Atypical Erythema Research Articles

Atypical erythema multiforme like pityriasis rosea manifestation following Covid vaccine

Various cutaneous manifestations have been reported after receiving the COVID-19 vaccine of different types. The commonest reactions were delayed large local reactions, local injection site reactions, urticaria, and morbilliform eruptions following mRNA vaccines. There are very few reports of erythema multiforme (EM) and pityriasis rosea(PR) following Covid vaccines. Erythema multiforme (EM) is one of the commonest reaction following viral infections, drugs and vaccines. Here we are reporting a case of atypical erythema multiforme like pityriasis rosea manifestation following Covishield Covid vaccine second dose.

Atypical erythema as a clinical presentation of tinea incognito.

Atypical erythema as a clinical presentation of tinea incognito.

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review.

Simple SummaryPatients diagnosed with COVID-19 and concomitant skin rashes have been frequently reported. We summarized the cases described to date, including only patients with positive RT-PCR testing from nasopharyngeal swabs. Six hundred and fifty-five patients were found who presented different types of skin rashes, from maculopapular, vascular, vesicular, urticarial, to atypical forms and ocular involvement. Chilblains which are lesions resembling frostbite have been more frequent in the younger population and seemed to predict a milder disease course. Vascular-purpuric lesions appeared in older patients and were linked to a more severe evolution. In the case of vesicular rashes, the possibility of herpesvirus co-infections was raised. Moreover, cutaneous hydroxychloroquine drug reactions have been described. For patients with conjunctivitis, eye discharge might be contagious. These skin manifestations may help identify asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.

A case of drug‐induced hypersensitivity syndrome due to diaminodiphenyl sulfone complicated by acute respiratory failure with atypical erythema around existing prurigo

A case of drug‐induced hypersensitivity syndrome due to diaminodiphenyl sulfone complicated by acute respiratory failure with atypical erythema around existing prurigo

Localisation atypique d’un cas de lèpre à Lomé (Togo)

This was a 50-year-old woman with a selling activity living in Lomé who came for a consultation in March 2016 for a facial flushing that had been going on for 2 months without pain or pruritus. On examination, there was a single, erythemato-squamous closet of the right hemiface. There was no infiltration of the right ear. There was moderate cutaneous heat compared to the left hemiface which was without any lesion. Examination of nails, hair, palms and plants was normal. There was no hypertrophy of the peripheral nerves (superficial cervical plexus, ulnar, median). The face was not fixed. Complementary examinations noted a normal blood count and negative HIV status. Histology performed on a biopsy fragment concluded tuberculoid leprosy. The patient was first put on WHO multidrug therapy during 6 months. But one month after stopping this treatment, the lesions resumed. She was referred to a multibacillary leprosy protocol during one year. She had been seen 4 months after stopping treatment, without recurrence. It is important not to ignore leprosy in case of atypical erythema of the face even in the absence of other evocative signs and to perform a biopsy to the slightest doubt.

Current Perspectives on Erythema Multiforme.

Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnosis of erythema multiforme, that has an acute, self-limiting course, is based on its typical clinical picture of targetoid erythematous lesions with predominant acral localization as well as histological findings. Clinically, erythema multiforme can be differentiated into isolated cutaneous and combined mucocutaneous forms. Atypical erythema multiforme manifestations include lichenoid or granulomatous lesions as well as lesional infiltrates of T cell lymphoma and histiocytes. Herpes simplex virus infection being the most common cause, other infectious agents like-especially in children-Mycoplasma pneumoniae, hepatitis C virus, Coxsackie virus, and Epstein Barr virus may also trigger erythema multiforme. The second most frequently identified cause of erythema multiforme is drugs. In different studies, e.g., allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described. In patients with recurrent herpes simplex virus-associated erythema multiforme, the topical prophylactic treatment with acyclovir does not seem to prevent further episodes of erythema multiforme. In case of resistance to one virostatic drug, the switch to an alternative drug, and in patients non-responsive to virostatic agents, the use of dapsone as well as new treatment options, e.g., JAK-inhibitors or apremilast, might be considered.

Anticonvulsant Hypersensitivity Syndrome Secondary to Carbamazepine

Anticonvulsant hypersensitivity syndrome (AHS) is a potentially fatal multiorgan drug reaction that presents with various cutaneous eruptions. There is a genetic predisposition to such reactions. We present a young woman with AHS due to carbamazepine that presented as an atypical erythema multiforme with elevated liver enzymes.

Atypical erythema nodosum leprosum as the presenting feature in multibacillary leprosy: A case report

Atypical erythema nodosum leprosum as the presenting feature in multibacillary leprosy: A case report

Atipik Eritema Multiforme ile Komplike Olmuş Bir Orf Olgusu

Human orf is a viral zoonotic infection caused by a parapoxvirus. Parapoxviruses are a genus of Poxvirus family that infect different species of wild and domestic animals which may serve as reservoirs for human infections. Human parapoxvirus infections are almost invariably arise as a result of occupational exposure. Farmers, veterinarians, butchers are at greatest risk for acquiring infections through contact with an infected animal or an animal product. Although orf is a self-limited disease most commonly resolves spontaneously within weeks, atypical presentations and complications of orf are well known. Here we report a case of human orf who had been presented with atypical targetoid lesions of erythema multiforme. After clinical and histopathological investigations a diagnosis of human orf complicated with atypical erythema multiforme was made. The patient was given symptomatic treatment in conjunction with single dose of prednisolone and within weeks all of the lesions almost completely resolved. Through the presentation of this case report we wanted to emphasize a rare complication of orf.

Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease

Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease

Atypical erythema multiforme is a prognostic indicator of severe hepatic dysfunction in Dress (Drug Reaction with Eosinophilia and Systemic Symptoms)

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) describes a heterogeneous group of severe adverse reactions to medications. The cutaneous phenotype has a number of guises, accompanied by a variety of systemic features including fever, haematological abnormalities and visceral involvement, most commonly the liver. Clinical markers of prognosis have not been identified. OBJECTIVES: To assess the cutaneous signs and dermatopathological features of DRESS in order to identify potential prognostic markers. METHODS: We reviewed the clinical features, dermatopathology and outcomes of 27 consecutive cases of DRESS presenting to a single unit. RESULTS: Four distinct patterns of cutaneous involvement were identified: an urticated papular exanthem (13/27 patients), a morbilliform erythema (three of 27), an exfoliative erythroderma (three of 27) and an erythema multiforme-like (EM-like) reaction consisting of atypical targets (eight of 27). All patients mounted a fever, most developed lymphadenopathy (24/27) and peripheral eosinophilia (25/27) and the most common organ involved was the liver (27/27). Review of the dermatopathic features of patients with DRESS demonstrated a superficial spongiotic dermatitis in the majority of cases (16/27). A smaller number of cases showed basal cell vacuolar degeneration and necrotic keratinocytes (nine of 27). The patients with these biopsy findings more commonly had an EM-like cutaneous phenotype, and more severe hepatic involvement. Three patients died, two following failed liver transplants. CONCLUSIONS: Our series is the first in which a detailed dermatological assessment has been made of consecutive patients presenting with DRESS, and the largest U.K. series to date. Our results suggest a possible prognostic role of the cutaneous and dermatopathic findings in DRESS in predicting the severity of visceral involvement in this syndrome. What's already known about this topic? Drug reaction with eosinophilia and systemic symptoms (DRESS) has a heterogeneous clinical presentation, with a skin eruption of variable morphology. DRESS carries considerable morbidity and mortality, usually hepatic in origin, although renal, pulmonary and pericardial involvement can be seen. What does this study add? The cutaneous phenotype in DRESS can be categorized as an urticated papular exanthem, a morbilliform erythema, exfoliative erythroderma or erythema multiforme-like (EM-like). An EM-like eruption DRESS may be prognostic of more severe hepatic involvement.

Rapid clinical change in lesions of atypical cutaneous lymphoproliferative disorder in an HIV patient: A case report and review of the literature

HIV associated atypical cutaneous lymphoproliferative disorder (ACLD) is a rare condition characterized by a pruritic, often generalized, eruption of patches and plaques or erythroderma clinically simulating mycosis fungoides (MF) or Sézary syndrome. A polyclonal CD8+ T-cell infiltrate on biopsy can help differentiate ACLD from MF or Sézary syndrome, but the clinical and histopathologic appearance must also be considered. Accurate diagnosis is imperative because HAART therapy has been reported to improve this condition in some patients. We report a case of HIV associated ACLD, with an atypical presentation, initially consisting of diffuse papules, some with a dusky targetoid center. Two weeks after starting antiviral therapy the papules flattened, evolving to xerotic, hyperpigmented macules. The working-theory of a reactive etiology for this condition might explain the evolution in appearance following initiation of HAART. The presence of papules with a dusky targetoid center suggests that this condition should be considered in the differential diagnosis with syphilis or atypical erythema multiforme in HIV patients.

Early pancreatic panniculitis associated with HELLP syndrome and acute fatty liver of pregnancy

Pancreatic panniculitis represents a rare cutaneous disorder most commonly associated with acute or chronic pancreatitis or pancreatic carcinoma. We describe a case of a 17-year-old woman who presented with a 2-day history of erythematous patches involving her bilateral knees and tender, scattered red-brown nodules involving her bilateral anterior shins. She was seen during a hospitalization for emergent cesarean section and her hospital course was complicated by HELLP syndrome (defined by the presence of hemolysis, elevated liver enzymes, low platelet count), acute fatty liver of pregnancy and pancreatitis. The characteristic histopathologic findings, including ghost cells, fat necrosis and granular basophilic material with dystrophic calcification, appear in later lesions. In early lesions, as was shown in this case, a neutrophilic subcutaneous infiltrate raises a differential diagnosis including infection, subcutaneous Sweet's syndrome or atypical erythema nodosum. To our knowledge, this represents the first report of pancreatic panniculitis in association with HELLP syndrome and acute fatty liver of pregnancy. Early recognition is critical, as skin lesions may precede the development of pancreatitis. Often, as in our case, the effects of pancreatitis may be life threatening.

Acute intrahepatic cholestasis accompanied with Chlamydophila pneumoniae infection

We report a case of Chlamydophila (C.) pneumoniae infection presenting with fever and rapid intrahepatic cholestasis. A 63-year-old man had a week-long history of intermittent high fever and rapidly progressive jaundice with atypical erythema. The results of liver function tests were recorded. The results of all serological tests were negative; the IgM, IgG, and IgA titers for C. pneumoniae had increased, which indicates a C. pneumoniae infection. The patient's fever and liver dysfunction improved upon administration of minocycline. Light microscopic findings showed the presence of enlarged liver cells with clear cytoplasm, a few mitotic figures, multinucleated cells, and bile cholestasis. The electron microscopic appearance of liver biopsy showed that bile canaliculi exhibited intrahepatic forms of cholestasis. From the results of light and electron microscopy, we inferred atypical intrahepatic cholestasis, probably resulting from the C. pneumoniae infection.

An atypical panniculitis

A 33 year old Caucasian male presented with a 6‐week history of purpuric tender nodules, first appearing on his lower legs. Over time, the nodules increased in size and number over his thighs, trunk and later, his face and neck. Initially, he had no associated symptoms and at this time diagnoses such as an atypical erythema nodosum, lupus panniculitis, and infections were considered.Incisional biopsies were taken from the thigh, for histopathology and bacterial, fungal and mycobacterial culture. He also had numerous blood tests and a chest X‐ray. Whilst awaiting conclusive results, the patient became unwell with fevers and a productive cough, precipitating admission for further investigation and management.The biopsy revealed a diffuse lobular panniculitis, characterised by an atypical dermal and subcutaneous lymphohistiocytic infiltrate, with a lymphocytic small and large vessel vasculitis. There were also poorly formed tuberculoid granulomata, more conspicuous in the dermis than the subcutis. The infiltrates of small atypical lymphocytes were interspersed with occasional larger, blastic lymphocytes and histiocytes with bubbly cytoplasm. Some of the histiocytes appeared phagocytic, but this was not a predominant feature. There was no polarisable foreign material and special stains excluded various micro‐organisms. This was supported by negative microscopy and culture of the fresh specimen.Immunocytochemistry demonstrated the diffuse lymphocytic infiltrate was >90% T cells, with majority CD4+. 10% of the T cells were CD56+ and there was no staining with Epstein Barr virus latent membrane protein or CD30. Lymphocyte gene rearrangement studies showed no clonal band on the TCR gamma/delta rearrangement.Based on these findings, it was not possible to either confirm or deny a definite subcutaneous T‐cell lymphoma. The histopathology findings favoured an atypical lymphocytic lobular panniculitis, which usually follows an indolent course. However, further staging revealed lymphomatous infiltrates in both lungs and bone marrow, and flow cytometry confirmed this as a T/NK cell non‐Hodgkin lymphoma, with extensive cutaneous and extra‐nodal involvement.

Stevens-Johnson syndrome limited to multiple sites of radiation therapy in a patient receiving phenobarbital

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to a medication. There have been 21 reported cases of atypical erythema multiforme, toxic epidermal necrolysis, and SJS arising in patients receiving radiation therapy in addition to phenytoin, phenobarbital, or carbamazepine. We report the second case of SJS resulting from concomitant phenobarbital and radiation therapy, in which the eruption was limited to the sites of radiation, which were multiple.(J Am Acad Dermatol 1999;40:493-6.)

Erythema elevatum diutinum-a solitary lesion in a patient with rheumatoid arthritis*

Erythema elevatum diutinum is a rare disease of unknown aetiology. It is usually symmetrical with multiple lesions. An association with rheumatoid has previously been reported. We report a case of atypical erythema elevatum diutinum affecting the right elbow of a female patient with seropositive rheumatoid arthritis.

Mucocutaneous complications of intraarterial 5-bromodeoxyuridine and radiation

5-Bromodeoxyuridine (BUDR), a halopyrimidine thymidine analogue, is incorporated into the DNA of dividing cells and causes photoradiosensitization. Twenty-five patients with malignant astrocytomas were treated with continuous intracarotid BUDR radiosensitization and radiotherapy for 8 1/2 weeks. Unique dose-limiting mucocutaneous complications were encountered. Ipsilateral facial dermatitis with epilation of eyebrows and eyelashes, ocular irritation, and bilateral nail dystrophy developed in all patients. Less common reactions included oral ulceration in six patients, body exanthem on the trunk in five, and atypical erythema multiforme major in one.

Clinical symptoms of infection with Yersinia enterocolitica.

AbstractThe clinical symptoms of 75 patients with infection with Yersinia enterocolitica (Y. ent.) in the district of Karlskrona in Sweden are summarized. 58 patients had gastroenteritis and 17 no symptoms from the digestive tracts. Erythema nodosum occurred in 24 cases. In 9 cases an atypical erythema appeared. 10 patients had arthritis and 1 only fever. The diagnosis was based on positive cultivation of Y. ent. (type 3) from stools and/or on serological tests. The prognosis was good. Several of the cases were familial. This enteric infection seems not to be uncommon in Sweden.

STEVENS-JOHNSON DISEASE

IN 1922 Stevens and Johnson 1 reported a new symptom complex, occurring in 2 of their patients. Since then, additional cases have been reported, so that this symptom complex now rests on a fairly firm foundation of accurate clinical observations. The syndrome is variously reported as Stevens-Johnson disease or syndrome or as atypical erythema exudativum multiforme (Hebra) with involvement of the eyes and mucous membranes. The syndrome 2 consists of the following symptoms: Stomatitis Ophthalmia Cutaneous eruption analogous to erythema exudativum multiforme (Hebra) Fever It is important for the rhinologist to become acquainted with this syndrome, 3 as he may be the first to see a patient with early symptoms of a badly infected mouth and pharynx which resemble those of severe Vincent's angina or stomatitis caused by a blood dyscrasia. The cutaneous lesions, the ophthalmia and certain complications, such as pneumonia, vulvovaginitis and balanitis, may follow. Relapses are not uncommon. Hebra 4 in 1866 first