Cases reported "Necrosis"

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1/11. Metastasising malignant lymphoma mimicking necrotising and hyperplastic gingivostomatitis.

    This paper presents the case of a 65 year-old woman suffering from recurrent oral aphthoid ulcers which rapidly evolved towards hyperplastic and ulcerated lesions over the entire floor of the mouth. The initial lesions were interpreted as non-specific aphthoid ulcers. Later, a tentative diagnosis of necrotising stomatitis with secondary reactive proliferating epithelial hyperplasia was made. The clinical symptoms and the immuno-phenotyping of lymphocytes circulating in the peripheral blood suggested the diagnosis of CD30-positive large cell anaplastic lymphoma. The biopsy showed only a pseudoepitheliomatous hyperplasia, reactive infiltrates and no lymphoma cells. The disease ran a fulminant course leading to death within 4 weeks due to acute gastro-intestinal bleeding. autopsy revealed infiltrates of CD30 large cell anaplastic lymphoma in a submandibular lymph node, in a thrombus stenosing the right subclavian vein, in the spleen, the anterior and posterior gastric wall as well as in the depth of the tumour on the floor of the mouth. The clinical and histopathological spectrum of CD30 large cell anaplastic lymphoma is considerably variable. The particular feature of pseudoepitheliomatous hyperplasia has been reported especially in CD30 anaplastic large cell lymphomas. An early correct diagnosis is rendered difficult in insufficient biopsy size, becauses this type of lymphoma often simulates other inflammatory or neoplastic skin diseases. Thus, with a necrotising and hyperplastic gingivostomatitis, the diagnosis of a CD30 anaplastic large cell lymphoma should be considered.
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2/11. Great cases from the University of pennsylvania.

    New skin diseases are reported yearly. Some well-known conditions may develop unusual manifestations. Other cutaneous findings are simply rare. While patients with such diseases represent only a small fraction of our practice they are an important subset of our experience. Many of these diseases are treatable, pinpoint the discovery of internal disease, or simply allow for a diagnosis and prognosis to be given to a concerned patient who had previously escaped classification. Such cases expand our knowledge and provide excitement to our day. Several patients from whom I have learned the most in the last few years are detailed for your enjoyment.
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3/11. necrosis in leg ulcers. Probable role of fluocinolone acetonide.

    necrosis in chronic leg ulcers developed in all of the four patients who were treated topically with a fluocinolone acetonide-neomycin sulfate ointment. This was probably due to the vasoconstrictive properties of the steroid. A warning against the topical use of potent steroids in skin diseases with impaired circulation seems to be justified.
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keywords = skin disease
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4/11. pyoderma gangrenosum: a great marauder.

    pyoderma gangrenosum is a progressively necrotizing and ulcerative skin disease that mimics a severe bacterial infection. However, the cause is not infectious in nature and the lesions are refractory to local wound care and antibiotic therapy. The etiology of pyoderma remains unknown, although pathogenic mechanisms may involve immunologically mediated cutaneous damage. The authors report a 67-year-old woman in whom a necrotic ulcer developed at a chest tube site. Treated with local wound care and antibiotics, this lesion spread progressively to involve 15% of her body surface area. A septic clinical picture developed despite sterile cultures, and she required several operative debridements. Her disease continued to spread and finally a diagnosis of pyoderma gangrenosum was considered. Treated with systemic steroids, hyperbaric oxygen (HBO), and local wound care, she eventually underwent skin grafts.
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5/11. Necrotizing mesenteric vasculitis after longstanding cutaneous polyarteritis nodosa.

    We describe a 21-year-old woman with cutaneous polyarteritis nodosa (PAN) who developed necrotizing mesenteric vasculitis 6 years after the onset of skin disease. Repeated investigation during that 6-year interval failed to reveal any evidence of systemic PAN. We were unable to wean the patient from prednisone or completely control her skin disease with topical and systemic therapy, including supersaturated potassium iodide, dapsone, azathioprine, methotrexate or plasmapheresis before the development of the mesenteric vasculitis, which responded to cyclophosphamide and prednisone. Development of visceral vasculitis after long-standing cutaneous PAN has very rarely been reported.
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keywords = skin disease
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6/11. Renal disease, epidermal necrosis, and epithelial cell antibodies.

    OBJECTIVE--To describe the association between epithelial cell IgM, which has previously been associated with an increased incidence of loss of renal graft in children, with a novel cutaneous eruption and unexplained native renal disease. DESIGN--observational study on children with epithelial cell antibody presenting with unexplained renal or skin disease. SETTING--General paediatric department and regional paediatric nephrology unit. patients--Six children (five girls, one boy), who presented to the unit in 1989-90. RESULTS--Three children, two of whom had a history of a hyperpigmented rash, presented with hypertension, proteinuria, and impaired renal function. Renal biopsy specimens from two of these children showed severe arteriolar endothelial cell swelling with arteriolar occlusion. These children fully recovered after treatment with antihypertensive drugs. The third child developed end stage renal failure and required dialysis. Three other children presented with an unusual cutaneous eruption but no evidence of renal disease. histology of the skin lesions showed acute epidermal necrosis and features consistent with a viral infection. CONCLUSIONS--The aetiology and pathogenesis of the epithelial cell antibody are unknown. These cases indicate that it may have a role in native kidney disease and focal epidermal necrosis. Clinical and histological features suggest that the antibody may be associated with a viral infection.
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7/11. necrolytic migratory erythema without glucagonoma.

    Two patients with clinical and histologic findings consistent with necrolytic migratory erythema are presented. Unlike previously described patients with this disorder, neither patient had substantially elevated glucagon levels nor an associated pancreatic islet cell tumor. The cause of the skin disease in these patients remains unknown but may be related to the underlying small-bowel disorder present in both.
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keywords = skin disease
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8/11. Haematobium schistosomiasis presenting in the netherlands as a skin disease.

    A rare case is reported of extragenital skin schistosomiasis as the presenting symptom in a 24-year-old Dutch student, who had swum some months earlier in Lake malawi in mozambique. Grouped papules dorsolateral on the lower thorax were shown by biopsy to be due to infection by schistosoma haematobium. The eggs were viable and surrounded by necrosis and partly purulent, partly granulomatous dermatitis that also affected hair follicles. The second biopsy, taken 2.5 months after treatment with praziquantel, still showed viable eggs and necrosis but no more microabscesses. In the third biopsy 5 weeks after a second praziquantel treatment, no eggs were found, but a partly granulomatous abscess forming inflammation affecting a hair follicle was still present.
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keywords = skin disease
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9/11. Cutaneous cryptococcosis--primary versus secondary disease. Report of two cases with review of literature.

    The clinical, immunological, and pathological features of solitary cutaneous cryptococcosis in two apparently healthy Chinese adults are reported. In patient 1, regional cryptococcal lymphadenopathy also occurred. Both patients showed lymphopenia with a proportionate decrease in T-helper and T-suppressor cells. Both skin and lymph node biopsies showed granulomatous inflammation and the presence of cryptococcus. A chancriform syndrome developed in patient 1, indicating primary cutaneous cryptococcosis. Chancriform syndrome is rare in cryptococcal skin infection, probably due to immunosuppression in susceptible patients. In patient 2, the deep dermal and subcutaneous inflammatory involvement and anatomic location of the lesion on the upper medial thigh are supportive of secondary skin disease. Unless negated by a reliable history, the following features are indicative of secondary disease: inflammation centered in deep dermis or subcutaneous fat, lesion on covered parts of body, and multifocal skin lesions. Some cases remain unclassifiable. In practice the distinction between primary and secondary cutaneous cryptococcal disease is not essential because less toxic, effective antifungal drugs are now available.
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10/11. necrolytic migratory erythema: a report of three cases.

    necrolytic migratory erythema (NME) is a cutaneous reaction pattern with specific histopathologic features that is typically associated with a functioning pancreatic islet cell neoplasm such as a glucagonoma. Three examples of NME, each associated with a different cause, are presented: glucagonoma, pancreatic insufficiency, and gluten-sensitive enteropathy. All three patients were successfully treated by surgical resection of the pancreatic tumor, total parenteral nutrition and pancreatic enzyme replacement, or a strict gluten-free diet, respectively. All remain free of skin disease more than 2 years later. Any patient with NME should be evaluated for glucagonoma and small bowel disease that may be associated with malabsorption and malnutrition.
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