Two children with skin rash and muscle weakness: juvenile dermatomyositis

Two girls aged 1.5 and 3 years, presented with a skin rash, loss of proximal muscle power and malaise. The younger girl recovered quickly after a short course of corticosteroids but the elder girl proved more difficult to treat effectively with corticosteroids, methotrexate, ciclosporin, intravenous immunoglobulins and hydroxychloroquine. This combination of symptoms should make one consider the diagnosis of juvenile dermatomyositis (JDM). To make the diagnosis of JDM, a characteristic skin rash, proximal muscle weakness, elevated muscle enzymes and, possibly, an abnormal EMG or muscle biopsy should be present. Treatment consists, of steroids and, if necessary, immunosuppressive agents or intravenous immunoglobulins. If cutaneous lesions are serious or persistent, hydroxychloroquine may also be prescribed.     

环境因素致皮肤过敏与支气管哮喘发病之间关系的分析

目的　为了评价常见环境因素致皮肤过敏对支气管哮喘的影响 ,探讨哮喘的病因。方法　在收集某地区 5 91例支气管哮喘病例的基础上 ,对哮喘患者家系的共 2 4 83位成员逐一询问调查并进行皮肤过敏试验。用EPI5 0 1和SAS6 12程序软件进行资料的处理分析 ,主要计算优势比 (OR值 )等指标。结果　哮喘患者家系亲属的患病率为 14 6 % ,并且有随年龄增加而增加的趋势。皮试阳性率为 30 0 % ,其中 ,皮肤红疹阳性为 4 1 5 % ,而皮肤红斑阳性率为 9 6 %。皮试阳性、皮肤红疹和皮肤红斑均增加患哮喘的危险性 ,其优势比 (OR值 )分别为 1 4 6、1 83和 2 0 5 ,且均有高度显著性意义 (P <0 0 1)。结论　对环境中过敏原产生皮肤过敏者患哮喘的危险性增加 ,环境中过敏原是哮喘重要的危险因素之一。     

Drug rash with eosinophilia and systemic symptoms (DRESS) attributed to the oral skin-care supplement Imedeen

In a 56-year-old woman, 'drug rash with eosinophilia and systemic symptoms' (DRESS) was diagnosed. She had been admitted to hospital twice in two months because of fever and skin rash. Further studies revealed that in addition to the skin rash, the woman also suffered from eosinophilia, lymphadenopathy and a temporary liver-function disorder. After infectious and malignant causes had been excluded, the DRESS syndrome was diagnosed. The syndrome was attributed to the oral skin-care supplement Imedeen. She had stopped using this preparation previously, after which the symptoms decreased markedly. Now she was treated with corticosteroids and methotrexate and recovered completely after almost four months. The DRESS syndrome is characterised by skin rash, fever, lymphadenopathy and haematological abnormalities, especially eosinophilia and/or atypical lymphocytosis. Single or multiple organ involvement, especially of the liver, kidney, lungs and/or heart, is also common. The syndrome is associated with a number of different drugs.     

The ampicillin rash as a diagnostic and management problem: case reports and literature review.

Ampicillin is the most commonly prescribed antibiotic in the United States, and causes skin reactions in five to ten percent of patient populations. These reactions are considerably more frequent in patients with a viral illness, infectious mononucleosis, and lymphocytic leukemia. Skin reactions to ampicillin are usually of two types: a maculopapular rash in about two thirds of cases, and urticaria in about one third of cases. There is strong evidence that the maculopapular rash is a benign, nonallergic phenomenon. Patients with the maculopapular ampicillin rash are often incorrectly labeled as allergic to ampicillin/penicillin. Ampicillin can be continued and administered again in the future in these patients, and this kind of skin reaction resolves spontaneously in a few days without sequelae. Skin tests are neither required nor recommended to document the nonallergic basis of the maculopapular ampicillin rash.     

活性银离子抗菌液Ⅲ型治疗手足口病皮疹的护理

目的探讨活性银离子抗菌液Ⅲ型(银耳通)治疗手足口病皮疹的护理效果。方法将78例手足口病皮疹患儿随机分为观察组和对照组各39例,在保持皮肤清洁的基础上,对照组采用炉甘石洗剂涂于皮疹部位;观察组采用活性银离子抗菌液Ⅲ型(银耳通)喷于皮疹处。两组均每日使用3～5次,连续使用3 d,观察比较两组疗效。结果两组手足口病患儿皮疹治疗效果比较,观察组疗效明显优于对照组,差异有统计学意义,p<0.05。结论活性银离子抗菌液Ⅲ型(银耳通)应用于治疗手足口病皮疹,有消肿、止痒、减轻患儿不适的作用,可有效促进受损皮肤愈合。     

气道高反应性与皮肤过敏反应之间关系分析

为了探讨气道高反应性与皮肤过敏反应之间关系 ,依据哮喘患者作为指示病例确定了 30 0 0个哮喘核心家系 ,对各家系的每位成员逐一询问调查、测定气道反应性和进行皮肤过敏试验。主要计算优势比(or值 )等指标。 1 2 51 6位哮喘核心家系亲属皮肤过敏实验的结果表明 :1 2 5 %的人皮斑阳性 ,而出现皮疹阳性的人占 51 3 %。且男性高于女性、低年龄组 (≤ 35岁 )高于高年龄组 (>35岁 ) ,其差别均有高度显著性 (P<0 0 1 )。哮喘家系中有 1 1 9%的人气道反应阳性 ,其中皮斑阳性与皮疹阳性人群出现气道高反应性分别为1 5 5 %和 1 2 7%。皮斑阳性与皮疹阳性者的气道高反应性发生的危险性均较高 ,OR值分别为 1 1 7和 1 44(P <0 0 1 )。并随着引起皮斑阳性或皮疹阳性过敏原的增多而出现气道高反应性的危险性逐渐增大。显示气道高反应性可能与皮肤过敏反应密切相关     

Skin symptoms and work-related skin symptoms among grape farmers in Crete, Greece

BACKGROUND: Grape farmers are exposed to a variety of agents capable of inducing occupational skin disease. We conducted a study to measure the prevalence of skin symptoms and work-related skin symptoms among grape farmers in the Malevisi region of Crete and to provide data on associated risk factors. METHODS: One hundred twenty grape farmers and 100 controls participated in the study. The protocol consisted of a questionnaire, skin prick tests for 16 common allergens, and measurement of specific IgE antibodies against 8 allergens. RESULTS: Self-reported itchy rash (OR, 2.31; 95%CI, 1.10-4.84, P<0.05) within the last 12 months, and work-related itchy rash (OR, 4.08; 95%CI, 1.01-20.33, P<0.05) were significantly higher in grape farmers than in controls, after adjusting for age and sex. Sensitization to pollens (OR, 4.20; 95% CI, 1.41-12.82, P<0.01) and allergic rhinitis (OR, 3.06; 95% CI, 1.21-8.28, P<0.05) were found to be significantly associated with self-reported itchy rash in the grape farmers group. CONCLUSIONS: Grape farmers reported skin symptoms more frequently than non-exposed controls, and IgE-mediated sensitization to pollens was found to be significantly associated with the reported symptoms. Further studies are needed to evaluate the impact of specific occupational agents on skin diseases among grape farmers.     

上海市莘庄社区结核病患者药物副反应发生及其危险因素分析

目的 了解上海市莘庄社区结核病患者药物副反应发生现状及其危险因素,为采取相应的干预措施提供参考依据。方法 收集上海市莘庄社区2010年1月1日-2014年12月31日登记的394例结核病患者病历资料和随访信息,分析结核病患者的药物副反应情况及其发生的危险因素。结果 上海市莘庄社区394例新登记结核病患者中,发生药物副反应者82例（20.81%）;82例发生药物副反应的结核病患者中,肝损异常者33例（40.3%）,胃肠道反应者7例（8.5%）,关节肌肉痛者12例（14.6%）,皮疹者23例（28.1%）,视神经损伤者6例（7.3%）,高胆红素血症者1例（1.2%）;多因素非条件logistic回归结果显示,有合并症是上海市莘庄社区结核病患者发生药物副反应的危险因素（OR=2.166,95%CI=1.114~4.212）。结论 上海市莘庄社区结核病患者药物副反应以肝损异常和皮疹为主,有合并症的结核病患者更易发生药物副反应。     

Systemic candidiasis: diagnosis from cutaneous manifestations.

Three patients are described who developed systemic candidiasis. Each had either leukaemia or lymphoma, and developed a similar erythematous maculopapular rash which, in places, was purpuric. In the first patient the nature of the rash was not appreciated during life, but postmortem histology revealed candida within the lesions. In the other two patients, a diagnosis of systemic candidiasis was successfully established by skin biopsy. This paper emphasizes that a maculopapular rash can be relatively characteristic clinical manifestation of systemic candidiasis and that skin biopsy can be diagnostic.     

Dermatomyositis-polymyositis in children

Sixteen cases of dermatomyositis-polymyositis in children (dermatomyositis 15; polymyositis 1) have been reviewed. Proximal muscle weakness with a characteristic skin rash was vital for diagnosis in the majority of children. The positive laboratory tests such as creatine phosphokinase (CPK), electromyography (EMG) and muscle biopsy were helpful but results were normal in some cases even in the acute phase of the illness. All but one had been treated initially with high dose corticosteroids followed by a low dose maintenance for a prolonged period. Two in addition had had cytotoxic agents. Thirteen of the sixteen were currently in remission. In the other three cases, one with polymyositis only, the disease remained active and the two with dermatomyositis died. Only three of the patients were incapacitated by residual fixed contractures and extruding calcinosis. On the whole the prognosis of dermatomyositis is good.     

Green tobacco sickness and skin integrity among migrant Latino farmworkers

BACKGROUND: Green tobacco sickness (GTS) affects approximately one-quarter of tobacco workers. The primary aim of this analysis is to expand existing knowledge of GTS risk factors by delineating the association of measures of skin integrity with the prevalence of GTS among Latino farmworkers. METHODS: Data are from a longitudinal study of skin disease among 304 North Carolina Latino farmworkers conducted in 2005. RESULTS: 18.4% of the farmworkers met the GTS case definition. Self-reported rash increased the odds of having GTS in the bivariate (OR 2.29, 95% CI 1.21, 4.35), and multivariate analyses (OR 3.30, CI 2.17, 5.02). Self-reported itch (OR 3.54, CI 2.38, 5.24) and superficial wounds (OR 2.49, CI 1.15, 5.39) had a significant relationship to GTS in the bivariate analysis. CONCLUSIONS: These analyses extend current knowledge of GTS risk factors to include skin integrity. Farmworkers with rash and other skin conditions can protect these affected skin areas from exposure to the tobacco plant to reduce their risk of GTS.     

儿童紫癜性肾炎的危险因素研究

目的分析儿童过敏性紫癜（HSP）的肾脏受累因素。方法将2007年1月1日～12月31日入住安徽医科大学第一附属医院的212例HSP患儿,分为紫癜性肾炎（HSPN）组和非肾炎组,对性别、年龄、临床表现及实验室检验等因素进行单变量和多变量分析。结果①HSP中96例（45.28%）出现肾脏损害,92.71%HSPN患儿尿检异常发生在起病3个月内;②皮疹症状严重,皮疹3月内反复≥3次,持续性剧烈腹痛及关节受累严重与HSPN发生密切相关,Logistic回归分析具有统计学意义（P〈0.05）。结论HSP中皮疹、关节、胃肠道等肾外症状严重及皮疹短期内反复多次者,易出现肾脏受累,应严密监测并采取积极治疗措施以防止肾损害的发生和进展。     

手足口病患儿两种皮疹护理方法的疗效观察

目的：探讨手足口病患儿有效的皮疹护理方法。方法：将120例有皮肤疱疹、溃疡的手足口病住院患儿随机分成观察组和对照组,分别用两种皮疹护理方法给予皮肤护理。结果：两组患儿皮肤疱疹消退溃疡愈合时间差异有显著性。结论：自制化毒散的皮疹护理方法能迅速缩短疱疹溃疡愈合时间。     

Human Infection with Rickettsia felis, Kenya

To determine the cause of acute febrile illnesses other than malaria in the North Eastern Province, Kenya, we investigated rickettsial infection among patients from Garissa Provincial Hospital for 23 months during 2006–2008. Nucleic acid preparations of serum from 6 (3.7%) of 163 patients were positive for rickettsial DNA as determined by a genus-specific quantitative real-time PCR and were subsequently confirmed by molecular sequencing to be positive for Rickettsia felis. The 6 febrile patients’ symptoms included headache; nausea; and muscle, back, and joint pain. None of the patients had a skin rash.     

济南市手足口病重症病例危险因素的病例对照研究

目的 探讨济南市手足口病重症病例发病的危险因素,为早期识别重症病例,降低手足口病重症病例的发生提供科学依据。 方法 采用病例对照研究方法,病例组为86例手足口病重症病例,对照组为86例手足口病轻症病例,用问卷调查收集病例组和对照组的社会人口学特征、接触史、就诊史、临床症状、实验室诊断等信息,对重症病例危险因素分析采用单因素和多因素非条件logistic回归分析。 结果 单因素结果显示发病到就诊日期、初诊单位类型为村级、患儿出现发热、足部皮疹、口腔疱疹、臀部皮疹、咳嗽、呕吐、有病例接触史、EV71阳性在两组间差异有统计学意义。多因素非条件Logistic回归分析结果显示,患儿出现发热(OR=89.38)、口腔疱疹(OR=22.28)、臀部皮疹(OR=234.81)、呕吐(OR=23.90)、有病例接触史(OR=31.48)和EV71阳性(OR=71.65)是手足口病重症病例发病的危险因素。 结论 早期识别发热、口腔疱疹、臀部皮疹、呕吐等症状的患儿,对降低手足口病重症病例的发生具有一定的参考意义。提高EV71手足口病疫苗的接种率,可降低由EV71导致的重症手足口病病例的发生率。     

Parenteral nutrition hypersensitivity

Total parenteral nutrition (TPN) is widely used. Although mechanical, septic, and metabolic complications are well known, hypersensitivity skin reactions are rare. We describe a 16-year-old boy with Burkitt's lymphoma who developed a urticarial skin rash when treated with TPN and vitamins. The adverse skin reaction was probably caused by the inactive component of excipient, polysorbate.     

A woman with leg cramps and rash

A 68-year-old woman presented with generalized weakness and a rash on her lower extremities. The weakness began one week earlier, shortly after treatment for leg cramps and two days before the rash appeared. She had also had blood-streaked sputum a few days before admission. There was no history of bleeding diathesis, nose bleeding, hematuria, vasculitis, muscle or joint aches, cinchonism, or exposure to tuberculosis. She denied fever, chills, night sweats, leg pain or swelling, chest pain, or abdominal pain.     

重庆市发现1例境外输入猴痘病例

分析上海市长宁区人感染猴痘确诊病例的临床与流行病学特征,探讨其临床特征和流行病学特征。

收集在2023年7月20日—9月30日由上海市长宁区医疗机构发现报告或居住在本区的猴痘病例10例的临床资料,进行流病学个案调查并由就诊医疗机构采集咽拭子、肛拭子和皮疹拭子标本,应用实时荧光定量PCR法进行猴痘病毒核酸检测。应用描述性流行病学分析方法分析病例的流行病学特征。

10例人感染猴痘确诊病例均为青年男性,平均年龄35.4岁,均为男男同性性行为（MSM）人群,无职业聚集性。病例主要临床症状以发热、皮疹、腹股沟淋巴结肿大、肌肉酸痛为主,9例病例出现皮疹,7例出现发热症状。10例病例中出现发热、皮疹、淋巴结肿大、肌肉酸痛者1例;出现发热、皮疹、淋巴结肿大者3例;出现发热、皮疹、全身酸痛者2例;仅出现皮疹者2例;出现发热、皮疹者1例;无症状1人。其中9例出现皮疹的病例出疹部位均为生殖器或肛周,四肢或躯干同时出现皮疹的情况较少。所有病例发病前21 d内均有非固定性伴侣MSM史,末次可疑高危暴露到出现可疑症状的间隔时间为4~10 d,平均间隔时间6.90 d。从出现发热到出疹的间隔时间为0~5 d,平均1.87 d。

人感染猴痘以发热、皮疹及腹股沟淋巴结肿大为主要临床表现;MSM是感染猴痘的高危人群,其感染来源可能与MSM暴露有关,发病早期症状较轻,容易漏诊,同时调查过程中患者存在隐瞒事实的情况,造成疫情防控难度增加。

     

Pharyngitis with necrotising pneumonia caused by Arcanobacterium haemolyticum

A 20-year-old woman developed symptoms of pharyngitis followed by generalised skin rash and pulmonary infiltrates with cavitation. Arcanobacterium haemolyticum was identified in blood culture, which was susceptible to the antibiotics given. After initiating pathogen-directed therapy, the patient recovered completely. A. haemolyticum is a Gram-positive rod that can grow under aerobic and anaerobic conditions. The pathogen causes a characteristic haemolysis when cultured on human blood agar. A. haemolyticum causes pharyngitis and skin rash, particularly in adolescents. If the infection is not treated adequately, progression to more severe infections such as pneumonia, meningitis and sepsis can occur. The treatment of choice is a macrolide antibiotic.