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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A 38-year-old man was burned by a piece of steel while soldering at work. His injury was a 2 × 4 cm partial thickness burn to the left posterior auricle and adjacent scalp. Mafenide acetate twice daily was prescribed because of the burn location over a cartilaginous area. After 2 weeks the patient developed erythema around the burn site. Mafenide acetate and dry dressings were continued with added oral antibiotics to prevent chondritis. Five days later, the patient returned with complaints of marked increase in swelling and tenderness of his left ear. At this time the edema extended down the angle of the jaw onto the lower face and side of the neck. The entire area was quite indurated. There was a considerable amount of watery drainage but no purulence or fluctuance. The patient did not have any adenopathy, he was afebrile, and his white blood cell count was 5900/mm without a left shift. Within 2 days of stopping mafenide acetate there was significant improvement in the amount of erythema and edema. A patch test and a repeat patch test one year later to the mafenide acetate product were positive (5).
Unexplained Fever Associated With Hypersensitivity and Auto-Immune Diseases
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
For Damiani et al. the diagnosis can be supported either by the association of a unique clinical criteria to histopathologic lesions or, if biopsy is not performed, by two distinct chondritis which respond either to corticosteroids or to dapsone.82
Bone and Cartilage
Published in George W. Casarett, Radiation Histopathology: Volume II, 2019
Minor damage to the vasculature or to the cell population in mature bone or cartilage may cause little or no visible change in the matrix at early times after irradiation. Rapid recovery from such damage may prevent even the temporary appearance of secondary effects in regions of the matrix which have a low metabolic rate. Large degrees of vascular damage and secondary degeneration and disappearance of many of the bone or cartilage cells are eventually reflected in gradual changes in the matrix. However for a considerable period of time after irradiation, the difference between viable and nonviable bone or cartilage, aside from the vascular and cellular changes, may consist only of slight differences in staining characteristics and mineralization of the matrix. In time, with persistence or progression of occlusion of the fine vasculature and secondary degeneration and loss of parenchymal cells, the bone matrix shows gradually increasing resorption of osteons (Figure 3), disorganization of structure, porosis, and fibrosis. Analogous effects occur in cartilage in so-called radiation chondritis (Figure 4).
Relapsing polychondritis: state-of-the-art review with three case presentations
Published in Postgraduate Medicine, 2021
Bogna Grygiel-Górniak, Hamza Tariq, Jacob Mitchell, Azad Mohammed, Włodzimierz Samborski
Furthermore, for patients who are corticosteroids dependent or patients unmanageable with high doses of corticosteroids, another treatment line is biologics, which have increasingly been reported over the last ten years. Moulis et al. [9] conducted a national multicentre retrospective study that included patients with RPC who received biologics from 2001 till July 2015 in France. They were treated with TNF inhibitors, tocilizumab, anakinra, rituximab, or abatacept. The dosage of mentioned medications was the same as given to rheumatoid arthritis patients. The biologics’ overall response in the first 6 months was 62.9%, and complete remission was at 19% of patients. Nasal or auricular chondritis responded well to tocilizumab treatment (77.8%). Respiratory manifestations were treated successfully with tocilizumab and TNF inhibitors (100% and 70.8% response, respectively). It was impossible to conclude the best cochlea–vestibular response among biologics since not all patients were exposed to each drug, but the authors suggested that adalimumab seemed promising (75%). Nearly 21% of biologics had to be withdrawn due to adverse drug reactions, exceptionally infectious, and allergic reactions at delivery sites of subcutaneous injection. In summary, biologics may help in refractory RPC patients, but more information and RCTs are required[9].
The benefits of ultrasonography in diagnosing and assessing auricular chondritis, arthritis, and tenosynovitis in a patient with relapsing polychondritis
Published in Modern Rheumatology Case Reports, 2019
Satoshi Shinohara, Koji Sakamoto
We herein reported the US findings for RP auricular chondritis, arthritis, and tenosynovitis at the early stage, based on our RP patient. When performing US, the following points should be kept in mind. (1) Approaches from the front and from the rear are advantageous for analysing the anthelix and concha auriculae, respectively. (2) As the auricle is sandwiched between air layers, it is important not to regard the virtual image as the real image. (3) Subcutaneous tissue of RP auricular chondritis with reduced echogenicity should be distinguished from anechoic cartilage. (4) PD signals for RP auricular chondritis are located in the subcutaneous tissue, but not in the cartilage, at least in the early stage. (5) Tenosynovitis in RP may occur commonly when evaluating musculoskeletal manifestations of RP by US. The US findings for RP chondritis in the advanced stage or end stage (floppy ear) are unknown. Therefore, accumulation of further US findings for RP is required.
A case of relapsing polychondritis localized to the laryngeal cartilage in which FDG-PET/CT was helpful for diagnosis
Published in Scandinavian Journal of Rheumatology, 2023
D Nakatsubo, Y Maeda, K Hosokawa, S Kawada, M Okamoto, H Shimagami, T Tada, H Kiyokawa, K Sato, S Tahara, E Morii, M Narazaki, A Kumanogoh
A 25-year-old woman developed hoarseness 6 years prior to presentation. Computed tomography showed calcification of the laryngeal cartilage, but the cause could not be identified. She was referred to our department owing to a lack of improvement in the hoarseness and progression of calcification of the laryngeal cartilage. Laryngoscopy revealed shortening of the anterior–posterior diameter of the vocal folds, with no swelling or mass, and no limitation of movement. There was no fever or wheezing, and no abnormalities were noted in the auricles, nose, eyes, or skin. There were no complications of inner ear disorder, cardiovascular damage, arthritis, or peripheral neuropathy. Blood tests showed no abnormal findings other than a mild elevation of C-reactive protein (0.42 mg/dL), and the results of anti-type II collagen (CII) antibody testing were negative. Contrast-enhanced magnetic resonance imaging revealed mild thickening of bilateral arytenoid cartilages with contrast effect (Figure 1A). FDG-PET was repeated and showed hyperaccumulation of FDG at the same site; however, there were no other hyperaccumulation sites suspicious for active inflammation (Figure 1B, C). Laryngeal chondritis was suspected, and biopsy of the site of inflammation was considered. However, biopsy of the arytenoid cartilage was considered invasive because it required general anaesthesia with tracheostomy. Therefore, biopsy of the thyroid cartilage was obtained because this cartilage showed calcification that was suspected as secondary to chronic inflammation. This approach was less invasive and was performed under local anaesthesia. Histological examination revealed inflammation and degeneration of the cartilage (Figure 1D). Damiani and Levine’s diagnostic criteria were fulfilled (1), and the patient was diagnosed with RP. Oral prednisolone (0.5 mg/kg/day) was started, with normalization of C-reactive protein concentrations and improvement in hoarseness within 1 month. The lesions have been followed up with laryngoscopy without progression for 6 months.