Tocilizumab monotherapy in a patient with rheumatoid arthritis and iatrogenic kaposi sarcoma

Kaposi sarcoma (KS) is a human herpesvirus-8-associated lymphoangioproliferative neoplasm. Both human and viral interleukin-6 (IL-6) proteins seem to drive much of the clinical manifestations of KS, which provides a new target for intervention by using IL-6-neutralizing antibodies. We describe the clinical course of a patient in whom tocilizumab, a monoclonal anti-IL-6 receptor antibody approved for rheumatoid arthritis (RA) treatment, was effective not only in inducing RA remission but was also safe for KS

Iatrogenic Kaposi's Sarcoma : a Retrospective Cohort Study in an Italian Tertiary Care Centre

Aims Kaposi's sarcoma (KS) is a lymphoangioproliferative multicentric disorder. Among its four distinct clinical variants, iatrogenic KS (iKS) typically affects patients who have received immunosuppressant regimens for organ transplants, proliferative disorders, or immune-mediated diseases. The aim of the current study was to examine the characteristics of a cohort of patients with iKS, evaluating the differences in terms of epidemiological and clinical features, management and outcomes between organ transplant recipients (OTR) and patients immunosuppressed for other medical conditions. Materials and methods This retrospective study included, out of 1389 KS patients, 143 patients suffering from iKS being followed in an Italian tertiary care centre from November 1995 to December 2016. Demographic data, clinical features, previous immunosuppressive therapies, management, and outcomes were recorded for each patient. Results We detected iKS in 10.3% of the analysed KS population. The mean age was 71.9 years in non-OTR versus 51.4 years in OTR (P = 0.04). Staging at diagnosis showed a more severe disease in non-OTR than in OTR, with stage IA observed in 33.3% of OTR versus 11.8% of non-OTR (P < 0.001) and stage IVB in 29.1% of non-OTR versus 12.1% of OTR (P = 0.001). Corticosteroids represented the most frequent immunosuppressive drugs at diagnosis in both groups, in conjunction with cyclosporine A in OTR. Immunosuppressant reduction or withdrawal was carried out in 93.9% of OTR versus 63.6% of non-OTR (P < 0.001). Conclusions As corticosteroids and cyclosporine A are the most common iKS-inducing drugs, their reduction or withdrawal, wherever possible, is needed. Differences in disease severity at presentation between OTR and non-OTR may interfere with the choice of management strategy and the consequent outcome

Pemfigo erpetiforme

Der Beitrag beschäftigt sich mit der Geschichte der „Befreiungskriege“ in der longue durée und lenkt den Blick auf ein Vermächtnis, das bislang kaum beachtet wurde. Gemeint ist die Bedeutung, die die Kriege in der Enkulturation der Schüler in Deutschland im 19. Jahrhundert besaßen. Drei Felder werden dabei näher betrachtet: Schulfeiern, Unterricht und Lehrmaterialen wie Schulbücher, Liedersammlungen oder Anthologien. Die Analyse der drei Bereiche in langfristiger Perspektive veranschaulicht erstens, dass die Kriege in Preußen bereits in den 1820er Jahren Eingang in die Schulen fanden, ansonsten aber nur langsam und allmählich in den schulischen Alltag integriert wurden, zweitens, dass trotz nicht zu leugnender Annäherungen weiterhin unterschiedliche Deutungsmuster über die Kriege koexistierten, und drittens, dass die Deutung und Bedeutung der „Befreiungskriege“ in der Schule dem Wandel und der Instabilität der Rahmenbedingungen entsprechend vielfältig und dynamisch waren

Efficacy of a detergent combined with a moisturiser for the treatment of pruritus associated with xerosis in an elderly population affected by Kaposi&apos;s sarcoma

BACKGROUND: Xerosis is common among patients with Kaposi's sarcoma (KS). The aim of our study was to evaluate the efficacy of a detergent containing dihydroavenanthramide D 5% combined with a moisturiser containing 1% of menthol for the treatment of chronic pruritus associated with xerosis in elderly KS patients. METHODS: We conducted a prospective, open-label, intra-individual, right/left comparative study. During the 4-week treatment study, patients used the test products on the right lower limb, and a basic skin cleanser plus basic cream on their left lower limb, in a predefined protocol. A 10 cm Visual Analogue Scale (VAS), the hydration index (HI) of the stratum corneum and the Overall Dry Skin Score (ODSS) were used to assess pruritus and xerosis severity on admission, at 2 and 4 weeks. RESULTS: Thirty patients (24 males, 6 females, mean age: 76.6 \ub1 6.8 years) were enrolled. At the end of 4 weeks, the mean pruritus VAS score declined from 4.2\ub12.2 to 1.7\ub11.4 on the right side, and from 4.2\ub12.2 to 2.3\ub11.5 on the left side. The HI score increased from 25.6\ub115.0 to 46.1\ub112.3 on the right side, and from 26.0\ub115.2 to 35.4\ub112.6 on the left side. Differences between the right and left limbs were significant for VAS score (p=0.0064), HI (p&lt;0.0001) and ODSS values (p=0.0049). There was no adverse reaction to the test products. CONCLUSIONS: Daily use of a detergent containing dihydroavenanthramide D 5% combined with a moisturiser containing 1% of menthol improves chronic pruritus associated with xerosis in elderly adults with KS

Widespread idiopathic pyoderma gangrenosum evolved from ulcerative to vegetative type: a 10-year history with a recent response to infliximab

Pyoderma gangrenosum (PG) is an infrequent neutrophilic dermatosis, which commonly presents with a limited number of ulcerative, pustular, bullous or vegetative lesions associated with an underlying systemic disorder. We report a 34-year-old man with ulcerative PG that was exceptionally widespread and not associated with any other condition. Moreover, it was resistant to steroid treatment and, after prolonged use of ciclosporin, it unexpectedly developed a vegetative pattern, further supporting the hypothesis that the different forms of PG are part of a single clinical spectrum. Finally, dramatic improvement of the condition occurred after treatment with infliximab, an antitumour necrosis factor-alpha monoclonal antibody; however, this produced circulating autoantibodies. Although this has not had any clinical consequence to date, accurate follow-up in patients treated with infliximab is essential to monitor the onset of a possible autoimmune disorder induced by the dru

Reticular erythematous mucinosis occurring in a brother and sister

Reticular erythematous mucinosis (REM) is a rare, primary cutaneous mucinosis clinically characterized by a persistent reticular erythema on the mid chest and mid-upper back, and histologically by a mononuclear cell infiltrate and deposits of mucin in the dermis. To our knowledge, the present report of REM occurring in a Caucasian man and his sister is the first reported case of familial REM. Since a host-specific immune response to unknown antigens may be involved in the pathogenesis of this entity, human leukocyte antigen typing was determined and compared to those reported in autoimmune diseases