Cases reported "Erythema"

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1/10. Photodynamic therapy for the treatment of erythema, papules, pustules, and severe flushing consistent with rosacea.

    We report a case of a 45-year-old woman who presented with facial erythema, papules, pustules, and severe flushing consistent with rosacea. The patient had failed standard pharmacologic treatments. The patient's flushing was so severe that she had undergone an elective sympathectomy. She received 6 sessions of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA as Levulan Kerastick, Dusa Pharmaceuticals) given at 2-week intervals. Improvement was evident after the second treatment and was considered "excellent" after the sixth treatment. Improvement continued and no flares were observed 1 month after the final treatment.
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2/10. Erythema figuratum in septic babesiosis.

    babesiosis is a rare worldwide-distributed protozoal zoonosis caused by a haemoprotozoan of the genus Babesia, transmitted through bites of tick of the genus ixodes. The first demonstrated case of human babesiosis in the world was discovered in europe, in 1957. However, most of the cases were reported later in the north-east of the united states where babesia microti has been the cause of over 300 cases of human babesiosis since 1969. In europe, the most severe cases are observed in asplenic patients infected by a parasite of cattle, the Babesia divergens. Only two cases of babesiosis have been reported in spain. We present a case of erythema figuratum associated to septic babesiosis in a non-splenectomized man, which is currently the third case of babesiosis in spain.
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3/10. Neurologic complications of erythema-migrans-disease in childhood--clinical aspects.

    Erythema-migrans-disease represents a tick-borne borreliosis with a high and widespread incidence according to first epidemiological surveys. The early symptom is a distinctive erythema migrans eventually followed by arthritis and cardiac involvement as well as neurologic complications in the form of lymphocytic meningoradiculitis Garin-Bujadoux-Bannwarth. In a one-year-period we observed 9 children who developed neurologic complications as the predominant feature of erythema-migrans-disease. Eight children suffered from a lymphocytic meningitis and/or a peripheral facial palsy and one child presented with a severe polyradiculoneuritis with complete transverse myelitis. In contrast to adults the clinical course of neurologic manifestations in children seems to be milder and shorter and not associated with the typical painful radiculitis. Acute Bell's palsy seems to be a rather common symptom, whereas other peripheral pareses of the mononeuritis multiplex type were not observed. With respect to the assumed frequency and because of the possibility of antibiotic therapy, erythema-migrans-disease should be ruled out in any case of so-called idiopathic facial palsy or aseptic meningitis, which are frequently encountered in children.
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4/10. Reinfection in erythema migrans disease.

    Two patients received oral penicillin for erythema migrans disease (EMD) in 1973 and 1977. Five and seven years later, respectively, they developed EMD for a second time after being bitten by ticks. The first and second erythema migrans lesions appeared in different places. Tests of sera evaluated for antibodies to borrelia burgdorferi before (in one case), during and after the second episode of EMD remained negative (patient 1) or yielded an at least four-fold rise of IgG antibody titers, but did not become positive (patient 2). These cases provide evidence that reinfection in EMD may occur without a significant elevation of specific antibody titers.
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5/10. Localized tick bite reaction.

    A woman presented with a localized tick bite reaction. The tick (Amblyomma americanum, the "lone star" tick) was still attached to the erythematous, indurated skin of the upper back. After several unsuccessful attempts at removal, a punch biopsy was performed, and the resultant histologic sections incorporated both tick and involved skin. The various systemic and localized tick bite reactions are discussed, as are the diagnostic dilemmas which may arise when the organism is no longer present. Punch biopsy is suggested as an effective means of removing the organism.
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6/10. erythema chronicum migrans in America.

    erythema chronicum migrans (ECM) developed in a man after a tick bite; the tick was probably lxodes pacificus. Despite extensive laboratory evaluation, including bacterial culture of involved skin, viral and rickettsial titers, biopsy and special stains, animal inoculation, and electron microscopy, the causal agent could not be identified. Although probably unrelated, an elevated measles titer with a twofold drop on serial determinations was of interest. To our knowledge, this report documents the first reported case of ECM acquired in this country in which the tick that caused the disease has been recovered.
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7/10. Eosinophilic cellulitis (Wells' syndrome): histologic and clinical features in arthropod bite reactions.

    Five patients are described with the clinical and histopathologic picture, including flame figures, of eosinophilic cellulitis (Wells' syndrome). Two of them had documented tick bites in the center of these expanding annular lesions, and the histologic picture showed the diagnostic flame figures of Wells' syndrome (eosinophilic cellulitis). A third patient had a clinical picture suggestive of a tick bite reaction but stated she was stung by a small garden bee at the involved site. The fourth patient removed a spider from the site of a spider bite, and this nodule also histopathologically was identical to that of eosinophilic cellulitis. Our fifth patient presented with papular urticaria of flea bites. We suggest that the characteristic flame figures of eosinophilic cellulitis (Wells' syndrome) are not diagnostic of a specific disease entity but rather a striking and peculiar histopathologic response to multiple factors of which arthropod bites (ticks, bees, fleas, and spiders) represent one definite etiology.
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8/10. lyme disease: additional evidence of widespread distribution. Recognition of a tick-borne dermatitis-encephalitis-arthritis syndrome in an area of known ixodes tick distribution.

    lyme disease is a process of unknown etiology that has been linked to bites of ticks of the ixodes ricinus complex. Central minnesota is an area of known ixodes dammini distribution. This case represents the first recognition of lyme disease from this area. This case presented as a fluctuating meningoencephalitis with superimposed cranial neuropathy. The characteristic skin lesion, erythema chronicum migrans, was recognized by history, and oligoarticular arthritis subsequently developed. physicians practicing in areas of known ixodes tick distribution outside of the northeastern united states (coastal areas of oregon and california, central minnesota, northwestern wisconsin, northwestern utah, certain parts of ontario) should be alert to this disease and aware fo the variety of symptom complexes that are possible with it.
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9/10. Lyme arthritis in wisconsin.

    Rash, severe constitutional symptoms, and arthritis developed in three persons who were bitten by ticks in wisconsin. On comparison with other reports of arthritis related to tick bites, we found that the illness of our patients had clinical features consistent with Lyme arthritis. Lyme arthritis appears not to be restricted to new england as has been previously reported.
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10/10. erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum.

    Thirty-two patients with the onset of erythema chronicum migrans, Lyme arthritis, or both in mid-1976 were studied prospectively. The skin lesion (24 patients) typically lasted about 3 weeks, beginning as a red macule or papule that expanded to form a large ring with central clearing. Associated symptoms ranged from none to malaise, fatigue, chills and fever, headache, stiff neck, backache, myalgias, nausea, vomiting, and sore throat. Three patients had been bitten by ticks at the site of the initial lesion 4 to 20 days before its onset. Nineteen patients suddenly developed a monoarticular or oligoarticular arthritis 4 days to 22 weeks (median, 4 weeks) after onset of the skin lesion; eight developed arthritis without a preceding skin lesion. Seven of these 27 experienced migratory joint pains. arthritis attacks, most commonly in the knee, were typically short (median, 8 days) but sometimes persisted for months. Other manifestations included neurologic abnormalties, myocardial conduction abnormalities, serum cryoprecipitates, elevated serum IgM levels, and elevated erythrocyte sedimentation rates. The diagnostic marker is the skin lesion; without it, geographic clustering is the most important clue.
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