Herpes simplex virus infection in a hyper-IgE patient: appearance of unusual mass lesions

A 7-year-old girl presented with large soft masses rising from the nostril and from behind the ear. She had previously been diagnosed as suffering from hyper-IgE syndrome. The presence of herpes simplex virus infection within these lesions was confirmed by biopsy and immunohistochemical studies. The mass lesions did not respond to antibacterial therapy with cefazolin, but improved promptly under antiviral therapy with acyclovir. Immunological studies revealed a mild decrease in the CD4 cell population. Based on our results and on the relevant literature we propose an immunological mechanism for this unique manifestation of herpes simplex virus infection in hyper-IgE syndrome.     

Principal inpatient diagnostic cost group model for Medicare risk adjustment

The Balanced Budget Act (BBA) of 1997 required HCFA to implement health-status-based risk adjustment for Medicare capitation payments for managed care plans by January 1, 2000. In support of this mandate, HCFA has been collecting inpatient encounter data from health plans since 1997. These data include diagnoses and other information that can be used to identify chronic medical problems that contribute to higher costs, so that health plans can be paid more when they care for sicker patients. In this article, the authors describe the risk-adjustment model HCFA is implementing in the year 2000, known as the Principal Inpatient Diagnostic Cost Group (PIPDCG) model.     

Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone

Background

Aquagenic pruritus is an intense prickling sensation that develops in affected individuals immediately after contact with water at any temperature. It is most commonly associated with polycythemia rubra vera. Common but often ineffective treatments include anticholinergics and antihistamines. Other moderately successful treatments include capsaicin cream, UVB phototherapy, and sodium bicarbonate bath water.

Objective

In this case report we describe a 55-year-old female with severe itching following showers. Underlying causes were ruled out with a series of blood tests, a chest X-ray, and serum protein electrophoresis. After multiple treatment failures, her itching was relieved with naltrexone.

Conclusion

Endogenous opiates, like naltrexone, can modify pruritus by influencing the peripheral and central sensation of itch. It has been found to be successful in suppressing the perception of pruritus from many diverse origins including aquagenic pruritus.

Antécédents

Aquagenic pruritus est une sensation intense de picotement qui apparaît immédiatement après le contact avec 1’eau, peu importe sa température. Elle est fréquemment associée à la polycythémie vraie. Les traitements courants, mais souvent inefficaces, comprennent les anticholinergiques et les antihistaminiques. D’autres traitements à succès modéré comprennent les crèmes de capsicine, la photothérapie aux rayons UV et les bains au bicarbonate de soude.

Objectifs

Le présent rapport de cas décrit la situation d’une femme âgée de 55 ans qui souffre de démangeaison aiguë après les douches. Une série de prélèvements sanguins, des radiographies pulmonaires et des électrophorèses des protéines sériques ont permis d’éliminer les causes sous-jacentes possibles. Après l’échec de multiples traitements, sa démangeaison a été soignée grâce au naltrexone.

Conclusion

Les agents endogènes opiacés, tels que naltrexone, peuvent modifier le prurit en agissant sur la sensation centrale et périphérique de démangeaison. Ce traitement semble efficace sur toute sorte de prurit, y compris le prurit lié à 1’eau.     

Exploring the mango-poison ivy connection: the riddle of discriminative plant dermatitis

A relationship between sensitivity to poison oak or poison ivy and mango dermatitis has been suggested by previous publications. The observation that acute allergic contact dermatitis can arise on first exposure to mango in patients who have been sensitized beforehand by contact with other urushiol-containing plants has been documented previously. We report 17 American patients employed in mango picking at a summer camp in Israel, who developed a rash of varying severity. All patients were either in contact with poison ivy/oak in the past or lived in areas where these plants are endemic. None recalled previous contact with mango. In contrast, none of their Israeli companions who had never been exposed to poison ivy/oak developed mango dermatitis. These observations suggest that individuals with known history of poison ivy/oak allergy, or those residing in area where these plants are common, may develop allergic contact dermatitis from mango on first exposure. We hypothesize that previous oral exposure to urushiol in the local Israeli population might establish immune tolerance to these plants.     

Morbidity of Brown Recluse spider bites. Clinical picture, treatment and prognosis.

A retrospective review was made of 35 cases of Brown Recluse spider bites treated during a period of 21 years. The most common location of the bite was on the lower limbs, particularly the thigh. The main systemic manifestations were fever, malaise and maculopapular rash, but there were no cases of hemolysis, coagulopathy, or of renal or neurologic involvement. Signs indicating a poor prognosis appeared to be lymphangitis, generalized maculopapular rash and location of the bite on the thigh or abdomen. Most cases were treated effectively by rest, elevation of the affected part of the body, local cleansing, and prophylactic antibiotics. On the basis of this experience it was concluded that only when lesions show a necrotic area measuring 2 to 3 cm should patients be treated with systemic corticosteroids. In most such cases, administration of corticosteroids for 14-21 days proved sufficient to avoid the need for surgery. Only 5 cases required surgical intervention.