Papular-purpuric gloves-and-socks syndrome. Presentation of a clinical case

Papular-Purpuric Glove-and-Sock Syndrome is a rare, infectious disease, of viral etiology, characterized by the presence of pruritus, edema and symmetrical erythema, very well defined at the wrists and ankles with a gloves-and-socks distribution. Other areas can be affected, with a moderate erythema appearing in cheeks, elbows, knees, armpits, abdomen, groin, external genitalia, internal face of the thighs and the buttocks. Erosions, small ulcers, enanthema and blisters can be observed in the oral cavity and lips, and less frequently in other mucous membranes. Complications are rare, although they can be severe, 50% of the published cases are related with the Parvovirus B19. Due to its oral involvement stomatologists should be aware of this syndrome in order to carry out a correct diagnosis of the disease.El Síndrome Papular Purpúrico en Guante y Calcetín es un síndrome raro, infeccioso, de etiología, viral que se caracteriza por la presencia de prurito, edema y eritema simétricos, muy bien delimitadas a nivel de las muñecas y de los tobillos con el aspecto en guante y calcetín. Pueden afectarse otras áreas apareciendo un eritema moderado en mejillas, codos, rodillas, axilas, abdomen, ingles, genitales externos, cara interna de muslos y glúteos. En la cavidad oral y labios y menos frecuentemente en otras membranas mucosas se pueden observar erosiones , pequeñas úlceras, enantema y vesículas. Las complicaciones son raras aunque pueden ser severas El 50% de los casos publicados están relacionados con el Parvovirus B19. La afectación oral en este síndrome hace que deba ser conocido por los estomatologos para realizar un correcto diagnostico de esta enfermedad

Study of the Clinical Patterns in Varicella in a Tertiary Hospital at Coastal Karnataka

Context: There are very few studies regarding the clinical patterns and manifestations of a very common viral infection, Varicella, especially from south India. Aims: To study the cutaneous manifestation of Varicella with an emphasis on vaccination status. Settings and Design: Cross sectional study. Methods and Material: A total of 118 patients attending the Dermatology OPD of a private medical college in coastal Karnataka with cutaneous manifestations of varicella were enrolled. Study period was from January 2010 to December 2010. Statistical analysis used: Data was analysed using SPSS version 11.5. Various frequency distribution tables, diagrams and chi square test were used to describe and analyse the data. Results: Majority of the patients were males (62.7%) and 21-30 years was the most common age group involved. There were 74 students, out of which eight were in the preschool group aged between 3-4 years. Most of the patients visited the hospital on the second day after onset of the symptoms. 108(91.5%) patients complained about the presence of various prodromal symptoms. Scalp was the most common (39.8%) site of onset of the rash. Itching was experienced by 76(64.4%) patients. Peak number of cases (35.6%) was seen in the month of January. The cutaneous rash was most commonly (57.7%) distributed over face, scalp, trunk, upper and lower limbs, with predominantly central distribution. Soft palate was the most common site (87%) involved in the oral cavity. Conclusions: A wide variety of combination symptoms with classical cutaneous polymorphic vesicular rash and oral lesions was seen

Comparison of Risk of Recrudescent Fever in Children With Kawasaki Disease Treated With Intravenous Immunoglobulin and Low-Dose vs High-Dose Aspirin

Importance: Timely initiation of intravenous immunoglobulin plus aspirin is necessary for decreasing the risk of recrudescent fever and coronary artery abnormalities in children with Kawasaki disease (KD). The optimal dose of aspirin, however, remains unclear. Objective: To evaluate whether initial treatment with low-dose compared with high-dose aspirin in children with KD is associated with an increase in fever recrudescence. Design, Setting, and Participants: A retrospective cohort study of 260 children with KD at Riley Hospital for Children, Indianapolis, Indiana, between January 1, 2007, and December 31, 2018, was conducted. Children aged 0 to 18 years with a first episode of KD, identified by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes treated within 10 days of symptom onset with high-dose intravenous immunoglobulin plus aspirin were eligible. Patients who received an alternative diagnosis, experienced a second episode of KD, did not receive intravenous immunoglobulin plus aspirin for initial treatment, were not treated within 10 days of symptoms, or had incomplete records were excluded. Exposures: High-dose (≥10 mg/kg/d) or low-dose (<10 mg/kg/d) aspirin therapy. Main Outcomes and Measures: The primary outcome was recrudescent fever necessitating retreatment of KD. The secondary outcomes were coronary artery abnormalities and hospital length of stay. Results: Among the 260 patients included, the median (interquartile range) age was 2.5 (1.6-4.3) years, 103 (39.6%) were girls, 166 (63.8%) were non-Hispanic white, 57 (21.9%) were African American, 22 (8.5%) were Asian, 11 (4.2%) were Hispanic, and 4 (1.5%) were of unknown race/ethnicity. One hundred-forty-two patients (54.6%) were treated with low-dose aspirin. There was no association between recrudescent fever and aspirin dose, with 39 children (27.5%) having recrudescent fever in the low-dose group compared with 26 children (22.0%) in the high-dose group (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P = .31), with similar results after adjusting for potential confounding variables (OR, 1.63; 95% CI, 0.89-2.97; P = .11). In a subset analysis of 167 children with complete KD, however, there was nearly a 2-fold difference in the odds of recrudescent fever with low-dose aspirin (OR, 1.87; 95% CI, 0.82-4.23; P = .14), although this difference did not reach statistical significance. In addition, no association was identified between treatment group and coronary artery abnormalities (low-dose, 7.4% vs high-dose, 9.4%; OR, 0.86; 95% CI, 0.48-1.55; P = .62) or median (interquartile range) length of stay (3 [3-5] days for both groups; P = .27). Conclusions and Relevance: In this study, low-dose aspirin for the initial treatment of children with KD was not associated with fever recrudescence or coronary artery abnormalities. Given the potential benefits, further study of low-dose aspirin to detect potentially clinically relevant outcome differences is warranted to inform treatment decisions and guideline development

Possible adverse drug reaction to parenteral amino acids in an infant: a case report

A case report of a possible adverse drug reaction to 10% parenteral aminoacid formulation in a 5½ month male patient diagnosed with bronchopulmonary pneumonia with acute respiratory distress syndrome in septic shock, is presented. There was a temporal relationship between the administration of the parenteral amino acid formulation and the onset of the exanthem. This was further evidenced by the regression of the exanthem following the discontinuation of the formulation. The causality assessment of this adverse drug reaction has been done, and the likely causes of this hypersensitivity reaction have been analyzed

Analysis of cutaneous adverse drug reactions in a tertiary care hospital in South Tamil Nadu

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently reported adverse drug reactions (10 to 30%) with overall incidence of 6.2/1000 cases in India and 8% of hospitalisation among Dermatology inpatients. The aim was to analyse the CADRs with reference to its prevalence, causative drugs, morphological patterns, polypharmacy and drug reaction severity by Hartwig’s severity assessment scale.Methods: This study was a retrospective study done in the Department of Dermatology, Venereology and Leprosy (DVL) over a period of 5 years (2015 to 2019) from CADR registers. Mean, standard deviation and chi square test were used for statistical analysis. P≤0.05 was considered as statistically significant.Results: A total of 134 cases of CADRs were encountered which comprised 0.2% (2/1000) of total OP census with equal gender ratio and involved most commonly the younger adults. The drug groups mainly responsible were anticonvulsants (24.7%) followed by non-steroidal anti-inflammatory drugs (NSAIDS) (22.5%), antibiotics (20.9%) followed by antiretrovirals (ART) and antituberculous drugs (ATT). The common morphological patterns were acute exanthem (32.2%), exfoliative dermatitis (14.9%) and toxic epidermal necrolysis (14.2%). Over the counter drugs accounted for 25.6% of cases. Around 38.1% were on polypharmacy. In this study, 15.7% had mild CADR, 53.7% had moderate and 30.6% had severe drug reactions with 2.2% mortality based on the Hartwig’s severity assessment scale. Commonest cause of severe CADRs was anticonvulsants and benign CADRs was NSAIDS.Conclusions: Proper history taking and documentation of data, recollection of sequence of events by the patient and drug re-challenge will help us in deciding the causative drug preventing further occurrence

Drug Allergy Clinical Characteristics in Pediatrics

Background: A drug allergy causes a morbidity and a mortality due to its various range of clinical manifestation. Unfortunately, a study  focusing in pediatric drug allergy is insufficient, especially in Bandung. Thus, this study is conducted to determine the clinical characteristic of pediatric drug allergy in Dr. Hasan Sadikin General Hospital Bandung.Methods: This study was a retrospective descriptive study using medical records of pediatric drug allergy patients between 2010–2015 in Dr. Hasan Sadikin General Hospital Bandung taken with total sampling method. The variables were patient age, gender, causative drug, and clinical manifestation. Clinical manifestation was then divided into exanthem, urticaria, erythema multiforme, Steven-Johnson’s syndrome/toxic epidemiolytic necrosis (SJS/TEN), and fixed drug eruption (FDE). Results: Out of 101 patients, only 71 were included in the study due to incomplete medical records of the rest. There were 34 (47.89%) males and 37 (52.11%) females. Patients’ age ranged from 1–18 years old with the mean of 7.4 years old. The most common clinical manifestation was SJS/TEN with 25 (35.21%) patients, followed by exanthem with 22 (30.98%) patients. The most common suspected causative drug was non-steriodal anti inflammatory drugs (NSAID) (24%), followed with penicillin (21%).Conclusions: Most common manifestation of pediatric drug allergy in female is SJS/TEN, meanwhile in male is exanthema. Steven-Johnson’s syndrome/toxic epidemiolytic necrosis mostly occurs at the age group of 12–18 years old, and exanthema at the age group of 0–3 years old. This condition is mostly caused by NSAID and penicillin.DOI: 10.15850/amj.v4n2.109

contemporary infectious exanthems an update

An exanthem is a skin rash that may be associated with mucous membrane eruption, fever or other symptoms. It may develop as manifestation of an infectious disease or as adverse reaction to drugs. Beside the 'classical exanthems' commonly occurring in childhood, other exanthems, defined as 'atypical' for the different morphology and causal agents, may occur. Among the atypical exanthems with infectious etiology, viral, bacterial, parasitic and helminth infections are implicated. We describe herein etiology and epidemiology of the atypical exanthems caused by infectious agents. In case of exanthem, to make a correct etiological diagnosis is crucial for both the patient and community concerning issues such as time off school, immunizations and risk in pregnancy and immunocompromised individuals

Cutaneous manifestations in patients with COVID-19 : a preliminary review of an emerging issue

Background: The infection caused by the recently identified SARS-CoV-2, called COronaVIrus Disease-19 (COVID-19), has rapidly spread throughout the world. With the exponential increase of patients worldwide, the clinical spectrum of COVID-19 is being better defined and new symptoms are emerging. Numerous reports are documenting the occurrence of different cutaneous manifestations in COVID-19 patients. Objectives: To provide a brief overview of the COVID-19-associated cutaneous lesions. Methods: Literature search was performed in the PubMed, Scopus and Web of Science databases up to 30 April 2020. This narrative review summarizes the available data regarding clinical and histological features of COVID-19-associated skin manifestations. Results: Literature reports showed a great heterogeneity in COVID-19-associated cutaneous manifestations, as well as in their latency periods and associated extracutaneous symptoms. Pathogenic mechanisms are unknown, although the role of hyperactive immune response, complement activation and microvascular injury has been hypothesized. Based on our experience and the literature data, we subdivided the reported cutaneous lesions into six main clinical patterns: i) urticarial rash, ii) confluent erythematous/maculo-papular/morbilliform rash, iii) papulovesicular exanthem, iv) chilblain-like acral pattern, v) livedo reticularis/racemosa-like pattern, vi) purpuric "vasculitic" pattern. These six patterns can be merged into two main settings: the first one - inflammatory/exanthematous - including the first three groups cited above and the second one including the vasculopathic/vasculitic lesions of the last three aforementioned groups. Conclusions: The possible presence of cutaneous findings leading to suspect COVID-19 puts dermatologists in a relevant position. Further studies are needed to delineate the diagnostic and prognostic value of such cutaneous manifestations