1/55. Invisible mycosis fungoides: A diagnostic challenge.We describe a 76-year-old woman who presented persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. skin biopsies obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/55. Generalized pruritus without primary lesions. Differential diagnosis and approach to treatment.A 65-year-old man presented with recurrent generalized pruritus and excoriations of many years' duration. He had been treated with antihistamines, topical corticosteroids, and antibiotics for secondary wound infections, but improvement was only temporary. He had also been hospitalized for leg ulcers complicated by cellulitis. Examination revealed multiple oval and linear red papules and nodules measuring 0.5 to 2 cm in diameter. Some of the lesions were eroded and had a central crater and yellowish crust. The patient also had hypopigmented linear scars localized to the posterior scalp, neck, upper back, chest, abdomen, arms, and legs with sparing of the middle and lower back (figures 1 and 2). An ulcer measuring 1.5 x 2 cm that was surrounded by indurated skin was present on the medial aspect of his right ankle. The ulcer was partially covered by yellow exudate. There was no evidence of cellulitis. liver enzyme, serum creatinine, and thyrotropin levels, as well as a chest roentgenogram, were normal. Wound cultures for bacteria and fungi were nonsignificant. A punch biopsy from a representative lesion showed an abrupt epidermal defect with sparse superficial lymphocytic infiltrate in the dermis. The patient was admitted to the hospital to isolate him from his home environment. He received a 10-day course of systemic cephalexin, topical clobetasol propionate ointment for the affected skin areas, and oral hydroxyzine for pruritus. Ultraviolet light therapy was instituted once daily and was to continue for 2 months. His lesions had improved moderately by the time he was discharged from the hospital. On follow-up 2 weeks later, his lesions were flat and had resulted in hypopigmented scars. Three months later, however, he had persistent, intense pruritus, and new excoriations had developed on his forearms and back. He improved after receiving treatment with oral doxepin hydrochloride.- - - - - - - - - - ranking = 9.170367545185keywords = back, upper, chest (Clic here for more details about this article) |
3/55. Secondary cutaneous amyloidosis in disseminated superficial porokeratosis: a case report.Disseminated superficial porokeratosis (DSP) is a rare cause of secondary cutaneous amyloidosis. An 83-year-old male patient showed an increase in both size and number of DSP lesions after contracting pulmonary tuberculosis. The DSP lesions of the patient consisted of numerous annular eruptions on both sun-exposed and sun-protected areas, which occurred over a period of 20 years. Multiple skin biopsies were taken from normal or lesional/sun-exposed or sun-protected skin samples. Histopathologic examination included routine H&E stains, congo red stains, thioflavin-T stains and anticytokeratin antibodies (AE1, AE3). And the results were as follows; 1) Positive staining with congo red and thioflavin-T indicated an amyloid nature for the deposits, 2) confinement of the amyloid deposition just below the lesional epidermis (while sparing the neighboring uninvolved or distant normal skin) indicated some role of the lesional epidermis, and 3) positive staining with AE3 further indicated an epidermal origin-type II epithelial keratin-of the amyloid. We present a case of DSP with a local amyloid deposit, characterized by association of positive familial background, severe pruritus and pulmonary tuberculosis.- - - - - - - - - - ranking = 2.2613858357624keywords = back (Clic here for more details about this article) |
4/55. Red man syndrome during administration of prophylactic antibiotic against infective endocarditis.Red man syndrome (RMS) is the occurrence flushing, pruritus, chest pain, muscle spasm or hypotension during vancomycin infusion. It usually happens as a result of rapid infusion of the drug but may also occur after slow administration. The frequency and severity of this phenomenon diminish with repeated administration of vancomycin. A case is presented whereby RMS occurred while prophylactic antibiotic against infective endocarditis was administered.- - - - - - - - - - ranking = 0.69310501894888keywords = chest (Clic here for more details about this article) |
5/55. amyotrophic lateral sclerosis in a battery-factory worker exposed to cadmium.A 44-year-old patient died from amyotrophic lateral sclerosis (ALS) after nine years of heavy exposure to cadmium (Cd) in a nickel cadmium (Ni-Cd) battery factory. Two years after starting work he and co-workers had experienced pruritus, loss of smell, nasal congestion, nosebleeds, cough, shortness of breath, severe headaches, bone pain, and proteinuria. Upper back pain and muscle weakness progressed to flaccid paralysis. EMG findings were consistent with motor neuron disease. Cd impairs the blood-brain barrier, reduces levels of brain copper-zinc (Cu-Zn) superoxide dismutase (SOD), and enhances excitoxicity of glutamate via up-regulation of glutamate dehydrogenase and down-regulation of glutamate uptake in glial cells. High levels of methallothionein, a sign of exposure to heavy metals, have been found in brain tissue of deceased ALS patients. The effects of Cd on enzyme systems that mediate neurotoxicity and motor neuron disease suggest a cause effect relationship between Cd and ALS in this worker.- - - - - - - - - - ranking = 3.0395748838345keywords = back, headache (Clic here for more details about this article) |
6/55. Treatment options for a patient experiencing pruritic rash associated with transdermal testosterone: a review of the literature.A 22-year-old man with hypogonadotropic hypogonadism was receiving monthly intramuscular injections of testosterone replacement therapy. The patient refused to self-administer the injections because of discomfort, so the therapy was switched to testosterone patches. He experienced a pruritic, macular, erythematous rash underneath the reservoir area of two different transdermal formulations, which did not improve after pretreatment with topical corticosteroids. Eventually, he tolerated application of a testosterone gel and his serum testosterone levels returned to normal after 1 month of therapy. Commercially available and investigational testosterone products and therapeutic monitoring guidelines for androgen replacement are reviewed.- - - - - - - - - - ranking = 31.664858618382keywords = discomfort (Clic here for more details about this article) |
7/55. pruritus, an uncommon but important symptom of systemic carcinoma.A distinctive pruritic syndrome associated with systemic cancer is described. Prolonged, variably severe pruritus with a tendency to localization on the legs, upper trunk, and extensor surfaces of the upper extremities is the presenting symptom. patients with unexplained persistent itching as herein described should be investigated for a hidden malignancy. The persistence or recurrence of itching, months or even years after apparent cure of a systemic carcinoma, suggests that destruction or removal of the primary tumor was incomplete, or that metastasis has supervened. A small carcinomatous focus may exist for many months and at times for years before clinical recognition is possible with diagnostic methods currently available.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
8/55. Neurological symptoms as the result of enlarged dimensions and non-typical course of inferior superficial temporal vein.Neurological symptoms as the result of non-typical course of superficial cerebral veins are described in available literature very rarely. The case described below indicates that in some circumstances the compression symptoms derived from the cerebral cortex may be incredibly more serious than their anatomical reasons. In our observation a young woman was described complaining of paroxysmal numbness of the left upper limb with paraesthesia of the left side of the face, the left eye and left half of the tongue. The patient said that in childhood she used to have paroxysmal itching of the left hand. She also said that CT of the head made a few years ago after a car accident was without pathological changes. Neurological examination, x-ray of the skull and EEG test performed during first visit proved normal. After one year of the disease, Jackson-type epilepsy, combined with loss of sensation of the left half of the face for the first time, was present. Neurological and ophthalmological examination of the bottom of the eye proved normal. skull x-ray was normal. Then disturbances of the vision in the left half of the field appeared. EEG was still in norm. The MRI test showed the asymmetry in the course and dilated superficial vein between the basis of the right temporal lobe and the tentorium of the cerebellum. The diameter of this vein was 2.5 mm, but there were no vascular malformations. Bottom of the eye was normal, but in the field of vision the white and red colours were dominated.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
9/55. The efficacy of hypnosis in the treatment of pruritus in people with hiv/AIDS: a time-series analysis.pruritus, or generalized itch, is a source of serious discomfort and distress in a significant minority of people living with AIDS. Anecdotal reports suggest hypnosis might be a useful treatment, leading to reductions in distress and improvements in the condition. But empirical examination of the question is notably lacking. This time-series study reports results of a 6-session self-hypnosis treatment (relaxation, deepening, imagery, and home practice) for 3 hiv-positive men suffering from pruritus, related to disease progression and/or hiv medications. Posttreatment, all 3 patients reported significant reductions in daily itch severity and extent of sleep disturbance due to itch. One patient also evidenced significantly less itch distress. Another also experienced significantly less time bothered by itch. For the 2 patients on which 4-month follow-up data were available, treatment benefit across variables was stable or further improved.- - - - - - - - - - ranking = 31.664858618382keywords = discomfort (Clic here for more details about this article) |
10/55. Primary sclerosing cholangitis and ulcerative colitis.This is a report on a 36-year-old male patient presenting with a rare combination of ulcerative colitis and primary sclerosing cholangitis. The disease of the biliary tract was suspected on the basis of the endoscopic retrograde representation of the common bile duct, and serologically differentiated from a chronic destructive, non-supperative cholangitis on the basis of a lack of antimitochondrial antibodies. Subsequently, a hepaticojejunostomy was carried out to normalize the bile flow.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
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