IMPACT OF CARRIAGE OF 4G/5G PAI-1 AND GLYCOPROTEIN IIB/IIIA POLYMORPHISM ON DEVELOPMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A PATIENT WITH PSORIASIS VULGARIS. Clinical Case.

Psoriasis vulgaris represents a chronic immune-inflammatory condition that besides skin and joints, also affects many other tissues and organs. Recent advances in psoriatic research highlighted that psoriatic patients are at higher risk to develop the chronic obstructive pulmonary disease (COPD). We report a case of a Caucasian man of 62 years’ age with plaque psoriasis diagnosed more than 20 years who developed psoriasis specific comorbidities: COPD in 2005 and later in 2006 arterial hypertension and ischemic cardiomyopathy disease. The patient’s blood parameters were specific for psoriasis and metabolic syndrome with high total cholesterol 6.13 mmol/L, high triglycerides 2.37 mmol/L, high LDL 4.7 mmol/L, low HDL-cholesterol 0.79 mmol/L. Enzyme-linked immunosorbent assay (ELISA) analysis demonstrated elevated serum plasminogen activator inhibitor 1 (PAI-1) levels – 63.21 ng/ml (ref.5-40 ng/mL). The DNA analysis revealed a carriage of heterozygous polymorphism in PAI-1 4G/5G and a carriage of heterozygous polymorphism PlA1/PlA2 in the gene for glycoprotein IIb/IIIa. This case on psoriasis and comorbidity is an example concerning the possible connection of impact of inherited factors with an increased risk of COPD

LUPUS VASCULITIS

Combination between Leucocytoclastic vasculitis and Subacute cutaneous lupus erythematosus has been only rarely reported in the literature. Pathological cutaneous lesions are presented by purpura, erythematous macules, urticarial, nodules and necroses.We present a 58-year-old woman with painful nodular lesions on the left thigh.The disease started in June 2015 with photosensitivity and psoriasiform rashes on the back. Pathological cutaneous changes affected lateral and dorsal surface of the left thigh. It was presented by painful, indurated in base, ulcerative plaques, with unclear borders and necrotic surface. There were no deviations from complete blood count and biochemistry. Immunological investigations revealed elevated levels of MPO(рАNCA) – 1.38 U/ml, antinuclear antibodies (ANA)- 134.1 U/ml, SS-A(Ro) antibodies – 233.7 U/ml CRP- 12.7mg/l. Urine analysis revealed positive protein results.Escherichia coli was isolated from microbiology testing. Histopathological result from ulcerative lesions from the left thigh of the patient revealed necrotizing leukocytoclastic vasculitis. The result from direct immunofluorescence microscopy of lesional skin corresponded to lupus erythematosus.The diagnosis lupus vasculitis was made. Systemic therapy with chloroquine phosphate, methylprednisolone, methotrexate was administered. Topical treatment included proteolytic enzyme in dressings and vacuum therapy with good effect

SERUM-CONCENTRATIONS OF Dehydroepyandrosterone-sulfate IN MEN WITH ANDROGENETIC ALOPECIA

Androgenetic alopecia (AA) is considered as a genetically determinate androgen (DHT)-dependent disorder. Theoretically Dehydroepyandrosterone-sulfate (DHEA-S) is the first main metabolite in the androgen metabolism. The aim of the study was to determine the serum-levels of DHEA-S (DHEA-S(s)) in patients with AA and the possible correlation between clinical stage of AA and DHEA-S(s). Forty-four men (37 with male pattern baldness and 7 healthy controls) aged 19 to 55 had DHEA-S(s) measured. Determination of the hormone was performed by standard radioimmunoassay. Only nine of the men with AA showed high levels of DHEA-S(s). In 3 of the patients were detected a boundary high levels of DHEA-S(s). No correlation between the clinical stage of AA and DHEA-S(s) -levels was established. There was relationship only between increase of the age and decrease of the concentrations of DHEA-S(s). In contrast to previous studies, in our investigation, no elevation of DHEA-S(s) in men with AA was found. Our results indirect support the current understanding of the importance of some follicular enzymes (STS, 3-beta-HSD, 17-beta-HSD etc.) that could increase the amount of the alternative DHT-sources in AA, as well as the theory for the “endocrinology of hair follicle”

FAMILIAL ALOPECIA ARETA, ATOPY AND THYROIDITIS HASHIMOTO

We present a case of morbid association of two organ-specific autoimmune diseases (Alopecia areata-AA and Thyreoiditis Hashimoto-TH) in two white sisters - 23 and 26 years old. There is no family history of AA or any autoimmune disorders. The onset of AA, in the both sisters was in early childhood (3 and 7 years of age). The clinical and laboratory examinations showed engagement of the scalp with round or oval large patches of alopecia, without involvement of the body hairs and nails. There were also alterations of thyroid gland function, positive TMA (Thyroid Microsomal Antibodies) and Rö-data of Pituitary adenoma as well as episodes of allergic rhinitis (in one of the sisters), and bronchial asthma (in the other). According to Ikeda’s classification, they have an "Atopic type" AA. We suppose that the observed case is not an occasional coincidence of AA and TH. HLA Aw32B18 determination could be support our suggesting about the familial pattern of these autoimmune diseases

DIAGNOSTIC POSSIBILITIES OF 3D-COMPUTED TOMOGRAPHY WITH INTRALESIONAL APPLICATION OF CONTRAST MATERIAL IN A CASE OF VERY LARGE RADICULAR MAXILLARY CYST - A CASE REPORT

Introduction: Diagnosis of odontogenic cysts despite their benign nature is a critical and challenging problem. Aim: The aim of this article is to demonstrate a different diagnostic approach in case of very large odontogenic cyst. Materials and Methods: This study was executed on one male patient aged of 38 using 3D computed tomography and contrast material inside the lesion. Differential diagnosis made by the residents was compared to the histopathological examination as the gold standard for identifying the nature of the cysts. Results: This diagnostic approach using 3D computed tomography combined with contrast material injected inside the lesion shows the real borders of the cyst of the maxilla and helps oral surgeon in planning the volume of the surgical intervention. Conclusion: Precise diagnose ensure the possibility of doing the optimal surgical intervention- a precondition for best wound healing

CLINICAL AND EPIDEMIOLOGICAL ANALYSIS ON SYPHILIS AMONG MEN WHO HAVE SEX WITH MEN

Purpose of the study: To investigate demographics, prevalence, risk factors and the different clinical forms and symptoms of syphilis in men who have sex with men (MSM). Material/Methods: 50 MSM with syphilis were registered at the Clinic of Dermatology and Venereology in the city of Pleven, Bulgaria, for the period 2008-2022. The diagnosis was confirmed by serological tests. Patients were distributed by their socio-demographic status. Risk factors and sexual behavior were studied, as well as clinical symptoms and co-morbidities of syphilis. Results: Of 50 MSM patients the most affected is the age between 20-29 years (54%). 34% of them are university graduates, 88% abused alcohol, nicotine and drugs in combination, 70% had sexual contacts with a casual partner, 26% of them had HIV co-infection. Secondary and early latent syphilis are the most common clinical forms of the disease (34%). The typical symptoms of primary and secondary syphilis were clinically manifested, 34% of them are localized in the genital. There is a significant correlation of the clinical form with the localization of the skin-mucosal lesions (p < 0.001). Antibiotic therapy is effective and leads to negative serological test results by the end of the second year of treatment. Conclusions: For 15 years (2008-2022), the number of registered MSM with syphilis in the Clinic of Dermatology and Venereology in Pleven increased after 2016 especialy in the time of the COVID-19 pandemic. Our results are close to the published data on the problem in the scientific literature for the last 10 years

EPIDERMOLYSIS BULLOSA SIMPLEX DOWLING-MEARA - A case report

A case with Epidermolysis bullosa simplex Dowling-Meara is presented. It concerns a 20 days breast-fed girl with severe blistering and erosions on the skin formed at birth after minor mechanical trauma. There are no other affected relatives. A medical examination showed normal somatic and visceral status. There were multiple herpetiform grouped bullous and erosive lesions on the face, trunk, upper and lower limbs, palms and soles. The mucous membranes were not affected. There was also a marked nail dystrophy on the fingers and toenails. The electron microscopic examination revealed cytolysis of the basal keratinocytes with clumping of the perinuclear tonofilaments in the lesional skin. Because of the clinical features and the results of the electron microscopic examination of the skin the case here reported should be considered as an Epidermolysis bullosa simplex Dowling-Meara. The child is followed up to the age of three. The course of the disease was benign with a decreased formation of blisters and erosions. The marked nail dystrophy was persistent. There was palmar and plantar hyperkeratosis. The child’s growth, neural and psychic development wsas normal. The early diagnosis of the bullous epidermolysis is helpful in the prognostic assessment of the disease and in the medical and genetic advice for the parents

CASE OF ALOPECIA AREATA ORIGINATED FROM DENTAL FOCUS.

For many years the oral infection, especially periodontitis, is considered as a potential contributing factor to a variety of clinically important systemic diseases. Alopecia areata (AA) is an autoimmune disease with unclear etiology and pathogenesis, rarely associated with dental foci. This disease has a strong psychological impact on the patient, because it presents with hair loss and can affect any hair-bearing area, but usually involves the face and scalp, where esthetic considerations play an important role in self perception. In this article is presented a case of alopecia areata resulting from dental foci that was effectively resolved by eliminating a focalized dental infection via dental extraction. In this sense, patients with AA should be subjected to careful exploration of the oral cavity in search of possible dental infections. Close collaboration between dentist, dermatologist, endocrinologist and other medical specialists in the interdisciplinary approach of diagnosis and treatment is needed

HERPES GESTATIONIS.

Herpes gestationis, also known as pemphigoidgestationis (PG) is an extremely rare autoimmune bullous dermatosis of the gestation and postpartum period. The disease was originally named herpes gestationis on the basis of the morphological herpetiform feature of the blisters. We report a 21-year-old woman, pregnant in the third trimester, who presented with a pruritic bullous cutaneous eruption of two weeks duration. The disease started with a red plaque in the abdominal area accompanied by mild itching. Soonafter, blisters appeared and affected almost the entire body. Physical examination revealed a primiparous woman in good general state, pregnant in 36 weeks of gestation. The skin changes affected the abdomen, back of the trunk, upper and lower extremities, hands and feet. They were manifested by a polymorphous eruption, consisting of erythematous urticaria-like plaques, small tense vesicles and multiple excoriations. Mucous membranes were not affected. Routine laboratory examinations were within normal limits. Direct immunofluorescence (DIF) on perilesional skin showed linear deposition of IgG (++) and C3 (++) at the cutaneous basement membrane zone (BMZ). Indirect immunofluorescence (IIF) on human esophagus substrate revealed circulating IgG anti-BMZ antibodies at a titer of 1:80. ELISABP180 NC16A was strongly positive. The diagnosis of PG was confirmed and a treatment with systemic methylprednisolone 60 mg/day was initiated, later gradually tapered to 20 mg/day, together with topical corticosteroids. As a result on the 10th day of the treatment we already achieved significant improvement with reduction of erythema and itching, absence of new skin lesions. The pregnancy ended in term with successful childbirth. No flare of the skin disease was observed in the puerperal period