(41/116) Acute hemorrhagic edema of infancy: a case report.
Acute hemorrhagic edema of infancy is a cutaneous leukocytoclastic vasculitis, clinically characterized by the acute development of peripheral edema and targetoid purpuric lesions on the face and extremities. The clinical picture has a violent onset with a short benign course followed by spontaneous complete recovery. We describe a five-month-old boy with acute hemorrhagic edema, in whom the disease appeared after antibiotic treatment for a cellulitis in front of the tragus. (+info)
(42/116) Cutaneous vasculitis as a presenting feature of multiple myeloma: a report of 2 cases.
We report two male patients who presented with symmetrical, painful purpura that evolved into bullae and necrotic ulcers, predominantly on the extremities, over two months in spite of conventional therapy including oral steroids. Examination showed livedoid and purpuric patches with necrotic centers in starburst pattern over the extremities and buttocks. The first case also had similar lesions over the ears. The clinical presentation and the histopathological examination suggested a diagnosis of necrotizing leukocytoclastic vasculitis (LCV). Blood testing ruled out connective tissue disease, hepatitis B or C infection or streptococcal infection as underlying cause of vasculitis. Serum antinuclear factor, antineutrophilic cytoplasmic antibody and anticardiolipin anticoagulant were negative in both cases. Cryoglobulins were positive in case 2. An incidental finding was raised serum proteins and globulins in case 2. Further investigations revealed M band on electrophoresis and features of multiple myeloma on bone marrow biopsy in both cases. These cases emphasize the importance of simple investigations like serum proteins in the evaluation of LCV. (+info)
(43/116) Leukocytoclastic vasculitis after pneumococcal pneumonia in an elderly adult.
Hypersensitivity vasculitis (HSV) has been used to describe several forms of vasculitis of small blood vessels, including Henoch-Schonlein purpura (HSP), mixed cryoglobulinemia, and allergic vasculitis, etc. HSP is a disease occasionally seen in childhood, and is characterized by dermatological and abdominal symptoms. Here, we report a rare case of HSV which showed a clinical course similar to HSP after pneumococcal pneumonia in an elderly adult. Generally, Streptococcus pneumoniae is the most common pathogen in adult community-acquired pneumonia. Therefore, it is critical to recognize HSV as one of the important complications after bacterial infection, especially Streptococcus pneumoniae. (+info)
(44/116) Outcome of ANCA-associated primary renal vasculitis in Miyazaki Prefecture.
OBJECT: We examined the prognosis of patients with onset of new primary renal vasculitis (PRV) in Miyazaki Prefecture. PATIENTS AND METHODS: We enrolled and followed-up 56 patients (age, 70.4 +/- 10.9 years, mean +/- SD) with onset of new PRV between January 2000 and December 2004, for a median of 24 months. Patients with PRV were defined according to the EUVAS (European Systemic Vasculitis Study Group) criteria. Outcome and factors predicting unfavorable outcome of death were examined. RESULTS: Among the patients, 25% (n=14) required dialysis therapy immediately at the start of immunosuppressive therapy and of these, renal function recovered in only 3 and 6 died during the first admission. On the other hand, 75% (n=42) did not require immediate dialysis, but 8 patients were introduced to dialysis therapy thereafter. At the end of follow-up, 26 (46%) had survived without dialysis, 10 (18%) were dependent on dialysis and 20 (36%) had died. Infection was the major cause of death (n=11) . The Cox proportional hazards model showed that the presence of lung lesions and immediate dialysis therapy conferred poorer survival rates (HR, 3.32, 95% CI, 1.14 to 9.71; HR 2.73, 95% CI, 1.03 to 7.23, respectively). CONCLUSION: A poor survival rate is independently associated with the presence of lung lesions and advanced renal failure at the start of immunosuppressive therapy in patients with PRV. Half of the deaths were due to infection. Thus, PRV should be identified at an early stage and the treatment protocol should prevent infectious complications. These measures should improve the prognosis of patients with PRV. (+info)
(45/116) Vasculonecrotic reactions in leprosy.
Multibacillary, lepromatous or borderline leprosy patients may present two types of vasculonecrotic reactions: Lucio phenomenon and that associated with erythema nodosum leprosum. Despite they can be distinguished through clinical and histological characteristics; both are often used as synonyms. It is said that leprosy reaction should be properly classified for therapeutic reasons, since it is well known that in Lucio phenomenon there is not a good response to thalidomide. The authors reported two cases of vasculonecrotic phenomena in lepromatous leprosy sharing clinical and histopathological characteristics of both reaction subtypes. The findings may indicate the spectral nature of the reaction phenomena in leprosy and emphasize the importance of the clinic-pathological correlation for proper classification. Our findings may contribute to the understanding of leprosy reactions pathogenesis, broaden the knowledge about their outcome with standard treatment, and provide the scientific background to design better therapeutic strategies for these complications. (+info)
(46/116) Leukocytoclastic vasculitis due to thalidomide in multiple myeloma.
Thalidomide is successfully used in the treatment of multiple myeloma, leprosy and various autoimmune diseases due to its anti-angiogenic, immunomodulatory and anti-inflammatory effects. Thalidomide's most common side effects are constipation, neuropathy, fatigue, sedation, rash, tremor and peripheral edema. We achieved complete response with a 400 mg/day dose thalidomide therapy in a 58-year-old male patient diagnosed with relapsing refractory multiple myeloma. While continuing thalidomide for sustainable response, the therapy was terminated at the ninth month due to development of leukocytoclastic vasculitis. We describe the case and discuss the place of thalidomide in the treatment of multiple myeloma and the rare occurrence of leukocytoclastic vasculitis during thalidomide therapy in multiple myeloma, since only one such case has been reported in the literature thus far. (+info)
(47/116) Brucella peritonitis and leucocytoclastic vasculitis due to Brucella melitensis.
Brucellosis is a multisystemic disease that rarely leads to a fatal outcome. While reticuloendothelial system organs are mostly affected, peritonitis and posthepatitic cirrhosis are also complications of brucellosis, though they are very rare. Brucella spp. can also trigger immunological reactions. We report a case of brucellosis with peritonitis, renal failure and leucocytoclastic vasculitis caused by Brucella melitensis, which led to a fatal outcome. Brucellosis should be considered in the differential diagnosis of vasculitic diseases, especially in endemic areas. (+info)
(48/116) Successful treatment of severe gastrointestinal involvement in adult-onset Henoch-Schonlein purpura.
Henoch-Schonlein purpura is a small vessel vasculitis which is uncommon in adults. The presentations of adult-onset disease are different from those seen in childhood. The commonly-recognised serious gastrointestinal complications of childhood are less well-documented in adults. We report three cases of adult-onset Henoch-Schonlein purpura with severe gastrointestinal involvement. All were men, aged 22, 35 and 42 years, respectively. Two of these patients had evidence of mesenteric ischaemia on computed tomography of the abdomen. All three patients were successfully treated with steroids. (+info)