Drug-induced anti-Ro positive subacute cutaneous lupus in a man treated with olmesartan

A 66-year-old man presented to the outpatient dermatology clinic with a chief complaint of a pruritic rash on his upper trunk and proximal upper extremities, which had been present for three weeks. Upon examination, he was found to have an erythematous, annular, and polycyclic eruption on the chest, upper back, and proximal extremities. A clinical diagnosis of subacute cutaneous lupus erythematosus (SCLE) was made. The patient was found to have a positive anti-nuclear antibody (ANA) in a speckled pattern and a positive anti-Ro antibody. A biopsy revealed an interface and lichenoid dermatitis with dermal mucin deposition, consistent with subacute cutaneous lupus erythematosus. The patient reported that he had recently been diagnosed with hypertension and began treatment with olmesartan, a potassium-sparing diuretic that blocks the angiotensin II receptor, commonly used as an antihypertensive or in patients with heart failure. Cutaneous reactions to olmesartan are rare and reported in <1% of patients in post-marketing surveillance. The patient discontinued use of olmesartan and the rash completely resolved within three weeks. To date, there are no other reported cases of drug induced SCLE in patients taking olmesartan to our knowledge

‘The only way is Essex’: Gender, union and mobilisation among fire service control room staff

This contribution to On the Front Line records a dialogue between two female Fire Brigades Union (FBU) representatives in the Essex Emergency Control Room who led industrial action over the imposition of a shift system that stretched their work–life balance to breaking point and constrained their ability to work full-time. Their testimony reveals how male members were mobilised in the interests of predominantly female control staff. Kate and Lynne’s discussion illuminates the interaction of gender and class interests and identities in the union and in the lives of its women members. It provides insight into the efficacy of trade unions for women’s collective action

Estrogen Receptor-Alpha 36 Mediates Mitogenic Antiestrogen Signaling in ER-Negative Breast Cancer Cells

It is prevailingly thought that the antiestrogens tamoxifen and ICI 182, 780 are competitive antagonists of the estrogen-binding site of the estrogen receptor-alpha (ER-α). However, a plethora of evidence demonstrated both antiestrogens exhibit agonist activities in different systems such as activation of the membrane-initiated signaling pathways. The mechanisms by which antiestrogens mediate estrogen-like activities have not been fully established. Previously, a variant of ER-α, EP–α36, has been cloned and showed to mediate membrane-initiated estrogen and antiestrogen signaling in cells only expressing ER-α36. Here, we investigated the molecular mechanisms underlying the antiestrogen signaling in ER-negative breast cancer MDA-MB-231 and MDA-MB-436 cells that express high levels of endogenous ER-α36. We found that the effects of both 4-hydoxytamoxifen (4-OHT) and ICI 182, 780 (ICI) exhibited a non-monotonic, or biphasic dose response curve; antiestrogens at low concentrations, elicited a mitogenic signaling pathway to stimulate cell proliferation while at high concentrations, antiestrogens inhibited cell growth. Antiestrogens at l nM induced the phosphorylation of the Src-Y416 residue, an event to activate Src, while at 5 µM induced Src-Y527 phosphorylation that inactivates Src. Antiestrogens at 1 nM also induced phosphorylation of the MAPK/ERK and activated the Cyclin D1 promoter activity through the Src/EGFR/STAT5 pathways but not at 5 µM. Knock-down of ER-α36 abrogated the biphasic antiestrogen signaling in these cells. Our results thus indicated that ER-α36 mediates biphasic antiestrogen signaling in the ER-negative breast cancer cells and Src functions as a switch of antiestrogen signaling dependent on concentrations of antiestrogens through the EGFR/STAT5 pathway

Multicentric reticulohistiocytosis masquerading as cutaneous connective tissue disease

Multicentric reticulohistiocytosis (MRH) is a rare type of non-Langerhans cell histiocytosis characterized by coral-toned papules with predilection for dorsal surfaces in addition to severe arthropathy. It sometimes proves difficult to differentiate these joint and skin findings clinically from certain rheumatologic diseases, primarily dermatomyositis. Herein, we present an 82-year-old woman who presented with the clinical findings described above and was subsequently diagnosed with MRH after biopsy and review of relevant clinical history. Because about 25% of patients diagnosed with MRH have an underlying occult malignancy, our patient underwent a complete malignancy workup that was negative. She was treated with systemic corticosteroids and methotrexate, which resulted in an improvement of the arthritis and constitutional symptoms. This case demonstrates that in patients with both rheumatologic and dermatologic symptoms, particularly on acral surfaces, MRH must be a diagnostic consideration. Identifying this disease early in its course can prevent negative consequences for the patients, specifically arthritis mutilans and upper airway involvement

Multicentric reticulohistiocytosis masquerading as cutaneous connective tissue disease

Multicentric reticulohistiocytosis (MRH) is a rare type of non-Langerhans cell histiocytosis characterized by coral-toned papules with predilection for dorsal surfaces in addition to severe arthropathy. It sometimes proves difficult to differentiate these joint and skin findings clinically from certain rheumatologic diseases, primarily dermatomyositis. Herein, we present an 82-year-old woman who presented with the clinical findings described above and was subsequently diagnosed with MRH after biopsy and review of relevant clinical history. Because about 25% of patients diagnosed with MRH have an underlying occult malignancy, our patient underwent a complete malignancy workup that was negative. She was treated with systemic corticosteroids and methotrexate, which resulted in an improvement of the arthritis and constitutional symptoms. This case demonstrates that in patients with both rheumatologic and dermatologic symptoms, particularly on acral surfaces, MRH must be a diagnostic consideration. Identifying this disease early in its course can prevent negative consequences for the patients, specifically arthritis mutilans and upper airway involvement

Red crusty plaques in a young man

Pemphigus foliaceus is a superficial blistering disorder characterized by erosions and scaling in a seborrheic distribution. The condition typically occurs in healthy individuals but issues arise from delayed diagnosis. Many cases remain undiagnosed or misdiagnosed due to the lack of awareness of the condition. With use of common diagnostic tools, pemphigus foliaceus can be easily identified and monitored. Histological analysis exhibits "chicken wire" patterning along keratinocytes in the upper epidermis, whereas immunofluorescence study displays subcorneal acantholysis. Pemphigus foliaceus is confirmed via ELISA studies revealing the presence of autoantibodies against desmoglein 1. Once correctly diagnosed, typically the condition is responsive to corticosteroid therapy. However in recalcitrant cases such as in ours, adjunctive immunosuppressive therapy with dapsone or rituximab may be indicated

Drug-induced anti-Ro positive subacute cutaneous lupus in a man treated with olmesartan

A 66-year-old man presented to the outpatient dermatology clinic with a chief complaint of a pruritic rash on his upper trunk and proximal upper extremities, which had been present for three weeks. Upon examination, he was found to have an erythematous, annular, and polycyclic eruption on the chest, upper back, and proximal extremities. A clinical diagnosis of subacute cutaneous lupus erythematosus (SCLE) was made. The patient was found to have a positive anti-nuclear antibody (ANA) in a speckled pattern and a positive anti-Ro antibody. A biopsy revealed an interface and lichenoid dermatitis with dermal mucin deposition, consistent with subacute cutaneous lupus erythematosus. The patient reported that he had recently been diagnosed with hypertension and began treatment with olmesartan, a potassium-sparing diuretic that blocks the angiotensin II receptor, commonly used as an antihypertensive or in patients with heart failure. Cutaneous reactions to olmesartan are rare and reported in <1% of patients in post-marketing surveillance. The patient discontinued use of olmesartan and the rash completely resolved within three weeks. To date, there are no other reported cases of drug induced SCLE in patients taking olmesartan to our knowledge

The application of technology acceptance and diffusion of innovation models in healthcare informatics

There have been many attempts to apply previously developed models of technology acceptance and the diffusion of innovations; however the models have weaknesses in predicting the behaviour of individuals and organisations, particularly within the complex health domain. The insights recent work on these models offer is relevant to health informatics development and innovation and need to be considered in the development of organisational strategies. This paper analyses the merits of several relevant models and explores their potential significance for the success or otherwise of health related Information Technology projects, highlighting their weaknesses in relation to the lack of differentiation between technological and human factors which limit their applicability in practice. © 2013 Fellowship of Postgraduate Medicine