1
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Emge DA, Bassett RL, Duvic M, Huen AO. Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in erythrodermic cutaneous T-cell lymphoma (CTCL) patients. Arch Dermatol Res 2020; 312:283-288. [PMID: 31776647 DOI: 10.1007/s00403-019-02015-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/16/2019] [Indexed: 02/03/2023]
Abstract
Erythroderma can occur in cutaneous T-cell lymphoma (CTCL). Staphylococcus aureus (S. aureus) prevalence is increased in CTCL patients and contributes to CTCL disease flares. Our primary aim was to describe S. aureus infections, including resistance patterns and the antibiotic treatment regimens used, in erythrodermic CTCL patients. This was a retrospective chart review of erythrodermic CTCL patients who had S. aureus infection or colonization and were treated at the UT MD Anderson Cancer Center's Melanoma Skin Center between 2012 and 2016. Twenty-six erythrodermic CTCL patients had 50 documented S. aureus colonization or infection events. Patients had an improvement in body surface area (BSA) or modified Severity Weighted Assessment Tool (mSWAT) in 53% events treated for S. aureus. Seventeen of the 50 (34%) events were due to methicillin-resistant S. aureus (MRSA). One-third (33%) of MRSA events were initially treated with dicloxacillin. The MRSA isolates were sensitive to trimethoprim-sulfamethoxazole (92%) and doxycycline (88%). Patients treated in the outpatient setting (OR 0.073; 95% CI 0.008-0.627; p = 0.017) and patients with a previous history of topical anti-S. aureus decolonization treatments before S. aureus event as stand-alone (OR 0.125; 95% CI 0.018-0.887; p = 0.038) or in combination treatment with systemic antibiotics (OR 0.094; 95% CI 0.009-0.944; p = 0.045) were less likely to see improvement in BSA or mSWAT from S. aureus treatment. Treatment of S. aureus improved CTCL skin score in a high number of erythrodermic patients. The MRSA prevalence was high in erythrodermic CTCL patients. Clinicians should consider using empiric MRSA antibiotic coverage for these patients.
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Affiliation(s)
- Drew A Emge
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
- , 1110 Orchard Oriole Lane, Durham, NC, 27713, USA.
| | - Roland L Bassett
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Auris O Huen
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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2
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Hernández-Martín A, Kennedy-Batalla R, Cañedo E, Bernaldo-de-Quirós E, Carazo-Gallego B, Vera A, Torrelo A, Noguera-Morel L, González-Sarmiento R, Bolling M, Martínez-Bonet M, Pion M, Correa-Rocha R. Imbalance in T-Helper 17 Cells and Targeted Therapy in an Infant with SAM-like Syndrome. N Engl J Med 2019; 381:2176-2178. [PMID: 31774967 DOI: 10.1056/nejmc1908531] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Elvira Cañedo
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Angel Vera
- Hospital Materno-Infantil, Málaga, Spain
| | | | | | | | - Marieke Bolling
- University Medical Center of Groningen, Groningen, the Netherlands
| | | | - Marjorie Pion
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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3
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Affiliation(s)
- Hiroyuki Irie
- Department of Dermatology, Kyoto University Graduate School of Medicine, 606-8507 Kyoto, Japan
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4
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Braegelmann J, D Erme AM, Akmal S, Maier J, Braegelmann C, Wenzel J. Interleukin-36γ (IL-1F9) Identifies Psoriasis Among Patients With Erythroderma. Acta Derm Venereol 2016; 96:386-7. [PMID: 26524325 DOI: 10.2340/00015555-2265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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5
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Otake H, Otsuka A, Nonomura Y, Iga N, Kabashima K. Up-regulation of Activation Markers on Basophils in Patients with Papuloerythroderma. Acta Derm Venereol 2016; 96:410-1. [PMID: 26439745 DOI: 10.2340/00015555-2255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hikari Otake
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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6
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Piana S, Bernardi C, Zoino JL. Itchy erythroderma in a neoplastic patient—mind the mite! Eur J Intern Med 2015; 26:139-40. [PMID: 25087690 DOI: 10.1016/j.ejim.2014.06.026] [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: 06/09/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Simonetta Piana
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - Chiara Bernardi
- Department of Internal Medicine, Ospedale Sant'Anna, Castelnovo Monti, Reggio Emilia, Italy
| | - Jorge Luis Zoino
- Department of Internal Medicine, Ospedale Sant'Anna, Castelnovo Monti, Reggio Emilia, Italy
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7
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Abstract
Papuloerythroderma of Ofuji (PEO) appears to be a T cell-mediated skin disease; however, the pathogenesis of PEO remains unclear. We report two cases of PEO and examine cytokine production and expression of skin-homing receptors in circulating T cells in the patients. The percentages of interleukin 4 (IL-4)-, IL-13- and IL-22-producing CD4+ and CD8+ T cells were markedly higher in the circulation of patients with PEO than in those of healthy subjects. The expression of both cutaneous lymphocyte antigen (CLA) and CC chemokine receptor 4 (CCR4) were significantly upregulated in the circulating CD4+ and CD8+ T cells. Moreover, serum levels of thymus and activation-regulated chemokine (TARC), a chemoattractant for CCR4, were increased. The number of IL-4-, IL-13- and IL-22-producing T cells, expression of CLA and CCR4 by T cells, and serum TARC levels significantly decreased after complete remission of PEO. These results suggest that skin-homing Th2/Th22 cells may play a role in the pathogenesis of PEO.
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Affiliation(s)
- Yuichi Teraki
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Kawagoe, Japan
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8
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El Ouali A, El Boussaadni Y, Ailal F, Bousfiha AA, Dikhaye S, Benajiba N. Érythrodermie néonatale: ne pas méconnaitre un déficit immunitaire. Pan Afr Med J 2014; 18:317. [PMID: 25478038 PMCID: PMC4250027 DOI: 10.11604/pamj.2014.18.317.5182] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 08/18/2014] [Indexed: 11/24/2022] Open
Abstract
Les érythrodermies du nouveau-né sont des tableaux rares, d’évolution chronique et potentiellement mortelles. Leurs étiologies sont diverses et variées dominées par les ichtyoses, le déficit immunitaire primaire, ou plus exceptionnellement le psoriasis sévère, les maladies métaboliques, la dermatite atopique ou une cause infectieuse. La détermination rapide de la cause sous-jacente est cruciale pour une meilleure prise en charge. Cependant, le diagnostic constitue un défi pour le clinicien et est souvent retardé en raison de la nature non spécifique des signes cliniques et histopathologiques. L'objectif de notre travail est de rappeler aux praticiens une étiologie grave de l’érythrodermie néonatale: le déficit immunitaire ceci à travers l'observation d'un nourrisson suivi pour une érythrodermie évoluant depuis la naissance, hospitalisé pour une fièvre prolongée, et chez qui un interrogatoire minutieux, un examen clinique soigneux, ainsi que l’évolution ont pu redresser le diagnostic vers un déficit immunitaire.
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Affiliation(s)
- Aziza El Ouali
- Service de Pédiatrie, CHU Mohammed VI, Université Mohamed I Oujda, Maroc
| | | | - Fatima Ailal
- Unité d'Immunologie Clinique Service des maladies infectieuses Pédiatriques, Hôpital Abderrahim Alharouchi CHU Casablanca, Maroc
| | - Ahmed Aziz Bousfiha
- Unité d'Immunologie Clinique Service des maladies infectieuses Pédiatriques, Hôpital Abderrahim Alharouchi CHU Casablanca, Maroc
| | - Sihame Dikhaye
- Service de Dermatologie CHU Mohammed VI, Université Mohamed I Oujda, Maroc
| | - Noufissa Benajiba
- Service de Pédiatrie, CHU Mohammed VI, Université Mohamed I Oujda, Maroc
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9
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Rabbat JC, Lin MY, Moy JN. Induction of tolerance in a patient with a history of exfoliative dermatitis to trimethoprim-sulfamethoxazole. Ann Allergy Asthma Immunol 2012; 109:360-1. [PMID: 23062394 DOI: 10.1016/j.anai.2012.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/04/2012] [Accepted: 08/06/2012] [Indexed: 11/30/2022]
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10
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Shimauchi T, Sugita K, Nakamura M, Tokura Y. Leukaemic cutaneous T-cell lymphoma-manifesting papuloerythroderma with CD3(-) CD4(+) phenotype. Acta Derm Venereol 2010; 90:68-72. [PMID: 20107729 DOI: 10.2340/00015555-0786] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/16/2022] Open
Abstract
The leukaemic form of cutaneous T-cell lymphoma, as represented by Sézary syndrome, exhibits erythroderma. We describe here an indolent leukaemic patient with cutaneous T-cell lymphoma, who initially had a nodulo-tumourous eruption with a crop of solid papules, but finally presented with papuloerythroderma. Histologically, the skin lesions showed non-epidermotropic dermal infiltration of atypical lymphocytes with lymphoid follicles and a granulomatous change. The circulating malignant CD4(+) CCR4(+) T cells lacked the expression of T-cell receptor and did not respond to concanavalin A. The unresponsiveness of T cells to the T-cell mitogen may be associated with the non-epidermotropic behaviour of the tumour cells and the initially non-erythrodermic eruption.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols
- Biopsy
- CD3 Complex/analysis
- CD4 Antigens/analysis
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/pathology
- Cells, Cultured
- Concanavalin A/pharmacology
- Dermatitis, Exfoliative/drug therapy
- Dermatitis, Exfoliative/immunology
- Dermatitis, Exfoliative/pathology
- Flow Cytometry
- Humans
- Immunophenotyping
- Lymphoma, T-Cell, Cutaneous/complications
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Mitogens/pharmacology
- Neoplastic Cells, Circulating/immunology
- Neoplastic Cells, Circulating/pathology
- Phenotype
- Receptors, Antigen, T-Cell/analysis
- Receptors, CCR4/analysis
- Skin Neoplasms/complications
- Skin Neoplasms/drug therapy
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Treatment Outcome
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Affiliation(s)
- Takatoshi Shimauchi
- Department of Dermatology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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11
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Jeong KH, Lew BL, Sim WY. Generalized leukaemia cutis from a small cell variant of T-cell prolymphocytic leukaemia presenting with exfoliative dermatitis. Acta Derm Venereol 2009; 89:509-12. [PMID: 19734979 DOI: 10.2340/00015555-0672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/16/2022] Open
Abstract
T-cell prolymphocytic leukaemia (T-PLL) is a rare, aggressive neoplasm of mature T lymphocytes. The small cell variant occurs in approximately 20% of T-PLL patients. The skin findings of leukaemia consist of leukaemia-specific skin lesions, which are infiltrated by leukaemia cells, and non-specific lesions. The former type of lesion signifies leukaemia cutis. Leukaemia cutis presents clinically as tumours, nodules, or patches on the scalp, face and trunk. We report here an 82-year-old Korean male patient who presented with erythema, erosion, vesicles, and scales on his entire body with no clear underlying cause. He had been treated with oral retinoids, steroids, and phototherapy for the diagnoses of drug eruption, pityriasis rubra pilaris, and exfoliative dermatitis at other hospitals. We suspected a hidden malignancy and diagnosed small cell variant T-PLL through blood and bone marrow examination. A skin biopsy specimen showed dense infiltration of small lymphocytes in the dermis. Most of the atypical lymphocytes stained positively with CD markers such as CD2, CD3, CD4, CD5, CD7 and CD8, thereby confirming the presence of leukaemia cells. To our knowledge, this is the first case of generalized leukaemia cutis from small cell variant of T-PLL presenting with exfoliative dermatitis over the whole body.
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MESH Headings
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Bone Marrow Examination
- Dermatitis, Exfoliative/drug therapy
- Dermatitis, Exfoliative/etiology
- Dermatitis, Exfoliative/immunology
- Dermatitis, Exfoliative/pathology
- Diagnostic Errors
- Erythema/etiology
- Erythema/immunology
- Fatal Outcome
- Humans
- Immunophenotyping
- Leukemia, Prolymphocytic, T-Cell/complications
- Leukemia, Prolymphocytic, T-Cell/drug therapy
- Leukemia, Prolymphocytic, T-Cell/immunology
- Leukemia, Prolymphocytic, T-Cell/pathology
- Leukemic Infiltration
- Male
- Prednisone/administration & dosage
- Skin/drug effects
- Skin/immunology
- Skin/pathology
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
- Treatment Failure
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- Ki-Heon Jeong
- Department of Dermatology, College of Medicine, Kyunghee University, Seoul, Korea
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12
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Abstract
Erythrodema secondary to subacute cutaneous lupus erythematosus (SCLE) is rare. We report a 61-year-old man presenting with erythroderma secondary to SCLE. During erythrodermic phase our patient still had few annular and polycyclic lesions characteristic of SCLE. He was successfully treated with topical and oral corticosteriods.
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Affiliation(s)
- M Kalavala
- Department of Dermatology, Singleton Hospital, Swansea, UK.
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13
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Tatli MM, Sarraoglu S, Shermatov K, Gurel MS, Karadag A. Exfoliative erythroderma, recurrent infections, generalized lymphadenopathy and hepatosplenomegaly in a newborn: Omenn syndrome. Australas J Dermatol 2007; 48:133-4. [PMID: 17535207 DOI: 10.1111/j.1440-0960.2007.00354.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Fierro MT, Comessatti A, Quaglino P, Ortoncelli M, Osella Abate S, Ponti R, Novelli M, Bernengo MG. Expression pattern of chemokine receptors and chemokine release in inflammatory erythroderma and Sézary syndrome. Dermatology 2007; 213:284-92. [PMID: 17135733 DOI: 10.1159/000096191] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 05/12/2006] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Erythroderma can be caused by inflammatory dermatoses or cutaneous T-cell lymphoma. Even if chemokines and their receptors are involved in the skin-selective lymphocyte recruitment, their role in inflammatory erythroderma is yet unclear. OBJECTIVE To evaluate the chemokine release (TARC, MDC, IP-10) and to define the expression pattern of Th1- (CCR5, CXCR3) and Th2-related (CCR4) chemokine receptors in inflammatory erythroderma and Sézary syndrome (SS). MATERIALS AND METHODS Flow cytometry has been carried out on both circulating and skin-infiltrating T lymphocytes; serum chemokine levels have been evaluated using ELISA techniques. RESULTS CCR4, CCR5 and CXCR3 were expressed on about 40% of peripheral blood lymphocytes and on the majority of skin-infiltrating lymphocytes in the inflammatory erythroderma patients, whereas the leukemic CD4+CD26- subpopulation in SS was characterized by a high CCR4 expression without a concurrent increase in CCR5 or CXCR3. TARC, MDC and IP-10 serum levels were significantly increased in both erythrodermic and SS patients. CONCLUSIONS Our results confirm that SS is a Th2 disorder with a selective expression of CCR4, whereas inflammatory erythroderma shares an overexpression of both Th1- and Th2-related chemokine receptors, suggesting an activation of different pathways driving reactive lymphocytes to the skin.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- CD4-Positive T-Lymphocytes/immunology
- Chemokine CCL17
- Chemokines/blood
- Chemokines/metabolism
- Chemokines, CC/analysis
- Chemokines, CC/blood
- Chemotaxis, Leukocyte/immunology
- Dermatitis, Exfoliative/blood
- Dermatitis, Exfoliative/immunology
- Dermatitis, Exfoliative/pathology
- Female
- Flow Cytometry
- Humans
- Lymphocyte Activation/immunology
- Male
- Middle Aged
- Receptors, CCR4
- Receptors, CCR5/analysis
- Receptors, CCR5/blood
- Receptors, CXCR3
- Receptors, Chemokine/analysis
- Receptors, Chemokine/blood
- Receptors, Cytokine/analysis
- Receptors, Cytokine/blood
- Sezary Syndrome/blood
- Sezary Syndrome/immunology
- Sezary Syndrome/pathology
- Skin Neoplasms/blood
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Th1 Cells/immunology
- Th2 Cells/immunology
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Affiliation(s)
- Maria Teresa Fierro
- Section of Dermatology, Department of Medical Sciences and Human Oncology, University of Turin, Turin, Italy.
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15
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Kano Y, Teraki Y, Shiohara T. Dramatic improvement of psoriatic erythroderma after acute hepatitis: analysis of cytokine synthesis capability in peripheral blood T cells. Br J Dermatol 2006; 155:455-9. [PMID: 16882189 DOI: 10.1111/j.1365-2133.2006.07270.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/30/2022]
Abstract
We report a patient with psoriasis and hepatitis C virus infection who initially presented with psoriatic erythroderma and eventually showed complete clearance of psoriatic lesions following acute hepatitis induced by etretinate treatment. Cytokine synthesis capabilities in peripheral blood T cells obtained at different stages were evaluated in this patient. A dramatic increase in the frequency of interferon-gamma-producing CD8+ T cells in peripheral blood was observed during the erythrodermic stage. In contrast, the frequencies of interleukin (IL)-4- and IL-13-producing CD4+ T and CD8+ T cells were remarkably high at the resolution stage. These results clearly indicate that a shift towards type 2 cytokine predominance contributes to the resolution of severe psoriasis.
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Affiliation(s)
- Y Kano
- Department of Dermatology, Kyorin University School of Medicine, 6-20-2 Shinkawa Mitaka, Tokyo 181-8611, Japan.
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16
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Abstract
The cause of psoriatic erythroderma (PE) is still unknown. Elevation of serum IgE has been reported in erythroderma, and as serum hyper-IgE is Th2 cell dominated it is of interest to investigate the serum IgE level in PE. In this study, the level of immunoglobulins in the sera of PE patients was analysed by a retrospective case-control study using psoriasis vulgaris (PV) patients as controls. The PE and PV patients were matched in a 1:3 pattern: the first three age and sex matched PV inpatients were selected. All of the subjects were nonatopic and without allergic history. The serum IgE level was found to be elevated in 81.3% of the PE group, which is much higher than that (6.3%) of the controls (odds ratio, 65.0; 95% CI, 11.7-361.2; P < 0.001; chi2 test). The mean level of serum IgE was much higher in the PE group (272.38 +/- 207.63 IU/mL vs. 53.20 +/- 86.05 IU/mL, P < 0.001, Student's t-test). No differences were found for other immunoglobulins. These results suggest that in PE the Th1/Th2 cell imbalance may be switched from Th1 dominant to Th2 dominant. The exact role of serum IgE in PE should be investigated further.
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Affiliation(s)
- L-F Li
- Department of Dermatology, Peking University Third Hospital, Beijing, People's Republic of China.
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17
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Abstract
BACKGROUND Erythroderma is a diffuse, inflammatory skin reaction that, in rare instances, is associated with hematologic malignancies such as cutaneous T-cell lymphoma (erythrodermic mycosis fungoides) or T-cell leukemia (Sezary syndrome or adult T-cell leukemia/lymphoma). OBSERVATIONS We screened 30 patients with erythroderma (20 patients with erythroderma of known etiology and 10 patients with idiopathic erythroderma) for the presence of circulating monoclonal T-lymphocyte populations using T-cell receptor (TCR)-gamma gene-specific polymerase chain reaction and automated capillary DNA electrophoresis. Moreover, the phenotypic analysis of peripheral blood CD4+ lymphocytes was performed using the following surface markers: CD3, CD7, CD8, CD25, CD26, CD27, CD28, CD29, CD30, CD45RO, CD45RA, CD56, CD134, HLA-DR, TCRalphabeta, TCRgammadelta, and cutaneous lymphocyte antigen (CLA). In 5 patients with idiopathic erythroderma we detected T-cell clones in peripheral blood (in 1 case, associated with the presence of the same clone in the skin) and a 2-fold increase in the proportion of CD3+ CD4+ CD7- CD26- cells. Cell depletion studies indicated that the monoclonal T cells were present within the CD4+ CD7- cell population. Clinically, all patients had chronic, recalcitrant erythroderma but none developed any hematological malignancy during their lifetimes or fulfilled the criteria for cutaneous lymphoma or Sezary syndrome. CONCLUSIONS A proportion of patients with chronic erythroderma present with the monoclonal expansion of CD4+ CD7- CD26- lymphocytes in their blood. This condition represents a probably benign T-cell dyscrasia, or one of very low malignancy. Alongside monoclonal gammapathy of undetermined significance (MGUS) and monoclonal (B-cell) lymphocytosis of undetermined significance (MLUS), we propose using monoclonal T-cell dyscrasia of undetermined significance (MTUS) to underline a conceptual similarity between this disorder and the more common types of lymphocytic dyscrasia.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- Antigens, CD/immunology
- Case-Control Studies
- Cell Transformation, Neoplastic/pathology
- Cohort Studies
- Dermatitis, Exfoliative/immunology
- Dermatitis, Exfoliative/pathology
- Female
- Humans
- Immunophenotyping
- Lymphocyte Activation
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Precancerous Conditions/genetics
- Precancerous Conditions/pathology
- Prognosis
- Receptors, Antigen, T-Cell/analysis
- Receptors, Antigen, T-Cell/immunology
- Risk Assessment
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
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Affiliation(s)
- Robert Gniadecki
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
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18
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Papadogiannakis EI, Koutinas AF, Saridomichelakis MN, Vlemmas J, Lekkas S, Karameris A, Fytianou A. Cellular immunophenotyping of exfoliative dermatitis in canine leishmaniosis (Leishmania infantum). Vet Immunol Immunopathol 2005; 104:227-37. [PMID: 15734543 DOI: 10.1016/j.vetimm.2004.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Revised: 10/13/2004] [Accepted: 12/02/2004] [Indexed: 11/23/2022]
Abstract
Lymphocyte subsets, major histocompatibility complex (MHC)-II expressing cells and number of amastigotes in the epidermis and dermis were investigated immunohistochemically in 48 dogs with patent leishmaniosis, with or without exfoliative dermatitis (ED) to study the immunopathogenesis of this common cutaneous form of the disease. Skin biopsies were obtained and compared for ED sites (group A, n = 26), normal-appearing skin from the same animals (group B, n = 24), and leishmanial dogs not exhibiting ED (group C, n = 22), and normal controls (group D, n = 22). The CD3+, CD45RA+, CD4+, CD8+ (CD8a+), CD21+, and MHC-II+ cells and leishmania amastigotes were identified immunohistochemically and counted with the aid of an image analysis system. Pyogranulomatous to granulomatous dermatitis, expressed in various histopathological patterns, was noticed in all groups A and B and in half of group C dogs. In the epidermis, the low number of T-cells and their subsets did not differ significantly between groups A and B, but CD8+ outnumbered CD4+ lymphocytes in both groups. MHC-II+ expression on epidermal keratinocytes was intense in the skin with and without lesions from dogs with ED but not in group C dogs. CD3+, CD8+ and MHC-II+ cells were fewer in group C compared to group A and B dogs. In the dermis, CD3+ cells in group A animals were mainly represented by the CD8+. CD45RA+ and CD21+ cells were also seen in high numbers. MHC-II expression, potentially in lymphocytes, fibroblasts, dendritic cells, and macrophages was intense. The numbers of all cellular subpopulations in the dermis were significantly different between the groups, being highest in group A and lowest in group D. In sebaceous adenitis sites, CD4+ outnumbered CD8+ cells in contrast to the neighbouring dermis and the epidermis. The number of CD21+ and CD45RA+ cells was much lower in the inflamed sebaceous glands compared to the dermis. Finally, the number of amastigotes in the normal-appearing skin was significantly higher in the ED dogs (group B) than in those not exhibiting this cutaneous form of the disease (group C).
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MESH Headings
- Animals
- Antigens, CD/immunology
- Biopsy/veterinary
- Dermatitis, Exfoliative/immunology
- Dermatitis, Exfoliative/parasitology
- Dermatitis, Exfoliative/pathology
- Dermatitis, Exfoliative/veterinary
- Dog Diseases/immunology
- Dog Diseases/parasitology
- Dog Diseases/pathology
- Dogs
- Female
- Histocompatibility Antigens Class II/immunology
- Immunophenotyping/veterinary
- Leishmania infantum/immunology
- Leishmaniasis, Cutaneous/immunology
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Cutaneous/pathology
- Leishmaniasis, Cutaneous/veterinary
- Male
- Statistics, Nonparametric
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Affiliation(s)
- E I Papadogiannakis
- Clinic of Companion Animal Medicine, School of Veterinary Medicine, Aristotles University of Thessaloniki, 11 Stavrou Voutyra, GR-54627 Thessaloniki, Greece
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19
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Poszepczynska E, Martinvalet D, Bouloc A, Echchakir H, Wechsler J, Bécherel PA, Boumsell L, Bensussan A, Bagot M. Erythrodermic cutaneous T-cell lymphoma with disseminated pustulosis. Production of high levels of interleukin-8 by tumour cells. Br J Dermatol 2001; 144:1073-9. [PMID: 11359402 DOI: 10.1046/j.1365-2133.2001.04203.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 01/09/2023]
Abstract
Interleukin (IL) -8 is a neutrophil chemoattractant cytokine with proinflammatory and growth-promoting activities, which is involved in the pathogenesis of several inflammatory diseases. It is found in high amounts in lesional biopsies of pustular diseases such as psoriasis and palmoplantar pustulosis. We report a 50-year-old woman with a 10-year history of erythroderma with disseminated pustulosis. Skin biopsies showed an epidermotropic infiltrate composed of atypical CD4+ CD8+ lymphocytes with numerous admixed neutrophils. Peripheral blood flow cytometric analysis revealed a major clonal subset of CD3+ CD4+ CD8+ T-cell receptor Vbeta22+ atypical lymphocytes. Bone marrow biopsy, lymph node biopsy and computed thoracoabdominal tomography were normal. Serologies for human T-cell lymphotropic virus type I and human immunodeficiency virus were negative. Our patient's status deteriorated despite topical (nitrogen mustard, psoralen plus ultraviolet A) and systemic (interferon, methotrexate, multiagent chemotherapy) treatments, and she finally died. We showed that our patient's peripheral blood lymphocytes (PBL) spontaneously produced high amounts of IL-8. In contrast, PBL of patients with classical Sézary syndrome produced lower amounts of IL-8. The production of IL-8 by tumour T cells could explain this unusual clinical and histopathological presentation of cutaneous T-cell lymphoma as disseminated pustulosis.
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Affiliation(s)
- E Poszepczynska
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, 94010 Créteil, France
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20
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Camacho FM, García-Hernandez MJ, Muñoz-Pérez MA, Mazuecos J, Sotillo I. Ofuji papuloerythroderma in an elderly woman with atopic erythroderma. J Eur Acad Dermatol Venereol 2001; 15:264-6. [PMID: 11683297] [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: 02/22/2023]
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21
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Pasmans SG, Bruijnzeel-Koomen CA, van Reijsen FC. Skin reactions to carbamazepine. Allergy 1999; 54:649-50. [PMID: 10435488] [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: 02/13/2023]
Affiliation(s)
- S G Pasmans
- Department of Dermatology/Allergology, Utrecht University Hospital, The Netherlands
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22
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Joly P, Tanasescu S, Wolkenstein P, Bocquet H, Gilbert D, Thomine E, Wechsler J, Roujeau JC, Revuz J, Tron F, Lauret P. Lichenoid erythrodermic bullous pemphigoid of the African patient. J Am Acad Dermatol 1998; 39:691-7. [PMID: 9810884 DOI: 10.1016/s0190-9622(98)70040-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 11/20/2022]
Abstract
BACKGROUND Lichen planus (LP) pemphigoides is defined by the concurrence of bullous pemphigoid (BP) and LP lesions. However, other autoimmune bullous skin diseases such as paraneoplastic pemphigus or bullous lupus erythematosus may also be associated with lichenoid eruptions. OBJECTIVE Our purpose was to describe 3 African patients with a similar form of lichenoid erythrodermic BP. METHODS Medical records of the 3 patients were reviewed for clinical, histologic, and biologic data. The ultrastructural localization of autoantibody deposits was studied by direct and indirect immunoelectron microscopy. The antigenic specificities recognized by the patients' sera were analyzed by immunoblotting on human epidermal extracts. RESULTS Three black African men had a severe lichenoid erythroderma associated with BP lesions involving the skin and mucosa. Histologic and direct immunofluorescence examination of skin and mucosal lesions were consistent with the diagnosis of BP associated with a lichenoid dermatitis. Immunoblot analysis of sera detected anti-BPAG1 and anti-BPAG2 antibodies and immunoelectron microscopy showed IgG deposits localized in the lamina lucida and the hemidesmosomes. The 3 patients were natives of an area near the Senegal River and had the common HLA-DR10 haplotype. CONCLUSION The clinical and histologic features of these 3 patients were distinct from classic LP pemphigoides. Their common geographic origin and the presence of the HLA-DR10 haplotype suggest that these cases represent a particular type of lichenoid erythrodermic BP, which is probably determined by genetic factors.
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Affiliation(s)
- P Joly
- Research Group on Immunopathology, IFR 23, Hôpital Charles Nicolle, Rouen, France
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23
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Scrivener Y, Cribier B, Le Coz C, Boehm N, Jelen G, Heid E, Grosshans E. [Erythroderma with immunoglobulin deposits along the basal membrane. Pemphigoid erythroderma?]. Ann Dermatol Venereol 1998; 125:13-7. [PMID: 9747199] [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: 02/08/2023]
Abstract
INTRODUCTION There are many clinical forms of bullous pemphigoid. Nodular, localised, vegetating, vesicular and dysidrosiform variants have been described. The appartenance to the spectrum of pemphigoid was confirmed by the demonstration of antibodies directed against the 230 and 180 kDa BP antigens. Three cases of erythrodermic pemphigoid were recently described. OBSERVATIONS We describe two cases of patients suffering from erythroderma for several months associated with a linear deposit of immunoglobulins and complement along the basement membrane. In the first observation, the patient suffered from bullae of the legs before developing erythroderma. The positive direct immunofluorescence of the skin was associated with circulating anti basement membrane antibodies, making therefore the diagnosis of erythrodermic pemphigoid possible. In the second case, the patient never developed blisters. We also found a linear deposit along the basement membrane, localized on the dermic side of a skin treated by molar NaCl. No circulating antibodies were found by indirect immunofluorescence or by immunoblott. Direct immuno electron microscopy showed a deposit of immunoglobulins into the deep layers of the lamina lucida and into a part of the lamina densa. CONCLUSION These two cases suggest that there are true erythrodermic pemphigoid without blisters. The value of the systematic direct immunofluorescence examination of the skin of erythroderma should be evaluated.
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Affiliation(s)
- Y Scrivener
- Clinique Dermatologique, Faculté de Médecine de Strasbourg, Europe
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24
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Abstract
Omenn syndrome comprises a rare form of combined immunodeficiency with TH2-type features of eosinophilia and elevated IgE. Previous studies have led to reports of restricted heterogeneity in the T lymphocyte repertoire, and in vitro cloned T lymphocytes have been shown to produce IL-4 and IL-5. We hypothesized that (1) T cell receptor beta V(D)J DNA sequence analysis would confirm and further define the putative restricted heterogeneity, and (2) increased production of IL-4 and IL-5 should be found in nonstimulated T lymphocytes, if the molecular pathogenesis of Omenn syndrome is an uncontrolled TH2 state. We report the results of molecular analyses of T lymphocytes from an untreated 3-month-old patient. Oligoclonal T cell receptor beta variable gene usage was found. Sequence analysis revealed sets of identical V(D)J sequences, each in-frame, with apparently normal N-diversification and no obvious antigen combining site motif. From fresh, nonstimulated lymphocytes, proinflammatory TH1 cytokines could be detected, but TH2 cytokines could not, so that a simple TH1/TH2 paradigm cannot explain the eosinophilia and elevated IgE in Omenn syndrome. Our studies fully document for the first time at the molecular level that clonally expanded populations of T lymphocytes are present in Omenn syndrome.
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Affiliation(s)
- T O Harville
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA
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25
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Jackow CM, Cather JC, Hearne V, Asano AT, Musser JM, Duvic M. Association of erythrodermic cutaneous T-cell lymphoma, superantigen-positive Staphylococcus aureus, and oligoclonal T-cell receptor V beta gene expansion. Blood 1997; 89:32-40. [PMID: 8978274] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Forty-two patients with cutaneous T-cell lymphoma, including 31 with exfoliative erythroderma or Sezary syndrome and 11 with mycosis fungoides, were studied for the occurrence of staphylococcal infection. Thirty-two of 42 (76%) had a positive staphylococcal culture from skin or blood. One half of the patients with positive cultures grew Staphylococcus aureus. This group included 11 with Sezary syndrome and 5 with rapidly enlarging mycosis fungoides plaques or tumors. All of the S aureus carried enterotoxin genes. Surprisingly, 6 of 16 strains were the same toxic shock toxin-1 (TSST-1)-positive clone, designated electrophoretic type (ET)-41. Analysis of the T-cell receptor V beta repertoire in 14 CTCL patients found that only 4 had the expected monoclonal expansion of a specific V beta gene, whereas 10 had oligoclonal or polyclonal expansion of several V beta families. All patients with TSST-1+ S aureus had overexpansion of V beta Z in blood and/or skin lesions. These studies show that S aureus containing superantigen enterotoxins are commonly found in patients with CTCL especially individuals with erythroderma where they could exacerbate and/or perpetuate stimulate chronic T-cell expansion and cutaneous inflammation. Attention to toxigenic S aureus in CTCL patients would be expected to improve the quality of care and outcome of this patient population.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, Bacterial/immunology
- Bacteremia/complications
- Bacteremia/epidemiology
- Bacteremia/immunology
- Bacteremia/microbiology
- Bacterial Toxins
- Comorbidity
- Dermatitis, Exfoliative/etiology
- Dermatitis, Exfoliative/immunology
- Enterotoxins/immunology
- Female
- Humans
- Lymphocyte Activation
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/etiology
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Male
- Middle Aged
- Prospective Studies
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Staphylococcal Infections/complications
- Staphylococcal Infections/epidemiology
- Staphylococcal Infections/immunology
- Staphylococcal Skin Infections/complications
- Staphylococcal Skin Infections/epidemiology
- Staphylococcal Skin Infections/immunology
- Staphylococcal Skin Infections/microbiology
- Staphylococcus aureus/immunology
- Superantigens/immunology
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- C M Jackow
- Department of Dermatology, University of Texas Medical School, Houston, USA
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26
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Duque S, de la Puente J, Rodríguez F, Fernandez Pellón L, Maquiera E, Jerez J. Zidovudine-related erythroderma and successful desensitization: a case report. J Allergy Clin Immunol 1996; 98:234-5. [PMID: 8765840 DOI: 10.1016/s0091-6749(96)70248-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S Duque
- Allergy Unit, Hospital Sierrallana, Torrelavega, Spain
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27
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Horn TD, Altomonte V, Vogelsang G, Kennedy MJ. Erythroderma after autologous bone marrow transplantation modified by administration of cyclosporine and interferon gamma for breast cancer. J Am Acad Dermatol 1996; 34:413-7. [PMID: 8609251 DOI: 10.1016/s0190-9622(96)90431-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/31/2023]
Abstract
BACKGROUND Allogeneic graft-versus-host disease is associated with decreased rates of tumor relapse. The addition of interferon gamma to cyclosporine, given to induce graft-versus-host disease after autologous bone marrow transplantation, increases the extent of the cutaneous eruption. OBJECTIVE Our purpose was to describe the clinical and histologic cutaneous changes in 10 patients with breast cancer who received interferon gamma to potentiate graft-versus-host disease after autologous bone marrow transplantation modified by cyclosporine. METHODS Ten women receiving autologous bone marrow transplantation modified by the administration of cyclosporine and interferon gamma were observed clinically with sequential biopsy of the skin weekly and at the time of cutaneous eruptions. RESULTS Erythroderma (stage 3) developed in five women after the first or second administration of interferon gamma. At least on skin biopsy specimen from 7 of the 10 women showed grade 2 changes of graft-versus-host reaction, including all patients with erythroderma. Epidermal intercellular edema was prominent in these specimens with expression of keratinocyte HLA-DR and intercellular adhesion molecule 1. Induction of keratinocyte HLA-DR and intercellular adhesion molecule 1 expression was not observed in specimens from normal skin during administration of interferon gamma. CONCLUSION This protocol causes a more widely distributed cutaneous eruption, including erythroderma (50%), than autologous bone marrow transplantation and cyclosporine administration alone (3%). Whether it will affect survival is unknown.
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Affiliation(s)
- T D Horn
- Department of Dermatology, The Johns Hopskins Medical Institutions, Baltimore, MD 21287, USA
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28
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Horiuchi Y, Okuno T, Yamanishi K. Mild reduction of generalized rash in guinea pigs experimentally infected with varicella zoster virus or herpes simplex virus type 1. J Dermatol 1995; 22:625-6. [PMID: 7560465 DOI: 10.1111/j.1346-8138.1995.tb03887.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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29
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Horiuchi Y, Tsukahara T, Otoyama K. Immunohistochemical study of elevated expression of squamous cell carcinoma (SCC)-related antigens in erythrodermic epidermis. J Dermatol 1994; 21:67-72. [PMID: 8182213 DOI: 10.1111/j.1346-8138.1994.tb01416.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 01/29/2023]
Abstract
Using immunohistochemical staining with the monoclonal antibodies (mAb) of squamous cell carcinoma-related antigens (SCC-RAg), the expression of SCC-RAg in erythrodermic epidermis, which included senile erythroderma following eczema, atopic erythroderma, psoriatic erythroderma, and Sézary syndrome was examined. In senile erythroderma and atopic dermatitis, the most intense staining with SCC-RAg mAb was evident in the upper epidermis. The cytoplasm of epidermal cells showed particularly strong staining. Although serum SCC-RAg in the Sézary syndrome was not as high as in other erythroderma patients, staining with SCC-RAg mAb was relatively strong in the upper epidermis. However, in psoriatic erythroderma cases with severe skin conditions, staining was weakly positive and diffuse throughout the entire epidermis. Following treatment, SCC-RAg decreased significantly with remission. Elevated SCC-RAg release may be attributed to epidermal cells, and SCC-RAg should prove useful as a clinical marker of erythroderma.
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Affiliation(s)
- Y Horiuchi
- Division of Dermatology, Kashima Rosai Hospital, Japan
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30
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Abstract
The usefulness of patch testing in the diagnosis of carbamazepine-induced allergic skin eruptions was studied in 18 patients with previous histories of skin eruptions caused by carbamazepine. The etiological role of carbamazepine was ascertained by peroral or topical provocation in 15 (out of 18) patients. The clinical reactions caused by the drug were classified as maculopapular exanthema with general symptoms (7 patients), other type of exanthema (3), exfoliative dermatitis (erythroderma) (3), fixed drug eruption (3), erythema multiforme (1) and urticaria (1). Patch testing showed positive reactions to carbamazepine in 7 patients; in addition, 2 patients had doubtful reactions. Positive patch test reactions were seen only in patients with exfoliative dermatitis (all 3 patients) and maculopapular exanthema (4 out of 7). None of the patients with fixed drug eruption, erythema multiforme or urticaria, or the control subjects, had positive patch test reactions to carbamazepine. The present study suggests that patch testing is useful in the diagnosis of carbamazepine allergy in patients with maculopapular eruptions or erythrodermas.
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Affiliation(s)
- K Alanko
- Department of Dermatology, Helsinki University Central Hospital, Finland
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31
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Daenen S, van Voorst Vader PC, Blom N, Pietens J, Hollema H, Smit JW. Clonal chronic lymphocytic leukaemia-like B lymphocytes in the blood of patients with cutaneous T-cell disorders. Br J Haematol 1993; 85:307-12. [PMID: 7506566 DOI: 10.1111/j.1365-2141.1993.tb03171.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/25/2023]
Abstract
A population of B cells with characteristics of chronic lymphocytic leukaemia was found in the peripheral blood of four patients who presented with cutaneous infiltration of atypical CD4+ T cells with cerebriform nuclei. The B cells had a low density of immunoglobulin on their surface membrane, expressed CD5-positivity, and showed monoclonality based on the restriction to either kappa or lambda light chains. In one patient with tumourous pleiomorphic CD4+CD30- T-cell lymphoma of the skin, it was the first manifestation of a concomitant B-cell non-Hodgkin's lymphoma of low-grade malignancy. In three other patients with reactive atypical T-cell erythroderma, there was no evidence for the coexistence of a B-cell malignancy. The number of CD5+ B cells decreased in two erythroderma patients with clinical remission of the cutaneous lesions. It is speculated that the presence of a monoclonal B cell population in patients with T-cell disorders of the skin is due either to a reactive process possibly conferring some protective effect, or a response to an unknown stimulus produced by the T cells.
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MESH Headings
- Aged
- Antigens, CD/analysis
- Antigens, Neoplasm/analysis
- B-Lymphocytes/immunology
- CD5 Antigens
- Dermatitis, Exfoliative/immunology
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphoma, B-Cell/immunology
- Lymphoma, T-Cell, Cutaneous/immunology
- Male
- Neoplasms, Second Primary/immunology
- Receptors, Antigen, B-Cell/analysis
- Skin Neoplasms/immunology
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Affiliation(s)
- S Daenen
- Department of Haematology, University Hospital Groningen, The Netherlands
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32
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Tsukahara T, Otoyama K, Horiuchi Y. Significance of elevated serum squamous cell carcinoma (SCC)-related antigen and lactate dehydrogenase (LDH) levels in senile erythroderma following eczema. J Dermatol 1993; 20:346-50. [PMID: 8349923 DOI: 10.1111/j.1346-8138.1993.tb01296.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 01/30/2023]
Abstract
Clinical and laboratory tests were used to evaluate fourteen patients with senile erythroderma following eczema, and the results were compared with those from four patients with psoriatic erythroderma, two with Sézary syndrome, and twelve with prurigo chronica multiformis or nummular dermatitis. Characteristic laboratory findings included elevated serum squamous cell carcinoma-related antigens (SCC-RAg), high lactate dehydrogenase (LDH), peripheral-blood eosinophilia, and a decreased peripheral blood lymphocyte percentage. Following treatment, titers of SCC-RAg and LDH resumed normal levels with remission. In patients with senile erythroderma following eczema, serum IgE was quite high and varied but, in a few instances, was within the normal range. SCC-RAg and LDH may thus be considered useful as markers for evaluating disease conditions of the skin of patients with senile erythroderma following eczema.
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Affiliation(s)
- T Tsukahara
- Department of Dermatology, Kitasato University School of Medicine, Sagamihara, Japan
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33
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Hisatomi K, Isomura T, Hirano A, Yasunaga H, Sato T, Hayashida N, Ohishi K, Toshima H. Postoperative erythroderma after cardiac operations. The possible role of depressed cell-mediated immunity. J Thorac Cardiovasc Surg 1992; 104:648-53. [PMID: 1387438] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Erythroderma as a manifestation of graft-versus-host disease after cardiac operations with blood transfusion may occur more frequently in Japan than in other countries. We have seen this problem in five patients who, after heart operations, died with symptoms and signs characteristic of graft-versus-host disease: cutaneous eruption, fever, diarrhea, leukopenia associated with agranulocytosis, and liver dysfunction. In the three patients seen most recently, skin biopsy showed findings similar to those of graft-versus-host disease after bone marrow transplantation. In addition, immunologic investigation showed remarkable differences in the findings in these patients and in those who did not have a graft-versus-host disease-like syndrome after cardiac operations. In particular, interleukin-2 production in response to mitogen stimulation was markedly diminished after operation in our patients, and the ratio of OKT4+ cells to OKT8+ cells in peripheral blood was low, reflecting increased numbers of OKT8+ cells after the occurrence of symptoms. The results raise the possibility that transient depression of cellular immunity after cardiac operations with blood transfusion may contribute to the occurrence of postoperative acute graft-versus-host disease.
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Affiliation(s)
- K Hisatomi
- Second Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
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34
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Heald P, Rook A, Perez M, Wintroub B, Knobler R, Jegasothy B, Gasparro F, Berger C, Edelson R. Treatment of erythrodermic cutaneous T-cell lymphoma with extracorporeal photochemotherapy. J Am Acad Dermatol 1992; 27:427-33. [PMID: 1401279 DOI: 10.1016/0190-9622(92)70212-x] [Citation(s) in RCA: 186] [Impact Index Per Article: 5.8] [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: 12/26/2022]
Abstract
BACKGROUND This original cohort of patients with erythrodermic cutaneous T-cell lymphoma (CTCL) was reported to have clinical improvement with photopheresis during the 12 months of the original study. No long-term follow-up data have been available to examine the impact of this therapy on the disease. OBJECTIVE Our purpose was to provide long-term follow-up on the original 29 erythrodermic CTCL patients treated with photopheresis and to compare these results with historical controls. METHODS Files of patients from the original photopheresis study centers were reviewed and their current status was documented. RESULTS The median survival of the treated patients was 60.33 months from the date of diagnosis and 47.9 months from the date of the start of photopheresis therapy. A complete remission has been maintained in four of the six patients who achieved complete responses in the original study. The best responses were seen in patients with a lower CD4/CD8 ratio in the peripheral blood at the start of therapy. CONCLUSION Photopheresis can influence the natural history of erythrodermic CTCL by inducing remissions and prolonging survival with minimal toxicity.
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MESH Headings
- CD4-CD8 Ratio
- Dermatitis, Exfoliative/drug therapy
- Dermatitis, Exfoliative/immunology
- Dermatitis, Exfoliative/mortality
- Dermatitis, Exfoliative/pathology
- Follow-Up Studies
- Humans
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/mortality
- Lymphoma, T-Cell, Cutaneous/pathology
- Methoxsalen/therapeutic use
- Photochemotherapy
- Skin/pathology
- Skin Neoplasms/drug therapy
- Skin Neoplasms/immunology
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Survival Rate
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Affiliation(s)
- P Heald
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
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35
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Hasatomi K, Yasunaga H, Isomura T, Fukunaga S, Hirano A, Kosuga K, Oishi K. [The changes of the cell-mediated immunity in patients with administration of recombinant erythropoietin]. Nihon Geka Gakkai Zasshi 1992; 93:518-22. [PMID: 1535415] [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: 12/27/2022]
Abstract
The change of cell-mediated immunity was studied in patients receiving open heart surgery with or without administration of recombinant erythropoietin (rEPO). Group I was not administered rEPO in 30 patients, and Group II was done intravenously with 200U/kg/day of rEPO for 6.4 +/- 2.4 days before operation and also for 7.2 +/- 3.6 days after operation in 20 patients. The ratio of reticulocyte increased in all patients receiving rEPO. In both groups the ratios of OKT3 and OKT4 positive T lymphocytes decreased significantly on postoperative day 1. However, the ratios in patients with rEPO increased more significantly than in those without rEPO. Lymphocyte blast formation which was indicated by PHA-SI (phytohemagglutinin stimulation index) increased after administration of rEPO. The postoperative PHA-SI in both groups showed similar changes. The level of interleukin-2 (IL-2) production increased after the administration similar to PHA-SI change. The level of it decreased on postoperative day 1 and increased on postoperative days 3 and 7. We administered 200U/kg/day of rEPO for 7 days in a patient with postoperative erythroderma after open heart surgery and the level of IL-2 production was found to also increase in patient according with recovery of symptom. In conclusion, our data suggested that the rEPO might effect on not only erythrocyte but also lymphocyte activation.
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Affiliation(s)
- K Hasatomi
- Second Department of Surgery, Kurume University School of Medicine, Japan
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36
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Vossbeck S, Knobloch C, Heymer B, Hartmann W, Friedrich W. [Severe combined immune defect. Presentation of exfoliative dermatitis with eosinophilia and lymphadenopathy]. Monatsschr Kinderheilkd 1992; 140:188-93. [PMID: 1534868] [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: 12/27/2022]
Abstract
BACKGROUND We report on 9 infants with severe combined immunodeficiency (SCID), who additionally showed signs of Omenn syndrome with an exfoliative dermatopathy, alopecia, enlarged lymph nodes, a hepatomegalia and a striking blood eosinophilia. The immunological evaluation revealed the characteristic abnormalities of SCID with cellular and humoral immunodeficiency. All patients however had the unusual finding of mature T cells in the peripheral blood. By HLA typing these cells were noted to be of maternal origin in 5 patients. In the other 4 patients the T cells were of host origin. We asked for additional differences between both patient groups. METHOD Both patient groups were analyzed and compared with regard to case histories, clinical, laboratory and histopathological parameters. RESULTS No clinical or laboratory differences could be detected. The histomorphologic analysis of patients with or without maternal T cells was identical. The skin biopsies showed dense cell infiltrations of lymphocytes, histiocytes and eosinophils, in the enlarged lymph nodes the latter two cell types predominated. Therefore the only difference between the 2 patient groups was the presence or absence of maternal T cells. CONCLUSION Since the Omenn syndrome is found in association with maternal as well as patient derived T cells, we postulate that the peculiar symptoms of this syndrome are the result of a T cell induced inflammatory reaction, similar but not identical to a graft versus host reaction, occurring on the basis of an inborn SCID.
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37
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Noji S, Kitamura N, Yamaguchi A, Miki T, Otaki M, Tamura H. [A case of "postoperative erythroderma" following coronary artery bypass grafting operation]. Nihon Kyobu Geka Gakkai Zasshi 1991; 39:1909-13. [PMID: 1835733] [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: 12/29/2022]
Abstract
So-called "Postoperative Erythroderma" was experienced in a 68 year-old man who received CABG for unstable angina. After a seemingly uneventful recovery, he revealed high grade fever on 13th post operative day (POD), rashes over the whole body on 15th POD and pancytopenia on 20th POD. He died of sepsis, multiple organ failure and DIC on 21st POD. Blood transfusion (concentrated red cell: 3 units) was done on operation. In this case, the rate of premature and atypical lymphocytes increased, and the ratio of OKT4 (helper)/OKT8 (suppressor) decreased. These findings of the examination suggested that there was a possibility of cell-mediated immunological depression. We considered this to be acute GVHD after blood transfusion.
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Affiliation(s)
- S Noji
- Department of Cardiovascular Surgery, Osaka National Hospital, Japan
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38
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Ito K, Fujita M, Norioka M, Yoshida H, Arii S, Tanaka J, Tobe T, Kakuyama M, Maruya E, Saji H. Postoperative erythroderma with change of HLA phenotypes from heterozygotes to homozygotes: a report of two cases. Eur J Haematol Suppl 1991; 46:217-22. [PMID: 1826657 DOI: 10.1111/j.1600-0609.1991.tb00544.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 12/28/2022]
Abstract
Fatal "postoperative erythroderma" (POE) developed in 2 patients treated with liver lobectomy and the transfusion of fresh blood. Their clinical features and skin-histological findings were indicative of acute graft-versus-host disease (GVHD). The HLA phenotypes of circulating lymphocytes of the 2 patients were heterozygous but became homozygous late in the clinical course and were identical with those of the blood donors. One of the patient's haplotypes was identical with the donor's homozygous haplotype. These findings suggest the mechanism of development of POE in apparently immunocompetent patients. The donor's T lymphocytes are histocompatible with the patient's tissues, are not rejected, and become engrafted. The patient's tissues are not histocompatible with the donor's, so that GVHD develops.
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Affiliation(s)
- K Ito
- Department of Transfusion Medicine, Kyoto University, Japan
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39
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Takematsu H, Tagami H. Complement fragment C4d and Bb levels in inflammatory skin diseases (e.g. SLE, atopic dermatitis, erythroderma and pustulosis palmaris et plantaris) for assessment of complement activation. TOHOKU J EXP MED 1991; 163:263-8. [PMID: 1831937 DOI: 10.1620/tjem.163.263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 12/29/2022]
Abstract
The complement is one of the major effector system in the process of inflammation. Complement activation has been shown to occur in inflammatory dermatoses such as systemic lupus erythematosus, atopic dermatitis, erythroderma of unknown origin, and pustulosis palmaris et plantaris by the elevated blood levels of complement fragments. To clarify the complement activation, especially the alternative pathway involvement, we have measured the concentrations of classical pathway-specific C4d and alternative pathway-derived Bb in the plasma of patients with these inflammatory disorders at a mild to exacerbated stage. Only the SLE plasma showed significantly elevated Bb levels. These results suggest that assessments of plasma C4d and Bb levels may be of value in monitoring the involvement of the complement system in patients with inflammatory dermatoses with significant complement activation.
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Affiliation(s)
- H Takematsu
- Department of Dermatology, Tohoku University School of Medicine, Sendai
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40
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Abstract
A case of senile erythroderma with serum hyper-IgE is presented. It is comparable to 8 cases previously described by Japanese authors.
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Affiliation(s)
- E Frenk
- Department of Dermatology, University Hospital, Lausanne, Switzerland
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42
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Abstract
Postoperative erythroderma is a rare disease of which the clinical course is almost always fatal. It is characterized by fever, skin rash, hepatic dysfunction and leukopenia, and many of the cases occur after cardiovascular surgery. We have experienced two cases of this disease which are suspected to be related to a large amount of blood transfusion. In the second case, we observed genetical mismatch of the HLA typing between the patient and his family members. This observation strongly suggests the possibility that postoperative erythroderma is a form of graft-versus-host (GVH) reaction induced by transfused lymphocytes. The reason why the patient's immunity is so suppressed as to cause GVH reaction is still unknown. Cardiopulmonary bypass and a large amount of fresh blood transfusion are suspected for immune suppression. The fact that postoperative erythroderma occurs almost exclusively in the Japanese cannot be fairly explained, either. Racial homogeneity in Japan might cause immune tolerance in blood transfusion.
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Abstract
Eight patients with senile erythroderma with serum hyper IgE were studied. Characteristic laboratory findings were persistently elevated IgE levels, high peripheral-blood eosinophils, and high lactic dehydrogenase (LDH). Immunologic analysis using immunoglobulin antibodies showed frozen sections of inguinal lymph nodes to stain with anti-IgE antibody, particularly in the germinal center. Five of the patients had an atopic history, suggesting hereditary factors.
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Affiliation(s)
- T Asai
- Department of Dermatology, Kitasato University School of Medicine, Sagamihara, Japan
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44
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Abstract
We report 7 cases of acute fatal illness characterized by fever, diffuse erythematous rash, and progressive leukopenia occurring 10 days after surgical operation. The outcome was uniformly fatal. The biopsy findings consisted of eosinophilic individual necrosis of epidermal cells, satellite cell necrosis, basal liquefaction degeneration, and scanty cell infiltration into the dermis. T lymphocytes were found in the epidermis but Langerhans cells disappeared. These findings are compatible with acute graft-vs-host disease following blood transfusion. Explanations based upon drug allergy, infection, toxic shock syndrome, or toxic epidermal necrolysis seem less reasonable.
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45
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46
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Küng E, Meissner K, Löning T. Cutaneous T cell lymphoma: immunocytochemical study on activation/proliferation and differentiation associated antigens in lymph nodes, skin, and peripheral blood. Virchows Arch A Pathol Anat Histopathol 1988; 413:539-49. [PMID: 2974217 DOI: 10.1007/bf00750395] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The expression of activation/proliferation antigens (CD 25, CD 30, Ki 67, transferrin receptor) in lymph nodes and skin were compared in nine patients with mycosis fungoides (MF) with patients with erythroderma not related to MF, and patients with reactive lymphofollicular hyperplasias (a total of 14 patients). A panel of differentiation antigens was analyzed in addition. Reactivities were revealed by the APAAP technique. Activation/proliferation antigen scores in lymph nodes were related to the clinical stages of MF in most instances (low scores in cases of MF stage I/II, high scores in 3/4 cases of MF stage III/IV). They differed markedly in cases of non-MF-erythrodermia with the exception of one patient, and in all cases of reactive lymphofollicular hyperplasia. Expression of activation/proliferation antigens in lymph nodes were different in most cases from those in skin and peripheral blood. For diagnostic use, the activation/proliferation antigen scores were superior to the cell differentiation antigen profiles. Among cellular differentiation antigens, only the extent of CD1+ cells provided some diagnostic information, since the number of these cells were markedly increased in all cases of dermatopathic lymphadenitis with/without MF when compared with reactive lymphofollicular hyperplasia. In the diagnosis of MF, immunohistochemistry of activation/proliferation or differentiation antigens cannot replace routine paraffin histology, but may provide supplement any data in equivocal cases.
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Affiliation(s)
- E Küng
- Institute of Pathology, University of Hamburg, Federal Republic of Germany
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Glover MT, Atherton DJ, Levinsky RJ. Syndrome of erythroderma, failure to thrive, and diarrhea in infancy: a manifestation of immunodeficiency. Pediatrics 1988; 81:66-72. [PMID: 2962064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Five infants with a triad of symptoms comprising generalized erythroderma, failure to thrive, and diarrhea are presented. All of these children demonstrated significant immunologic abnormalities. This is a recognizable clinical syndrome that reflects immunodeficiency; however, the responsible immunodeficiencies do not appear to be the same in every case. Early investigation and appropriate therapy may considerably reduce morbidity, and mortality in children with this syndrome.
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Affiliation(s)
- M T Glover
- Department of Dermatology, Hospital for Sick Children, London, England
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48
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Abstract
A 6-week-old female infant experienced recurrent diarrhea, wasting, and generalized seborrheic dermatitis. She manifested defective yeast opsonization and concomitant very low level of the third component of complement (C3). This is the first report of Leiner's disease associated with diminished C3. It corroborates evidence to suggest that yeast opsonic activity of normal human serum is dependent on C3 levels.
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Affiliation(s)
- M J Sonea
- Department of Dermatology, McGill University, Montreal, Quebec, Canada
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Fujioka A, Yasui Y, Baba S, Suzuki H. [Erythroderma with the high value of serum IgE continually over 200,000IU/ml]. Nihon Hifuka Gakkai Zasshi 1986; 96:1019-24. [PMID: 2948039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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50
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Inoue S, Orihara T, Shimada A, Furuya T. [Two cases of psoriatic erythroderma with high values of plasma CEA and the simultaneous co-existence of CEA in the epidermis of the cutaneous lesions]. Nihon Hifuka Gakkai Zasshi 1986; 96:711-8. [PMID: 2945018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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