Angio-oedema without hives, IgE and omalizumab

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Alpha-1 Antitrypsin Deficiency Presenting with MPO-ANCA Associated Vasculitis and Aortic Dissection

The combination of alpha-1 antitrypsin (AAT) deficiency, ANCA-vasculitis, and aortic aneurysm has been rarely described in literature. We report an eventually fatal case in a 70-year-old patient who initially presented with giant cell arteritis and ANCA associated glomerulonephritis. Several years later, he presented with aortic dissection due to large vessel vasculitis, raising the suspicion of AAT deficiency, as two first-line relatives had chronic obstructive pulmonary disease, while they never smoked. This diagnosis was confirmed by AAT electrophoresis and immunohistochemistry on a temporal artery biopsy. Considering AAT deficiency in these cases might lead to a more timely diagnosis.

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Recalcitrant hypertrophic herpes genitalis in HIV-infected patient successfully treated with topical imiquimod

Abstract

Herpes Simplex Virus type 2 is the primary cause of genital ulceration worldwide. The presence of atypical features like deep ulcerations, hypertrophic, or pseudotumoural lesions or unusual location can be a marker for co-infection with HIV. These immunocompromised patients are usually resistant to the conventional antiviral treatment. We present a case of an HIV-infected patient with hypertrophic herpes genitalis, refractory to conventional oral antiviral therapy, who was successfully treated with a combination of oral valcyclovir and topical application of 5% imiquimod.

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A refined surgical treatment modality for bromhidrosis: Subcutaneous scissor with micropore

Abstract

Axillary bromhidrosis has a strong negative effect on one's social life. A high success rate and few complications are criteria for a surgical treatment. The objective of this study was to evaluate a new surgical treatment modality for bromhidrosis: subcutaneous scissor with micropore. Twenty patients with bromhidrosis were treated. Patients were placed in a supine position with their treated arms abducted to 110°. After injection of 60 mL of tumescent solution into each axilla, one small incision was made at the middle axillary of the hair-bearing area. The whole hair-bearing skin was undermined at the level of the superficial fat to obtain adequate skin eversion. The flaps were everted to offer full exposure of the apocrine glands, and meticulous excision of each gland was performed. Both sides were punctured with scalpel. The micropore was used for drainage, and whose width was just 3 mm. Finally, the incisions were re-approximated, and bulky compressive dressings were applied to the area for 72 hours. Of the 40 axillae (20 patients), 34 (85.0%) showed excellent results, and six (15.0%) had good results. Malodor was significantly decreased. There were no serious complications. This technique can produce excellent results with a lower complication rate than most other surgical modalities and can be performed without costly equipment.

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Pirfenidone combined with corticosteroids in a patient with systemic lupus erythematosus associated interstitial lung disease

Abstract

A 54-year-old woman (weight 45 kg) presented to our clinic complaining of a dry cough and exertional dyspnea for 1 week. She had been diagnosed with SLE and lupus nephritis at age 52, with manifestations including oral ulcers, lipsotrichia, butterfly erythema, high anti-nuclear antibody titers (with a speckled pattern at a 1:1,000 dilution), positive anti-double stranded DNA, hypocomplementemia C3, and a renal biopsy that indicated type III(A) lupus nephritis. The patient was a non-smoker.

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Purpuric lesion in an immunocompromised patient: a presentation of disseminated strongyloidiasis

Abstract

Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis, a predominantly intestinal nematode that has human as its main reservoir, broadly distributed worldwide. (1,2,3,4,5,6) The presence of periumbilical purpura is a rare clinical found in disseminated cases, with high morbimortality. (1,2,4) Due to the atypical presentation, we report this case.

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Apolipoprotein B: a possible new biomarker for anaphylaxis

There are few published studies describing biochemical markers that correlate with the severity of anaphylactic reactions during oral food challenges or accidental reactions to foods. Identifying patients with increased risk of severe reactions is a priority within the field of anaphylaxis. Previous studies have examined laboratory markers such as specific immunoglobulin E (IgE; to allergenic foods or components thereof), parameters of the basophil activation test, and platelet-activating factor (PAF).

http://ift.tt/2mtKEXO