Superficial Perivascular Dermatitis With Eosinophils: A Diagnostic Challenge in a Patient With Autoimmune Disease

Index of Suspicion| July 01 2011 Index of Suspicion Pediatr Rev (2011) 32 (7): 299–305. https://doi.org/10.1542/pir.32-7-299 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Index of Suspicion. Pediatr Rev July 2011; 32 (7): 299–305. https://doi.org/10.1542/pir.32-7-299 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsPediatrics In ReviewPediatricsHospital PediatricsNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search Subjects: AAP Awards, Commentary, Consultant's Corner, In Memoriam, Letter from the President, Pediatric Drug Labeling Update Topics: abdominal pain, diarrhea, fever, glucocorticoids, hyperbilirubinemia, hyperimmunoglobulin d with periodic fever, hypoglycemia, hypothermia, induced, hypothermia, natural, leg cramp A 12-year-old previously healthy boy presents with leg cramps for 2 weeks and spasms of his hands since yesterday. He also complains of nausea, bloating, epigastric pain, and recurrent watery and loose stools for 1 month. Currently, he is taking lansoprazole for epigastric pain without any relief. He also has a history of involuntary weight loss of 10 lb over 2 months. The family history contains no findings of note. On physical examination, the boy's weight is 36 kg (25th percentile) and height is 140 cm (10th percentile) and he exhibits a positive Trousseau sign and negative Chvostek sign. Remaining physical signs, including on abdominal examination, are normal. Laboratory evaluation shows hypocalcemia (total calcium of 5.3 mg/dL [1.3 mmol/L], ionized calcium of 2 mg/dL [0.5 mmol/L], and corrected calcium of 6.1 mg/dL [1.5 mmol/L]) as well as hypoalbuminemia (3 g/dL [30 g/L]). Serum magnesium measures 1.6 g/dL. CBC shows Hgb... You do not currently have access to this content.

Eosinophilic annular erythema (EAE) is a rare skin disease characterized by relapsing and remitting pruritic, annular erythematous plaques and tissue eosinophilia. A 39-year-old male presented with a mildly pruritic, relapsing, and remitting urticarial rash.A biopsy revealed superficial and deep perivascular dermatitis with numerous eosinophils and some neutrophils, with an absence of flame figures. Based on clinical and histopathologic findings, the patient was given a diagnosis of eosinophilic annular erythema. Treatment was initiated with doxycycline 100 mg twice daily. The patient reported substantial improvement at three months and sustained clearance at one year, remaining on doxycycline well tolerated throughout. To our knowledge, no cases of EAE improving with doxycycline have been reported in the literature and, thus, our findings highlight a potential new therapy to consider ina patient with EAE.

This large, handsome volume is a virtuoso performance in the creation of a patterned approach to dermatopathology. The search for Bronowski's hidden likeness in diversity has led to the development of nine patterns of pathology, to be recognized as subsuming all inflammatory pathologic events in the skin. The patterns to be recognized at scanning power of the microscope are as follows: superficial perivascular dermatitis, superficial and deep perivascular dermatitis, vasculitis, nodular and diffuse dermatitis, intraepidermal vesicular dermatitis, subepidermal vesicular dermatitis, folliculitis, fibrosing dermatitis, and panniculitis. Each section is defined and illustrated by explanatory drawings and not only is each individual entity described, but a highlighted outline of the pathology precedes the longer descriptions. Clinical information is used to emphasize the differential diagnosis, as well as problems of diagnosis. Each section is beautifully and selectively illustrated with low- and high-power photomicrographs. The labeling of the photomicrographs is extensive, discrete, and accomplished

Background: Localized chronic cutaneous lupus erythematosus (CCLE), also known as discoid lupus erythematosus, is one of the most prevalent canine autoimmune skin diseases. Histopathology is considered the gold standard for the diagnosis of CCLE and the accuracy of which can be increased by use of direct immunofluorescence (DIF). This study aimed to investigate the fluorescence pattern revealed by DIF in cases of canine localized CCLE and to establish and compare its effectiveness with that obtained from histopathology.Materials, Methods & Results: Eleven dogs suspicious to localized CCLE, i.e., those animals that presented mucocutaneous lesions as erythema, leucoderma, erosive-ulcerative lesions, and loss of nasal planum architecture and its transition to the haired skin underwent medical physical and laboratory examinations (blood count, platelet count, determination of alanine transaminase, alkaline phosphatase, total protein, serum albumin, urea, creatinine). Only those animals that proved to be normal across both the physical and laboratorial evaluation were included in Group I. Animals belonging to this group were submitted to general anesthesia to biopsy two samples of lesioned skin from nasal planum to histopathologic examination and DIF test. Five dogs with no skin lesions were included in Group II as negative control to the DIF assay. Two samples of no lesioned skin from nasal planum were biopsied to histopathologic and DIF evaluation. The kappa (k) coefficient was used to determine the degree of agreement and reliability of the results of both tests. A P-value < 5% was considered to be statistically significant. In Group I, all animals were normal across both the physical and laboratorial evaluation. A diagnosis of canine CCLE was established in 81.8% (9/11) of the animals based on histopathology analysis. Two dogs, numbers 10 and 11, respectively, had histopathologic findings suggestive of cutaneous leishmaniasis and compatible with canine demodicosis. The DIF assay confirmed the diagnostic of canine CCLE in 100% (11/11) of the cases, including dogs numbers 10 and 11. Direct immunofluorescence positivity for canine localized CCLE was determined by the presence of homogeneous green fluorescence in the basement membrane zone, with IgM and C3 immunoreagents being found at a significantly higher frequency (P = 0.007) than IgA and IgG (P = 0.017 and P = 0.037, respectively). In Group II, no alterations from histopathologic examination and unspecific fluorescence from DIF reaction were shown in all animals belonging to this group. A substantial and significant degree of agreement or reliability (k = 0.738 and P = 0.002, respectively) was established between the results of both tests.Discussion: In veterinary medicine, there is a lack of studies about DIF around autoimmune dermatoses. This is the first manuscript comparing histopathological and direct immunofluorescence findings in the diagnostic of dogs with localized CCLE. In the present study, the positivity to the DIF assay for canine localized CCLE was established by the presence of green fluorescence of a homogeneous morphologic pattern, especially for IgM and C3, located in the BMZ and cutaneous annexes. Direct immunofluorescence excluded the suspicion of cutaneous leishmaniasis determined by the histopathological findings and confirmed the diagnostic of canine localized CCLE in the dog number 10. Statistically, a substantial degree of agreement and reliability was shown between DIF and histopathology. Therefore, we concluded that the DIF assay is a highly effective and useful complementary examination that improves our ability to diagnose canine CCLE.

Uveitis and Renal Dysfunction in a 16-year-old Boy.

The hallmark of type 2 inflammation is eosinophilia and/or high IgE serum levels, mostly in atopic dermatitis. Nevertheless, many dermatoses may present similar findings. Our aim is to explore the biological and clinical spectrum of cutaneous manifestations involving tissue and/or systemic eosinophilia, and distinct serum levels of IgE, where atopic dermatitis or other primary allergic eczema, not always is the definitive diagnosis. A total of 37 scientific papers were enrolled in this narrative review. A diagnostic approach for patients with elevated serum IgE level and a list of conditions not related to atopic dermatitis that runs through inborn errors of immunity, inflammatory disorders, lung disorders, malignancy, infections/infestations are displayed. Regarding to peripheral eosinophilia, differential diagnosis is also explored and clinical patterns of skin diseases associated with tissue eosinophilia are listed, to facilitate our diagnosis. We should maintain a high level of suspicion about other differential diagnosis involving eosinophilia and IgE dysregulation, especially in patients very young (when innate errors of the immunity may present) and in middle to elderly patients classified as having atopic dermatitis, due to the possibility of cutaneous hematological malignancies, paraneoplasia or autoimmune blistering diseases.

Introduction: Eosinophils are multifunctional cells that play a characteristic role in various diseases of allergic and infective etiology. Eosinophils play an important role in immunity hence eosinophilia occurs in various diseases of skin and systemic allergic disorders. Materials and Methods: One hundred patients admitted to the Dermatology ward with absolute eosinophil count (AEC) above 500 cells per cubic millimeter were included in the study. Detailed history, including, drug history, travel history, history of atopy, and insect bites, was taken. A complete hemogram, stool examination, chest x-ray, and serological test were done to rule out eosinophilia due to other causes. Results: In our study, most of the patients (40%) were between the age group of 40 and 60 years. Fifty-six percent were male patients. Most of the patients (98%) fell in the category of mild-to-moderate eosinophilia. Marked eosinophilia was seen in only 2%. Most common skin conditions were chronic urticaria (28%) followed by generalized pruritus (16%), eczema (10%), drug reaction (10%), psoriasis (7%), bullous diseases (6%), palmoplantar keratoderma (4%), and HIV (4%). Malignancy was seen in 2%. Other conditions constituted 13%. Out of all these, 12% had stool examination positive for ova and cysts. Histopathological examination was done in 22 patients, 12 of whom showed tissue eosinophilia. Conclusion: Peripheral blood eosinophilia and/or infiltration of skin by eosinophils occur in various skin diseases. Coexisting parasitic infestations may be a predominant contributing factor for eosinophilia in tropical countries.

Artificial intelligence (AI) is rapidly transforming diagnostic approaches in different fields of medical sciences, demonstrating an emerging potential to revolutionize dermatopathology due to its capacity to process large amounts of data in the shortest possible time, both for diagnosis and research purposes. Different AI models have been applied to neoplastic skin diseases, especially melanoma. However, to date, very few studies have investigated the role of AI in dermatoses. Herein, we provide an overview of the key aspects of AI and its functioning, focusing on medical applications. Then, we summarize all the existing English-language literature about AI applications in the field of non-neoplastic skin diseases: superficial perivascular dermatitis, psoriasis, fungal infections, onychomycosis, immunohistochemical characterization of inflammatory dermatoses, and differential diagnosis between the latter and mycosis fungoides (MF). Finally, we discuss the main challenges related to AI implementation in pathology.

Drug-induced hypersensitivity syndrome like reaction with angioedema and hypotension associated with BRAF inhibitor use and antecedent immune checkpoint therapy

The 2019 Society for Hematopathology and European Association for Haematopathology Workshop reviewed the spectrum of neoplastic, nonneoplastic, and borderline entities associated with reactive eosinophilia in tissue. The workshop panel reviewed 46 cases covered in 2 workshop sessions. The 46 cases were presented with their consensus diagnoses during the workshop. Reactive eosinophilia in lymph nodes and other tissues may be accompanied by or be distinct from peripheral blood eosinophilia. Reactive etiologies included inflammatory disorders such as Kimura disease and IgG4-related disease, which may show overlapping pathologic features and reactions to infectious agents and hypersensitivity (covered in a separate review). Hodgkin, T-cell, and B-cell lymphomas and histiocytic neoplasms can result in reactive eosinophilia. The spectrum of these diseases is discussed and illustrated through representative cases. Reactive eosinophilia in lymph nodes and tissues may be related to both nonneoplastic and neoplastic lymphoid proliferations and histiocytic and nonhematolymphoid processes. Understanding the differential diagnosis of reactive eosinophilia and the potential for overlapping clinical and pathologic findings is critical in reaching the correct diagnosis so that patients can be treated appropriately.

Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis

Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis.

Diagnostic Approach to the Complexity of IgG4-Related Disease

Patient: Male, 68Final Diagnosis: Pyoderma gangrenosumSymptoms: Worsening lower extremity woundMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Pyoderma gangrenosum is a rare, ulcerative cutaneous condition that was first described by Brocq in 1916. This diagnosis is quite challenging as the histopathological findings are nonspecific. Pyoderma gangrenosum is usually associated with inflammatory bowel disease, leukemia, and hepatitis C. We describe a rare clinical case of a patient with hepatitis C (HCV), mixed cryoglubinemia, and pyoderma gangrenosum, which was successfully treated with prednisone in combination with the new antiviral medication ledipasvir/sofosbuvir.Case Report:A 68-year-old male with a history of untreated HCV presented to the clinic with a left lower extremity ulcer that had progressively worsened over 4 days after the patient sustained a minor trauma to the left lower extremity. Examination revealed a 2×3 cm purulent ulcer with an erythematous rim on medial aspect of his left lower leg. HCV viral load and genotype analysis revealed genotype 1A with polymerase chain reaction (PCR) showing viral counts of 9,506,048 and cryoglobulinemia. With a worsening and enlarging erythematous ulcer and failure of IV antibiotic therapy, the patient underwent skin biopsy, which showed acanthotic epidermis with superficial and deep perivascular lymphoplasmacytic dermatitis admixed with mild neutrophilic infiltrate. The patient was subsequently started on ledipasvir/sofosbuvir and prednisone with a high suspicion of pyoderma gangrenosum. At one-month follow-up at the hepatology clinic, the patient demonstrated a near resolution of the lower extremity ulcer with undetectable viral load.Conclusions:Pyoderma gangrenosum is an inflammatory process of unknown etiology, and establishing the correct diagnosis can be a difficult task. For this reason it is prudent for clinicians to consider Pyoderma gangrenosum in their differential diagnosis, especially in the setting of a nonhealing surgical wound or skin infection.

Skin diseases differ in different countries, and within various regions of a country depending on social, economic, racial and environmental factors. Many patients have reported various patterns of skin diseases in different countries. We have conducted this study during the period from January 2018 to December 2018 in the dept. of Skin Dermatology and Venereology, Birdem General Hospital, Dhaka, Bangladesh. The purpose of the present study was to evaluate the pattern of skin diseases in a tertiary care hospital in Bangladesh. In addition, we wanted to collect more information regarding skin diseases in this region. This was a crosssectional study and was conducted in the outpatient department of Birdem General Hospital, Dhaka, Bangladesh” during the period from January 2018 to December 2018. In our study period, total 2, 62,870 patients visited OPD. Among them 26,980 patients visited OPD for skin disorders/diseases. All the patients at any age and sex who were attended in the OPD of Skin and Venereal Diseases of the hospital were selected as study population. In this study, we found among 26,980 participants, 56% was suffering from some infectious and 44% from some non-infectious skin diseases. Among the patients with infectious skin diseases it was found parasitic, fungal and bacterial infection were about 33%, 28%, and 20% respectively. On the other hand in non-infectious group about 38% patients suffer from eczema or dermatitis only. So to do something betterment for the patients with skin diseases one should pay more attention to those four (4) skin diseases and/disorders at first. The diagnosis was made on clinical basis by expert dermatologists. Lab investigations were restricted to the cases where they carried diagnostic importance. In this study we found 56% patients of our study were suffering from infectious diseases. Among that 33.21% had parasitic infection which was the highest ratio. Besides this 28.28% had fungal, 20.06 had bacterial, 9.56% had viral, 4.72% had STI, and (4.16%) had other infections. On the other hand we found 44% patients had several types of non-infectious diseases and disorders. The highest number of patients with non-infectious diseases was suffering from eczema or dermatitis. This number was 1681 (37.79%). In rest of the patients 17.87% had the papulosquamous disease, 14.25% had acne, 14.01% had urticaria, 3.15% had drug reaction, 8.70% had vitiligo and rest 4.22% patients had some other non-infectious skin diseases