Cases reported "Erythema"

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1/28. The relationship between facial annular erythema and anti-SS-A/Ro antibodies in three East Asian women.

    A distinct annular erythema developed on the cheeks of three East Asian women who had anti-SS-A/Ro (SSA) antibodies. The erythema was characterized by a wide, elevated border and central pallor. Histologically, there was a coat-sleeve-like infiltration of lymphocytes around the blood vessels, appendages, and secretory gland cells in the dermis. Immunohistological analysis clarified that the majority of infiltrating lymphocytes were CD4-positive T cells. Abnormal expression of hla-dr antigens in the perivascular, appendage, and secretory gland cells in the dermis was also observed. The differential diagnosis of the three patients lay between Sjogren syndrome (SjS), Sjogren/systemic lupus erythematosus overlap syndrome and an asymptomatic clinical state. These results are consistent with recent findings of major histocompatibility complex class II expression on target organs in various autoimmune diseases. Based on these findings, erythema appears to represent a broad cutaneous manifestation of these diseases. Furthermore, the presence of SSA antibodies, aberrant HLA-DR expression, and sun exposure may be responsible for the development of erythema.
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2/28. superior vena cava syndrome presenting as persistent erythematous oedema of the face.

    The superior vena cava syndrome occurs when extrinsic compression or intraluminal occlusion impedes blood flow through this vessel. Detecting the characteristic cutaneous features can lead to an early diagnosis of this condition. We report a 73-year-old patient with a 4-year-history of erythematous oedema of the face. The underlying cause was a large retrosternal goitre obstructing the superior vena cava. Subtotal thyroidectomy led to dramatic improvement of all dermatologic symptoms.
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3/28. pseudomonas aeruginosa infection mimicking erythema annulare centrifugum.

    A 3-year-old girl receiving chemotherapy for acute lymphocytic leukaemia developed a rapidly expanding red annular plaque on her thigh, initially without signs of systemic toxicity or local pain. Subsequently she developed Pseudomonas aeruginosa sepsis and purpura at the leading edge of the plaque. Skin biopsy showed an extensive necrotizing vasculitis with numerous Gram-negative bacilli in the blood vessel walls. In immunocompromised individuals, skin biopsy and culture of cutaneous lesions for bacteria and fungi should be considered even in the absence of signs of systemic toxicity or multiple lesions.
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4/28. Unusual annular erythema associated with myelodysplastic syndrome.

    We report a case of unusual annular erythema associated with myelodysplastic syndrome (MDS). A 58-year-old male with MDS developed annular erythema on his back, scaly erythema on the dorsa of hands, and exudative erythema on his eyelids. Histological examination revealed a mononuclear cell infiltrate around vessels and follicles in the mid- to lower dermis. He had no history of treatment with granulocyte-colony-stimulating factor (G-CSF). serum granulocyte-macrophage-colony-stimulating factor (GM-CSF) level was slightly elevated (5.84 pg/ml, normal < 2.0 pg/ml), whereas other cytokines including G-CSF, IL-6, and IL-8 were within normal limits. skin manifestations were much improved by systemic mepitiostane, and serum GM-CSF level returned to normal levels.
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5/28. Autoimmune keratolysis in a patient with leukocytoclastic vasculitis: unusual erythema elevatum diutinum with granulomatous pattern.

    PURPOSE: Leukocytoclastic vasculitis (LCCV) is an immune complex-mediated, small vessel disease that is clinically characterized by the presence of palpable purpuric lesions, most often in association with rheumatic diseases. Ocular manifestations of LCCV are rare. methods: We describe a patient with an unusual granulomatous pattern of erythema elevatum diutinum (EED) associated with autoimmune keratolysis. RESULTS: We studied a 64-year-old man with decreased visual acuity and nodular lesions in both hands. Ocular examination revealed bilateral superior corneal melting with perforation in the left eye and conjunctival thickening in both eyes, in association with a severe inflammatory reaction. Histopathologic examination of the conjunctiva revealed granulomatous vasculitis with neutrophilic infiltrate, giant cells, and fibroblastic proliferation. A punch biopsy taken from his skin showed similar characteristics that suggested EED; however, there were no giant cells. CONCLUSION: To our knowledge, autoimmune keratolysis secondary to cutaneous LCCV (EED) has not been described previously, and there has been no description of granulomatous reaction (in the conjunctiva) in EED.
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6/28. Palpebral edema as a cutaneous manifestation of hyperthyroidism.

    Three cases of palpebral edema associated with Graves' disease are described. These patients had unilateral edema and minimal erythema of the upper eyelid. Notable was that, histologically, dermal edema and dilation of lymphatic vessels were observed, but deposition of mucopolysaccharides was not. In 2 cases, edema of the eyelid was resistant to treatment with an antithyroid drug. Unilateral edema of the upper eyelid is an important cutaneous manifestation that indicates the presence of hyperthyroidism.
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7/28. REM syndrome (reticular erythematous mucinosis): report of a further case or variant of it.

    A 50-year-old woman had cervical lymphadenopathy, swollen and waxy-looking gums, and a diamond-shaped, reticular erythematous eruption on her back of eight years' duration. Histologic examination of the gingival tissue and skin showed round-cell infiltration around the small blood vessels and in the upper part of the dermis, and an extensive eosinophilic amorphous deposit throughout the dermis that stained with alcian blue. The clinical and histologic features, although not identical, resembled those reported by Lischka and Orthenberger (1972) and later by Steigleder et al (1974).
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8/28. erythema elevatum diutinum: skin and systemic manifestations, immunologic studies, and successful treatment with dapsone.

    erythema elevatum diutinum is a disease characterized by red, pink, purple and yellow cutaneous papules, nodules, and plaques distributed mainly over extensor surfaces. Histologically, there is leukocytoclastic vasculitis with fibrinoid necrosis of the upper and mid dermal vessel walls. Two of the five patients presented had moderately severe arthralgias and, unlike previously reported cases, three of them had a long history of bacterial infections and one had a coincident IgA monoclonal gammopathy. Each of the four patients treated with dapsone responded dramatically with rapid resolution of existing lesions and marked diminution of systemic symptoms. Skin lesions and systemic complaints recurred within 12 to 48 hours after discontinuing dapsone. Four of the patients had Arthus-like reactions to SKSD skin tests prior to therapy, with a marked decrease in the response after institution of therapy. Neutrophil chemotactic responsiveness of two patients was impaired. The sera of three patients had significant C1q binding activity suggesting that they might have circulating immune complexes.
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9/28. Cutaneous reactive angiomatosis occurring in erythema ab igne can cause atypia in endothelial cells: potential mimic of malignant vascular neoplasm.

    erythema ab igne (EAI), an old and rare disease, is an erythematous, often pigmented, reticular, macular dermatosis that occurs at the site of repeated exposure to moderate heat. Reported herein is an unusual case of EAI occurring in a 33-year-old woman with a very broad lesion of reticular erythema and pigmentation on the lower extremities. The patient frequently put her lower extremities close to a heater in the wintertime to alleviate chill. The lesion started a decade ago, and it gradually became conspicuous. Microscopic findings showed a proliferation of small blood vessels in a thickened papillary dermis, not as typical as seen in EAI, but as seen in cutaneous reactive angiomatosis. They were arranged as small lobules and associated with hyalinization, edema and delicate fibroplasia. Many vessels were lined by plump endothelial cells, some of which had enlarged hyperchromatic nuclei. Many of these cells were multinucleated. Similar-appearing cells were associated with concentric foci of hyalinization without vascular lumina. A few atypical mitoses were observed. The lesion became much less conspicuous after the patient started avoiding close exposure to a heater, without any other special treatments. The aforementioned changes may be confused with malignant vascular neoplasm because of unusual cytological atypia and atypical mitoses in the endothelial cells.
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10/28. Carcinoma erysipelatoides from squamous cell carcinoma of unknown origin.

    Carcinoma erysipelatoides, also known as inflammatory metastatic carcinoma, is a rare form of cutaneous metastasis from a malignancy. The characteristic histopathological finding is metastatic tumour cells inside the dermal lymphatic ducts. It is frequently observed in patients with breast carcinoma as well as adenocarcinoma of pancreas, rectum, lung, ovary and parotid gland. We present a 66-year-old man diagnosed to have metastatic squamous cell carcinoma by aspiration cytology from an enlarged neck lymph node and a core biopsy of a left axillary mass. He subsequently received radiotherapy; however, due to intolerance to erythema and swelling on local irradiated skin, radiotherapy was deferred. Skin lesions on upper chest and neck area, consisting of erythematous induration with telangiectasia and tenderness, progressed slowly and were treated as cellulitis. The erythema remained stationary with antibiotic treatment. Skin biopsy shows poorly differentiated squamous carcinoma cells within dermis and dilated dermal vessels.
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