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Generalized perforating granuloma annulare associated with latent tuberculosis successfully treated with isoniazid: case report and review
Generalized perforating granuloma annulare (GPGA) is a very rare form of granuloma annulare, with only 31 reported cases to the best of our knowledge. Furthermore, GPGA is a chronic disease that mimics many diseases, with no known exact etiology, resulting in a lack of specific clinical criteria leading to a lack of guidelines for diagnosis and therapy. In GPGA, papules are the predominant lesions followed by central crusting/scaling or umbilication; pustules, plaques, annular lesions or nodules are less frequent. We report a 66-year-old woman who presented with a 7-month history of mostly asymptomatic generalized infiltrated, flesh-colored to red-brown umbilicated or crusted papules. Histopathological findings were compatible with perforating granuloma annulare. Diagnostic workup revealed latent tuberculosis. To the best of our knowledge, this is the second published case of GPGA associated with latent tuberculosis and the first one that was successfully treated by isoniazid monotherapy. From our case we can speculate and support the theory that GPGA is a phenotypic granulomatous response to multiple etiologies and/or antigenic stimulation and that testing for tuberculosis should be seriously considered in the evaluation of patients with GPGA
Relaxant Effect of the Ethanol Extract of Helichrysum plicatum (Asteraceae) on Isolated Rat Ileum Contractions
Helichrysum plicatum (Turkish Helichrysum) has been used in folk medicine for the treatment of gastric and hepatic disorders. The aim of the present study was to examine the relaxant activity of an extract of H. plicatum flowers on isolated rat ileum. Segments of ileum of rats were suspended in an organ bath. Cumulative concentrations of H. plicatum ethanol extract induced a relaxant effect on spontaneous rat ileum contractions. H. plicatum extract caused a mean contractile response of 81.68 ± 6.17% (at a dose of 0.01 mg/mL) and 30.08 ± 9.07% (at a dose of 1 mg/mL). A similar effect was observed with papaverine (0.01–3 μg/mL). H. plicatum extract (0.01–1 mg/mL) relaxed high K+ (80 mM) precontractions, an effect similar to that caused by papaverine (0.01–3 μg/mL). The plant extract (0.03–0.3 mg/mL) also induced a significant depression of the cumulative concentration response curve for acetylcholine (5–1500 nM) (p < 0.01). Atropine (140 nM) abolished the acetylcholine effect. The extract (0.03–0.3 mg/mL) reduced the histamine (1–300 nM) and BaCl2 (3–900 μM) induced contractions (p < 0.01). Our results showed the relaxant effect of the ethanol extract of Helichrysum plicatum flowers on the isolated rat intestine Extract of H. plicatum can inhibit the spontaneous ileum contractions and contractions induced by acetylcholine, histamine, barium and potassium ions