1/418. Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature. Autoerythrocyte sensitization (psychogenic purpura) is an unusual diagnosis, but one that has a characteristic dermatologic manifestation of painful bruising. A typical case is presented, as well as a review of the literature. Treatment consists of psychiatric therapy, which is most effective when initiated early in the disease, so early diagnosis will not only minimize the cost of the medical evaluation but will also benefit the patient. ( info) |
2/418. Pigmented purpuric dermatosis in a young male. The pigmented purpuric dermatoses (PPD) are a group of disorders that most often occur on the lower extremities of middle-aged adults as asymptomatic, yellow-orange patches with petechiae. The PPD represent a benign, often chronic, capillaritis of unknown cause. We present a case of PPD on the abdomen of a young male and emphasize careful observation in such a patient to reveal possible progression to purpuric mycosis fungoides. ( info) |
3/418. Cutaneous manifestations of hypothyroidism including purpura and ecchymoses. hypothyroidism has distinctive cutaneous manifestations which may be diagnostic. biopsy and histologic study of the skin may provide a simple and useful tool for diagnosing hypothyroidism. purpura and ecchymoses, although not often mentioned among cutaneous manifestations of hypothyroidism, occurred in nine of 222 hypothyroid patients at Ochsner Clinic between 1958 and 1972. ( info) |
4/418. Familial primary cryofibrinogenemia. BACKGROUND: To our best knowledge this is the second case ever described of familial primary cryofibrinogenemia (CFG). patients: A 29-year-old Moroccan female and two of her three children suffered from painful purpura, slow healing small ulcerations and edema of both feet during the winter season. Laboratory investigations revealed the presence of cryofibrinogen in their blood plasma. All three patients were otherwise healthy and no associated disease could be demonstrated. CONCLUSIONS: The diagnosis of CFG has to be considered in patients with livedo reticularis, edema, painful purpura and slow healing ulcera after cold exposure. Cryofibrinogen-precipitates in the blood plasma have to be determined. Because secondary CFG occurs much more frequently than the primary form, it is important to rule out associated diseases through extensive physical examination and laboratory investigations. This communication also stresses the importance of a through family history of patients with CFG. An autosomal dominant mode of inheritance is supposed. ( info) |
5/418. Intravascular and diffuse dermal reactive angioendotheliomatosis secondary to iatrogenic arteriovenous fistulas. Reactive angioendotheliomatosis is a rare benign process that has been mainly described in patients with systemic infections, such as subacute bacterial endocarditis or tuberculosis, and in association with intravascular deposition of cryoproteins. Histopathologically, it is characterized by a proliferation of endothelial cells within vascular lumina resulting in the obliteration of the involved vessels. Another rare variant of reactive angioendotheliomatosis has been described in the lower extremities of patients with severe peripheral vascular atherosclerotic disease. It consists of violaceous and purpuric plaques histopathologically characterized by diffuse proliferation of endothelial cells interstitially arranged between collagen bundles of the reticular dermis. This second variant has been named diffuse dermal reactive angioendotheliomatosis. We report two patients with reactive cutaneous angioendotheliomatosis appearing distally to arteriovenous fistulas used for hemodialysis because of chronic renal failure. The first patient showed intravascular reactive angioendotheliomatosis, while the second one had purpuric plaques that were characterized histopathologically by diffuse dermal angioendotheliomatosis. Both patients showed an arteriovenous "steal" syndrome with distal ischemia, and it is possible that a local increase of vascular endothelial growth factor, as is the case in hypoxia situations, induces the endothelial proliferation. To the best of our knowledge, cutaneous reactive angioendotheliomatosis has not been previously described in association with arteriovenous shunts. ( info) |
6/418. purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children. The cutaneous side-effects of levamisole include non-specific and lichenoid eruptions, fixed drug eruption and, very rarely, cutaneous vasculitis. We describe a distinctive clinical and histological vasculopathy with immunological abnormalities in children with paediatric nephrotic syndrome receiving long-term levamisole treatment. Four boys and one girl were identified. Their average age was 10 years. levamisole had been used for an average of 24 months. purpura of the ears was the most common finding corresponding histologically to a vasculopathic reaction pattern ranging from a leucocytoclastic and thrombotic vasculitis to a vascular occlusive disease without true vasculitis but with associated antinuclear, antiphospholipid and anticytoplasmic antibodies. The eruption resolved in all patients 2-3 weeks after the discontinuation of levamisole, but serum autoantibodies persisted for 2-14 months. ( info) |
7/418. A reaction to tape after tracheal extubation in a patient with systemic amyloidosis. A reaction to tape after tracheal extubation in a patient with systemic amyloidosis is reported. A patient underwent a right thoracotomy with general anesthesia. A double-lumen tube secured with 1-inch adhesive tape (3M Blenderm, 3M health Care, St Paul, MN) was used. The same kind of tape was used to cover the eyelids. On removal of the tape, hemorrhagic and purpuric lesions appeared on the skin in regions corresponding to the tape contact area. A diagnosis of amyloidosis was made based on large tongue, lip edema, purpuric and hemorrhagic spots on the skin, congestive heart failure, and skin biopsy. amyloidosis and its anesthetic implications are discussed. ( info) |
8/418. Splenic peliosis: a rare complication following liver transplantation. In this article, we report a rare case of isolated splenic peliosis in an individual who had recently undergone liver transplantation. The disorder had remained clinically and radiologically undiagnosed until he suffered a traumatic rupture of the affected organ. The relevant literature on this topic is briefly reviewed. ( info) |
| A common chronic feature of sickle cell disease is the presence of painful, punched-out leg ulcers. Other cutaneous findings in patients with homozygous sickle cell disease have not been described in the literature. We present a case of a 50-year-old black woman with sickle cell disease who was admitted for acute onset of arm and hip pain. After admission she deteriorated clinically, with multiorgan failure and mental status changes. Examination of the skin revealed erythematous papules and plaques with scaly centers and purpura on the upper trunk. The clinical differential diagnosis was vasculitis versus sepsis. skin biopsy of two representative lesions was performed. hematoxylin- and eosin-stained sections showed a superficial perivascular mixed inflammatory infiltrate with numerous eosinophils and extravasated erythrocytes, some of which exhibited bizarre morphology of sickled red blood cells. These findings indicated that the patient's cutaneous lesions, possibly multifactorial in origin, could be a component of her sickle cell crisis. This case is presented as an unusual one in which evaluation of erythrocyte morphology contributed to patient management and to emphasize the importance of examining erythrocyte morphology as a part of the histologic evaluation of stained tissue. ( info) |
| carbamazepine (CBZ), a widely used anticonvulsant, occasionally causes serious hematologic disorders. A 12-year-old boy was admitted because of a diffuse petechial rash and profound thrombocytopenia (10 x 10(9) platelets/l), after having been treated for epilepsy with CBZ for 12 days. Seven days following withdrawal of CBZ and initiation of prednisolone therapy, the platelet count recovered. In a subsequent challenge test with CBZ, platelet counts again decreased, and the levels of platelet-associated IgG and serum interleukin-6 increased. No antibodies against platelet glycoprotein IIb/IIIa or Ib were detected in plasma. We believe that this is the first reported occasion when CBZ-induced thrombocytopenia has been defined by a rechallenge test. ( info) |