with cryopreservation of parathyroid tissue. One year after the parathyroidectomy, the patient had no recurrence of calciphylaxis. CONCLUSION This case suggests that despite the potential complex pathophysiologic aspects of calciphylaxis, even in the absence of both renal failure and an elevated calcium/phosphorus product, early parathyroidectomy in patients with appreciably increased PTH levels may improve wound healing and diminish pain.
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Affiliation(s)
- Francesca M Couto
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792, USA
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9
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Srivastava M. Primary cutaneous nodular amyloidosis in a patient with Sjögren's syndrome. J Drugs Dermatol 2006; 5:279-80. [PMID: 16573263] [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: 05/08/2023]
Abstract
A 71-year-old woman with a history of Sjögren's syndrome presented for evaluation of a waxy nodule present on the scalp for 6 months. Histopathologic examination revealed deposition of homogenous eosinophilic material throughout the reticular dermis consistent with amyloidosis. Primary cutaneous nodular amyloidosis is a rare phenomenon characterized by the deposition of immunoglobin light chains by a clonal plasma cell population. Patients need to be monitored for progression to systemic amyloidosis or plasma cell dyscrasias.
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Affiliation(s)
- Monika Srivastava
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, USA.
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10
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Phillips P, Weightman W. Diabetes and the skin. (Part 3--diabetic cheiroarthropathy). Aust Fam Physician 2005; 34:1037-8. [PMID: 16333487] [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: 05/05/2023]
Affiliation(s)
- Pat Phillips
- Department of Endocrinology, The Queen Elizabeth Hospital, Woodville, South Australia.
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Abstract
Over the last years, the genetic basis of several monogenic inherited metabolic diseases has been elucidated. Interestingly, some of these disorders manifest with characteristic cutaneous symptoms that are often crucial for diagnosis. In most cases, however, besides the skin other organs are affected. Therefore, an interdisciplinary supervision of these patients is highly important. In this review we will discuss diseases that constitute a challenge not only for dermatologists but also for physicians from other specialties. A particular emphasis is put on genetic and clinical features of these disorders as well as current therapeutic concepts.
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Affiliation(s)
- P Poblete-Gutiérrez
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen
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12
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Neumaier J. [Diagnosis at a glance in metabolic diseases: when skin symptoms indicate diabetes]. MMW Fortschr Med 2004; 146:14, 16. [PMID: 15357472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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13
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Al-Rikabi AC, Al-Homsi HI. Propionic acidemia and zinc deficiency presenting as necrolytic migratory erythema. Saudi Med J 2004; 25:660-2. [PMID: 15138538] [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: 04/29/2023] Open
Abstract
Necrolytic migratory erythema was first described in 1942 in a patient with pancreatic islet cell carcinoma. The disease can, however, have other etiologies including nutritional dermatoses. Here, we describe the clinicopathological picture of a 7-year-old female patient who presented with necrolytic migratory erythema which we believe is secondary to a rare combination of zinc deficiency and propionic acidemia.
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Kuhl J, Davis MDP, Kalaaji AN, Kamath PS, Hand JL, Peine CJ. Skin Signs as the Presenting Manifestation of Severe Nutritional Deficiency. ACTA ACUST UNITED AC 2004; 140:521-4. [PMID: 15148094 DOI: 10.1001/archderm.140.5.521] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John Kuhl
- Creighton University, Omaha, Nebraska, USA
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Chan LY, Tang WYM, Leung CY, Lo KK. Lichen amyloidosis. Hong Kong Med J 2002; 8:224. [PMID: 12055372] [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: 02/25/2023] Open
Affiliation(s)
- L Y Chan
- Social Hygiene Service, Department of Health, Tuen Mun Social Hygiene Clinic, 9/F, Tuen Mun Hospital Ambulatory Care Center, Tuen Mun Hospital, Tsing Chung Koon Road, Hong Kong
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Bröker LE, van den Berg H, van Groningen K, van der Wateren AR, de Nef JJ. [Juvenile xanthogranuloma: a form of histiocytosis with an excellent prognosis]. Ned Tijdschr Geneeskd 2001; 145:635-9. [PMID: 11305214] [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: 02/19/2023]
Abstract
In three patients, a girl aged six weeks and two boys aged eight and three months, juvenile xanthogranuloma was diagnosed. This is a rare cutaneous disorder that predominantly occurs during infancy and early childhood. It is one of the non-malignant, non-Langerhans cell histiocytoses (class II histiocytoses). It is characterized by a circumscript, firm, yellow-brown and sometimes pink-red nodule or papule located mainly on the face or scalp. Diagnosis can be made on the clinical appearance. However, this may need to be confirmed by a histopathological investigation, which includes immunohistochemical stains. In contrast to generalized histiocytoses, the prognosis of juvenile xanthogranuloma is excellent: the cutaneous tumour disappears spontaneously in one to six years. However, extracutaneous involvement, which is most frequently located in the eye, can occur. Moreover, juvenile xanthogranuloma is associated with neurofibromatosis type I and juvenile chronic myeloid leukaemia. This rare but possibly life-threatening systemic involvement justifies meticulous follow-up.
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Affiliation(s)
- L E Bröker
- Afd. Kindergeneeskunde, Spaarne Ziekenhuis, Postbus 1644, 2003 BR Haarlem
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Abstract
The cutaneous deposition disorders are a group of unrelated conditions characterized by the presence of either endogenous or exogenous substances within the dermis or the subcutis. Part I of this two-part series will focus on metabolic processes involved in the endogenous deposition in the various forms of amyloidosis, porphyria, colloid milium, and lipoid proteinosis. We will also review the clinical, histologic, biochemical, and ultrastructural findings relevant to each disorder. Basic mechanisms of pathogenesis, diagnostic modalities, and treatment options are also discussed.
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Affiliation(s)
- D M Touart
- Dermatology Service, Walter Reed Army Medical Center, Washington DC, USA
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Howard R, Frieden IJ, Crawford D, McCalmont T, Levy ML, Rosenblatt DS, Sweetman L, Goodman SI, Ohnstad C, Hart K, Berrios M, Packman S. Methylmalonic acidemia, cobalamin C type, presenting with cutaneous manifestations. Arch Dermatol 1997; 133:1563-6. [PMID: 9420542] [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: 02/05/2023]
Abstract
BACKGROUND Erosive dermatitis resembling the skin lesions of acrodermatitis enteropathica has been described in a number of aminoacidopathies and organic acidemias. In some, the dermatitis is a manifestation of untreated disease, while in others, including methylmalonic acidemia, skin lesions have been ascribed to nutritional deficiency due to therapeutic amino acid restrictions. OBSERVATIONS We report 2 cases of methylmalonic acidemia presenting with cutaneous manifestations in the perinatal period before restrictive nutritional interventions. The cutaneous involvement consisted of cheilitis and diffuse erythema with erosions and desquamation. Methylmalonic acidemia, cobalamin C type, was subsequently diagnosed in both cases. CONCLUSIONS An erosive, desquamating dermatitis with histopathologic characteristics resembling acrodermatitis enteropathica may be a presenting sign in cobalamin C methylmalonic acidemia, even in the absence of long-standing nutritional restrictions or deficiency.
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Affiliation(s)
- R Howard
- Department of Dermatology, University of California, San Francisco, USA
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