Histopathological comparison of pathergy positive and negative areas of newly diagnosed behçet patients

Behçet hastalığı, atak ve remisyonlarla kronik bir seyir izleyen, esas patolojisi hemen her organı ve sistemi tutabilen inflamatuar bir vaskülit tablosudur. Paterji reaksiyonu, hastalık için özgün bir klinik bulgu olup tanı kriterlerinin vazgeçilmez bir elemanıdır. Literatürde yeni tanı Behçet hastalarında negatif paterji testi ile pozitif paterji testinin histopatolojisini karşılaştıran bir çalışma bulunmamaktadır. Çalışmamızda, paterji pozitif ve paterji negatif olan yeni tanı konulan Behçet hastalarımızın, paterji pozitif ve paterji negatif reaksiyon bölgelerinden aldığımız cilt biyopsilerinin histopatolojik bulgularının karşılaştırılması amaçlandı. Behçet hastalığının önemli bir bulgusu olan vaskülitin paterji histopatolojisinde sıklığının araştırılması birincil hedefti. Gereç ve Yöntem Deri ve Zührevi Hastalıkları polikliniğine başvuran ve Uluslararası Çalışma Grubu kriterlerine göre Behçet hastalığı tanısı konulan 42 paterjisi pozitif, 46 paterjisi negatif olan toplam 88 hasta değerlendirmeye alındı. Çalışmada yer alan hastalarının demografik özellikleri, başvuru şikayeti, aile öyküsü, paterji testi pozitiflik oranı ve direkt immünfloresan işleminin sonuçları not edildi. Paterji testi pozitif ve paterji testi negatif olan hastaların histopatolojilerinde vaskülit mi, vaskülopati mi olduğu tespit edildi ve iltihabi reaksiyon histopatolojik şiddetine göre bir ile üç arasında skorlandı. Histopatolojide perivasküler alandaki nötrofil, lenfosit, eozinofil ve mast hücrelerinin sayımı yapılarak yüzde olarak kaydedildi. Bulgular Çalışmaya katılan 88 Behçet hastasının 45'i kadın, 43'ü erkek hastaydı. Olguların yaş ortalaması 30,17±8,65 idi. Paterji testi pozitif 42 hastanın 23'ünde histopatolojik olarak vaskülit saptanırken, paterji testi negatif 46 hastanın 18'inde histopatolojik olarak vaskülit saptandı. Paterji testi pozitif olanlarda histopatolojisinde vaskülit görülme oranı paterji testi negatif olanlara göre istatistiksel olarak anlamlı farklı değildi (p=0,14). Çalışmamızda özellikle erkek cinsiyet ile üveit arasında ilişki sınırda anlamlı ve paterji pozitifliği ile üveit arasında da ilişki anlamlı saptanmamış olmasına rağmen histopatolojide vaskülit görülmesi ile üveit arasında anlamlı ilişki saptandı (p=0,023). Sonuç Paterji fenomeninin Behçet hastalığının tanısını koymada sensitiviteyi artırdığı ve gerçek hastaları yakalamadaki başarısının oldukça yüksek olduğu bilinmektedir. Fakat değerlendirmenin sadece klinik olarak yapılması testin yanlış pozitif veya yanlış negatif yorumlanması riskini doğurmaktadır. Çalışmamızdan yola çıkan sonuçlarla histopatolojinin paterji testinin klinik olarak şüphe oluşturan ve özellikle negatif paterji testi olan olgularda klinik değerlendirmeye katkı sağlayacağını düşünmekteyiz. Belki de paterji testinin gerçek değeri bu yaklaşımla daha iyi anlaşılabilir.Behçet's disease is an inflammatory vasculitis which has a chronic course with attacks and remissions and its main pathology can involve almost every organ and system. Pathergy reaction is a unique clinical finding for the disease and is an indispensable element of the diagnostic criteria. In the literature, there is no study comparing the histopathology of negative pathergy test and positive pathergy test in newly diagnosed Behçet's patients. In our study, we aimed to compare the histopathological findings of skin biopsies obtained from pathergy positive and pathergy negative reaction sites of newly diagnosed Behçet's patients who are patergy positive and patergy negative. The primary goal was to investigate the frequency of vasculitis, which is an important finding of Behçet's disease, in the pathergy histopathology. Materials and Methods A total of 88 patients, 42 of whom were pathergy positive and 46 whom were pathergy negative who were admitted to the outpatient clinic of Skin and Venereal Diseases and diagnosed as Behçet's disease according to the International Study Group criteria were included in the study. Demographic characteristics, presenting complaints, family history, pathergy test positivity rate and results of direct immunofluorescence procedure of the patients included in the study were noted. The histopathology of patients with positive and negative pathergy tests revealed vasculitis or vasculopathy and the inflammatory reaction was scored between one and three according to the histopathological severity. In the histopathology, neutrophils, lymphocytes, eosinophils and mast cells in the perivascular area were counted and recorded as a percentage. Results Of the 88 Behçet patients who participated in the study, 45 were female and 43 were male. The mean age of the cases was 30.17±8.65 years. Vasculitis was detected histopathologically in 23 of 42 patients who were positive for pathergy test and vasculitis was detected histopathologically in 18 of 46 patients who were negative for pathergy test. The rate of vasculitis in histopathology of those who were positive for pathergy test was not statistically different than those of those with negative pathergy test (p=0,14). In our study, although the relationship between male gender and uveitis was significant at the border and the relationship between pathergy positivity and uveitis was not found to be significant, a significant relationship was found between vasculitis and uveitis in histopathology (p=0,023). Conclusion It is known that pathergy phenomenon increases the sensitivity in the diagnosis of Behçet's disease and its success in catching real patients is quite high. However, only clinical evaluation of the test poses the risk of false positive or false negative interpretation of the test. Based on the results of our study, we think that pathergy test of histopathology will contribute to the clinical evaluation in cases with suspicious clinical pathergy test and especially in cases with negative pathergy test. Perhaps the true value of the pathergy test can be better understood with this approach

The Relationship of Hematological Parameters with Metabolic Syndrome in Type 1 and Type 2 Psoriasis

Objective: Psoriasis is a chronic, inflammatory disease with a rate of 2% in the population, with periods of remission and exacerbation. Psoriasis has been accepted as an independent risk factor for cardiovascular diseases and is known to be closely related to metabolic syndrome. It is known that the mean platelet volume (MPV), the platelet distribution width (PDW), the red blood cell distribution width (RDW) levels are parameters predicting systemic inflammation. Studies have found that some of these parameters can be used to predict metabolic syndrome in patients with psoriasis. In the literature, there is no study showing the relationship between the frequency of metabolic syndrome (MS) and hematological parameters by evaluating type 1 and type 2 psoriasis separately. Materials and Methods: A total of 186 participants were included in the study, 93 patients over 18 years of age with psoriasis diagnosed and 93 age and gender equivalent control groups, who applied to the dermatology clinic. Results: While PDW was significantly different between psoriasis and control group, RDW was significantly different in the type 2 psoriasis group compared to the type 1 psoriasis group. Although MPV, RDW, and PDW were higher in the MS groups for both type 1 and type 2 psoriasis groups, and they did not create a statistically significant difference in any of them. Conclusions: This study showed that the frequency of MS and related parameters were different between patients with type 1 and type 2 psoriasis, and we found that type 2 psoriasis was more associated with MS. In addition, we think that among the inflammatory parameters, especially RDW, may be an important marker for type 2 and type 1 psoriasis and comorbidities

A Case of Staphylococcal Scalded Skin Syndrome in a 1-Year Old Boy with Otitis Media

WOS:000449352600003Introduction: Staphylococcal scalded skin syndrome (SSSS), also known as Ritter’s Disease, is a severe disease seen mostly in newborns and children aged 5 years, and the mortality rate might reach to 4% despite an appropriate treatment. Exfoliative toxins cause intraepidermal separation in the stratum granulosum and lead to a condition that is characterized with widespread epidermolysis all over the body and bullae with positive Nikolsky’s sign. SSSS might be fatal due to loss of skin barrier. Immediate initiation of an anti-staphylococcal drug therapy is required for the treatment of this toxin-dependent disease, which is one of the emergencies of dermatology practices. Case Report: A 1-year-old boy was referred to a dermatology clinic from pediatric emergency service with widespread epidermolysis all over the body, including erosion and bullous formation that had been appeared in the inguinal region. SSSS was suspected in this case, and skin biopsy was performed to confirm the diagnosis. He was hospitalized in the Pediatric Infectious Diseases Service, and treatment comprising intravenous administration of (i.v.) vancomycin (40 mg/kg/day) and 3 gIVIG ( intravenous immunoglobulin) was initiated. Conclusion: Staphylococcus aureus, a rather rare agent of otitis media, is remarkable in terms of causing the complication of SSSS, which is very rare. In our case report, we aimed to remark to this rare condition (association of otitis media and SSSS). Keywords: Staphylococcal scalded skin syndrome, Staphylococcus aureus, otitis media

A case of entecavir-associated bullous fixed drug eruption and a review of literature

WOS:000462167400013PubMed ID: 30459136Fixed drug eruption (FDE) is a type of drug reaction characterized by localized erythema, hyperpigmentation, and bullous at the samesite(s), generally observed following every intake of a causative drug. Delayed-type cellular hypersensitivity (Type IVC) is considered toplay a role in FDE etiology. Several antibiotics, barbiturates, oral contraceptives, nonsteroidal anti-inflammatory drugs, laxative-containing phenolphthalein, metronidazole, and quinine are known to be the primary drugs responsible for FDE. Bullous FDE, on the otherhand, is a relatively rare form of FDE. Hepatitis B is a significant worldwide health problem, and entecavir is a common nucleoside(deoxyguanosine) analog used for treating hepatitis B; however, it has various side effects, such as lactic acidosis, myalgia, azotemia,hypophosphatemia, headache, diarrhea, pancreatitis, and neuropathy, and, in rare cases, cutaneous drug eruption. Our aim is to presenta case of entecavir-associated bullous drug reaction, which has not been reported in the literature. Furthermore, we performed a reviewof literature to compile previously reported entecavir-associated drug reactions

Papüler müsinozis: İki olgu sunumu

Papular mucinosis (PM) (lichen myxoedematosus) is a unique, chronic idiopathic disease characterized by lichenoid papules or nodules due todermal mucin deposition and a variable degree of fibrosis. PM is a quite rare disease of unknown etiology, with fewer than one hundred andfifty cases reported. In this paper, we present two cases of PM with no associated monoclonal gammopathy in two male patients aged 75 and38 years, for its rare occurrence in the literature.Papüler müsinozis (PM) (liken miksödematozis) likenoid papüller ve nodüller, dermal müsin birikimi ve değişken derecedeki fibrozis ile karakterizederinin oldukça nadir, kronik ve idiyopatik bir hastalığıdır. PM etiyolojisi bilinmeyen, literatürde yüz elli olgudan daha az bildirilmiş olan, oldukçanadir görülen bir hastalıktır. Literatürde seyrek görülmesi nedeniyle ek bir hastalıkla ilişkili olmayan iki PM olgumuzu sunmak istedik. Burada, 75ve 38 yaşında iki erkek PM’li hasta monoklonal gammopati olmaksızın nadir olarak görüldüğünden dolayı sunulmaktadır

Hirudoterapiye Bağlı Kutanöz Psödolenfoma

Pseudolymphoma, also known as Jessner’s lymphocytic infiltration, is a benign but usually chronic, T-cell infiltrating diseasewith erythematous papules and plaques usually seen on the skin of the face, neck, and back. The use of leech therapy also knownas hirudotherapy has increased in recent years. Here, we report a 52-year-old male patient who had undergone hirudotherapy inhis neck and developed infiltrating plaques after four months. A skin biopsy confirmed the diagnosis of Jessner’s lymphocyticinfiltration. In parallel with the increasing use of hirudotherapy in recent years, the side-effect reports will likely to increase.Indications and contraindications of hirudotherapy, which is being used officially in hospitals, should be taken into consideration.Psödolenfoma diğer adıyla Jessner’in lenfositik infiltrasyonu; genellikle yüz, boyun ve sırtta görülebilen, eritematöz papül veplaklarla seyreden, derinin benign; ancak genellikle kronik, enfiltratif bir T-hücre hastalığıdır. Hirudoterapi olarak da bilinensülüklerle tedavinin kullanımı son yıllarda giderek artmaya başlamıştır. Bu yazıda, dört ay önce boynuna hirudoterapi yaptırmışve sonrasında enfiltratif plaklar gelişmiş 52 yaşında bir erkek olgu bildiriyoruz. Deri biyopsisi ile Jessner’in lenfositik infiltrasyonutanısı doğrulanmıştır. Son yıllarda giderek artan kullanıma paralel olarak hirudoterapinin yan etki bildirimlerinin artacağımuhtemeldir. Hastanelerde de resmi olarak kullanılmaya başlanan hirudoterapinin endikasyonları ve kontrendikasyonları gözönünde tutulmalıdır