RESUMEN
Multisystem inflammatory syndrome in children (MIS-C) is a rare and serious complication of Sars-Cov-2 infection. Dermatologic manifestations are present in the majority of patients. Skin lesions found in children with MIS-C are classified into four categories: morbilliform, reticulated, scarlatiniform, and urticarial lesions. Clinicopathologic characterization within these categories is limited. Thus, we present a clear example of an urticarial lesion in the context of MIS-C with well-documented clinicopathologic phenomena. A previously healthy 16-year-old female presented with 3 weeks of an itchy, burning rash initially presenting on her right forearm (and lasting greater than 24 hours without migration) before spreading diffusely. She also reported fever, cough, myalgias, nausea, and vomiting of 4 weeks' duration. Physical examination revealed an edematous, maculopapular, nonblanching, erythematous rash covering the patient's upper extremities, abdomen, back, anterior thighs, and face. The patient tested positive for COVID-19. A low-grade leukocytoclastic vasculitis was noted along with intraluminal fibrin and rare microthrombi in vessels of the mid to deep dermis. The patient was diagnosed with MIS-C and urticarial vasculitis. She was treated with steroids and naproxen for subsequent MIS-C flares. Dapsone treatment was started for the urticarial vasculitis.
Asunto(s)
COVID-19/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/patología , Urticaria/virología , Vasculitis Leucocitoclástica Cutánea/virología , Adolescente , COVID-19/patología , Femenino , Humanos , SARS-CoV-2RESUMEN
The current case report describes a 13-year-old young boy who presented with purpuric rashes following a completely asymptomatic COVID-19 infection and biopsy-confirmed leucocytoclastic vasculitis, mild haematuria and mild elevation of serum IgA. This case highlights one of the dermatological manifestations of COVID-19 infection which has not been reported so far. Paediatricians should explore the history of this infection when evaluating any child presenting with a vasculitic rash.
Asunto(s)
COVID-19/complicaciones , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Adolescente , Infecciones Asintomáticas , Humanos , Inmunoglobulina A/sangre , Masculino , Púrpura , Vasculitis Leucocitoclástica Cutánea/virologíaRESUMEN
Erythema elevatum diutinum is a small vessel vasculitis which is benign, rare, and chronic. It is clinically characterized by violaceous, brown, or yellowish plaques, nodules, and papules. It has been associated with autoimmune, infectious, and neoplastic processes. The following case describes a patient with hepatitis B virus and human immunodeficiency virus with CD4 count<200mm3, HIV-seropositive for 16 years, and diagnosed with hepatitis B virus at the hospital. The patient was treated with oral dapsone 100mg/day, showing regression after seven months of treatment. The authors found three cases in the literature of association of erythema elevatum diutinum, human immunodeficiency virus, and hepatitis B virus.
Asunto(s)
Infecciones por VIH/complicaciones , Hepatitis B/complicaciones , Vasculitis Leucocitoclástica Cutánea/patología , Vasculitis Leucocitoclástica Cutánea/virología , Adulto , Biopsia , VIH/patogenicidad , Virus de la Hepatitis B/patogenicidad , Humanos , MasculinoRESUMEN
Abstract Erythema elevatum diutinum is a small vessel vasculitis which is benign, rare, and chronic. It is clinically characterized by violaceous, brown, or yellowish plaques, nodules, and papules. It has been associated with autoimmune, infectious, and neoplastic processes. The following case describes a patient with hepatitis B virus and human immunodeficiency virus with CD4 count < 200 mm3, HIV-seropositive for 16 years, and diagnosed with hepatitis B virus at the hospital. The patient was treated with oral dapsone 100 mg/day, showing regression after seven months of treatment. The authors found three cases in the literature of association of erythema elevatum diutinum, human immunodeficiency virus, and hepatitis B virus.
Asunto(s)
Humanos , Masculino , Adulto , Infecciones por VIH/complicaciones , Vasculitis Leucocitoclástica Cutánea/patología , Hepatitis B/complicaciones , Biopsia , Virus de la Hepatitis B/patogenicidad , VIH/patogenicidad , Vasculitis Leucocitoclástica Cutánea/virologíaRESUMEN
Ischemic stroke is a rare complication of varicella-zoster virus (VZV) infection. We present the case of a patient with a medical history of type 2 diabetes mellitus (DM) who experienced disseminated cutaneous VZV infection followed by multiple cerebral infarcts associated with VZV vasculopathy. Brain magnetic resonance imaging revealed multiple hyperintense lesions over the bilateral deep white matter and basal ganglia. A skin biopsy revealed small-vessel leukocytoclastic vasculitis with neutrophilic, lymphocytic, and eosinophilic infiltration. This case report describes the rare finding of cutaneous leukocytoclastic vasculitis in VZV infection and highlights that VZV infection is an uncommon but critical etiology of cryptogenic stroke in patients with DM.
Asunto(s)
Infarto Cerebral/etiología , Diabetes Mellitus Tipo 2/complicaciones , Herpes Zóster/complicaciones , Accidente Cerebrovascular Isquémico/etiología , Anciano , Humanos , Masculino , Vasculitis Leucocitoclástica Cutánea/virologíaAsunto(s)
Infecciones por VIH , VIH-1 , Sífilis Cutánea , Vasculitis Leucocitoclástica Cutánea , Adulto , Infecciones por VIH/metabolismo , Infecciones por VIH/microbiología , Infecciones por VIH/patología , Humanos , Masculino , Sífilis Cutánea/metabolismo , Sífilis Cutánea/patología , Sífilis Cutánea/virología , Vasculitis Leucocitoclástica Cutánea/metabolismo , Vasculitis Leucocitoclástica Cutánea/microbiología , Vasculitis Leucocitoclástica Cutánea/patología , Vasculitis Leucocitoclástica Cutánea/virologíaRESUMEN
BACKGROUND AND OBJECTIVE: Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis that can be limited to the skin but may also affect other organs. Often, its cause is unknown. LCV has previously been reported to occur with the reactivation of human herpesvirus 6 (HHV-6). Here, we report a second instance of HHV-6 reactivation in a 43-year-old woman with idiopathic cutaneous LCV. CASE DESCRIPTION: In this case, the patient was immunocompetent, and testing revealed that she had inherited chromosomally integrated human herpesvirus 6 variant A (iciHHV6-A) with a parallel skin infection of HHV-6B. The integrated ciHHV-6A strain was found to be transcriptionally active in the blood, while HHV-6B late antigen was detected in a skin biopsy. The patient's rash was not accompanied by fever nor systemic symptoms and resolved over four weeks without any therapeutic intervention. CONCLUSION: In light of the transcriptional activity documented in our case, further examination of a possible role for HHV-6 in the etiology of LCV is warranted.
Asunto(s)
Exantema Súbito/complicaciones , Herpesvirus Humano 6 , Inmunocompetencia , Vasculitis Leucocitoclástica Cutánea/complicaciones , Adulto , Coinfección/complicaciones , Coinfección/diagnóstico , Coinfección/inmunología , Coinfección/virología , Exantema Súbito/diagnóstico , Exantema Súbito/inmunología , Exantema Súbito/virología , Femenino , Herpesvirus Humano 6/clasificación , Herpesvirus Humano 6/aislamiento & purificación , Humanos , Infecciones por Roseolovirus/complicaciones , Infecciones por Roseolovirus/inmunología , Infecciones por Roseolovirus/virología , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Vasculitis Leucocitoclástica Cutánea/inmunología , Vasculitis Leucocitoclástica Cutánea/virologíaRESUMEN
A 24-year-old man with untreated human immunodeficiency virus (HIV) infection consulted our outreach clinic owing to the development of numerous asymptomatic nodules on his palms and fingers. Histopathologic evaluation revealed leukocytoclastic vasculitis and prominent fibrosis with a neutrophilic infiltrate consistent with erythema elevatum diutinum (EED). We referred the patient for initiation of antiretroviral therapy and started him on dapsone. The pathogenesis of EED is not completely understood, but it has been associated with numerous systemic conditions that may be infectious, inflammatory, or neoplastic. Only recently has EED been recognized as a defined reactive dermatosis of HIV. We present an exemplary case of HIV-associated EED and review the differential diagnosis, highlighting clinical features of EED that appear to be more frequently encountered in the HIV-infected population.
Asunto(s)
Antiinfecciosos/uso terapéutico , Dapsona/uso terapéutico , Infecciones por VIH/complicaciones , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Vasculitis Leucocitoclástica Cutánea/virología , Adulto JovenRESUMEN
Extensive necrotizing vasculitis (ENV) is a rare paraneoplastic phenomenon, and the majority of cases reported are associated with hematolymphoid neoplasms. Histologically, most cases of ENV represent leukocytoclastic vasculitis (LCV). Here we report the clinicopahological features of a 68-year-old man with ENV associated to a Epstein Barr virus-positive diffuse large B-cell lymphoma (EBV+DLBCL) of the elderly, a newly recognized lymphoproliferative disorder, most likely representing a paraneoplastic manifestation. The patient was treated with standard chemotherapy regimen for malignant lymphoma. Due to the extensive involvement of the extremities by ENV, surgical debridement was not feasible and a novel therapy based on CHITOSAN apposits was initiated with overall good response and subsequent re-epithelization of the skin lesions. The patient died of sepsis secondary to a Pseudomona pneumonia 17 months after diagnosis.
Asunto(s)
Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4/aislamiento & purificación , Linfoma de Células B Grandes Difuso/diagnóstico , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Anciano , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Quimioterapia Combinada , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Resultado Fatal , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/virología , Masculino , Metilprednisolona/uso terapéutico , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Rituximab , Sepsis , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/virología , Vincristina/administración & dosificación , Vincristina/uso terapéuticoAsunto(s)
Infecciones por Virus de Epstein-Barr/complicaciones , Glomerulonefritis/virología , Vasculitis Leucocitoclástica Cutánea/virología , Enfermedad Aguda , Adolescente , Antiinfecciosos/uso terapéutico , Biopsia , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Glomerulonefritis/tratamiento farmacológico , Glomerulonefritis/patología , Humanos , Inmunosupresores/uso terapéutico , Riñón/patología , Riñón/virología , Masculino , Índice de Severidad de la Enfermedad , Piel/patología , Piel/virología , Resultado del Tratamiento , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/patologíaRESUMEN
Human immunodeficiency virus (HIV) infection has an impact on all systems of the body, including the cardiovascular system. A 54-year-old man presented with abdominal pain. Enhanced computed tomography revealed rupture of a pseudoaneurysm of the abdominal aorta. After surgery, the patient tested positive for HIV. Histological examination of the resected aorta showed leukocytoclastic vasculitis, a characteristic feature of HIV-related vasculitis.
Asunto(s)
Aneurisma Falso/virología , Aneurisma de la Aorta Abdominal/virología , Rotura de la Aorta/virología , Infecciones por VIH/complicaciones , Vasculitis Leucocitoclástica Cutánea/virología , Dolor Abdominal/virología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Terapia Antirretroviral Altamente Activa , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/cirugía , Aortografía/métodos , Biopsia , Implantación de Prótesis Vascular , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vasculitis Leucocitoclástica Cutánea/diagnóstico por imagen , Vasculitis Leucocitoclástica Cutánea/cirugíaRESUMEN
BACKGROUND: Leukocytoclastic vasculitis (LCV) and necrolytic acral erythema (NAE) are skin disorders associated with hepatitis C virus (HCV) infection. However, they have not been found to occur simultaneously in the same patient. OBJECTIVE: We sought to analyze the role of serum HCV-RNA levels and HCV genotype in the pathogenesis of both LCV and NAE in an attempt to assess whether these two parameters play a role in mutual exclusivity of LCV and NAE in the same patient. METHODS: The study included 11 patients with LCV and 13 with NAE, all of whom were infected with HCV. All 24 patients were evaluated for the quantitative levels of HCV-RNA, using real-time polymerase chain reaction. HCV genotyping was performed on 10 patients in each group (N = 20). RESULTS: Patients with LCV had a higher prevalence of moderate and high levels of HCV-RNA viremia (P = .038) than those with NAE. However, there was no significant difference in HCV genotype between LCV and NAE groups (P = .211). LIMITATIONS: Small number of cases is a limitation. CONCLUSION: Viral load seems to play a role in determining the response of the skin to HCV infection. High levels of HCV viremia were found to be significantly associated with LCV but not with NAE. HCV viremia may play a role in the development of LCV in HCV-infected patients.
Asunto(s)
Eritema/epidemiología , Eritema/virología , Hepacivirus/genética , Hepatitis C Crónica/epidemiología , Vasculitis Leucocitoclástica Cutánea/epidemiología , Vasculitis Leucocitoclástica Cutánea/virología , Adulto , Eritema/patología , Femenino , Genotipo , Hepacivirus/crecimiento & desarrollo , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Prevalencia , ARN Viral/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Piel/patología , Regiones no Traducidas/genética , Vasculitis Leucocitoclástica Cutánea/patología , Carga Viral , Viremia/epidemiología , Adulto JovenRESUMEN
Hepatitis B virus (HBV) infection is known to be responsible for both hepatic and extrahepatic manifestations including dermatitis, polyarthralgias and arthritis, pulmonary disease, aplastic anemia, glomerulonephritis and vasculitis. The mechanism of these extrahepatic disorders is thought to be linked to immune complex disease, but their pathogenesis is poorly clarified. Immunosuppressive treatment could promote viral load and impair hepatic disease, also worsening the vasculitis by enhancing viral antigenemia. Lamivudine is a nucleoside analogue approved for treating chronic hepatitis B, that decreases the amount of viral antigens by suppressing HBV replication. Several reports have suggested lamivudine in the treatment of vasculitis associated with HBV infection, but, although significant inhibition of HBV is achieved in the short term, resistance develops in 15-32 percent annual risk rating. We report an elderly patient whose chronic hepatitis B decompensated cirrhosis with associated refractory hepatic hydrothorax and extensive leukocytoclastic vasculitis was successfully treated with ongoing long-term lamivudine monotherapy.
Asunto(s)
Antivirales/uso terapéutico , Hepatitis B Crónica/tratamiento farmacológico , Lamivudine/uso terapéutico , Cirrosis Hepática/virología , Vasculitis Leucocitoclástica Cutánea/virología , Anciano de 80 o más Años , ADN Viral/sangre , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/genética , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/inmunología , Humanos , Hidrotórax/tratamiento farmacológico , Hidrotórax/virología , Cirrosis Hepática/tratamiento farmacológico , Cirrosis Hepática/inmunología , Masculino , Resultado del Tratamiento , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/inmunología , Carga Viral , Replicación Viral/efectos de los fármacosRESUMEN
A wide variety of rheumatologic complications have been reported in the setting of HIV-1 infection. We present the case of an HIV-1-infected patient with small-vessel vasculitis and inflammatory lung disease. This case illustrates the complexity of the differential diagnosis of inflammatory and autoimmune disease states in HIV-1-infected patients.