Cases reported "Exanthema"

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1/11. Human herpesvirus-6 (HHV-6)-associated hemophagocytic syndrome.

    Virus-associated hemophagocytic syndrome (VAHS) is characterized by histiocytic proliferation and phagocytosis triggered by virus infections. viruses in the herpes group, especially the Epstein-Barr virus (EBV), are well known to cause VAHS; however, the relationship between this syndrome and human herpesvirus-6 (HHV-6) infection has rarely been reported. In this study, we describe a 23-month-old girl who exhibited typical manifestations of VAHS associated with HHV-6 infection. To the best of our knowledge, this case is the fifth reported case in the English literature.
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2/11. Benign cutaneous Degos' disease: a case report with emphasis on histopathology as papules chronologically evolve.

    The following case report details a 53-year-old man with a 6-year history of the benign cutaneous or skin-limited form of Degos' disease. Clinically, the patient demonstrated a diffuse eruption of papules on the upper trunk and arms. Many papules demonstrated the classic porcelain-white centers characteristic of Degos' disease, but others exhibited different clinical morphologies that corresponded to the evolutionary stages of papules originally described by Degos. Over the course of several clinic visits, the patient underwent a total of 5 punch biopsies, the histologies of which were correlated with their clinical morphologies. Early papules were skin-colored and demonstrated a superficial and deep perivascular, periadnexal, and perineural chronic inflammatory cell infiltrate associated with interstitial mucin deposition. The overlying epidermis showed a mild vacuolar interface reaction and the histologic appearances at this early stage resembled tumid lupus erythematosus. Fully developed papules were raised with umbilicated porcelain-white centers and a surrounding erythematous rim. Histologically these exhibited a prominent interface reaction with squamatization of the dermo-epidermal junction, melanin incontinence, epidermal atrophy, and a developing zone of papillary dermal sclerosis that resembled the early stages of lichen sclerosus et atrophicus in miniature. These interface reactions were invariably confined to the central portion of the punch biopsy specimen, corresponding to the central porcelain-white area seen clinically. Additional features of fully developed papules included a prominent lymphocytic vasculitis affecting venules, a mild periadnexal infiltrate of neutrophils and/or eosinophils, and interstitial mucin deposition. In late-stage papules, the porcelain-white areas were better developed and the lesion flattened. Histologically, the degree of inflammation was generally sparse and the overall picture mirrored the classic histologic description of Degos' disease with a central roughly wedge-shaped zone of sclerosis surmounted by an atrophic epidermis and hyperkeratotic compact stratum corneum. These late-stage papules closely resembled a miniaturized version of fully developed lichen sclerosus et atrophicus confined to the center of the punch biopsy specimen.
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3/11. Needlestick transmission of hepatitis c.

    hepatitis c virus (HCV) transmission following a needlestick is an important threat to health care workers. We present the case of a 29-year-old medical intern who sustained a needlestick injury from a source patient known to be infected with both human immunodeficiency virus and HCV. The case patient subsequently developed acute HCV infection. The optimal strategy for diagnosing HCV infection after occupational exposures has not been defined. At a minimum, HCV antibody and alanine aminotransferase testing should be done within several days of exposure (to assess if the health care worker is already infected with HCV) and 6 months after percutaneous, mucosal, or nonintact skin exposure to blood or infectious body fluids from an HCV-infected patient. Currently, it is not possible to prevent HCV infection after exposure. However, recent data suggest that early treatment of acute HCV infection with interferon alpha may be highly effective in preventing chronic HCV infection. These data underscore the importance of identifying persons with acute HCV infection and promptly referring them to experienced clinicians who can provide updated counseling and treatment.
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ranking = 23.142173473418
keywords = tick
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4/11. Tula virus infection associated with fever and exanthema after a wild rodent bite.

    Reported here is the first case of human acute infection with Tula virus, which occurred in a 12-year-old boy in switzerland. This hantavirus had been considered apathogenic to humans, and in switzerland only TULV-genome sequences have been demonstrated in wild rodents to date. In this case, paronychia, fever and exanthema occurred after the patient was bitten by a wild rodent, indicating an unusual route of hantavirus transmission. Thus, Tula virus infection should be taken into account in patients with appropriate clinical symptoms and contact with rodents.
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5/11. Fever and rash in a 3-year-old girl: rocky mountain spotted fever.

    Initial symptoms of rocky mountain spotted fever (RMSF), a tick-borne illness caused by rickettsia rickettsii, are nonspecific and include headache, gastrointestinal disturbances, malaise, and myalgias, followed by fever and rash. The classic triad of fever, rash, and history of tick exposure is uncommon at presentation. Clinical manifestations of RMSF range from virtually asymptomatic to severe. Because of the potentially fatal outcome of RMSF, presumptive clinical diagnosis and empiric antimicrobial therapy can be critical. We present the case of a 3-year-old girl from new york State who presented with fever and rash.
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ranking = 7.7140578244726
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6/11. Pediatric ingestion of lamotrigine.

    A 3-year-old female presented to the emergency department after ingesting forty-six 25-mg tablets of lamotrigine that resulted in sedation, rash, and transient elevation of liver function tests. Her initial physical examination was significant for marked somnolence and a lacy reticular blanching rash. Laboratory studies were all within normal limits except for mildly elevated liver function tests. Initial plasma lamotrigine level was found to be elevated above adult therapeutic levels (25.3 microg/mL). Treatment consisted of gastric lavage followed by activated charcoal. The patient was subsequently observed in the pediatric intensive care unit where symptoms and laboratory abnormalities promptly resolved, and she was discharged 24 hours later without further complication. This case report describes the largest single ingestion of lamotrigine ever reported in a pediatric patient. The patient exhibited significant somnolence, rash, and liver function test abnormalities with only a slight elevation of serum level of lamotrigine above adult therapeutic levels. More research is required to investigate the toxic profile of lamotrigine in pediatric patients.
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7/11. Aural involvement in loxoscelism: case report and literature review.

    An 11-year-old male presented with fever, rash, and a necrotic lesion on the lobule of the left ear. The lesion became tender and formed an eschar over 4 days. The patient developed leukocytosis, hemolytic anemia, and proteinuria, and was diagnosed with systemic loxoscelism from a brown recluse spider bite. He was managed with supportive therapy and improved in 4 days. Loxoscelism is a clinical diagnosis which should be suspected in an otherwise healthy patient with a necrotic wound, particulary in the endemic Southern and midwestern united states. physicians should be aware of this disease entity and its complications.
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8/11. Clinical and serologic responses to human 'apathogenic' trypanosomes.

    We describe a female patient suffering from a benign self-healing febrile disease with strongly positive serology for trypanosoma brucei. The patient showed a clinical picture with similarities to that of human African trypanosomiasis (HAT). HAT due to T. b. gambiense and T. b. rhodesiense were ruled out. We performed serologic tests because the patient was worried about HAT after receiving tsetse bites. The possibilities of an infection with human 'apathogenic' trypanosomes such as T. b. brucei, T. congolense or T. vivax are discussed.
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9/11. Hereditary mucoepithelial dysplasia: clinical, ultrastructural and genetic study of eight patients and literature review.

    BACKGROUND: Hereditary mucoepithelial dysplasia is a dominantly inherited disease, mainly characterized by chronic mucosal lesions associated with keratitis, non-scarring alopecia, keratosis pilaris and perineal intertrigo. Since the original report by Witkop, this condition has been considered to be a disorder of desmosome/gap junction formation, but there has been no ex vivo investigation of these components using genetic and immunolabelling techniques. OBJECTIVES: To perform light and immunoelectron microscopic studies, and partial genetic analysis on five patients in a family and three sporadic cases and to point out similarities of this rare disorder with chronic mucocutaneous candidiasis and other follicular keratosis syndromes, i.e. ichthyosis follicularis-alopecia-photophobia (IFAP), keratitis-ichthyosis-deafness (KID) and Siemens syndromes. methods: Biopsies from the involved oral mucosa and armpit skin of patient 1 were prepared for standard histopathology, electron microscopy and immunocytochemistry. Microsatellite genotyping was performed in three affected family members. Direct sequencing after polymerase chain reaction amplification of the entire coding region was performed. RESULTS: A 14-year-old male had recurrent keratitis, widespread keratosis pilaris, perineal intertrigo, hypotrichosis and oral mucosal involvement. A similar phenotype was noted in four members of his family and in three sporadic cases. Histological examination of oral mucosa and skin samples showed a psoriasiform pattern, dyskeratotic features and cytoplasmic vacuoles. Expression of connexins (Cx), desmosomal, adherens junction and cytoskeleton proteins (Cx 26, 32 and 43, desmogleins 1 and 2, plakoglobin, desmoplakins I-II, plakophilin 1, beta-catenin, E-cadherin, keratins, beta-tubulin, vimentin and actin) was normal. Ultrastructural studies showed a reduced number of desmosomes. Dyskeratotic cells exhibited internalized gap junctions, long filamentous inclusions reactive with antikeratin antibodies, and bundles of perinuclear fibres resembling clear tonofilaments. Genetic analysis in the studied family excluded the desmosomal cadherins in chromosome 18q12 as candidate genes. CONCLUSIONS: A diagnosis of hereditary mucoepithelial dysplasia should be strongly suggested by the triad of non-scarring alopecia, well-demarcated erythema of oral mucosa and psoriasiform perineal rash, after exclusion of the clinically related follicular keratosis syndromes. Defective expression of cytoskeleton elements and/or a modification of mechanisms regulating junction-cytoskeleton assembly may be primarily responsible for impaired epithelial cohesion.
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10/11. rat-bite fever presenting with rash and septic arthritis.

    rat-bite fever is an uncommon disease known for its endemicity to occur worldwide. Although most patients tend to develop mild symptoms with improvement from conventional antibiotics, it can progress with severe complications with a mortality rate as high as 13% without proper treatment. The authors report a complicated case of rat bite-fever involving a 61-year old woman who presented with fever petechial rash, and septic arthritis following a rat bite. Initially, multiple antibiotics were administered but were not effective. As a consequence, invasive procedures such as arthrotomy and joint debridement were done and prolonged antibiotic was administered until clinical resolution. Since many cases do not have a history of rat bite and may present with fever, rashes, and arthritis it is essential to distinguish it from other diseases. Here, the authors will provide details on the etiology, clinical manifestations, diagnosis, and management to aid prompt detection and treatment of the disease.
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