Migratory Erythema Research Articles

Borreliosis, enfermedad de Lyme y fiebre recurrente

Lyme borreliosis is a bacterial infection transmitted by ticks of the Ixodes genus that are infected by some members of the Borrelia burgdorferisensu lato spirochetes group. A common symptom is migratory erythema, the early rash caused by the tick bite on the skin. The disease progresses in months or even years, causing systemic symptoms that mainly affect the skin, joints, heart, and nervous system. The diagnosis is mainly based on symptoms and serology. The treatment of choice is doxycycline or beta-lactams; macrolides are an alternative. The prognosis with appropriate antibiotic treatment is favorable. Recurrent fever is a zoonosis caused by other species of Borrelia transmitted by flea and tick bites. It is characterized by a periodic fever and short febrile periods followed by a period of apyrexia. During the febrile period, spirochetes can be observed on a blood smear test. It is treated with doxycycline or penicillin and Jarisch–Herxheimer reactions are common.

A Case of Erythema Induratum of Bazin with Migratory Erythema at Unilateral Lower Limb

A Case of Erythema Induratum of Bazin with Migratory Erythema at Unilateral Lower Limb

Borrelious lymphocytoma as rare manifestation of Lyme disease

In recent years, an increase in the incidence of Lyme borreliosis (Lyme disease (LD)) has been noted in the world, which causes the need for constant epidemic and clinical alertness. The causative agent of LD is Borrelia burgdorferi spirochete, transmitting agents are Ixodes ricinus mites. Migratory erythema appears at the site of mite suction, which is a marker of cutaneous manifestation of LD — an early localized (І) stage of the disease. In the presence of migratory erythema, the diagnosis of Lyme borreliosis is not difficult, but in the absence of the information about tick inoculation, the diagnosis is difficult. Timely detection and treatment of LD is important to prevent chronic disease, its progression with multiorgan lesions and complications, one of which is Borrelious lymphocytoma which refers to pathognomonic cutaneous manifestations of LD as a sign of dissemination (II or III) stage.Borreliosis lymphocytoma is diagnosed by positive serological tests — detection of antibodies to B. burgdorferi. The localization of borreliosis lymphocytoma — ear lobes, areolas of the nipples of the mammary glands, axillary cavities, occiput, scrotum, rear feet — is of decisive importance for the diagnosis. Treatment of both migratory erythema and borreliosis lymphocytoma consists of antibiotics. A rare case of borreliosis lymphocytoma is described in a patient with the disease duration of more than 15 years with the localization of the pathological process on the skin of the left ear in the area of the lobe and around it. The treatment plan was drawn up in two directions: the first included antibiotics and a synthetic drug that inhibited the activity of T lymphocytes without affecting B lymphocytes; the second one included pathogenetic drugs that increase the production of antibodies, reduce the manifestations of secondary immunodeficiency and have an anti-inflammatory effect. The pictures of the patient in dynamics are presented as she recovers. After the therapy, the patient achieved clinical recovery.

Innate and Th1/Th17 adaptive immunity in acute and convalescent Brazilian borreliosis disease

IntroductionBrazilian borreliosis (BB) disease is an infectious disease transmitted by ticks that mimics Lyme disease (LD) from the Northern Hemisphere. The BB clinical picture is characterized by a pathognomonic skin lesion (migratory erythema) and joint, neurological, cardiac and psychiatric symptoms. Innate and Th1/Th17 adaptive immunity seem to play an important role in the pathogenesis of Lyme disease. ObjectiveThe aim of this study was to characterize the role of innate and Th1/Th17 adaptive immunity in BB patients with acute (<3 months) and convalescent (>3 months) disease. MethodsFifty BB patients (28 with acute and 22 with convalescent disease) without treatment and 30 healthy subjects were evaluated. Levels of 20 cytokines or chemokines associated with innate and Th1/Th17 adaptive immunity were analyzed using Luminex (Millipore Corp., Billerica, MA). ResultsOverall, BB patients had increased levels of IL-8 (6.29 vs 2.12 p = 0.002) and MIP-1α/CCL3 (5.20 vs 2.06, p = 0.030), associated with innate immunity, and MIP3B/CCL19 (Th1; 297.86 vs 212.41, p = 0.031) and IL-17A (Th17; 3.11 vs 2.20, p = 0.037), associated with adaptive immunity, compared with the levels of healthy controls. When comparing acute BB vs. convalescent BB subjects vs. healthy controls, IL-1β, IL-8 and MIP-1α/CCL3 (innate mediators) levels were highest in patients in the acute phase of disease (p < 0.05). TNF-α was associated with disseminated symptoms and with humoral reactivity against Borrelia burgdorferi. IL-10 was significantly correlated with IL-6 (r = 0.59, p = 0.003), IL-8 (r = 0.51, p < 0.001), MIP-1α/CCL3 (r = 0.42, p < 0.001) and MIP-3β/CCL19 (r = 0.40, p = 0.002) in all BB patients. ConclusionsThis is the first study describing that innate and Th1/Th17 adaptive immunity play a crucial role in BB disease. Furthermore, innate mediators are particularly important in acute BB disease, and TNF-α is associated with evolution of BB symptoms.

Waxing and waning eczematous dermatitis and glossitis

Fig 2 View Large Image Figure Viewer Download Hi-res image Fig 3 View Large Image Figure Viewer Download Hi-res image A 61-year-old woman presented with a 3-year history of a recurrent, painful rash and tongue pain. She denied jaundice, fatigue, abdominal pain, or a change in bowel habits. The physical examination revealed atrophic glossitis and thin, scaly, erythematous, tender plaques and scattered erosions on her face, trunk, perineum, buttocks, gluteal cleft, and extremities (Fig 1, Fig 2, Fig 3). Her abdomen was soft, nontender, and without palpable masses. A skin biopsy obtained by a different institution revealed “eczema.” However, she experienced minimal relief with topical or systemic corticosteroids. Two years after onset of the rash, she developed nausea, vomiting, and an unintended weight loss of 10 kg, which prompted additional work-up and treatment. 1.What is the most likely diagnosis? A.Drug eruption B.Seborrheic dermatitis C.Necrolytic migratory erythema D.Tinea corporis E.Necrolytic acral erythema 2.Which of the following is the most specific test for diagnosing the underlying cause of the patient's rash? A.Serum glucagon level B.Serum zinc level C.Potassium hydroxide preparation D.Hepatitis C serologies E.Absolute eosinophil count 3.What would be an appropriate first-line treatment for the underlying cause of the patient's eruption? A.Topical steroids B.Topical antifungal medications C.Nutritional supplementation D.Surgical resection E.Antiviral medications

Gnathostomiasis: A rare case of cutaneous creeping eruptions

A 21-year-old vegetarian lady presenting with migratory erythema and pain in her right hand subsequently developed a blister on the palm. A worm-like structure came out of the wound and was identified as Gnathostoma spp. adult male worm. It is a very rare cause of creeping eruptions and so far only one case of cutaneous gnathostomiasis caused by a larva has been reported from India. This is the first case of cutaneous gnathostomiasis due to an adult Gnathostoma spp. in India.

Erythema migrans arciforme et palpabile

A 39-year-old man presented with an annular clearly palpable erythema on the décolleté. Based on clinical and histopathological findings, palpable migratory arciform erythema was diagnosed. This skin condition is classified as a rare type of T-cell pseudolymphoma. It is still a matter of debate whether palpable migratory arciform erythema is a specific entity or a clinical variant of lymphocytic infiltration of the skin (Jessner-Kanof). Topical corticosteroids or oral antibiotics are generally used. In our patient, UV-A1 therapy led to a complete regression of the lesions.

TRAPS, un síndrome autoinflamatorio: Casos cínicos

Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is an autoinflammatory disorder associated to a mutation of the Tumor Necrosis Factor Receptor 1 (TNFR1) whose clinical presentation consists on recurrent episodes of prolonged fever, abdominal pain, myalgias, migratory cutaneous erythema, conjunctivitis or periorbitary edema. The diagnosis is confirmed by genetic analysis of the TNFR1 gene. Its main complication is amyloidosis and the treatment is based on the use of corticosteroids or anti-TNF antibodies. We report a 17 year-old male and 23 year-old female with the syndrome. Both cases had heterozygous mutations of the TNFR1 gene, C30R in the first case and T50M in the second case.

An Israeli Arab patient with a de novoTNFRSF1A mutation causing tumor necrosis factor receptor-associated periodic syndrome

To investigate genetic susceptibility to recurrent fevers, generalized severe myalgia, and migratory erythema in an Israeli Arab child with no family history of similar disease. DNA sequencing of exons 1-6 of the TNFRSF1A gene (formerly TNFR1) was performed in the patient and his parents to determine the presence of the autosomal-dominant tumor necrosis factor receptor-associated periodic syndrome (TRAPS); informative markers spanning the TNFRSF1A locus were used to genotype all available members of the patient's family. The TNFRSF1A gene was subsequently screened in 69 healthy Arab controls and 96 Caucasian controls. Formal forensic paternity testing was performed on the child. We found a de novo missense mutation in exon 3 of the TNFRSF1A gene, involving a novel C-->T transition encoding a Cys70Arg (C70R) variant, in the Israeli Arab patient. Eight of the common familial Mediterranean fever (FMF) gene MEFV mutations were excluded. This mutation was not present in the parents or siblings, or among the 69 healthy Arab controls. However, another TNFRSF1A variant, Pro46Lys (P46L), was present in 1 of the Arab controls. We have identified a TNFRSF1A mutation associated with periodic fever in an Arab patient, and a TNFRSF1A variant, which is variably pathogenic in Caucasians, in an Arab control. This is the first report of a de novo mutation in periodic fevers in general, and also of TRAPS in the Arab population. These findings demonstrate the need to include TRAPS in the differential diagnosis of recurrent fevers in this population.

Erythrokeratoderma variabilis: case report and review of the literature

We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low-sedating H1-antihistamine. Revision of the literature in order to allocate the frequency of pruritus in EV and discussion of this association will follow.

Erythrokeratoderma variabilis: case report and review of the literature

We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low-sedating H1-antihistamine. Revision of the literature in order to allocate the frequency of pruritus in EV and discussion of this association will follow.

Therapeutic strategies in the management of endocrine GEP tumours

The therapeutic principles in the management of endocrine gastroenteropancreatic (GEP) tumours include surgical extirpation of the primary tumour in the absence of metastases and medical control of symptoms in the preoperative phase. In the presence of metastases only palliative procedures are available. Tumour growth might be controlled by surgical procedures as debulking of tumour masses, medically by chemotherapy and more recently by new developments as a long-acting somatostatin analogue (SMS 201-995) and alpha-interferon. Their efficacy is currently evaluated in prospective studies. In contrast to inhibition of growth symptoms derived from excessive hormone production by GEP tumours can be well controlled. SMS 201-995 effectively prevents or at least improves flush and diarrhoea in the carcinoid syndrome, disabling diarrhoea in the Verner-Morrison syndrome and migratory erythema in the glucagonoma syndrome. SMS acts by inhibition of hormone release from the tumour and by a direct mechanism at the site of the target cell via SMS receptors present on tumour and target cells. For control of acid hypersecretion in gastrinoma patients omeprazole is superior to all former and present alternatives and replaced total gastrectomy completely. A similarly effective drug to prevent hypoglycaemia due to uncontrolled insulin release from insulinomas is not available since neither SMS nor diazoxide are effective in every insulinoma patient.

Cutaneous Signs of Internal Malignancies

The more common paraneoplastic skin changes associated with internal malignancies (acanthosis nigricans, dermatomyositis, secondary ichthyosis) are discussed. The rare glucagonoma syndrome, consisting of alpha cell tumor of the pancreas, migratory necrolytic erythema, and diabetes mellitus, is described. The importance of recognition of these skin lesions may lead to early detection of the underlying cancer with possible cure.

CHICAGO DERMATOLOGICAL SOCIETY

<b>Migratory Erythema: Erythema Annulare Centrifugum?</b>Presented byDr. Adolph Rostenberg, Jr.and (by invitation)Dr. Betsy B. Brennan. A 50-year-old white married man, a dairy worker, since January, 1955, has had progressive dusky erythema and scaling of the right foot, followed in a few months by progressive pain and weakness of the right foot and leg. For four months there has been a continuous eruption on the right leg and thigh of large, ring-like lesions. The border of the lesions consists of fine erythematous papules leaving a clear center which shows slight scaling and pigmentation. Some lesions have coalesced, producing an arciform border. The rings, according to him, change in position and size. The right foot shows uninterrupted dusky erythema from the ankle downward, over which there is a dry scale. The nails are thickened, ridged, and opaque. Scrapings from the nails and skin contained no fungus. This