Asunto(s)
Anticuerpos Monoclonales Humanizados , Erupciones por Medicamentos , Psoriasis , Humanos , Anticuerpos Monoclonales Humanizados/efectos adversos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Psoriasis/tratamiento farmacológico , Psoriasis/inducido químicamente , Psoriasis/patología , Antineoplásicos Inmunológicos/efectos adversos , Exantema/inducido químicamente , Exantema/patología , Masculino , Femenino , AncianoRESUMEN
As of March 2020, skin lesions associated with COVID-19 have been described. The objectives of the study were to characterize the skin lesions in these patients, analyze their temporal relationship, association with the severity of the disease, extracutaneous symptoms and laboratory parameters. A prospective, observational, analytical and cross-sectional study was conducted in hospitalized patients diagnosed with COVID-19. Dermatoses were classified as primary and secondary. Forty-five patients were included, 44.4% with primary dermatoses and 53.3% with secondary lesions. The mean age was 46 years (SD: 17), with a male predominance (68.9%). The primary lesions appeared after a median of 5 days (IQR: 3-10) from the onset of COVID-19 symptoms and the secondary ones after 14.5 days (IQR: 7-20). The primary dermatoses found were maculopapular rash (65%), urticarial (20%, half with vesicular lesions), livedo reticular (10%) and purpura (5%). The most frequent secondary dermatoses were adverse drug reactions (37.1%) and infectious dermatoses (25.9%). Maculopapular rash was associated with moderate COVID-19 and pressure injuries with severe COVID-19 (p < 0.05). The finding of neutrophilia was higher among those with secondary infectious dermatoses (p < 0.05). No significant differences were found when evaluating other laboratory parameters. This work shows the skin manifestations in patients hospitalized with COVID-19 in our environment. The most prevalent pattern was the maculopapular rash that was associated with the moderate form of the disease. The appearance of lesions 2 weeks after the onset of COVID-19 symptoms was associated with secondary dermatoses.
Desde marzo 2020 se describieron lesiones cutáneas asociadas a COVID-19. Los objetivos del estudio fueron caracterizar las lesiones cutáneas en estos pacientes, analizar su relación temporal, asociación con la gravedad de la enfermedad, los síntomas extracutáneos y parámetros de laboratorio. Es un estudio prospectivo, observacional, analítico y de corte transversal, en internados con diagnóstico de COVID-19. Se catalogaron las dermatosis en primarias y secundarias. Se incluyeron 45 pacientes, 44.4% con dermatosis primarias y 53.3% con lesiones secundarias. La edad media fue de 46 años (DS: 17), con predominio del sexo masculino (68.9%). Las lesiones primarias aparecieron luego de una mediana de 5 días (RIC: 3-10) del inicio de los síntomas de COVID-19 y las secundarias luego de 14.5 días (RIC: 7-20). Las dermatosis primarias fueron: exantema maculopapuloso (65%), urticariforme (20%, la mitad con lesiones vesiculosas), livedo reticular (10%) y púrpura (5%). Las dermatosis secundarias más frecuentes fueron reacciones adversas a fármacos (37.1%) y dermatosis infecciosas (25.9%). El exantema maculopapuloso se asoció a COVID-19 moderado y las lesiones por presión a COVID-19 grave (p < 0.05). El hallazgo de neutrofilia fue mayor entre aquellos con dermatosis infecciosas secundarias (p < 0.05). No se encontraron diferencias significativas al evaluar otros parámetros de laboratorio, ni síntomas extracutáneos. Este trabajo muestra las manifestaciones cutáneas en internados con COVID-19. El patrón más prevalente fue el exantema maculopapuloso que se asoció con la forma moderada de la enfermedad. La aparición de lesiones luego de las 2 semanas del inicio de los síntomas de COVID-19 se asoció a dermatosis secundarias.
Asunto(s)
COVID-19 , Exantema , Enfermedades de la Piel , COVID-19/complicaciones , Estudios Transversales , Exantema/etiología , Exantema/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2 , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etiologíaRESUMEN
The SARS-Cov-2 is a single-stranded RNA virus composed of 16 non-structural proteins (NSP 1-16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid-19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid-19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a 'cytokine storm'. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D-dimer, lactic dehydrogenase, reactive-C-protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema. This review describes the complexity of Covid-19, its pathophysiological and clinical aspects.
Asunto(s)
Infecciones por Coronavirus/inmunología , Síndrome de Liberación de Citoquinas/inmunología , Coagulación Intravascular Diseminada/inmunología , Eritema/inmunología , Exantema/inmunología , Interacciones Huésped-Patógeno/inmunología , Neumonía Viral/inmunología , Enzima Convertidora de Angiotensina 2 , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , COVID-19 , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/patología , Síndrome de Liberación de Citoquinas/virología , Progresión de la Enfermedad , Coagulación Intravascular Diseminada/patología , Coagulación Intravascular Diseminada/virología , Eritema/patología , Eritema/virología , Exantema/patología , Exantema/virología , Regulación de la Expresión Génica , Interacciones Huésped-Patógeno/genética , Humanos , Inmunidad Innata , Linfocitos/inmunología , Linfocitos/patología , Linfocitos/virología , Macrófagos/inmunología , Macrófagos/patología , Macrófagos/virología , Pandemias , Peptidil-Dipeptidasa A/genética , Peptidil-Dipeptidasa A/inmunología , Neumonía Viral/patología , Neumonía Viral/virología , Receptores Virales/genética , Receptores Virales/inmunología , SARS-CoV-2 , Serina Endopeptidasas/genética , Serina Endopeptidasas/inmunología , Índice de Severidad de la Enfermedad , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/inmunologíaRESUMEN
The asymmetric periflexural exanthema of childhood is an underdiagnosed entity of unknown etiology that affects, most commonly, girls around two years of age. Clinically, it affects only one side of the body and it eventually disappears without the need of any specific treatment. We report two cases of this entity. The first case is a 14-month-old female patient with an erythematosus papular eruption that initiates near the axilla and progresses, in a period of seven days, towards the ipsilateral upper limb and hemithorax, with no other alterations. The second case is a 24-month-old female with a pruriginous erythematosus papular exanthema that begins on the left lower extremity and extends throughout the left hemibody. Due to the characteristics of the exanthema and the age range of the patients, they were diagnosed with asymmetric periflexural exanthema. They both received symptomatic treatment with spontaneous resolution of the condition.
El exantema periflexural asimétrico de la infancia es una entidad subdiagnosticada, de etiología incierta, que afecta, predominantemente, a niñas alrededor de los dos años de edad. Se caracteriza por ser un exantema que solo afecta a un hemicuerpo y que se resuelve sin tratamiento específico. Se reportan dos casos clínicos acerca de esta entidad. El primero, referente a una niña de 14 meses con exantema papuloeritematoso de inicio en la axila siete días antes y extensión a la extremidad superior y el hemitronco ipsilateral sin otras alteraciones. El segundo, referente a una niña de 24 meses de edad con exantema papuloeritematoso pruriginoso de inicio en la extremidad inferior izquierda y la posterior extensión por el hemicuerpo izquierdo. Dadas las características del exantema y la edad de las pacientes, se diagnosticó exantema periflexural asimétrico y recibió tratamiento sintomático, con resolución del cuadro de forma espontánea.
Asunto(s)
Axila/patología , Exantema/diagnóstico , Preescolar , Progresión de la Enfermedad , Exantema/patología , Exantema/terapia , Femenino , Humanos , LactanteAsunto(s)
Infecciones por Coronavirus/diagnóstico , Exantema/patología , Inmunosupresores/administración & dosificación , Neumonía Viral/diagnóstico , Púrpura/patología , Adulto , COVID-19 , Infecciones por Coronavirus/epidemiología , Dermoscopía/métodos , Servicio de Urgencia en Hospital , Exantema/complicaciones , Exantema/diagnóstico , Exantema/tratamiento farmacológico , Femenino , Humanos , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Pronóstico , Púrpura/complicaciones , Púrpura/diagnóstico , Púrpura/tratamiento farmacológico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
A rash is a disseminated eruption of cutaneous lesions with great variation in appearance, cause, and severity. When the physician is facing a rash, the history and physical examination of the patient are extremely important for the identification of the disease and its causal agent. There are various causes for a rash, which may be infectious, allergic, or rheumatologic, besides many others. Rashes associated with mucosal ulcers may have causes related to viral and bacterial infections or drug reactions. They may be associated with measles; erythema infectiosum; roseola infantum; rubella; hand, foot, and mouth disease; pityriasis rosea; dengue fever; chikungunya; zika; scarlet fever; meningococcal diseases; syphilis; and exanthematous drug eruptions.
Asunto(s)
Infecciones Bacterianas/complicaciones , Exantema/etiología , Exantema/microbiología , Membrana Mucosa/patología , Úlcera/etiología , Úlcera/microbiología , Virosis/complicaciones , Infecciones Bacterianas/patología , Exantema/patología , Humanos , Úlcera/patología , Virosis/patologíaRESUMEN
Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.
Asunto(s)
Fiebre Chikungunya/diagnóstico , Enfermedad Relacionada con los Viajes , Artralgia/virología , Virus Chikungunya/genética , El Salvador , Enfermedades Endémicas , Exantema/patología , Exantema/virología , Patologia Forense , Humanos , Los Angeles , Pulmón/patología , Masculino , Persona de Mediana Edad , Neumonía Viral/etiología , Reacción en Cadena de la Polimerasa , Edema Pulmonar/patología , Edema Pulmonar/virologíaAsunto(s)
Exantema/patología , Incontinencia Pigmentaria/diagnóstico , Enfermedades Asintomáticas , Biopsia , Humanos , Lactante , MasculinoRESUMEN
Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B-cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.
Asunto(s)
Eosinofilia/tratamiento farmacológico , Exantema/tratamiento farmacológico , Lenalidomida/uso terapéutico , Linfoma de Células del Manto/complicaciones , Síndromes Paraneoplásicos/tratamiento farmacológico , Prurito/tratamiento farmacológico , Eosinofilia/etiología , Eosinofilia/patología , Exantema/etiología , Exantema/patología , Humanos , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/etiología , Síndromes Paraneoplásicos/patología , Prurito/etiología , Prurito/patología , Piel/patología , Resultado del TratamientoRESUMEN
Adult-onset Still's disease is a systemic inflammatory disorder of unknown etiology, characterized by skin rash, spiking fever, arthralgias or arthritis, and leukocytosis. The typical skin rash is evanescent, salmon-pink, nonpruritic and maculopapular, predominantly on the extremities. It is considered one of the major Yamaguchi's criteria in adult-onset Still's disease. However, atypical skin lesions are also described. Here, a 61-year-old woman with sore throat, spiking fever, polyarthritis and evanescent salmon-pink nonpruritic maculopapular skin rash on the extremities was diagnosed with adult-onset Still's disease. In addition, atypical brown macules on oral mucosa, localized on the inner lips and tongue were also observed. Biopsy revealed a neutrophilic infiltrate. Despite treatment and improvement of the adult-onset Still's disease, the atypical oral mucosal lesions persisted.
Asunto(s)
Enfermedades de la Boca/patología , Mucosa Bucal/patología , Enfermedad de Still del Adulto/patología , Biopsia , Exantema/patología , Femenino , Humanos , Labio/patología , Persona de Mediana Edad , Enfermedades de la Boca/diagnóstico , Infiltración Neutrófila , Enfermedad de Still del Adulto/diagnóstico , Lengua/patologíaRESUMEN
Abstract: Adult-onset Still's disease is a systemic inflammatory disorder of unknown etiology, characterized by skin rash, spiking fever, arthralgias or arthritis, and leukocytosis. The typical skin rash is evanescent, salmon-pink, nonpruritic and maculopapular, predominantly on the extremities. It is considered one of the major Yamaguchi's criteria in adult-onset Still's disease. However, atypical skin lesions are also described. Here, a 61-year-old woman with sore throat, spiking fever, polyarthritis and evanescent salmon-pink nonpruritic maculopapular skin rash on the extremities was diagnosed with adult-onset Still's disease. In addition, atypical brown macules on oral mucosa, localized on the inner lips and tongue were also observed. Biopsy revealed a neutrophilic infiltrate. Despite treatment and improvement of the adult-onset Still's disease, the atypical oral mucosal lesions persisted.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedad de Still del Adulto/patología , Enfermedades de la Boca/patología , Mucosa Bucal/patología , Lengua/patología , Biopsia , Enfermedad de Still del Adulto/diagnóstico , Infiltración Neutrófila , Exantema/patología , Labio/patología , Enfermedades de la Boca/diagnósticoRESUMEN
We investigated an outbreak of exanthematous illness in Maceió by using molecular surveillance; 76% of samples tested positive for chikungunya virus. Genetic analysis of 23 newly generated genomes identified the East/Central/South African genotype, suggesting that this lineage has persisted since mid-2014 in Brazil and may spread in the Americas and beyond.
Asunto(s)
Fiebre Chikungunya/epidemiología , Virus Chikungunya/genética , Brotes de Enfermedades , ARN Viral/genética , Infección por el Virus Zika/epidemiología , Virus Zika/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Brasil/epidemiología , Fiebre Chikungunya/transmisión , Fiebre Chikungunya/virología , Virus Chikungunya/clasificación , Virus Chikungunya/aislamiento & purificación , Niño , Preescolar , Coinfección , Exantema/patología , Exantema/virología , Femenino , Genotipo , Humanos , Lactante , Masculino , Persona de Mediana Edad , Filogenia , Virus Zika/clasificación , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/transmisión , Infección por el Virus Zika/virologíaAsunto(s)
Antibacterianos/efectos adversos , Claritromicina/efectos adversos , Erupciones por Medicamentos/etiología , Exantema/inducido químicamente , Adulto , Erupciones por Medicamentos/patología , Exantema/patología , Humanos , Masculino , Pruebas del Parche , Infecciones del Sistema Respiratorio/tratamiento farmacológicoAsunto(s)
Humanos , Masculino , Adulto , Claritromicina/efectos adversos , Erupciones por Medicamentos/etiología , Exantema/inducido químicamente , Antibacterianos/efectos adversos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Pruebas del Parche , Erupciones por Medicamentos/patología , Exantema/patologíaRESUMEN
We provide a guide for dermatologists to follow if they encounter patients with a rash and clinical history suspicious of Zika virus infection, including diagnostic testing and management options. We also provide an illustrative case report of a patient from Brazil who was diagnosed with Zika virus infection after presenting with a generalized pruritic rash. One of the most prominent symptoms of Zika virus infection is a cutaneous eruption. As such, it is especially necessary for dermatologists to understand this virus so that they may appropriately recognize this entity as a diagnostic consideration in the clinic. The rash associated with Zika virus infection is most commonly an erythematous maculopapular eruption that presents after an initial 3-4 days of fever, headache, and arthralgia or myalgia. The rash typically lasts for an average of 6 days, and can spread to involve any part of the body, including the face, torso, extremities, palms, and soles.