Acute generalized exanthematous pustulosis with erythema multiforme-like lesions

Acute generalized exanthematous pustulosis (AGEP) resembles generalized pustular psoriasis, but may manifest targetoid lesions, purpura, and blisters in addition to pustules. We describe a case of AGEP with erythema multiforme (EM)-like features in a 35-year-old woman who presented with acute onset of high fever and a strikingly polymorphic eruption consisting of numerous tiny pustules on erythematous bases, marked facial edema, oral and genital erosions, targetoid vesicular and purpuric lesions, pustules in string-of-pearl configuration and ring-like vesicles. The histology revealed, in addition to subcorneal pustules, vacuolar interface dermatitis with involvement of eccrine glands, and microabscesses in pilosebaceous structures. Systemic corticorsteroid and antibiotics were initiated, resulting in rapid resolution without recurrence. Recognition of EM-like lesions on a background of generalized pustular eruption could facilitate the diagnosis of AGEP and the institution of appropriate treatment.     

多形红斑型玫瑰糠疹一例

患者男,56岁,因全身红斑、脱屑10余天于2013年11月11日就诊。皮疹首发于背部,后累及胸腹部、头面、四肢,有轻度痒感。患者发病前1周曾经出现“感冒”症状。在当地医院应用地塞米松10 mg/d、氯雷他定10 mg/d及头孢类抗菌素治疗3 d,效果欠佳。既往身体健康,否认家族有遗传病史,发病前1个月内没有用药史……     

Sarcoidosis presenting as palmar erythema

Sarcoidosis, a multisystem disease of unknown aetiology, is characterized by the formation of non-caseating granulomas which may involve any organ of the body. The commonest sites of predilection are the lungs, skin and lymph nodes. We now report a patient who presented with palmar erythema which on biopsy confirmed the presence of non-caseating granulomas and who responded to systemic corticosteroids. We are unaware of any previous report in the literature of sarcoidosis presenting in this way.     

Lupus erythematosus with antiphospholipid syndrome and erythema multiforme-like lesions

The occurrence of erythema multiforme (EM) in patients with lupus erythematosus (LE) has been described previously as a coincidental association. In contrast, LE with EM-like lesions and a peculiar immunological pattern, including positive rheumatoid factor, antinuclear antibodies and a serum antibody against an extract of human tissues recently recognized as similar to Ro (SSA), constitutes an established entity named Rowell's syndrome. We describe a woman with LE and long-standing widespread vesiculobullous and necrotic haemorrhagic EM-like lesions in combination with Ro (SSA) and scl-70 antibodies and the typical laboratory findings of the antiphospholipid syndrome (APS), namely lupus anticoagulant, anticardiolipin antibodies and prolonged activated partial thromboplastin time. This case could conceivably be consistent with a diagnosis of Rowell's syndrome, if the latter is regarded as a clinicopathological spectrum. However, the coexistence of LE, persistent EM-like disease and incomplete APS may also fulfil the diagnostic criteria for the 'multiple autoimmune syndromes'. We speculate that the laboratory markers of APS play a pivotal part in such an unusual clinical presentation.     

Lupus erythematosus associated with erythema multiforme-like lesions in identical twins

Identical twin sisters are described who developed lupus erythematosus associated with erythema multiforme-like lesions.     

Sarcoidosis presenting as erythema annulare centrifugum

Erythema annulare centrifugum (EAC), a disease belonging to the poorly characterized category of ‘figurate erythemas’, has been associated with a variety of conditions, such as connective tissue diseases, infections, neoplasms and drug reactions. Here we report a case of EAC associated with sarcoidosis, the first case in the literature to our knowledge. EAC was the sole sign of the granulomatous disease process, which was diagnosed by means of appropriate investigations only after the patient reported the sudden resolution of a long-standing sensitization to perfumes and parabens. Steroid treatment for sarcoidosis improved the patient's condition, and restored the allergic response to these substances.     

Sarcoidosis presenting with multiple delled atrophic facial lesions

We describe a patient who presented with multiple atrophic, delled erythematous facial lesions with surface scaling. Skin biopsy revealed a granulomatous histology, and a Kveim test was positive. Similar cutaneous lesions have not been previously reported in sarcoidosis.     

Photosensitive erythema multiforme and erythema multiforme-like polymorphous light eruption

BACKGROUND: Photosensitive erythema multiforme (EM) is a rare disorder. It usually occurs only if a herpes virus infection or ingestion of drugs precedes exposure to sunlight in selected patients. METHODS: We report a 37-year-old man who had recurrent EM eruptions following sun exposures over a period of 20 years. Lesions were prevalently located on exposed skin, but unexposed skin and mucosa of the oropharynx were also affected. The patient had poor tolerance to sunlight and denied having herpes simplex infection or using drugs. RESULTS: Provocative phototest induced clinically and histologically similar lesions at low dose thresholds of UVA (10 J/cm2) and UVB (100 mJ/cm2). CONCLUSION: On the basis of clinical and histological findings and results of phototesting, a diagnosis of photosensitive EM was made. The EM-like variant of polymorphous light eruption is discussed in the differential diagnosis.     

1,2-Ethanedithiol-induced erythema multiforme-like contact dermatitis

Contact dermatitis simulating erythema multiforme can be caused by many allergens. The chemical agent 1,2-ethanedithiol, which serves as a protective group in chemical synthesis, has hitherto only been implicated as an irritant. We report on a 22-year-old female chemistry student who developed widespread erythema multiforme-like lesions after local contact with 1,2-ethanedithiol. Many target lesions were observed bilaterally on her hands, forearms, arms, and on her forehead. One such lesion was histologically compatible with erythema multiforme. The patient had a positive patch test to 1,2-ethanedithiol, whereas none of 30 healthy subjects showed a positive reaction. However, eight of the 30 controls (26.7%) developed irritant reactions to 1,2-ethanedithiol. Cautious handling of the compound is a prudent precaution.     

Psoriatic erythroderma coexisting with erythema multiforme-like lesions induced by retinoids or retinoids combined with an antibiotic: case report

Psoriasis is currently considered a multifactorial disease, which can coexist with many somatic and psychological disorders. We present the case of a 50-year-old woman referred to our department due to erythroderma with concomitant peculiar violaceous, polycyclic lesions most likely induced by medications. Past medical history revealed numerous systemic disorders, including metabolic syndrome, hypertension, cardiac insufficiency, obesity, and depression. Additional examinations and consultations demonstrated dyslipidemia, xanthelasma, incomplete block of the right branch of His bundle, thyreocardiac syndrome, benign adrenal tumor, and delusions. Recently, psoriasis has been intensively studied. We present the case in which erythroderma was most likely triggered by acitretin combined with ceftriaxone. Treatment of many diseases and psychiatric disturbances coexisting with psoriasis is extremely difficult and requires cooperation of various specialists.     

A leukaemic acute lymphoblastic leukaemia presenting with cutaneous lesions

A middle aged female patient presented at a skin clinic with a localized subcutaneous tumour of the chest wall. The skin over this showed purpura. Biopsy of this lesion showed it to be a malignant lymphoid neoplasm of lymphoblastoma type. Aberrant lymphoid cells were noted in the cutaneous blood vessels but examination of the peripheral blood at that time showed no evidence of leukaemia. Three months elapsed before a fall in haemoglobin and platelets was recorded and sternal marrow examination confirmed the diagnosis of acute lymphoblastic leukaemia.