Painful Lesions Research Articles

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome presenting as recurrent aseptic peritonitis in a patient receiving peritoneal dialysis: a case report

BackgroundVacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is caused by mutations in the ubiquitin-activating enzyme1 (UBA1) gene and characterised by an overlap between autoinflammatory and haematologic disorders.Case presentationWe reported a case of a 67-year-Japanese man receiving peritoneal dialysis (PD) who had recurrent aseptic peritonitis caused by the VEXAS syndrome. He presented with unexplained fevers, headache, abdominal pain, conjunctival hyperaemia, ocular pain, auricular pain, arthralgia, and inflammatory skin lesions. Laboratory investigations showed high serum C-reactive protein concentration and increased cell count in PD effluent. He was treated with antibiotics for PD-related peritonitis, but this was unsuccessful. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography images demonstrated intense FDG uptake in his left superficial temporal artery, nasal septum, and bilateral auricles. The working diagnosis was giant cell arteritis, and he was treated with oral prednisolone (PSL) 15 mg daily with good response. However, he was unable to taper the dose to less than 10 mg daily because his symptoms flared up. Since Tocilizumab was initiated, he could taper PSL dose to 2 mg daily. Sanger sequencing of his peripheral blood sample showed a mutation of the UBA1 gene (c.122 T > C; p.Met41Thr). We made a final diagnosis of VEXAS syndrome. He suffered from flare of VEXAS syndrome at PSL of 1 mg daily with his cloudy PD effluent. PSL dose of 11 mg daily relieved the symptom within a few days.ConclusionsIt is crucial to recognise aseptic peritonitis as one of the symptoms of VEXAS syndrome and pay attention to the systemic findings in the patients.

Post-traumatic AV Fistula of the Hand Successfully Treated With Percutaneous Endovascular Laser Ablation: Report of a Case.

Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.

Proinflammatory CD14highCD16low monocytes/macrophages prevail in Treponema phagedenis-associated bovine digital dermatitis.

Digital dermatitis (DD) is a skin disease in cattle characterized by painful inflammatory ulcerative lesions in the feet, mostly associated with local colonization by Treponema spp., including Treponema phagedenis. The reason why most DD lesions remain actively inflamed and progress to chronic conditions despite antibiotic treatment remains unknown. Herein, we show an abundant infiltration of proinflammatory (CD14highCD16low) monocytes/macrophages in active DD lesions, a skin response that was not mitigated by topical treatment with oxytetracycline. The associated bacterium, T. phagedenis, isolated from DD lesions in cattle, when injected subcutaneously into mice, induced abscesses with a local recruitment of Ly6G+ neutrophils and proinflammatory (Ly6ChighCCR2+) monocytes/macrophages, which appeared at infection onset (4 days post challenge) and persisted for at least 7 days post challenge. When exploring the ability of macrophages to regulate inflammation, we showed that bovine blood-derived macrophages challenged with live T. phagedenis or its structural components secreted IL-1β via a mechanism dependent on the NLRP3 inflammasome. This study shows that proinflammatory characteristics of monocytes/macrophages and neutrophils dominate active non-healing ulcerative lesions in active DD, thus likely impeding wound healing after antibiotic treatment.

Prevalence of Painful Lesions of the Digits and Risk Factors Associated with Digital Dermatitis, Ulcers and White Line Disease on Swiss Cattle Farms.

The first aim of this study was to calculate the prevalence of painful lesions of the digits ("alarm" lesions; ALs) in Swiss dairy herds and cow-calf operations over a three-year study period. The following ALs were included in the calculation: the M2 stage of digital dermatitis (DD M2), ulcers (U), white line fissures (WLF) of moderate and high severity, white line abscesses (WLA), interdigital phlegmon (IP) and swelling of the coronet and/or bulb (SW). Between February 2020 and February 2023, digit disorders were electronically recorded during routine trimmings by 40 specially trained hoof trimmers on Swiss cattle farms participating in the national claw health programme. The data set used consisted of over 35,000 observations from almost 25,000 cows from 702 herds. While at the herd-level, the predominant AL documented in 2022 was U with 50.3% followed by WLF with 38.1%, at the cow-level, in 2022, it was DD M2 with 5.4% followed by U with 3.7%. During the study period, within-herd prevalences of ALs ranged from 0.0% to a maximum of 66.1% in 2020. The second aim of this study was to determine herd- and cow-level risk factors associated with digital dermatitis (DD), U and white line disease (WL) in dairy cows using data from 2022. While for DD, analysed herd-level factors appeared to have a greater effect on the probability of its occurrence, the presence of U and WL was mainly associated with the analysed cow-level factors. The risk for DD increased with a higher herd trimming frequency. Herds kept in tie stalls had a lower risk for DD and WL and a higher risk for U compared to herds kept in loose housing systems. Herds with predominantly Holstein Friesian cows as well as Holstein Friesian cows had a higher risk for the occurrence of DD compared to herds and cows of other breeds. With increasing parity, cows had a higher risk of developing U and WL, whereas for DD, parity was negatively associated with prevalence. Cows trimmed during the grazing period had a higher risk of U and WL than cows trimmed during the housing period. These findings may contribute to improve management measures affecting the health of the digits in farms with structures similar to those evaluated in the current study, such as small herds with frequent access to pasture. Further research is warranted to demonstrate how measures addressing the current results combined with those of individual herd risk assessments might contribute to an improvement in the health of the digits in the respective dairy herds.

NPD1 Relieves Neuropathic Pain and Accelerates the Recovery of Motor Function After Peripheral Nerve Injury.

The incidence of peripheral nerve injury (PNI) in China is continuously increasing. With an inability to function due to sensory and motor abnormalities, patients with PNI suffer from neuropathic pain and subsequent lesions. Presently, effective treatments for PNI are limited. To determine the role of neuroprotectin D1 (NPD1) in PNI, a sciatic nerve crush injury model was developed to investigate the impact of NPD1 on sensory and motor function recovery following nerve injury. The results demonstrated that NPD1 administered at different time points might reduce mechanical allodynia and thermal hyperalgesia caused by PNI, and its analgesic effect was not tolerated. Immunohistochemistry analyses revealed that administering NPD1 to PNI mice decreased the spinal microglia and astrocyte activation and decreased the inflammatory factor expression in the spinal dorsal horn. Furthermore, NPD1 can inhibit the invasion of IBA-1+ macrophages in dorsal root ganglions generated by nerve injury. Meanwhile, it can help rehabilitate motor and neuromuscular functions following PNI. The results indicate that NPD1 may be involved in the sensory and motor function recovery following PNI.

Innovative Healing: Managing an Infected Non-Healing Chronic Ulcer with Panchvalkal Ointment

A wound that has not started to heal within 4 weeks, or not healed in 8 weeks is called a chronic, non-healing ulcer. Wounds such as varicose ulcers, diabetic foot ulceration, Pressure sores and other venous related lesions. These ulcers are frequently large, slow and non-healing painful erosions that come back time to time with signs of superimposed infection. Case history- A 50-year-old male presented to complaining of inflamed, painful and ulcerated lesion on the dorsum aspect on his left foot measuring 10 cm x 7 cm being present for nearly three months. His complaint was discharge and swelling of left leg. The diagnosis was infected non-healing chronic ulcer. Treatment strategy included topical application of Panchvalkal ointment and integrated care regime. The traditional Ayurvedic combinations in the form of Panchvalkal was used for wound healing. First the wound was cleaned with Panchvalkal Kwath, thereafter Panchvalkal ointment was applied twice a day, in combination with morning and evening dressing. In 90 days of regular therapy, the wound healed without any complications. The Case illustrate the potential beneficial effect of Panchvalkal ointment in chronic wounds, especially when conventional therapies are mostly unavailable or unsparing. The cure of the ulcer effectively highlights on how much there is need for involving traditional remedies in our daily medical practices to realize an optimum patient outcome. The patient’s complete recovery shows that using Panchavalkal ointment is effective for treating infected, non-healing chronic ulcers.

Case Report: BLASTX® Antimicrobial Wound Gel Treatment in Sweets Syndrome with Lymphedema: A Comprehensive Case Presentation

Sweets Syndrome (SS), a rare autoinflammatory skin condition, presents challenges in wound management. This case study explores a patient with SS complicated by lymphedema, highlighting the efficacy of BLASTX® treatment. SS, marked by fever and painful skin lesions, often accompanies immune system dysregulation. Chronic ulcers associated with autoinflammatory diseases serve as significant diagnostic indicators. This report examines the case, emphasizing the role of BLASTX® Antimicrobial Wound Gel in managing SS-related cutaneous ulcers.

User-centered design of a personal-use exoskeleton: a clinical investigation on the feasibility and usability of the ABLE Exoskeleton device for individuals with spinal cord injury to perform skills for home and community environments.

The ABLE Exoskeleton has been tested to be safe and feasible for persons with spinal cord injury (SCI) to complete basic skills in clinical settings but has not been tested for use in home and community environments. A user-centered design process was employed to test the feasibility of the current ABLE Exoskeleton (designed for clinical use) for persons with SCI to perform the basic and advanced skills required for home and community environments, to gain crucial feedback for the development of a novel personal-use exoskeleton. In this prospective pretest-posttest quasi-experimental study across two SCI centers (Germany, Spain), in-and outpatients with SCI were included into a 22-session training and assessment protocol, utilizing the ABLE Exoskeleton. Feasibility and usability measures [level of assistance (LoA) for basic and advanced skills, donning/doffing-time and LoA] were recorded together with safety outcomes, and participant and therapist satisfaction with the device. 10 participants (44.4 ± 24 years), with SCI from C5 to T11, (American Spinal Injury Association Impairment Scale A-D) completed the study. In 209 sessions, six device-related adverse events (pain and skin lesions) were reported. Average total time for don and doff was 10:23 ± 3:30 min. Eight participants were able to complete don and doff with minimal assistance or less. Independence to carry out all skills in the device increased significantly for all participants (p < 0.05). Participants with chronic SCI required a significantly (p < 0.05) lower LoA for six of the nine advanced skills than those in the sub-acute phase. This study shows that the ABLE Exoskeleton is safe, feasible and usable for people with SCI in respect to independent donning, doffing and performance of basic and advanced exoskeleton skills. The supervised exoskeleton use in the clinical environment was a highly valuable approach for identifying the challenging tasks and the necessary technological developments that need to be carried out for a personal-use exoskeleton, including a more independent sit-to-stand transition, faster speed of transitions between states and a richer display on the remote control for the user. https://clinicaltrials.gov/study/NCT05643313.

Calciphylaxis: complexity from presentation to treatment

Calciphylaxis is a rare but potentially life-threatening condition most often observed in patients with end-stage renal disease. The following case illustrates the presentation of non-nephrogenic and nephrogenic calciphylaxis. The prevalence of calciphylaxis appears to be rising; therefore, it is important to maintain a high index of suspicion in the evaluation of painful ulcerating skin lesions.

Purpura Fulminans Secondary to Varicella-Zoster Virus Infection

Background. Purpura fulminans (PF) is a rare, life-threatening condition involving consumptive coagulopathy and intravascular thrombosis, causing purpura and necrosis in the skin and soft tissue. Case Report. A 4-year-old Tajik girl with PF secondary to varicella-zoster virus (VZV) infection presented with purplish red, diffuse, painful lesions localized to the entire right leg. Her vaccination status was unknown, and she did not have concurrent chronic illness. Ten days before admission, the girl was admitted to another hospital in Tajikistan with a diagnosis of chickenpox and PF. She was then transferred to the hospital of the authors of the current report due to the enlargement of lesions to the gluteal region, a change in the color of lesions from red to black, and the detection of arterial thrombosis via Doppler ultrasonography. Multiple surgical debridements were performed to manage tissue necrosis, and the patient’s right leg was amputated at the 18th week of admission. The patient was discharged after 26 weeks of hospitalization. Conclusion. Although VZV infections mostly cause mild and self-limiting eruptive disease, they can progress, with life-threatening complications, including PF. To prevent VZV infection and resulting complications, immunization with live attenuated vaccines and maintaining population immunity above a certain threshold are the most important strategies to prevent the circulation of the virus.

ORF disease: a case report with images.

This article presents the case of a 25-year-old Moroccan male who contracted Orf disease (Ecthyma contagiosum), a common zoonotic viral infection in sheep and goats. The disease, caused by a parapoxvirus, can be transmitted to humans through contact with infected animals. The patient developed painful lesions on his fingers after interacting with a sheep during the Feast of Sacrifice. Diagnosis was clinically established considering exposure history and lesion characteristics. Treatment involved local antiseptics and 2% fusidic acid cream. The lesions resolved spontaneously over a few weeks without functional impairment.

Monkey Pox: An Emerging Outbreak

Monkeypox is a viral disease, with very rare cases. It has gained attention because of its similarities to smallpox. It was diagnosed in 1958 for the first time in monkeys and then later this disease effected people of Africa who were living in the western and central parts of Africa. The virus is liable for monkeypox, an orthopoxvirus, and is generally transmitted to people through contact with animals such as rodents, monkeys, and different wildlife. Human-to-human transmission can occur, mainly in localized outbreaks. Although monkeypox is sporadic and typically considered a zoonotic disease, it has caused epidemics in Central and West Africa. These outbreaks are often connected to close touch with infected animals, especially in rural communities. Some common symptoms include rash, fever, and pustules. While the mortality rate of this disease is 1-10% which is less than small pox. Treatment includes addressing signs such as fever, pain, and skin lesions. Patients may also require hospitalization, especially if they develop extreme complications, and have to be isolated to prevent human-to-human transmission. Research into antiviral medicinal drugs and vaccines is ongoing; however, in September 2021, no licensed monkeypox-specific antiviral drugs or vaccines were available. Preventing monkeypox generally includes decreasing the risk of exposure to the virus. Key preventive measures include people in endemic regions reducing contact with animals that carry the virus, including rodents and monkeys. This review provides an overview of monkeypox, focusing on its epidemiology, treatment, and prevention strategies.

Sarcoidosis: A Case Report of an Often-Misdiagnosed Clinical Entity from Bangladesh

A chronic granulomatous disease of unknown etiology without any definite diagnostic criteria with an incidence of 1-1,00,000 among Asians affects multiple systems of our body and is often misdiagnosed owing to its elusive nature and resemblance with other granulomatous disease , especially tuberculosis (TB) in our subcontinent .A 38 years old diabetic woman came with the complaints of low grade fever, night sweats, cough, weight loss, migratory joint pain involving multiple small joints of hands without any morning stiffness and painful skin lesions which resolved spontaneously. Investigation showed Hb 11.5 g/dl with normocytic normochromic anaemia, increased sedimentation, increased CRP, insignificant MT, RA and ANA serology, Sputum for AFB didn't reveal any Mycobacteria. CXR revealed Bilateral Hilar Lymphadenopathy (BHL) and HRCT lungs showed bilateral hilar, mediastinal lymphadenopathy and pulmonary inflammatory lesions. Angiotensin Converting Enzyme (ACE)was 163 U/L which was higher than the normal. She was diagnosed as a case of sarcoidosis and was treated in line with oral prednisolone 40mg/day which was gradually tapered over a period of 5 months. Methotrexate 15mg/day once a week was supplemented with folic acid every consecutive day.Vaccination against H.influenzae and S.pneumoniae were advised and on subsequent follow ups she has been improving .The mortality rate is around 5% however, early suspicion, diagnosis and treatment can be life saving for the patient.

Ultrasound appearance and targeted therapy of symptomatic neural lesions in the breast and chest wall after breast cancer surgery.

To evaluate the feasibility of ultrasound (US) in identification of nerve lesions after breast cancer surgery in patients with neuropathic pain and assess the effect of a targeted US-guided therapy. Patients with neuropathic pain after breast cancer surgery underwent US examination. Nerve lesions identified by US were treated by a US-guided application of a mixture of local anesthetics and corticoids. The patients reported pain relief on a 100-point scale (0% = no effect, 100% = complete relief) and its duration in the next 18 months. We performed 17 interventions in 11 women. A neuroma was observed in 2 patients, edema of the nerve in 5 patients, and scarring across the nerve in 4 patients. The affected nerves were the intercostobrachial nerve (5 patients), the long thoracic nerve (4), cutaneous branch of the pectoral nerve (1), and both the intercostobrachial and the long thoracic nerve (1). After 15 (88%) interventions, the patients reported relief (55±32%) with a median duration of 3 months (0.5-18 months). In patients after breast cancer surgery, ultrasound can reliably identify small painful neural lesions which can be efficiently treated by ultrasound-guided intervention.

Risk factors and clinical features for pulmonary paragonimiasis-associated pneumothorax.

Pulmonary paragonimiasis, a food-borne zoonotic helminthiasis, is a parasitic disease of the lung caused by infection with trematodes species of the genus Paragonimus. Although pneumothorax has been reported as occuring with paragonimiasis, to date no study has been performed concerning the clinical features and predictive risk factors for this condition. This retrospective study, which aims to fill this gap, was conducted at Jeonbuk National University Hospital. All patients (aged ≥19 years) were diagnosed with paragonimiasis between May 2011 and December 2021. Medical records were reviewed and information concerning age, sex, vital signs, underlying diseases, clinical signs and symptoms, laboratory findings, radiologic findings, treatment, and clinical outcomes was collected. An odds ratio (OR) for the risk factors associated with pneumothorax was calculated using the binary logistic regression model. Among 179 consecutive patients diagnosed with pulmonary paragonimiasis, the postive rate of pneumothorax was 10.6% (19/179). Pneumothorax occurred mostly in the right lung (78.9%, 15/19), and intrapulmonary parenchymal lesions showed an ipsilateral relationship with pneumothorax (94.7%, 18/19). Fifteen patients (78.9%, 15/19) of pneumothorax associated with pulmonary paragonimiasis are accompanied by pleural effusion. Most of patients with pneumothorax (89.5%, 17/19) underwent chest tube insertion as a first treatment. Three patients (15.8%) showed relapses but in no case was a death recorded. Asthma (odds ratio [OR] 8.10, 95% confidence interval [CI] 1.43-45.91), chest pain (OR 8.15, 95% CI 2.70-24.58), and intrapulmonary lesions (OR 8.94, 95% CI 1.12-71.36) were independent risk factors for pulmonary paragonimiasis-associated pneumothorax. Our findings suggest that clinicians should keep in mind the possibility of pneumothorax when approached by patients with pulmonary paragonimiasis complaining of chest pain, accompanied by intrapulmonary lesions or with asthma as an underlying disease.

A Case of Ramsay Hunt Syndrome Showing Central Findings due to Brainstem Involvement

Ramsay Hunt syndrome occurs when the varicella zoster virus reactivates. Classic findings include the triad of facial paralysis, otic pain and herpetic lesions due to the pathogenesis associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. In addition to the classic triad, rare features such as a central type of vestibular function test may be observed due to the retrograde spread of the varicella zoster virus from the geniculate ganglion into the brain stem, including involvement of the vestibular nucleus. We present a case of Ramsay Hunt syndrome in a 57-year-old male patients, manifesting not only the typical triad of symptoms but also the unique features associated with brain stem involvement. This presented as direction-changing gaze-evoked nystagmus and a decrease in gain on both sides on video head impulse test. And brain magnetic resonance imaging showed a lesion in the vestibular nucleus of the brain stem.

Painful burning lesions on the chest wall of a patient with advanced breast cancer

A 90-year-old woman presented at our emergency department complaining of dyspnea (sO2 88% on room air, respiratory rate 24/min) and severe (NRS 8/10) burning chest pain. Ten years earlier, she had undergone a bilateral radical mastectomy and radio-chemotherapy for breast cancer. In September 2023, she developed some nodules on her chest skin treated with electrochemotherapy, multiple liver lesions, and a bilateral paraneoplastic pleural effusion.

Painful Palmoplantar Lesions Following Vaccination: Answer.

Painful Palmoplantar Lesions Following Vaccination: Answer.

Clinical Pathology Correlation Case 1: Multiple painful lesions of the tongue

Clinical Pathology Correlation Case 1: Multiple painful lesions of the tongue

1385. Granulomatous Mastitis: An Elusive Disease

Abstract Background Background Granulomatous mastitis (GM) is a chronic inflammatory disease of the breast characterized by painful and recurrent breast lesions and masses. It affects women of childbearing age with a history of breastfeeding. It is a rare diagnosis with an estimated incidence of 2.4 per 100,000 women in the United States, with a prevalence 12 times higher in Hispanic women. Methods Methods We conducted a retrospective review of women with GM seen at NYC Health + Hospitals/Jacobi, a safety net hospital in the Bronx, New York City from January 2017 to March 2023. Patients were included if they had pathologic confirmation of the disease. Demographic and clinical data was extracted from the electronic medical records. Results Results A total of 29 patients were included, 86.2% were Hispanic; median age was 40 years old. None of the patients was postpartum and only one patient was breastfeeding at the time of diagnosis. Pain and unilateral palpable mass were the most commonly reported symptoms. Of those who had cultures, only 42.1% reported growth and the most prevalent organisms were Corynebacterium species. 89.7% received antibiotic treatment as a first line therapy; only 37.9% of them reported improvement within a month of presentation. Trimethoprim-sulfamethoxazole, clindamycin and doxycycline were the most prescribed treatments. 27.6% of all patients received systemic steroids following failure to improve with antibiotic treatment and 17.2% received intralesional steroids. 65.5% of those reported resolution of symptoms within three months. Two patients received a trial of adalimumab. Seven patients (24%) presented with recurrence after a year. Conclusion Conclusions GM occurs predominantly in Hispanic females and seems to be associated with Corynebacterium species when an organism is isolated. Recurrences occur in ¼ of patients despite therapy. The pathophysiology of this condition and optimal treatment of this disease is not well defined, but antibiotics alone do not seem to be effective. Immune modulation seems to be an important adjunctive treatment, but which agent and how long is not clear. Further studies are needed to elucidate these answers. Disclosures All Authors: No reported disclosures