Erythematous Skin Rash Research Articles

067 Mycoplasma auto-immune mediated encephalitis

49 Year old male police officer, presented with acute onset fever, headache, arthralgia, ataxia, dysar- thria, opthalmoplegia, and diplopia, on a background of a 3 day skin erythematous skin rash, which was previously treated as SWEET syndrome. Physical examination further showed cerebellar syndrome, with no pyramidal signs. Blood tests showed raised inflammatory markers. Patient was initially treated for meningoencephalitis, with no change in symptoms after antibiotics and antivirals were administered. MRI revealed hyper intensity at the right pons and cerebellar peduncles, raising concerns of subacute infarct or demyelination. Lumbar puncture showed high protein of 1.15 mg/dL, and no other findings. However, when PCR was performed on the cerebrospinal fluid, mycoplasma pneumoniae was successfully isolated. IV prednisolone 1g was initially trialled, with no obvious therapeutic response after 5 days. As antibiotics and steroids had proved ineffective, decision was made to trial IV-IG. Two courses of IV-IG were trialled on suspicion of mycoplasma auto-immune mediated encephalitis, and symptoms subsequently resolved after 5 days. MRI was repeated after neurorehabilitation, and the hyper intensity found on the previous MRI had resolved completely. (Full Case Report Available on Request)d.mosh666@yahoo.com

National safety surveillance of quadrivalent recombinant influenza vaccine in Taiwan during NH 20/21

BackgroundDuring the COVID-19 pandemic, the need for influenza vaccine significantly increased in the initial weeks of the 2020–2021 influenza vaccination campaign season in Taiwan. To meet this demand, the Taiwanese government therefore purchased additional influenza vaccines via special import, including 350,000 doses of quadrivalent recombinant influenza vaccines (RIV4, Flublok Quadrivalent). Approved in the United States since 2016, there were limited numbers of published studies regarding RIV4 outside America. We utilized the national passive surveillance system consisting adverse event (AE) reports following RIV4 immunization to describe its safety profiles in Taiwan. MethodsWe obtained the database from the Taiwan National Adverse Drugs Reactions Reporting System and collected reports from January 2021 to July 2021, which was at least one month after RIV4 immunization. AE reporting rates were calculated based on the total administered doses. ResultsEight AEs were reported among 200,287 administered doses, which led to a reporting rate of 3.99 AEs per 100,000 doses administered. The mean age of the reported individuals were 47.53 years, and women (75%) were the predominant gender. Most adverse events started within the first day after immunization, with one reported as starting 4 days after vaccination. Among the 8 cases, 75% (n = 6) were non-serious and the most common symptoms were erythematous skin rashes with pruritus. Two cases were listed as serious based on the criteria of “other clinically significant medical conditions”, but neither was judged to have a causal relationship with RIV4 immunization. ConclusionThe Taiwan national passive surveillance data supported the safety profiles of RIV4 in Taiwan population.

Erythrodermic Psoriasis in Medico-Legal Practice: An Overview of a Case

Abstract Psoriasis represents a chronic autoimmune disease of great interest as its incidence has increased over the last decades. It encompasses a multitude of subtypes with various manifestations and complications. Erythrodermic psoriasis represents one of the most severe forms of the disease and is characterized by the appearance of a generalized erythematous rash on top of pre-existing lesions. We present the case of a 71-year-old patient with history of arthropathic psoriasis who is admitted to the dermatovenerology clinic for deterioration of his general condition, exacerbated pre-existing cardiovascular conditions, a diffuse generalized erythematous skin rash, pronounced leg edema and nail changes. After following topical and systemic treatment, the patient was discharged in an improved condition. Two weeks later the woman is found dead in their home. An autopsy was performed and the necropsy examination describes the skin lesions presented before but in an aggravated form and the histopathological examination establishes the cause of death which is represented by acute heart failure, the consequence of lymphocytic interstitial myocarditis. The particularity of the case is represented by the simultaneous exacerbation of cardiac and skin pathology, both having autoimmune components and an inflammatory substrate.

P082 Appendicular syndrome revealing Kawasaki-like syndrome: a case report

BackgroundWith the wide spread of the current SARS-CoV-2, It was found that about 2% of children was affected according to several studies, However, a small number of children with Covid-19 develop a significant systemic inflammatory response similar to Kawasaki disease, a new disease entity called multisystem inflammatory syndrome.MethodsA 12-year-old child, without a notable pathological history, who presented to the emergency, during the SARS-CoV-2 pandemic, for management of a pseudo-appendicular syndrome. Our patient was initially assessed by the surgical team due to his query acute abdomen. The pain had been evolving for 3 days associated with several episodes of bilious vomiting in a context of fever at 38.5°. Abdominal examination noted abdominal tenderness and defence. Extradigestive signs were not reported, The Lab Testing objectified a CRP at 235, elevated white blood cells at 18 180, an abdominal ultrasound was requested returning without particularities. Faced with the persistence of bilious vomiting, surgical exploration was indicated objectifying a catarrhal appendix. A pediatric opinion was requested, the clinical examination shows conscious child who presents infra cervical lymphadenopathy with a fever at 38 associated with an erythematous skin rash on the back and aseptic conjunctivitis. The Lab Testing objectified an important inflammatory syndrome, a acute kidney and heart failure a Covid 19 serology was requested with positive IGG, négative IGM, PCR covid test was negative, given the unavailability of In immunoglobulins, the treatment was based on corticosteroid bolus then relay by oral corticosteroid associated with an anti-inflammatory treatment, gastric protection by proton pump inhibitors, treatment of heart and acute kidney failure. The evolution was marked by clinical and biological improvementDiscussionCoronavirus 2 (SARS-CoV-2) infection among children and adolescents, is mainly responsible for mild respiratory symptoms, in contrast to the severe forms reported in adults [7]. A systemic inflammatory syndrome mimicking kDa, temporally associated with infection with SARS-CoV-2 (Kawa-COVID-19) has recently been described as a serious illness sometimes requiring intensive care (44%). The median age is older (> 5 years), the frequency and severity of myocarditis are very different from classic kDa, abdominal pain and/or diarrhea were more frequently (81%) reported than in classic kDa, heart failure, pneumonia, neurological and renal impairment, associated with elevated CRP, hyperferritinemia are more common in Kawasaki-Like syndrome [10]. Some investigations must be systematically realized urgently to diagnose potentially fatal complications. These include testing for myocarditis, patients should benefit from careful monitoring and treatment with IV Ig 2 g/kg should be administered rapidly and seems to be effective in the majority of cases, associated anti-inflammatory therapy, such as steroids is necessaryConclusionPediatricians should be aware of these atypical presentations of COVID-19 infection for early diagnosis.

Effects of Manna of Alhagi persarum (Taranjabin) and Portulaca oleracea (Khorfeh) Seed Administration on Nickel-induced Allergic Contact Dermatitis: A Case Report

A 19-year-old girl with documented nickel-induced allergic contact dermatitis was referred to the department of traditional Persian medicine five weeks after the sudden onset of bolus and erythematous skin rash to receive treatment based on complementary and alternative medicine. A detailed history of jewelry exposures, lifestyle, food intake, and dietary habits was obtained, as well as the history of other physicians� visits and administered treatments within the past eight weeks. Despite receiving treatment with corticosteroids, anti-histamines, and antibiotics, no satisfactory remission was achieved, and the patient discontinued the treatments. As the alternative medicine approach, treatment was started based on avoiding contact with nickel, administration of Manna of Alhagi persarum and Portulaca oleracea seeds, and avoidance of consuming tomato sauce, cocoa, coffee, and bitter chocolate. Within six weeks, a complete remission of the skin lesions and symptoms occurred. Moreover, normal clinical follow-up was observed after 12 months. Notably, the CARE (CAse REport) guidelines were used in the preparation of this case report.

Asymmetrical erythematous rash secondary to subcutaneous emphysema

Subcutaneous emphysema is a frequent post-operative complication. Although many cardiorespiratory complications associated with subcutaneous emphysema has been described, skin rashes have not been described as a complication. We present a case of asymmetrical erythematous skin rash secondary to subcutaneous emphysema. To the best of our knowledge this association has not been reported before. It is important to recognise cutaneous changes such as skin rash as a potential complication of subcutaneous emphysema and avoid inappropriate management and prolonged hospital stay. complication.

Erythrodermic Manifestation due to Hyperinfestation of Scabies

Background: Scabies is a highly contagious skin disease with various skin clinical presentations. In consideration of its clinical presentations, proper early-onset diagnosis of scabies may not be met, leading to mistreatment and more severe scabies, Norwegian (crusted) scabies. Purpose: To report a case of Norwegian scabies misdiagnosed as eczema in a previously immunocompetent patient. Case: A 32-year-old man was admitted with generalized erythematous skin rash, pruritic, and hyperkeratotic scales of the body. He was previously diagnosed with eczema two months ago and was prescribed both topical and systemic steroid. Skin scales worsened and kept expanding after the treatment. There was a family history of nocturnal itch. Dermoscopic and microscopic examination from skin lesion and scraping with potassium hydroxide revealed the signs of scabies infection. Discussion: Norwegian scabies could be prevented by the correct diagnosis at the early-onset of the disease. Misdiagnosis due to various skin clinical presentations, leading to mistreatment of the infection. In this case, family history plays a role that could elucidate the presence of scabies infection. Conclusion: A correct diagnosis and treatment for the early-phase scabies-infected patient will be beneficial for the patient to prevent hyperinfestation of scabies mites. Specific examination for scabies decreases the possibility of misdiagnosis.

Characteristics of hospitalizations and emergency department visits due to generalized pustular psoriasis in the United States

Objectives Generalized pustular psoriasis (GPP) is a rare and severe, inflammatory skin disease. GPP is characterized by recurrent flares that consist of disseminated erythematous skin rash with sterile neutrophil-filled pustules that can result in an emergency department (ED) visit or hospital stay due to systemic complications. This study characterizes hospitalizations, ED visits, and inpatient treatment due to GPP in the United States (US). Methods A descriptive, retrospective cross-sectional analysis was conducted in Cerner Health Facts, a US electronic medical record database. Hospitalizations and ED visits were identified between 1 October 2015 and 1 July 2017. Visits were included in the study if they were GPP-related, defined as a GPP diagnosis (ICD-10-CM code: L40.1) in the first or second position at admission or discharge, and if the discharge date was within the study period. Hospitalizations and ED visits were the units of analysis. Demographics, comorbidities, medication use, and outcomes were characterized with descriptive statistics. Outcomes included length of stay, intensive care unit (ICU) admission, and death. Results A total of 71 GPP-related hospitalizations and 64 GPP-related ED visits were included in the study. Other specified inflammatory skin conditions (OSICS)/skin and subcutaneous tissue infections (54%/34%), fluid and electrolyte disorders (46%), hypertension (30%), septicemia (24%), and acute renal failure (18%) were the most frequently coded conditions accompanying a GPP-related hospitalization. OSICS/skin and subcutaneous tissue infections (47%/42%) were the most commonly coded conditions accompanying a GPP-related ED visit. Medication use during GPP-related hospitalizations included topicals (triamcinolone (42%); clobetasol (17%)), systemic corticosteroids (prednisone (20%); methylprednisolone (11%)), and non-biologic and biologic immunosuppressants (cyclosporine (6%); methotrexate (4%); etanercept (1%)). Analgesics (acetaminophen 67%; morphine 24%), and antibiotics (vancomycin 21%) were also common. The median length of stay for hospitalizations was 5 days. Three hospitalizations included an ICU admission and two hospitalizations resulted in death. Conclusions The presence of concurrent immune-mediated conditions, and frequent prescribing of analgesics, including opioids, illustrate the burden of GPP in patients requiring acute and inpatient care.

Approach to Children with Hives.

Urticaria (or hives) is a pruritic and erythematous skin rash. Angioedema commonly occurs with urticaria. The term "chronic urticaria" is used when hives are present for more than 6 weeks. Acute urticaria is common in children, whereas chronic urticaria is rare. Causes of urticaria can be identified in many cases of acute urticaria with a thorough medical history. Laboratory evaluation may be needed to confirm the etiology of acute urticaria. Chronic urticaria is often idiopathic. Clinicians should avoid universal allergy testing for food allergens or aeroallergens in chronic urticaria as it usually does not help in identifying the cause, can lead to false-positive results, and unnecessary avoidance of allergens or foods. Urticarial vasculitis should be considered for lesions that are painful, present for more than 48 hours, leave scars/hyperpigmentation, or present with systemic symptoms such as fever, weight loss, and arthritis. Skin biopsy should be considered for suspected urticarial vasculitis. [Pediatr Ann. 2021(5):e191-e197.].

AMLOPIDINE AND DRESS SYNDROME: UP TO DATE WITH MY KNOWLEDGE?

Objective: Drug hypersensitivity syndrome or “Drug Reaction with Eosinophilia and Systemic Symptoms” (DRESS) is a severe form of cutaneous drug eruptions that combines skin manifestations and systemic damage. More than 50 drugs have been associated with this syndrome. Amlodipine is a long-acting calcium channel antagonist of type L (DHP), used as an antihypertensive drug. Peripheral edema remains one of the most common side effects of this drug, while dermatological events are very rare (1/100,000). We report a patient with DRESS syndrome who appeared under amlodipine treatment. Design and method: An 84-year-old hypertensive patient with eradicated chronic hepatitis C, chronic renal failure, idiopathic thrombocytopenia and dyslipidaemia was hospitalized with a febrile rash. Treatment with amlodipine 5 mg/d is prescribed for hypertension and then stopped by the patient after 15 days. Resumption of treatment is an accompanied at 4 weeks by a diffuse and infiltrated erythematous skin rash (initially suggestive of a large mesh livedo), associated with facial edema and fever at 39°. EKG is normal. The biological parameters: progressive hypereosinophilia up to 9 G/l, lymphopenia at 0,9 G/l with hyperbasophilic activated T lymphocytes (TL), hepatic cytolysis, HHV6 PCR is positive. The autoimmune test remains negative. The skin biopsy shows an inflammatory infiltrate, rich in eosinophils, with a few rare necrosis areas leading to cutaneous drug eruption. There is no vasculitis. The RegiSCAR score was 4. The discontinuation of amlodipine and high-dose dermocorticoids allowed the rash and hypereosinophilia is reduced within a few weeks until complete disappearance. The pharmacovigilance survey retained this diagnosis with proscription from this drug class. Results: The pathogenesis of DRESS syndrome is still very controversial. A hypersensitivity cytokine mediation of TL, and the reactivation of HHV6 are involved. The RegiSCAR score (European register of Serious Adverse Skin Reactions) is used to categorize the imputability to a drug. Amlodipine remains an exceptional cause but should be known because of the very common frequency of prescribing this treatment. Conclusions: DRESS syndrome is a rare but serious side effect of calcium channel blockers. Lack of knowledge can leaf to diagnostic errors and unnecessary additional examinations.

Anakinra and canakinumab for patients with R92Q-associated autoinflammatory syndrome: a multicenter observational study from the AIDA Network.

Background:This study aims at describing the therapeutic outcome of patients carrying the R92Q variant in the TNFRSF1A gene treated with anakinra (ANA) or canakinumab (CAN) and identifying any factors predictive of complete response to IL-1 inhibition.Methods:Clinical data of patients treated with ANA or CAN for recurrent inflammatory attacks due to the presence of the R92Q variant were retrospectively collected and analysed.Results:Data about 20 treatment courses with IL-1 inhibitors (16 with ANA and 4 with CAN) from 19 patients were collected. Mean age at disease onset was 20.2 ± 14.8 years. In 5 cases (26%) the R92Q variant was found in a family member affected by recurrent fever. The therapeutic response was complete in 13(68%) and partial in 2 patients (11%); treatment failure was observed in 4 cases (21%). Median AIDAI decreased from 10 (interquartile range [IQR] = 28) to 0 (IQR = 1) at the 12-month follow-up visit (p < 0.001). Mean ESR and median CRP dropped respectively from 40.8 ± 24.8 to 9.1 ± 4.5 mm/h (p < 0.001) and from 3.0 (IQR = 1.9) to 0.3 (IQR = 0.3) mg/dl (p < 0.001) after 12 months of treatment. A steroid-sparing effect was observed from the third month of treatment (p < 0.01). Thirteen patients (65%) were still on treatment at the last follow-up visit (median duration of treatment 17 (IQR = 38) months). The presence of R92Q mutation in a symptomatic relative (p = 0.022), the relapsing remitting disease course (p < 0.001) and the presence of migratory erythematous skin rashes during fever attacks (p = 0.005) were associated with complete efficacy of IL-1 inhibitors.Conclusions:R92Q patients showed a favourable response to ANA and CAN, particularly when the mutation segregated in a family member and when a relapsing-remitting disease course or TNF-α receptor-associated periodic syndrome (TRAPS) typical skin rash were observed. In the subgroup of patients not taking advantage of IL-1 blockage different molecular mechanisms underlying the autoinflammatory picture are likely to exist.

An itchy erythematous papular skin rash as a possible early sign of COVID-19: a case report

BackgroundSeveral recent studies suggest the possibility of a skin rash being a clinical presentation of coronavirus disease 2019 (COVID-19). The purpose of this case report is to bring attention to skin manifestations in the early stage of COVID-19 in order to support frontline physicians in their crucial activity of case identification.Case presentationThe patient is an Italian 32-year-old female nurse who had several close contacts with multiple patients with COVID-19 as part of her professional workload. On March 13, 2020, the patient developed an itchy, erythematous papular rash (sparing only her face, scalp, and abdomen), which lasted for 10 days. The rash was accompanied by a feeling of general fatigue that gradually worsened over the following days and has continued for 5 months (until the end of July 2020). During the first week of remote assessment carried out by her general practitioner, the patient gradually developed a dry cough, intermittent fever, and diarrhoea and then had a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Her skin manifestations disappeared completely 48 days after the onset of the disease, followed by the disappearance of the dry cough.ConclusionsIn light of recent studies, this case report suggests that skin manifestations, when taken into account with other situational factors (such as profession and patient history) should be taken into proper consideration by frontline physicians as possibly being caused by SARS-CoV-2. Early identification of COVID-19 is a key part of the strategy of case detection and case isolation. To enhance this activity, further research is needed to establish frequency, symptoms, signs, and pathogenesis of skin manifestations in patients with COVID-19.

S2273 A Drug Reaction to Ustekinumab in a Patient With Crohn’s Disease

INTRODUCTION: In 2016, ustekinumab became the newest biologic with FDA approval for treatment of Crohn’s disease (CD). It is a human monoclonal antibody that binds to the p40 subunit of interleukin-12 (IL-12) and interleukin-23 (IL-23). It is overall very well tolerated. Dermatologic complications are relatively uncommon. During post-marketing approval, there have been reports of pustular psoriasis, erythrodermic psoriasis, pseudolymphomatous drug eruption, and eczematous drug eruption in psoriasis patients. CASE DESCRIPTION/METHODS: A 42 year old man with a complicated 25 year history of ileocolonic CD, prior ileocolic resection for a colonic stricture, and partial left hemicolectomy for a colo-cutaneous fistula and abdominal abscess while on adalimumab presented with abdominal pain after 4 years without follow up. Imaging and colonoscopy showed ileitis and an enterocolonic fistula. Ustekinumab was started. 2 days later, he developed a pruritic erythematous blistering skin rash on his neck, arms, and trunk without mucous membrane involvement or fever. Skin biopsy revealed a hypersensitivity skin reaction, which resolved in 10 days. He received 4 days of premedication with acetaminophen, famotidine, prednisone, and diphenhydramine before his maintenance dose of 90 mg subcutaneously without any reaction. He continues to be on the drug with good effect. DISCUSSION: Only a few case reports of drug eruptions to ustekinumab exist in the literature, and all are in patients treated for psoriasis. One patient had urticaria 3 weeks after their 4th dose of ustekinumab and subsequent doses. They likely formed drug antibodies and had a change in therapy. Another patient had multiple painless indurated pink papules and plaques on their trunk 9 days after the 1st dose. Biopsy showed a lymphomatoid drug reaction, which resolved spontaneously after 2 months. Another patient had a psoriasiform eczematous drug eruption on their trunk and limbs 3 days after the 2nd injection; it resolved in 2 weeks with topical steroids. This is the first case report of a drug eruption in a patient with ustekinumab for CD. Management varies. Antibody formation requires discontinuation of therapy. If we extrapolate from anti-TNF literature, non-antibody reactions may be able to be managed with short term topical or systemic therapy and without necessarily discontinuing the drug. Treatment should occur on a case-by-case basis because reported dermatologic reactions are so few in number.

Kawasaki-like Syndrome as an Emerging Complication of SARS-CoV-2 Infection in Young Adults.

Kawasaki-like syndrome occurring in children during the COVID-19 pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) by the CDC and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC. We report the case of an 18-year-old male patient presenting with a 72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and diarrhoea. Examination showed he also had shock and he was first thought to have oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low ejection fraction and low cardiac index. High-sensitivity troponin serum levels were elevated. The patient received inotropic and vasopressor support. As he fulfilled several criteria for MIS-C/PIMS-TS, he was administered acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical response. This case emphasizes how this severe presentation of COVID-19 can easily be misdiagnosed if the clinician is less aware of this syndrome in younger patients. SARS-CoV-2 infection is a diagnostic challenge in some patients with atypical clinical presentations, who may have MIS-C/PIMS-TS.Physicians should be aware of this condition when evaluating teenagers and young adults with COVID-19.

PRO16 Healthcare Resource Utilization (HCRU) in Patients with Generalized Pustular Psoriasis (GPP) in JAPAN: A Claims Database Study

GPP is a rare, severe, potentially life-threatening, systemic disease, characterized by recurrent acute flares comprising disseminated erythematous skin rash with sterile neutrophil-filled pustules, and may include systemic symptoms. So far, the burden of this disease is poorly understood. This study describes comorbidities and HCRU in GPP patients. Patients were identified as having GPP if they had ≥1 inpatient or 1 outpatient ICD-10 L40.1 confirmed diagnosis code(s), separated by 30–365 days. All analyses were conducted via the Aetion Evidence Platform™ v3.17 using the Japan Medical Data Center, a Japanese database. The study period was from January 1, 2015 to February 28, 2019. The first diagnosis code marked the index date. A general population matched cohort (MC) of 4:1, based on age and sex, was generated for context. Patient characteristics, treatment, and all-cause utilization of inpatient and outpatient care during the 12-month follow-up (FU) were analyzed. Analyses were descriptive in nature; no formal comparisons were conducted. 125 patients with GPP were identified at baseline and 82 had ≥12 months’ FU. Three of the most common comorbidities reported for GPP patients compared with the MC were chronic obstructive pulmonary disease (GPP: 18.3% vs MC: 13.8%), asthma (15.9% vs 9.2%), and hyperlipidemia (6.1% vs 2.1%) at the 12-month FU. During this time, patients with GPP were more likely to be treated with a systemic therapy (biologic or non-biologic) compared with the MC (56.1% vs 5.8%). Compared with the MC, GPP patients had more days of outpatient visits (median: 8.0 vs 4.0), a greater frequency of inpatient visits (32.9% vs 6.1%) and were hospitalized for longer (median: 9.0 vs 4.5 days). This analysis suggests that in Japan, GPP patients have greater use of outpatient and inpatient care than the MC, highlighting an unmet need among this patient population.

439 Characteristics of patients with generalized pustular psoriasis compared to those with psoriasis vulgaris: A claims database study

Generalized pustular psoriasis (GPP) is a rare and severe systemic disease characterized by recurrent acute flares consisting of disseminated erythematous skin rash with sterile neutrophil-filled pustules. There is little real-world evidence characterizing patients (Pts) with GPP. This study examined demographics, comorbidities, and concurrent medication use for Pts with GPP compared to those with psoriasis vulgaris (PsO) in a real-world setting. GPP or PsO Pts were identified if they had ≥1 inpatient or ≥2 outpatient ICD-10 diagnosis codes (L40.1 or L40.0, respectively) separated by 30 to 365 days.

PRO89 SYMPTOM EXPERIENCE OF PATIENTS WITH GENERALIZED PUSTULAR PSORIASIS (GPP)

To understand patient-reported symptoms of generalized pustular psoriasis (GPP), a rare and severe disease, characterized by recurrent flares that consist of a disseminated erythematous skin rash with sterile neutrophil-filled pustules and may include systemic symptoms. Another objective was to confirm the relevance and content validity of the Psoriasis Symptom Scale (PSS) in GPP. A targeted literature review and clinical expert interviews were conducted to develop a qualitative discussion guide for semi-structured, one-on-one interviews with GPP patients. These interviews involved a combined concept elicitation to determine disease-specific symptoms and cognitive debriefing of the PSS. Interviews were conducted in-person or by telephone by three different outcomes research scientists trained in qualitative research. Seven patients with a GPP diagnosis, based on clinician verification were recruited in the US. The median age of patients was 58 years (range: 40–70). Most were female (n=5; 71%), a majority were Caucasian (n=4, 57%); 3 (43%) were African American. Four (57%) patients self-reported moderate GPP, two (29%) self-reported severe GPP, and one (14%) self-reported very mild disease. During concept elicitation, patients indicated pustules as the underlying cause of their symptoms. The most commonly reported symptoms or signs were pain, redness, discomfort, and inflammation/swelling (n=7, 100%), followed by itching, burning, irritation, dryness/dry skin, and soreness (n=6, 86%). Burning, itch, pain, and redness, the symptoms included in the PSS, were considered important to GPP patients. Signs such as flaky/peeling skin and inflammation/swelling are better as clinician-report. GPP patients are significantly burdened with pain, redness, itching, burning, dryness, and swelling. Patients thought the PSS measure was relevant for GPP, straightforward, and easy to understand.

Coexisting schwannoma of the gallbladder and sarcoidosis: a case report

BackgroundSchwannomas originate from Schwann cells, which are constituents of peripheral nerve sheaths, and can occur anywhere in the body at any age. Most occur in soft tissues such as subcutaneous tissues and muscles, occurrence in the abdominal cavity being relatively rare. In particular, schwannomas of the gallbladder are extremely rare. We herein report a rare case of a schwannoma that coexisted with systemic sarcoidosis and presented as a steroid-resistant mass in the gallbladder wall.Case presentationA 40-year-old woman was found to have thickening of the gallbladder wall during a routine medical examination and was referred to our hospital, where she was found to have granular shadows in the lungs; mediastinal, cervical, intraperitoneal, and inguinal lymphadenopathy; parotid gland enlargement; and an erythematous skin rash. She was diagnosed as having systemic sarcoidosis by transbronchial lung biopsy and bronchoalveolar lavage. All her systemic mass lesions except for the one in the gallbladder resolved or became smaller with steroid treatment. The steroid-resistant gallbladder lesion showed enhancement on contrast-enhanced computed tomography and was shown by endoscopic ultrasonography to be a 30-mm-diameter gallbladder wall lesion. We performed laparoscopic cholecystectomy, which resulted in diagnosis of the steroid-resistant tumor as a schwannoma. Five months after surgery, the patient’s prednisolone dosage had been gradually reduced to 5 mg/day and she was doing well with no evidence of recurrence.ConclusionResection of a steroid-resistant tumor resulted in diagnosis of schwannoma, enabling reduction in the patient’s steroid dosage for sarcoidosis.

Dolutegravir (DTG) Based Fixed Dose Combination (FDC) of Tenofovir/Lamivudine/Dolutegravir (TLD) and Viral Load Suppression in Children in Port Harcourt, Nigeria

Background: Currently, dolutegravir (DTG) based fixed dose combinations (FDC) of tenofovir/ lamivudine/dolutegravir (TLD) and Abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) is now recommended by the World Health Organisation (WHO) as the preferred first-and second line antiretroviral drug necessitating transition of eligible children to TLD.&#x0D; Objective: The objective of this study is to compare the HIV viral suppression rate at baseline and after 6 months of transition to TLD and to determine adverse drug reaction associated with the use of TLD if any.&#x0D; Methods: This was a prospective cross-sectional study carried out among stable children who were on treatment and follow up for HIV disease at the Paediatric HIV clinic of the University of Port Harcourt Teaching Hospital (UPTH). All Children who were eligible for transition to TLD, whose care givers/parents gave a verbal consent and who gave consent or accent were recruited for the study. Information obtained included the sociodemographic characteristics, weight and height, ART regimen at initiation of treatment and when it was commenced, the baseline viral load and viral load 6 months after transition and any adverse drug reaction. Obtained data were analysed. Comparison of categorical variables was done using chi square and Fischer’s exact test while A p-value of &lt; 0.05 was set as statistically significant.&#x0D; Results: A total 106 children aged 9 to 18 years with a mean age of 13.4±2.3 years were recruited for the study. Sixty (56.6%) were males, while 59 (55.5%) were from the lower socioeconomic class. The mean weight was 44.4±11.1 kg while the mean height was 151.3 ± 15.2 cm. At baseline, 48 (45.3%) were virally suppressed (viral load &lt; 1000 copies/ml), however after 6 months, 97 (91.5%) became virally suppressed, the difference in viral suppression rate was statistically significant (X2 =53.77, p= 0.0001). Twenty-five (23.6%) had undetectable viral load (&lt;20 copies/ml) at baseline while 61(57.5%) had undetectable viral load after transition. All those who were virally suppressed at baseline remained so 6 months after transition. Also, 80.6% (29/36) of those with treatment failure became virally suppressed. Only one child developed severe erythematous skin rashes. There was no statistically significant relationship between viral suppression and age, sex and social class (P &gt;0.05).&#x0D; Conclusion: This study has shown that DTG-based FDC is efficacious in the treatment of eligible children and adolescents with HIV/AIDS with significant viral load suppression in all age groups, gender and social class. Adverse drug reaction with the use of DTG-based ART is low. Transition to TLD is therefore advocated in eligible patients.

Investigation of a healthcare-associated Candida tropicalis candidiasis cluster in a haematology unit and a systematic review of nosocomial outbreaks.

Non-albicans Candida spp. are an emerging cause of hospital-acquired bloodstream infections, associated with high mortality due to the challenges in diagnosis and delayed treatment. We aimed to investigate a cluster of healthcare-associated invasive candidiasis caused by Ctropicalis and review the literature of healthcare-associated outbreaks or clusters caused by Ctropicalis. An investigation was performed to determine clinical presentation, treatment outcomes and the factors contributing to Ctropicalis candidemia occurrence. We searched the Medline database via PubMed and Ovid using the keywords of "Candida tropicalis" combined with "outbreak" or "clustering" or "clusters," and we limited the search to studies conducted from January 1989 to January 2019. We report two related cases of Ctropicalis candidemia among patients with AML following a period of neutropenia, who had erythematous skin rash as a first manifesting sign of candidiasis. Ctropicalis was isolated from blood and skin cultures of both patients, which were identical by pulsed-field gel electrophoresis typing. Our systematic review of outbreaks caused by Ctropicalis suggests that (a) most reported outbreaks have occurred in neonatal and adult ICUs; (b) patients who receive total parenteral therapy, antibiotics and those who have indwelling catheters and recent surgery are at high risk of infection; and (c) environmental and healthcare personnel surveillance suggest that cross-contamination is a major risk factor. Control of nosocomial outbreaks caused by Ctropicalis should include better infection control measures, education of healthcare professionals especially working in adult and neonatal intensive care and haematology units.