Atypical pyoderma gangrenosum in a patient with osteomyelofibrosis

Dubravka Zivanovic; Srdjan Tanasilovic; Dusan Skiljevic; Maja Tomovic; Andrija Bogdanovic; Sonja Vesic; Ljiljana Medenica

doi:10.2298/vsp0711787z

Atypical pyoderma gangrenosum in a patient with osteomyelofibrosis

Vojnosanitetski pregled ◽

10.2298/vsp0711787z ◽

2007 ◽

Vol 64 (11) ◽

pp. 787-789 ◽

Cited By ~ 4

Author(s):

Dubravka Zivanovic ◽

Srdjan Tanasilovic ◽

Dusan Skiljevic ◽

Maja Tomovic ◽

Andrija Bogdanovic ◽

...

Keyword(s):

Pyoderma Gangrenosum ◽

Clinical Presentation ◽

Myeloproliferative Disorders ◽

Upper Extremities ◽

Minor Trauma ◽

Systemic Steroids ◽

Dorsal Aspect ◽

Skin Malignancy ◽

Underlying Malignancy ◽

A Minor

Background. Atypical forms of pyoderma gangrenosum generally appear on the upper extremities; most frequently they are associated with myeloproliferative disorders, including osteomyelofibrosis. A response to systemic steroids is more pronounced than in classical form. Sometimes it may be the first sign of an underlying malignancy. Case report. We reported a patient with atypical pyoderma gangrenosum developed during the course of a myeloid malignancy - osteomyelofibrosis. The lesions occurred after a minor trauma. Painful blistering plaques, with an elevated, bluish-gray border were located on the dorsal aspect of hands. No skin malignancy was found. The lesions resolved rapidly to systemic steroids. Conclusion. Considering the unusual clinical presentation which makes the diagnosis difficult, as well as the fact that atypical forms of pyoderma gangrenosum can be the first sign of malignancies, especially myeloproliferative ones, recognizing this entity enables timely guiding future investigations toward their prompt detection.

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Rare splenic complications and specific serology: decisive diagnostic tools in two cases of visceral leishmaniasis

Italian Journal of Medicine ◽

10.4081/itjm.2011.274 ◽

2012 ◽

pp. 274-277

Author(s):

Andrea Celestini ◽

Federica Paglia ◽

Orlando Dell’ Unto ◽

Riccardo Guarisco ◽

Claudio Puoti

Keyword(s):

Bone Marrow ◽

Visceral Leishmaniasis ◽

Bone Marrow Biopsy ◽

Clinical Presentation ◽

Splenic Rupture ◽

Splenic Infarction ◽

Diagnostic Tools ◽

Minor Trauma ◽

Vector Borne ◽

A Minor

Introduction: Visceral leishmaniasis (VL) is a major endemic vector-borne disease in Southern Europe. We present two cases of VL, both characterized by splenic complications. Methods and results: Case 1: A 47-year-old female presented with effort angina, hepatosplenomegaly and pancytopenia. The clinical course was complicated by splenic infarction. Although bone marrow biopsy failed to show amastigotes, diagnosis was performed by a fast agglutinating screening test (FAST) and confirmed by a direct agglutinating test (DAT). The patient was treated successfully with AmBisome. Case 2: A 22-year-old male who had undergone a splenectomy to treat splenic rupture related to a minor trauma four months earlier presented with fever, nocturnal sweats and weight loss. The lack of pancytopenia was due to the absence of the spleen. The first biopsy did not identify parasites, but because the FAST had been positive, another bone marrow biopsy was performed, which demonstrated leishmaniasis. This patient was treated with the same schedule of AmBisome infusion. Discussion: 1) The clinical presentation of VL can be atypical, 2) splenic complications can characterize this disease, and 3) specific serology may be an important tool to reach a diagnosis.

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The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine

The Spine Journal ◽

10.1016/j.spinee.2012.10.039 ◽

2013 ◽

Vol 13 (6) ◽

pp. 605-612 ◽

Cited By ~ 31

Author(s):

Nikolaus Aebli ◽

Anina G. Wicki ◽

Tabea B. Rüegg ◽

Nassos Petrou ◽

Heidrun Eisenlohr ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Acute Spinal Cord Injury ◽

Minor Trauma ◽

Cord Injury ◽

A Minor

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Rapidly Spreading Deep Dissecting Hematoma Occurring One Month After A Minor Trauma: A Case Report.

10.21203/rs.3.rs-889457/v2 ◽

2021 ◽

Author(s):

Rémy Hamdan ◽

Narcisse Zwetyenga ◽

Yvan Macheboeuf ◽

Patrick Ray

Keyword(s):

Skin Necrosis ◽

Clinical Signs ◽

International Normalized Ratio ◽

Blood Collection ◽

Minor Trauma ◽

Surgical Emergency ◽

Superficial Skin ◽

Muscle Fascia ◽

The Right ◽

A Minor

Abstract Background: Deep dissecting hematoma (DDH) is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. A delay of several weeks between the appearance of a superficial haematoma following a minor trauma and its sudden decompensation into a rapidly spreading DDH has been scarcely mentioned in the medical literature. Case presentation: We report the admission of a 70-year-old woman under anticoagulation to the emergency department of our hospital for the sudden appearance of a rapidly evolving hematoma one month after a negligible trauma to the right leg. A complete skin examination revealed clinical signs (spontaneous superficial skin haematomas, lacerations, wrinkles, stellate pseudo-scars) of advanced dermatoporosis, especially on the forearms. The initial biological testing disclosed an International Normalized Ratio of 3.15. The clinical aspect of the haematoma, its rapid extension and the cutaneous signs of dermatoporosis on the forearms allowed the diagnosis of DDH. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Due the extent of the lesion and the risk of extended skin necrosis, surgical debridement and hematoma drainage were performed. The operative report confirmed the diagnosis of DDH. Wound healing was obtained spontaneously after three months. Conclusion: DDH is the most serious complication of dermatoporosis. Given its rapid horizontal extension and the risk of skin necrosis it induces, DDH is a medical-surgical emergency and must be diagnosed early. This observation emphasises that in patients with severe dermatoporosis, on the occasion of a Vitamin K Antagonist overdose, a limb-threatening DDH can develop suddenly, even several weeks after a minor impact.

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Posterior Inferior Cerebellar Artery Aneurysm: Subarachnoid Hemorrhage after a Minor Trauma, Fusiform Dissecting Aneurysm, Treatment with a p64 Flow Diverter

The Aneurysm Casebook ◽

10.1007/978-3-319-77827-3_10 ◽

2020 ◽

pp. 1427-1432

Author(s):

Stephan Felber ◽

Ali Daoun

Keyword(s):

Subarachnoid Hemorrhage ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Flow Diverter ◽

Dissecting Aneurysm ◽

Minor Trauma ◽

Aneurysm Treatment ◽

Cerebellar Artery ◽

A Minor

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Detection of chromosome 20q deletions in bone marrow metaphases but not peripheral blood granulocytes in patients with myeloproliferative disorders or myelodysplastic syndromes

Blood ◽

10.1182/blood.v87.4.1561.bloodjournal8741561 ◽

1996 ◽

Vol 87 (4) ◽

pp. 1561-1570 ◽

Cited By ~ 36

Author(s):

FA Asimakopoulos ◽

TL Holloway ◽

EP Nacheva ◽

MA Scott ◽

P Fenaux ◽

...

Keyword(s):

Bone Marrow ◽

Myelodysplastic Syndromes ◽

Peripheral Blood ◽

Myeloproliferative Disorders ◽

Pcr Analysis ◽

Multipotent Progenitors ◽

The Common ◽

Polymerase Chain ◽

A Minor

Myeloproliferative disorders and myelodysplastic syndromes arise in multipotent progenitors and may be associated with chromosomal deletions that can be detected in peripheral blood granulocytes. We present here seven patients with myeloproliferative disorders or myelodysplastic syndromes in whom a deletion of the long arm of chromosome 20 was detectable by G-banding and/or fluorescence in situ hybridization in most or all bone marrow metaphases. However, in each case, microsatellite polymerase chain reaction (PCR) using 15 primer pairs spanning the common deleted region on 20q showed that the deletion was absent from most peripheral blood granulocytes. The human androgen receptor clonality assay was used to show that the vast majority of peripheral blood granulocytes were clonal in all four female patients. This represents the first demonstration that the 20q deletion can arise as a second event in patients with pre-existing clonal granulopoiesis. Microsatellite PCR analysis of whole bone marrow from two patients was consistent with cytogenetic studies, a result that suggests that cytogenetic analysis was not merely selecting for a minor subclone of cells carrying the deletion. Furthermore, in one patient, the deletion was present in both erythroid and granulocyte/monocyte colonies. This implies that the absence of the deletion in most peripheral blood granulocytes did not reflect lineage restriction of the progenitors carrying the deletion but may instead result from other selective influences such as preferential retention/destruction within the bone marrow of granulocytes carrying the deletion.

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Aeromonas hydrophila Survives the Treatment of Posttraumatic Cellulitis in the Shelter of an Obscured Fish-Bone Fragment

Case Reports in Dermatological Medicine ◽

10.1155/2020/6498950 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Areti Ganiatsa ◽

Constantina Gartzonika ◽

Georgios Gaitanis ◽

Paraskevi Voulgari ◽

Stamatina Levidiotou-Stefanou ◽

...

Keyword(s):

Aeromonas Hydrophila ◽

Organic Material ◽

Skin Infection ◽

Fish Meal ◽

Clinical Presentation ◽

Fish Bone ◽

Upper Extremities ◽

Bone Fragment ◽

Fresh Fish ◽

Doxycycline Treatment

Fish bone and/or spine puncture injuries can result in infection of the upper extremities with aquatic bacterial pathogens. Additionally, in such injuries, the inoculation of foreign organic material is frequent and may further complicate the clinical presentation and course of the resulting infection. We describe the case of a 45-year-old female patient with a minimal fish rostrum puncture trauma acquired during preparation of fresh fish meal, which resulted in a galloping hand cellulitis. The alarming clinical presentation and the prompt response of the skin infection to clindamycin obscured the presence of inoculated fish rostrum remnants in the tissue that, three weeks later, gave rise to a foreign body granuloma, from which Aeromonas hydrophila was isolated. Final resolution was achieved with an additional two-week doxycycline treatment. In conclusion, the reported case highlights the potential of the accidentally implanted organic material, as are fish bones, not only to transfer uncommon pathogens but also to offer a sanctuary that favors microbial survival despite antibiotic therapy thus enabling latent or recurrent infections.

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Coexistence of Acral Syringomas and Multiple Trichoepitheliomas on the Face

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2008.08011 ◽

2009 ◽

Vol 13 (3) ◽

pp. 169-171 ◽

Cited By ~ 4

Author(s):

Didem Didar Balci ◽

Esin Atik ◽

Suleyman Altintas

Keyword(s):

Rare Variant ◽

Clinical Picture ◽

Upper Extremities ◽

Dorsal Aspect ◽

First Case ◽

The Face ◽

Inner Aspect

Background: An extremely rare variant of syringoma is an acral form, which affects the upper extremities as an isolated finding. The acral syringomas may also be associated with syringomas on the feet or usual distribution around the eyelids. Of the eight previously documented cases of acral syringomas, all were located on the dorsal aspect of the upper extremities (fingers, hand, wrist, or forearm) dominantly. Objective: We report a 41-year-old woman who presented with multiple flesh-colored to reddish brown papules on the inner aspect of the forearms and many pearly, small papules on the periorbital regions. Results: The clinical picture and histopathology indicated the coexistence of acral syringomas and multiple trichoepitheliomas on the face. Conclusion: To the best of our knowledge, this is the first case of acral syringomas coexisting with multiple trichoepitheliomas.

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