Cases reported "Pruritus"

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1/11. Household papular urticaria.

    BACKGROUND: Papular urticaria often occurs after bites of insects such as mosquitoes, sandflies, bed bugs and fleas. Multiple bites and local pruritus are characteristic symptoms. Treatment is usually symptomatic and includes antihistamines and corticosteroids. The reappearance of the symptoms can be prevented by successful control of the parasite. OBJECTIVES: To find the causative agent of papular urticaria in afflicted households with involvement of numerous family members, all in a narrow geographic area. patients: We describe the cases of 20 patients belonging to seven families, who presented to the local primary clinic, suffering from papular urticaria. RESULTS: The cat flea, ctenocephalides felis, was the hematophagous insect responsible for all infestations. The pruritus and the papular urticaria were treated symptomatically with calamine lotion, topical corticosteroids or oral antihistamines. All clinical symptoms disappeared within a few weeks after effective control of the parasites by spraying and fumigating the infested locations. CONCLUSIONS: Thorough investigation--including, at times, environmental inspection--is necessary to reach the rewarding discovery of the etiology of household papular urticaria. This condition may arise in other environments of similar character.
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2/11. What has dry cough in common with pruritus? Treatment of dry cough with paroxetine.

    Distressing persistent dry cough is commonly the consequence of sensitization of the cough reflex. A slight and transient peripheral nociceptive impulse, such as bronchitis, may be perpetuated for weeks because of sensitization of the cough reflex. cough usually can be inhibited by opioids, but some types of cough can be out of opioid control or even be induced by opioids. We describe here a series of 5 patients with dry cough that did not respond to codeine. Because two of these patients also suffered with pruritus, paroxetine was tried. In all patients, cough ceased within hours to days. The only observed adverse effect was sleepiness in the first days of therapy. paroxetine should be investigated as antitussive in cases of opioid-resistant cough. The putative mechanism of action of paroxetine on pruritus and rough is discussed.
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3/11. Insect bite-like reaction associated with mantle cell lymphoma: a report of two cases and review of the literature.

    BACKGROUND: An insect bite-like reaction and exaggerated reactions to insect bites are nonspecific phenomena described primarily in association with chronic lymphocytic leukemia (CLL), but also with other hematological malignancies. Two cases of mantle cell lymphoma (MCL), one associated with an insect bite-like reaction and the other with a true hypersensitivity to mosquito bites, have previously been reported in the English language literature. The pathogenesis of the skin eruption may be related to the release of different cytokines that also trigger an IgE elevation and dermal eosinophils. CASE REPORT: We describe two additional cases of MCL associated with an insect bite-like reaction. One patient had been diagnosed with MCL 4.5 years prior to the appearance of the skin eruption, and in the other patient the skin symptoms preceded the diagnosis of the MCL by 2 years and led to its diagnosis. CONCLUSIONS: Insect bite-like reaction may appear in patients with MCL. It is important to recognize this entity because it may be the presenting sign of MCL.
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4/11. The return of the common bedbug.

    The incidence of skin disease secondary to infestation with the human bedbug, Cimex lectularius, has increased dramatically in the united states and in the United Kingdom. We describe a child with a recurrent pruritic eruption of urticarial, erythematous papules on the face, neck, and extremities. The etiology of her cutaneous lesions was discovered to be a bedbug infestation in the home. The epidemiology, entomology, presentation, and treatment of bedbugs and their bites are discussed.
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5/11. Congenital idiopathic inability to perceive pain: a new syndrome of insensitivity to pain and itch with preserved small fibers.

    Individuals vary widely in their sensitivity to painful stimuli. Some exhibit heightened reactions to pain (hyperpathia), while others show relative indifference. Although multiple factors may be responsible for these differences, varying sensitivities to pain also can be due to underlying differences in nociceptive neurophysiology. We present here the case of an individual with an apparent congenital inability to perceive pain. This patient appears to be different from other reported cases of insensitivity to pain described in the medical literature. He exhibited no evidence of an abnormality of the peripheral or autonomic nervous system and no apparent abnormality of the central nervous system other than isolated deficits in pain and temperature perception. Since pain is a subjective phenomenon, there is no definitive way to assess this patient's reported inability to perceive painful somatic stimulation, but available evidence suggests he has a defect in the supraspinal processing of nociceptive stimuli which renders him insensitive to pain. This raises the possibility of either deficient central nociceptive functioning or aberrant endogenous anti-nociceptive functioning.
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6/11. Multiple pruritic papules from lone star tick larvae bites.

    BACKGROUND: ticks are the second most common vectors of human infectious diseases in the world. In addition to their role as vectors, ticks and their larvae can also produce primary skin manifestations. Infestation by the larvae of ticks is not commonly recognized, with only 3 cases reported in the literature. The presence of multiple lesions and partially burrowed 6-legged tick larvae can present a diagnostic challenge for clinicians. observation: We describe a 51-year-old healthy woman who presented to our clinic with multiple erythematous papules and partially burrowed organisms 5 days after exposure to a wooded area in southern kentucky. She was treated with permethrin cream and the lesions resolved over the following 3 weeks without sequelae. The organism was later identified as the larva of Amblyomma species, the lone star tick. CONCLUSIONS: Multiple pruritic papules can pose a diagnostic challenge. The patient described herein had an unusually large number of pruritic papules as well as tick larvae present on her skin. Recognition of lone star tick larvae as a cause of multiple bites may be helpful in similar cases.
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7/11. Wells' syndrome is a distinctive disease entity and not a histologic diagnosis.

    Wells' syndrome is a distinctive dermatosis clinically resembling acute cellulitis with solid edema; it resolves spontaneously after weeks or months without residues. Recurrences over many years are common. light microscopy is characteristic for the disease, with diffuse tissue eosinophilia and marked edema, fibrinoid "flame figures," and palisading microgranuloma. vasculitis is never found. eosinophilia of the peripheral blood is a frequent feature. Etiology and pathogenesis are unknown, but the disease has been found to be associated with hematologic disorders in several cases, and recurrences can often be related to infections, arthropod bites, drug administration, or surgery. The diagnosis of Wells' syndrome should be based on the typical clinical picture and the course of the disease with its recurrences and histopathology. Flame figures in histologic sections are an important diagnostic feature but not diagnostic per se for the disease because they represent a reaction pattern that can occur in other conditions. A dilution of Wells' syndrome by making flame figures the central criterion of diagnosis and by lumping all flame figure-positive skin reactions together is therefore unjustified.
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8/11. Blisters, pruritus, and fever after bites by the Arabian tick ornithodoros (Alectorobius) muesebecki.

    A biologist was bitten by ornithodoros (Alectorobius) muesebecki Hoogstraal, an endemic tick parasite of nesting and resting marine birds on islands in eastern arabia. Irritating bullae developed and for four months he experienced intermittent inflammation and irritation. Two years earlier, after being bitten by the same tick species on a different island, he had experienced only irritation lasting no more than a fortnight. petroleum-industry labourers on another island were admitted to hospital for about two weeks with bullae at numerous bite sites, intense pruritus, headache, and fever. Zirqu virus (bunyaviridae, nairovirus) has been isolated from O. (A.) muesebecki samples from Abu Dhabi. The role of Zirqa virus and/or of salivary toxins in producing irritation and illness, as well as individual sensitivity to the tick and the seasonal dynamics of toxicity or infectivity, should be investigated.
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9/11. Paroxysmal pruritus. Its clinical characterization and a hypothesis of its pathogenesis.

    In dermatologic literature generally, itching, that familiar sensation that evokes a desire to rub or scratch, has been attributed almost without exception to something occurring in the skin: e.g., an insect bite, ringworm, contact dermatitis, urticaria, lymphoma, provocation by bile salts in jaundice. Itching in such instances is almost invariably relieved quite promptly, even if only temporarily, by rubbing or scratching with only moderate vigor, not enough to damage the skin, or at most to damage it only superficially. No one scratches a mosquito bite, hives, ringworm, or even lichen planus to the point of bleeding and scarring. Winkelmann and Muller suggested in 1964, "In rare instances, the itching response does not reside in the skin...but may be analogous to phantom limb sensations." I believe that this is a common phenomenon that is characteristic of several familiar, common skin disorders, that can be readily identified from the patient's history, and that serves to explain some otherwise mysterious clinical features of those disorders; in particular, why they are regularly scratched to the point of oozing, bleeding, scarring, or lichenification.
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10/11. Successful treatment of chronic idiopathic urticaria and angioedema with cimetidine alone.

    We have studied a 50-year-old white man with chronic urticaria and angioedema who has responded to treatment with cimetidine alone for over 2 yr. In a double-blind, placebo-controlled study, cimetidine alone was at least as effective as chlorpheniramine in relief of urticaria and angioedema. Additionally, cimetidine significantly inhibited (p less than 0.01) the wheal response to histamine when it was compared to placebo. The inhibition of wheal response to histamine by cimetidine was significantly higher (p less than 0.05) than chlorpheniramine. The presence of predominantly H2- rather than H1-histamine receptors in the cutaneous blood vessels may be responsible for the therapeutic effects of cimetidine in this patient.
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