Polymorphous Erythema Research Articles

First Case of Chryseobacterium gleum Post-COVID-19 in a Child with Recurrent Fever

Background and Clinical Significance:Chryseobacterium gleum is a Gram-negative opportunistic and emerging pathogen able to induce systemic manifestations (e.g., peritonitis, pneumonia, urinary tract infections, meningitis) in immunocompromised patients. No data on children have been published. Case Presentation: A 2-year-old child presented in the pediatric ambulatory room with recurrent fever, submandibular lymphadenopathy, and skin rash. Laboratory findings revealed the presence of microcytic anemia with an increase in c-reactive protein. Chest X-ray reported mild accentuation of the bronchial structure, especially on the right side and middle–lower zone. In the peripheral blood smear, anisopoikilocytosis and elliptical red cells were evident. Clinical evaluation revealed the presence of conjunctivitis and polymorphic erythema, hyperemic pharynx and tonsils, SPO2 99%, auscultation of the chest, harsh vesicular murmur all over the area, and some wheezing. Microbiological analysis of sputum and throat swabs revealed the presence of numerous colonies of Chryseobacterium gleum confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS score > 2.2). Conclusions: This is the first case of Chryseobacterium gleum post-COVID in a child. We suggest that a quick identification and an appropriate treatment represent the critical factors able to prevent the adverse outcomes related to C. gleum infection.

Un érythème polymorphe bulleux mimant un syndrome de Sweet

We report a case of bullous polymorphous erythema mimicking Sweet syndrome in a 34-year-old patient treated for refractory classical sclerodular Hodgkin's lymphoma treated with chemotherapy 10 days before the onset of symptoms, in whom the diagnosis of Sweet syndrome was strongly suspected based on the presence of several diagnostic criteria, but skin biopsy was in favor of bullous polymorphous erythema.

P094 Atypical cutaneous manifestations of sporotrichosis in Brazil

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectivesInform the general practitioner of the possibilities of cutaneous manifestations secondary to sporotrichosis unrelated to the classic finding of contiguous lymphocutaneous ulcers.MethodsThis is a single-center, cross-sectional, retrospective study with patients evaluated and seen from June 2018 to April 2022 at the Mycology Outpatient Clinic of Hospital Universitário Oswaldo Cruz, University of Pernambuco.All patients were evaluated by the same infectious disease physician throughout the course, from diagnosis to outpatient discharge.Scrapings and cultures were collected by the institution's specialized Mycology team. Biopsies were sent to the University Pathology Service (CIAP).ResultsDuring the 4-year period, 231 patients started their treatment for sporotrichosis following clinical, laboratory, and histopathological criteria. Of these, 35 had atypical skin manifestations (15.15%).Of the 35 cases, most had erythema nodosum (22/35 - 63%), followed by simple cutaneous (6/35 - 17%), polymorphous erythema (5/35 - 14%), and cutaneous fistula and lymphangitis with one case each (Fig. 1).Both erythema nodosum and erythema nodosum showed a good response to corticosteroid therapy (standard with 20 mg prednisone for 5 days). In non-responsive cases, we increased the dose to 40 mg with a good response.Simple cutaneous lesions were infiltrating still in the process of ulceration without presenting involvement of the contiguous lymph node chain. The face, abdomen, chest, and limbs were the affected sites.One of the cases was a dental abscess with a fistula to the face. Upon biopsy of the lesion on the right hemiface, spores suggestive of sporotrichosis were found. When examining the patient, we observed the compromised right upper malar, which was surgically removed with drainage of the gingiva and the presence of Sporotrix in both the tooth and the gingiva.And, finally, a case of lymphangitis with improvement after specific treatment with itraconazole whose diagnosis was made by biopsy with Sporotrix findings in lymphatic vessels.As most patients had a late diagnosis due to the difficulty in carrying out the specific investigation of the agent by a non-specialized team, the diagnosis by scraping and culture was compromised by early treatment with antifungals, especially itraconazole. It is very common in the Northeast of Brazil that the association of sick cats with typical lesions of sporotrichosis is the main epidemiological factor since our case series for infections caused by soil manipulation is low. Therefore, 37% (13/35) had a clinical-epidemiological diagnosis of sporotrichosis, with an excellent clinical response to itraconazole (Fig. 2). Our standard dose is 200 mg/day after lunch, as a fatty diet interferes with improved medication absorption. All patients were instructed not to use medications with known interactions, especially proton pump inhibitors and alcohol use.ConclusionLymphocutaneous sporotrichosis is the most common manifestation, but there is a need for care teams working in primary and secondary care to identify atypical skin lesions and expand the investigation into the possibility of fungal infections. The epidemiology of the neighborhood associated with the presence and contact with sick cats with ulcerative lesions must be considered and taken into account.

Ponatinib in pediatric patients with Philadelphia chromosome-positive leukemia: a retrospective survey of the Japan Children's Cancer Group.

Ponatinib is effective in adults with Philadelphia chromosome-positive (Ph+) leukemia, resistant or intolerant to second-generation tyrosine kinase inhibitors, but there are limited data on its use in children. The clinical courses of nine pediatric patients with Ph+ acute lymphoblastic leukemia (Ph+ ALL) and four with chronic myeloid leukemia (CML) who received ponatinib therapy were retrospectively reviewed. The median age at the start of ponatinib therapy was 12years (range 8-16years). Nine patients were male and four were female. Six patients received ponatinib alone, three received ponatinib with prednisolone, one received ponatinib with rituximab intrathecal therapy, and one received ponatinib with conventional chemotherapy. Two patients received ponatinib both alone and in combination with chemotherapy. The median dose and duration of ponatinib were 16.9mg/m2 (7-34.3) and 1.1months (0.2-22.7), respectively. Six patients with Ph+ ALL and two with CML responded to ponatinib. One of the eight patients who received ponatinib alone had grade 4 increased lipase levels. Grade 3 non-hematologic toxicities included elevated alanine aminotransferase levels (25%), elevated aspartate aminotransferase levels (25%), elevated gamma-glutamyl transferase levels (12.5%), hypertension (12.5%), and polymorphic erythema (12.5%). Ponatinib may be safe and effective in pediatric patients with Ph+ leukemia.

Polymorphic erythema associated with mycoplasma pneumoniae.

Image in medicine Male child, 6 and a half years old, followed for psychomotor delay from the age of 2 years with diagnosis of epilepsy put on sodium valproate for 3 years and in the absence of seizure control carbamazepine was added 2 months before admission. The patient had presented 5 days before his consultation a generalized erythematous rash with edemas of two lower limbs, a dry cough and a fever. He was initially treated as a meningococcemia. On skin examination: generalized erythematous lesions with a rosette appearance, vesicular lesions in the lips. On admission to the service, the patient was put on acilovir, josamycin with discontinuation of carbamazepine. HSV 1 and 2 serology returned negative. Mycoplasma serology was positive for IgM and negative for IgG. The chest X-ray was normal. The skin biopsy was in favor of superficial dermatitis. The evolution was favorable with progressive disappearance of the lesions. Aciclovir was discontinued due to the rapid improvement and negativity of serology and josamycin was discontinued after 14 days of treatment. The general condition improved in 48 hours and the skin lesions disappeared in 15 days. Figure 1 polymorphic erythema associated with mycoplasma pneumoniae in a child of six and half years old

Stevens–Johnson syndrome and acute vanishing bile duct syndrome after the use of amoxicillin and naproxen in a child

We present the case report of a 6-year-old patient who developed Stevens–Johnson syndrome (SJS) and acute vanishing bile duct syndrome (VBDS) after taking oral amoxicillin and naproxen. SJS, an immune complex-mediated hypersensitivity reaction involving the skin and mucosa, is usually drug-induced, and it can lead to systemic symptoms. Acute VBDS is rare, often presenting with progressive loss of the intrahepatic biliary tract. VBDS is an immune-mediated bile duct-associated disease, and immunological damage to the bile duct system is an important mechanism for VBDS. Serious drug-induced liver injury (DILI) is also associated with immunity. The drug acts as a hapten with keratin on the surface of biliary epithelial cells. The autoantibodies produced by this action can damage the bile duct epithelial cells and cause the bile duct to disappear. SJS is a serious type of polymorphic erythema that is mainly considered to be a hypersensitivity reaction to drugs, and it may involve multiple factors. The patient in this case report was treated with glucocorticoids, plasma exchange, ursodeoxycholic acid, and traditional Chinese medicine. He recovered completely within 5 months. This case report indicates that caution should be used because amoxicillin and naproxen can cause SJS and VBDS in children.

The nursing in human cytomegalovirus infection combined with infantile severe exudative polymorphous erythema

Objective To summarize the clinical nursing experience of a human cytomegalovirus infection combined with infantile polymorphic erythema. Methods Through evidence-based nursing, the family members of the children and their families were evaluated in two ways and carried out the family-centered holistic nursing care. The nursing problems of the children should be evaluated in a timely and effective manner. Results After 15 days of treatment, the patient was discharged from hospital and achieved satisfactory results. Conclusions For human cytomegalovirus infection with baby severity exudative polymorphic lupus patients, the implementation of strict protective isolation, meticulous care of skin mucous membrane, prevent eye and perineal secondary infection, close observation and prevention of severe complications in children with play a crucial role in the course of the disease and rehabilitation. Key words: Nursing care; Human cytomegalovirus; Exudative erythema multiforme

Manifestations cutanées immuno-allergiques liées aux nouveaux animaux de compagnie : trois observations

The number of household pets increased greatly during the twentieth century, with numbers of new pets (NP, i.e. any pets other than cats and dogs) rising especially sharply over the last decade. We first of all report the case of a female patient with eczema lesions on areas skin coming into contact with a ferret, with removal of the animal resulting in wound healing, followed by two patients presenting atypical polymorphous erythema reactions induced by dermatophytes present in their pet rat. While the most common allergies are respiratory, allergic skin reactions, both immediate and delayed, may also result from contact with these new allergens. The animal itself or its environment may be the cause.

Enfermedad de Kawasaki: serie de casos en la Clfnica Universitaria Colombia, 2007-2009

BackgroundKawasaki disease is a vasculitis of unknown etiology, first described by Tomisaku Kawasaki in January 1961. During the decade of the 1960s it was called "ocular mucocutane-ous syndrome" or "mucocutaneous lymph-node syndrome". In 1974 Kawasaki published the first report of 50 patients, from which the disease was renamed with the eponymous currently in use. Kawasaki's disease had an initial presentation as a national epidemic, but currently occurs as regional outbreaks. It is a clinical entity poorly diagnosed in our setting, which can be attributed in part to limited knowledge about the diagnostic criteria by health professionals. Summary of casesWe conducted a review of clinical records for the years 2007 to 2009 of children less than five years of age who had a feverish syndrome or exanthemáta's viral features, identifying four who were diagnosed as Kawasaki disease. The most common clinical manifestations were fever and changes in the oropharynx (100% of the cases), alterations in palms and soles polymorphic erythema (75%), and conjunctival injection and cervical adenop-athy (50%). Two of the patients presented echo-cardiograms coronary alterations. ConclusionsThe appropriate use of clinical criteria is the most important tool for the health professional to diagnose of Kawasaki disease and prevent associated complications.

Skin lesions in histoplasmosis

Histoplasmosis is a granulomatous infection caused by Histoplasma capsulatum, a dimorphic fungus. It is distributed worldwide and prevalent in certain regions of North and Central America. Pulmonary involvement is the most common clinical presentation. Cutaneous manifestations are reported to occur in 10% to 25% of AIDS patients with disseminated histoplasmosis. The skin lesions are polymorphic papules, plaques with or without crusts, pustules, nodules, mucosal ulcers, erosions, punched out ulcers, lesions resembling molluscum contagiosum, acneiform eruptions, erythematosus papules and keratotic plaques, purpuric lesions, and localized and generalized vegetant forms of dermatitis, sometimes an eruption similar to rosacea, keratotic papules with transepidermal elimination, polymorphous erythema, erythroderma syndromes, pyoderma gangrenosum, panniculitis, diffuse hyperpigmentation, abscesses, and cellulitis.

A Case of 5-Year-History of Polymorphic Erythema, which Subsided after Stopping Fluvastatin that Had Been Administered for 7 Years: Drug Eruption Due to Fluvastatin?

A Case of 5-Year-History of Polymorphic Erythema, which Subsided after Stopping Fluvastatin that Had Been Administered for 7 Years: Drug Eruption Due to Fluvastatin?

Les photoallergies graves

Photosensitivity reactions group together reactions to sunlight, in which the pathophysiology involves the subject's immune system. Concerning exogenous photosensitivity reactions, the photosensitizing molecules responsible for their development have been definitively identified and the reactions are known to be a form of classical delayed hypersensitivity. Nevertheless, while the photosensitizing molecules in idiopathic light eruptions (e.g., polymorphic light eruptions and chronic actinic dermatitis) have not been identified, here, the mechanism is now most often considered to be a delayed hypersensitivity; they can also be IgE-dependent (e.g., solar urticaria). The diagnosis of photosensitivity reactions rests on the patient's history, the appearance of the lesions, their histology and the results of a photo-testing examination. During an exogenous photosensitivity reaction, its severity will depend on the intensity of the reaction, on its evolution to chronic actinic dermatitis or even more on the severity of the specific condition (e.g., polymorphous erythema and hypersensitivity syndrome). Solar urticaria is a serious condition because of its disabling character, the difficulty of treating it and, occasionally, by the existence of general signs or its association with systemic diseases. Hydroa vacciniform (vacciniform cold sores) and pruriginous lesions can lead to the development of particularly ugly scars. More disturbing, vacciniform cold sores can be associated with latent EBV infection and may be complicated by lymphoproliferative disorders involving natural killer cells or by haemolytic syndromes. Chronic actinic dermatitis is surely the most severe photosensitivity reaction because of the severity of the photosensitivity and the risk of its evolution to a lymphoproliferative disorder.

Kawasaki disease after burns

Case 1 is an 11-month-old male infant who developed a high fever 7 days after suffering grade II burns on both lower extremities and the trunk caused by hot water. The results of laboratory examinations are shown in Table 1. Two days after the onset of high fever, he developed red, swollen and fissured lips, edema on his hands and feet and non-purulent conjunctivitis. Polymorphous erythema appeared on his extremities and trunk. Five days following the onset of the high fever, he was provided intravenous gamma-globulin therapy (IVG: 2 g/kg) and a nonsteroidal antiinflammatory drug (NSAID) based on the diagnosis of KD. The next day his fever and clinical signs resolved. Membranous desquamation of his fingertips and toes began to appear 5 days after the initiation of IVG therapy. Case 2 is a 1-year and 11-month-old male infant who developed a high fever 11 days after suffering a grade II burn injury on his left lower extremity caused by a hightemperature shower. He developed red, swollen and cracked lips, non-purulent conjunctivitis, edema on his hands and feet and a skin rash on his extremities and trunk on the following day. Results of the laboratory examinations are shown in Table 1. Five days following the onset of high fever, he was treated with IVG (2 g/kg) and NSAID. The next day, his fever and clinical signs resolved. Membranous desquamation of his hands and feet was subsequently observed. Case 3 is a two-year-old male child who developed a high fever 3 days after suffering grade II contact burns on both soles of his feet after walking on hot charcoal. Two days later he developed red, swollen and fissured lips, nonpurulent conjunctivitis, cervical lymph node enlargement and a skin rash on his extremities and trunk. Results of the laboratory examinations are shown in Table 1. He was treated only with NSAID. Three days later fever and other manifestations resolved. Desquamation of his fingertips was subsequently observed. None of these patients showed any apparent sign of infection on the burns nor had any cardiac involvement. In all three patients the bacterial cultures from the throat, blood, urine and scalds were all negative except for normal flora.

SYPHILITIC MACULAR ATROPHY

Macular atrophy of the skin may be divided in two groups: (1) idiopathic macular atrophy, (2) secondary macular atrophy. The first group is formed by a limited number of clinical entities of unknown etiology. The second group is more numerous and includes atrophic macular lesions following a dermatosis and those with a well defined cause. In the first group are placed anetodermia erythematodes maculosa of Jadassohn, multiple benign tumor-like new-growths of Schweninger and Buzzi, idiopathic atrophic macules and the lesions that have been united under the name of white spot disease. In the second group are included the macular atrophic lesions following lichen planus, leprosy, tuberculosis, syphilis, the cases reported by Pellizzari under the name of atrophic erythema, the case of Balzer and Reblaub of dissociated polymorphous erythema, the case of Pospelow consecutive to purpura, the atrophic urticarial erythema following urticaria and several other conditions which are sequelae of lupus