RESUMO
Scholars around the world have dedicated themselves to developing an effective vaccine against SARS-CoV-2. However, vaccines have produced adverse effects in some patients. We report the case of a 44-year-old man who developed a pruritic papulosquamous rash on the trunk with a characteristic pattern known as Christmas tree after receiving the first dose of the Oxford-AstraZeneca COVID-19 vaccine, similar to pityriasis rosea (PR). He had no previous symptoms of viral infection and tested negative for neutralizing antibodies (enzyme immunoassay) against COVID-19. There are few reports in the literature about the relationship between the onset of cutaneous adverse reactions and the Oxford-AstraZeneca vaccine, therefore, the dissemination of this case is of paramount importance.
Assuntos
Humanos , Masculino , Adulto , Pitiríase Rósea/diagnóstico , Vacinas contra COVID-19/efeitos adversos , ChAdOx1 nCoV-19/efeitos adversos , SARS-CoV-2 , COVID-19/patologiaRESUMO
Las manifestaciones cutáneas relacionadas a la infección por el coronavirus SARS-CoV-2, causante de COVID-19, se han descrito entre el 0,2% y 20,4% de las personas que cursan con esta enfermedad. Las más frecuentemente descritas son: lesiones maculopapulares (47%), lesiones acrales eritematosas con vesículas o pústulas (pseudoperniosis) (19%), urticariales (19%), lesiones vesiculosas (9%) y livedo/necrosis (6%). En particular, la pitiriasis rosada es una dermatosis autolimitada de etiología desconocida, sin embargo, se ha visto asociada a la infección por SARS-CoV-2, con algunos reportes de casos en la literatura. El mecanismo fisiopatológico de las lesiones cutáneas en COVID-19 no es claro, y se han planteado algunas teorías, entre las cuales está el papel que juega la enzima convertidora de angiotensina 2 (ACE2) utilizada por el virus para infectar las células, los infiltrados linfocíticos, los depósitos de factores del complemento en la piel, y la reactivación de virus latentes como los herpes virus humanos. Se presenta el caso de una paciente con pitiriasis rosada asociada a COVID-19 y se describen los casos reportados hasta la fecha
Assuntos
Humanos , Pitiríase Rósea , Pele , Manifestações Cutâneas , Urticária , Coronavirus , Exantema , SARS-CoV-2 , COVID-19RESUMO
ABSTRACT Introduction: Pityriasis rosea is an acute and self-limited exanthem first described by Gilbert in 1860. Its treatment is symptomatic, and although there is no conclusive evidence, it has been associated with the reactivation of the human herpesviruses 6 and 7 (HHV-6 and HHV-7). Case presentation: A 28-year-old woman, from Bogotá, Colombia, a health worker, attended the emergency room due to the onset of symptoms that began 20 days earlier with the appearance of punctiform lesions in the left arm that later spread to the thorax, abdomen, opposite arm, and thighs. The patient reported a history of bipolar II disorder and retinal detachment. After ruling out several infectious diseases, and due to the evolution of the symptoms, pityriasis rosea was suspected. Therefore, treatment was started with deflazacort 30mg for 21 days, obtaining a favorable outcome and improvement of symptoms after 2 months. At the time of writing this case report, the patient had not consulted for recurrence. Conclusion: Primary care physicians should have sufficient training in dermatology to recognize and treat dermatological diseases since many of them are diagnosed based on clinical findings. This is an atypical case, in which the patient did not present with some of the pathognomonic signs associated with pityriasis rosea.
RESUMEN Introducción. La pitiriasis rosada es un exantema agudo y autolimitado que fue descrito formalmente por Gilbert en 1860. Su tratamiento es sintomático y, aunque faltan pruebas concluyentes, su aparición se ha asociado a la reactivación de los herpevirus humanos 7 y 6 (HHV6 y HHV7). Presentación del caso. Mujer de 28 años procedente de Bogotá, Colombia, quien se desempeñaba como trabajadora de la salud y consultó al servicio de urgencias por un cuadro clínico de 20 días de evolución que inició con la aparición de lesiones punteadas en el brazo izquierdo que se expandieron posteriormente a tórax, abdomen, brazo contralateral y muslos. La paciente informó antecedente de trastorno bipolar tipo II y desprendimiento de retina. Después de descartar varias enfermedades infecciosas, y debido a la evolución del cuadro clínico, se sospechó pitiriasis rosada, por lo que se instauró tratamiento con 30mg de deflazacort por 21 días, con el cual se logró una evolución favorable y la mejoría total de los síntomas a los 2 meses. Hasta el momento de la elaboración del presente reporte de caso la joven no había consultado por recurrencia. Conclusión. Es indispensable que los médicos de atención primaria tengan una educación adecuada en dermatología para poder reconocer y tratar la pitiriasis rosada, pues su diagnóstico es eminentemente clínico y puede tener múltiples presentaciones atípicas, como en el caso aquí reportado donde la paciente no tuvo algunos de los signos patognomónicos característicos.
RESUMO
Pityriasis rosea (PR) has been manifested in patients suffering from COVID-19 as well as after vaccine protocols against SARS-CoV-2. It has a possible association with the HHV-6B virus (roseola infantum) and can be controlled by antivirals such as acyclovir as well as by the amino acid l-Lysine that showed a positive result in reducing the number of lesions and healing time. The aim of this study was to report a case of PR after a second dose of Oxford-AstraZeneca, the adopted therapy and a brief literature review. A 53-year-old woman, phototype II, presented an erythematous lesion in the posterior right thigh 15 days after the second dose of Oxford-AstraZeneca vaccine. Eight days after the initial injury, new injuries appeared in the calf, buttocks and thighs. The diagnosis was PR with a 5-week eruption cycle. The treatment consisted of the use of l-Lysine, 3 grams loading dose and 500 mg for 30 days and moisturizing/healing lotion, starting 14 days after the herald patch. After the 5th week of the disease cycle, there were no new eruptions and the repair cycle continued for up to 8 weeks leaving some residual skin spots. It is concluded that the patient may be a carrier a latent virus, HHV-6, and the vaccine administration with immune system stimulation, would have activated the possible virus causing PR. l-Lysine helped to control the manifestation by limiting the number of lesions and their location, which were restricted to the legs, thighs and buttocks.
Assuntos
COVID-19 , Herpesvirus Humano 7 , Pitiríase Rósea , Vacinas , Feminino , Humanos , Pessoa de Meia-Idade , Pitiríase Rósea/induzido quimicamente , Pitiríase Rósea/diagnóstico , SARS-CoV-2RESUMO
Pityriasis rosea (PR) is a dermatological disease with an erythemato-papulosquamous manifestation, distributed on the trunk and extremities affecting healthy people, especially children and young people between 10 and 35 years of age. The evolution is 6 to 8 weeks and may remain for 3 to 6 months. It regresses spontaneously and can leave changes in the skin color but reversibly. Acyclovir is indicated to minimize clinical manifestations with the suspected of viral association (HHV-6 and 7). Another group of the human herpesvirus family (HHV-1 and 2), causes herpes simplex that is controlled with the antivirals, including acyclovir, as well as the amino acid L-lysine, both showing positive and similar results in reducing the number of annual manifestations and the healing time of the lesions. The aim of this study is to report a case of PR in a child, to review the literature on the etiopathogenesis of the disease and on the effects of L-lysine as well as another amino acid in the treatment. An 11-year-old girl, phototype II, presented lesions diagnosed as PR. The cycle would be 6 to 8 weeks on average. A solution of L-lysine was prescribed for 30 days, on an empty stomach. After the fourth day of therapy, the cycle of new eruptions was interrupted, initial lesions regressed, accelerating the repair of larger lesions resulting in an improvement of the clinical condition. We concluded that the administration of L-lysine, in therapeutic doses, can be a safe alternative for the PR control.
Assuntos
Herpesvirus Humano 6 , Herpesvirus Humano 7 , Pitiríase Rósea , Aciclovir/uso terapêutico , Adolescente , Criança , Feminino , Humanos , Lisina , Pitiríase Rósea/diagnóstico , Pitiríase Rósea/tratamento farmacológicoRESUMO
Abstract: Background: Pityriasis rosea is a common papulosquamous disorder. However, its etiology and pathogenesis remain unclear. Objective: We investigate the types of inflammatory cells infiltrating the lesional skin of pityriasis rosea and demonstrate whether T-cell-mediated immunity is involved in the pathogenesis of this condition or not. Methods: The biopsies were taken from the lesional skin of 35 cases of patients diagnosed with pityriasis rosea. The specimens were prepared in paraffin sections, then submitted to routine immunohistochemistry procedures using monoclonal antibodies directed against CD3, CD4, CD8, CD20 and CD45RO and horseradish peroxidase-labeled goat anti-human antibodies. The positive sections were determined by the ratio and staining intensity of positive inflammatory cells. Results: The mean score of positive CD3, CD4, CD8, and CD45RO staining was respectively 3.74±3.88, 5.67±4.40, 2.94±3.42 and 7.68±4.33 in these pityriasis rosea patients (P<0.001). The percentage of positive staining was 54.29% (19/35), 69.7% (23/33), 40% (14/35) and 79.41% (27/34) (P<0.05). However, the staining of CD20 was negative in all samples. The mean score of CD3 staining in patients with time for remission ≤60 days (4.90±4.21) was higher than that in patients with time for remission >60 days (2.00±2.5) (P<0.05), whereas no statistical difference in the mean score of CD4, CD8 and CD45RO staining was observed. study liMitations: The sample size and the selected monoclonal antibody are limited, so the results reflect only part of the cellular immunity in the pathogenesis of pityriasis rosea. Conclusion: Our findings support a predominantly T-cell mediated immunity in the development of pityriasis rosea.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Subpopulações de Linfócitos T/patologia , Pitiríase Rósea/patologia , Valores de Referência , Coloração e Rotulagem , Fatores de Tempo , Biópsia , Imuno-Histoquímica , Linfócitos T CD4-Positivos/patologia , Subpopulações de Linfócitos T/imunologia , Pitiríase Rósea/imunologia , Antígenos Comuns de Leucócito/análise , Complexo CD3/análise , Linfócitos T CD8-Positivos/patologia , Imunidade CelularRESUMO
Abstract: Background: There is a lack of evidence to support acyclovir administration in pityriasis rosea. Objective: To determine the efficacy of acyclovir in patients with typical pityriasis rosea. Methods: A systematic review and meta-analysis of experimental studies was performed in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on acyclovir for pityriasis rosea. Random effect model was used to find the pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression of lesions, cessation of lesions, decrease of symptoms and duration of disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment alone. Results: Seven papers were analyzed with 324 participants, of which 159 received acyclovir and 165 were controls. Acyclovir was superior to placebo for complete regression of lesions at week 1 (Risk Ratio 5.72, CI95% 2.36-13.88). However, combined therapy was not superior to symptomatic treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies showed the superiority of acyclovir for the control of symptoms and pruritus. Study limitations: We faced differences designs of trials and inconsistency between reports. Conclusion: Symptomatic treatment is a reasonable option for pityriasis rosea, and the addition of acyclovir is justified for the control of symptoms and pruritus.
Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Antivirais/uso terapêutico , Aciclovir/uso terapêutico , Pitiríase Rósea/tratamento farmacológico , Antivirais/administração & dosagem , Placebos , Aciclovir/administração & dosagem , Seguimentos , Administração Tópica , Resultado do TratamentoRESUMO
RESUMEN A pesar de que la Pitiriasis Rosada se considera una condición cutánea benigna, en el marco del embarazo, hay estudios que relacionan la aparición de esta patología con complicaciones asociadas en el feto. Metodología: Se realiza un reporte de caso, prospectivo, a una mujer de 36 años chilena que presentó esta patología durante la semana 12 de gestación. El objetivo fue describir, la evolución y control y contrastar su evolución con la evidencia científica actual sobre esta temática. Resultados: Paciente presenta placas eritematodescamativas concordantes con diagnóstico de pitiriasis rosada (superficie afectada menos al 50% de su cuerpo), sin presentar enantema, ni síntomas sistémicos. Tuvo un recién nacido sano a las 38 semanas de gestación, sin presentar ningún efecto adverso de los que relaciona la literatura analizada. Conclusiones: Distintos estudios han estudiado los posibles efectos adversos en el feto en madres que han presentado Pitiriasis Rosada en el embarazo, sin embargo, en este reporte de caso no se presentaron complicaciones asociadas. Faltan estudios realizados en mayor cantidad de pacientes.
ABSTRACT Although Pityriasis Rosea is considered a benign cutaneous condition, in the context of pregnancy, there are studies that relate the appearance of this pathology with associated complications in the fetus. Methodology: A prospective case report was made to a 36-year-old Chilean woman who presented this pathology during the twelve weeks of pregnancy. The objective was to describe, the evolution and control and to contrast its evolution with the current scientific evidence on this subject. Results: Patient presents concordant erythematous-desquamative plaques with diagnosis of Pityriasis Rosea (surface affected less than 50% of his body), without presenting enanthem, nor systemic symptoms. Had a healthy newborn at 38 weeks of gestation, without presenting any adverse effect related to the analyzed literature. Conclusions: Different studies have studied the possible adverse effects on the fetus in mothers who have presented pityriasis rosea in pregnancy, however in this case report there were no associated complications. Missing studies in a greater number of patients.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Pitiríase Rósea/complicações , Pitiríase Rósea/diagnóstico , Pitiríase Rósea/prevenção & controle , Complicações na Gravidez , Pitiríase Rósea/patologia , Pitiríase Rósea/virologia , Herpesvirus Humano 6/isolamento & purificação , Herpesvirus Humano 7/isolamento & purificaçãoRESUMO
Pityriasis rosea (PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR is not an exception. Variants of the disease in some cases may be troublesome to diagnose and confuse clinicians. Prompt diagnosis and treatment of the condition becomes necessary to avoid unnecessary investigations. We hereby review and illustrate atypical presentations of the disease, including diverse forms of location and morphology of the lesions, the course of the eruption, and its differential diagnoses.
RESUMO
Comunicamos el caso de una paciente femenina de 23 años de edad, natural y procedente de la localidad, quien consulta el 30 de Noviembre de 2016 al Centro Integral de Especialidades "Los Grillitos", CORPOSALUD, Municipio Mario Briceño Iragorry, por presentar lesiones puntiformes no pruriginosas en tronco, cuya aparición fue posterior al cuadro viral leve, motivo por el que acude al médico quien le indica antihistamínicos orales y glucocorticoides tópicos no fluorados. Con posterioridad a la primera consulta médica, se evidencian lesiones ovales rosadas con relieve no pruriginoso, diseminado en tronco. Se continúa tratamiento y se indica administrar una ampolla de betametasona intramuscular. Acude nuevamente a evaluación médica y se evidencian lesiones ovales menos eritematosas, descamativas en el límite del borde libre; en general se encuentran involucionadas, observándose actualmente mejoría clínica del cuadro.
We communicate a 23-year-old female patient, natural and from the locality, who on November 30, 2016, visits the Integral Center of Specialties "Los Grillitos", CORPOSALUD, Municipality Mario Briceño Iragorry, for presenting non-pruriginous punctate lesions on the trunk, which appeared after a mild viral picture, reason why she goes to the doctor who indicates oral antihistamines and non-fluorinated topical glucocorticoids. Subsequent medical evolution shows pink oval lesions with non-pruriginous relief, disseminated in the trunk. Treatment is continued and an intramuscular betamethasone ampoule is indicated. The patient returns to medical evaluation and there is evidence of oval lesions less erythematous, desquamative at the border of the free border; in general they are involuted, observing at the moment clinical improvement of the picture.
RESUMO
Pitiríase rósea é doença inflamatória aguda da pele, que regride espontaneamente, normalmente sem deixar seqüelas, em período que varia de quatro a oito semanas. Clinicamente é caracterizada pelo aparecimento de típicas lesões eritêmato-pápulo-escamosas. Atinge todas as idades, embora seja mais comumente observada entre 10 e 35 anos. Apesar de exaustivas pesquisas, sua etiologia ainda permanece desconhecida. São discutidos alguns aspectos epidemiológicos, anatomoclínicos, diagnósticos diferenciais, doenças associadas, com ênfase no tratamento e etiologia da doença.
Pityriasis rosea is a skin disease characterized by acute inflammation that fades away spontaneously without scar tissue formation for an average period of 4 to 8 weeks. Clinically, it is characterized by the occurrence of typical erythematous papulosquamous lesions distributed mainly over the trunk and extremities. It affects people of all ages, but is more often observed in the age range of 10 to 35 years. Even though it is extensively studied, its etiology remains unknown. In this study, the authors analyze some epidemiologic aspects, differential diagnosis, related diseases, and give special attention to treatment and possible etiology.