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Viral Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Laboratory studies: The diagnosis is typically easy to make clinically because the exanthem is characteristic of erythema infectiosum. If needed, PCR for the virus or serology to detect anti-B19 IgM antibodies can be used to confirm the diagnosis. A skin biopsy is generally not needed.
Epilepsy and exanthema
Published in Dinesh Kumar Jain, Homeopathy, 2022
The pathogenesis of an exanthem may be caused by (1) Multiplication of the pathogen in the skin. (2) Carriage of the agent in plasma or in infected hematopoietic cells (leukocytes and or lymphocytes) into integumentary blood vessels (3) Antigen antibody or delayed hypersensitivity reactions to antigen derived from the infecting microorganisms … Regional multiplication of the virus, primary viremia and visceral dissemination of virus occur prior to the development of the exanthem and explain why the initial clinical manifestations of many viral illnesses occur prior to the development of the rash … In some petechial eruptions direct evidence of viral or bacterial invasion can be obtained by direct aspiration and culture of the lesion, by demonstrating the agent with Gram's stain or by immunofluorescent stain to detect microbial agents. (Corex, 1983, p. 1109)
Drug Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Type IV reactions cause delayed cutaneous eruptions that are usually seen 24 hours or more after the initial exposure to the medication. The most important reaction is a drug-induced exanthem. This often presents as a morbilliform rash starting about 2 weeks after the initial exposure or 24–72 hours after re-exposure to an offending drug and accounts for about 75% of all cutaneous drug reactions. The rash generally resolves following removal of the drug. Type IV reactions are also responsible delayed maculopapular eruptions caused by oral antibiotics such as amoxicillin and sulfonamides. Patch testing may help to identify contact allergens. After avoidance is instituted, topical and/or systemic corticosteroids may be used to treat a contact dermatitis (Fonacier et al. 2015).
Dermatologic adverse events associated with targeted therapies for melanoma
Published in Expert Opinion on Drug Safety, 2022
Luigi Scarpato, Lucia Festino, Vito Vanella, Gabriele Madonna, Massimo Mastroianni, Marco Palla, Paolo Antonio Ascierto
These are skin adverse events mostly related to MEK inhibitors and they represent a different grade of aseptic immune-cell invasion of epidermis and hair follicles that often lead to bacterial suprainfections. The follicular/maculo-papular/acneiform eruption could be considered an evolution of hair follicle immune infiltration and consists of itchy follicles and papules that could evolve into pustules or acneiform eruption. Pustules may lead to crusts and hyperkeratosis. The head, neck, trunk, and proximal upper extremities are the main distribution areas [66]. The morbilliform eruption is characterized by diffuse itching and symmetric eruption of erythematous macules or small papules, mainly involving the trunk and the upper and lower extremities. Grade severity is based on the body surface area (BSA) involved and the degree of limitation in performing daily living activities (ADL) [72]. Maculo-papular exanthem covering 10–30% of BSA with systemic symptoms and lymphadenopathy can be treated with topical emollients, oral antihistamines and medium-to-high strength topical corticosteroids. Sometimes it is possible to add prednisone (or equivalent) 0.5–1 mg/kg when tapered over at least 4 weeks. The mucosal involvement with mucous membrane detachment warrants a burn consultation with attention to supportive care including fluid and electrolyte, and administration of a methylprednisolone (or equivalent) i.v. 0,5–1 mg/kg converting to oral corticosteroids on response. The use of immunosuppressants should be considered in the case of steroid resistance.
Spotted fever diagnosis: Experience from a South Indian center
Published in Pathogens and Global Health, 2021
Elangovan D, Perumalla S, Gunasekaran K, Rose W, Verghese V p, Abhilash K Pp, Prakash Jaj, Dumler Js
This prospective study was undertaken in the Department of Clinical Microbiology, Christian Medical College, Vellore from December 2017 to May 2019. Following Ethics Committee clearance (IRB min No. 11013 dated 4 December 2017), eligible individuals were consented into the study. The study population included individuals of either sex and any age with acute undifferentiated fever (without localizing signs) of ≤15 days’ duration and rash whose samples were sent for spotted fever Rickettsia serology. Exclusion criteria included those with malaria, sepsis, enteric fever, drug-induced rashes, pustular rashes, viral exanthem or enanthem. Individuals with drug rash, pustular rashes, viral exanthems and enanthems were excluded by the physicians using detailed history and physical examination. Malaria was ruled out by testing three consecutive EDTA blood specimens by quantitative buffy coat (QBC venous tube, Tosoh India Pvt Ltd, Thane, India). Automated blood culture system (BacT/Alert, bioMerieux, Durham, NC, USA) was used to exclude enteric fever and septicemia (minimum one set of two bottles each). ELISA to detect NS1 Antigen, IgM and IgG antibodies (J. Mitra & Co. Pvt. Ltd., New Delhi, India) was performed to exclude dengue.
Painful purpura from intravascular large B-cell lymphoma cutaneous variant
Published in Baylor University Medical Center Proceedings, 2021
Rosalyn Ortiz-Manso, Kelvin Soewono, Hao Nguyen
One week after being discharged from his second hospitalization, he presented to the same hospital with new onset of a painful purpuric rash on his upper and lower extremities. His only new medication was trimethoprim/sulfamethoxazole for Pneumocystis jiroveci prophylaxis since he was on chronic steroids for panhypopituitarism. Physical examination showed pitting edema of the abdomen and bilateral lower extremities. Painful purpuric exanthem (Figure 1a–c) was seen on the upper and lower extremities. His purpuric rash enlarged and formed bullae and some skin sloughing (Figure 1d–f) during his hospitalization. A skin biopsy showed clonal lymphocytes in the lumina of blood vessels with an increased nuclear-to-cytoplasmic ratio, prominent nuclei, and multiple mitotic figures. Combined with the immunohistochemical stains for CD20, these findings confirmed a diagnosis of IVLBCL.