Sahana Srihari, P. Ranugha, V. Shastry, J. Betkerur
Cutaneous tuberculosis (TB) is the result of a chronic infection by Mycobacterium TB. The clinical manifestations are variable and depend on the interaction of several factors. TB and malignancy present global threats claiming millions of lives and inflicting formidable suffering worldwide. We present two cases of atypical, rare presentations of cutaneous TB. Cases of concurrent scrofuloderma and lupus vulgaris (LV) with miliary tuberculosis of the lung and cutaneous tuberculosis; atypical presentation of LV with concurrent HIV in a 10 year old child. Concurrent presentation of cutaneous TB with internal organ involvement is a rare entity in an immunocompetent asymptomatic individual like our patient. HIV coinfection with cutaneous TB has not been described in any of the childhood series published from India and ours is probably the first report of its kind. It is imperative that physicians have a high index of suspicion to quickly and effectively diagnose and treat these substantially morbid skin conditions.
皮肤结核病（TB）是结核分枝杆菌慢性感染的结果。其临床表现多种多样，取决于多种因素的相互作用。结核病和恶性肿瘤是全球性的威胁，夺走了数百万人的生命，给全世界带来了巨大的痛苦。我们介绍了两例非典型、罕见的皮肤结核病例。瘰疬性皮肤病和寻常狼疮（LV）并发肺部粟粒性结核和皮肤结核的病例；一名 10 岁儿童 LV 并发 HIV 的不典型表现。像我们的患者这样免疫功能正常、无症状的人同时出现皮肤结核和内脏器官受累的情况非常罕见。在印度发表的儿童系列病例中，还没有人描述过皮肤结核合并艾滋病病毒感染的情况，我们的病例可能是首例此类报告。当务之急是，医生要有高度的怀疑精神，以便快速有效地诊断和治疗这些严重的皮肤病。
{"title":"Atypical Rare Presentations of Cutaneous Tuberculosis: A Report of Two Cases","authors":"Sahana Srihari, P. Ranugha, V. Shastry, J. Betkerur","doi":"10.4103/cdr.cdr_17_23","DOIUrl":"https://doi.org/10.4103/cdr.cdr_17_23","url":null,"abstract":"Cutaneous tuberculosis (TB) is the result of a chronic infection by Mycobacterium TB. The clinical manifestations are variable and depend on the interaction of several factors. TB and malignancy present global threats claiming millions of lives and inflicting formidable suffering worldwide. We present two cases of atypical, rare presentations of cutaneous TB. Cases of concurrent scrofuloderma and lupus vulgaris (LV) with miliary tuberculosis of the lung and cutaneous tuberculosis; atypical presentation of LV with concurrent HIV in a 10 year old child. Concurrent presentation of cutaneous TB with internal organ involvement is a rare entity in an immunocompetent asymptomatic individual like our patient. HIV coinfection with cutaneous TB has not been described in any of the childhood series published from India and ours is probably the first report of its kind. It is imperative that physicians have a high index of suspicion to quickly and effectively diagnose and treat these substantially morbid skin conditions.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anant Kumar Singh, Ravi Phulware, N. Hazarika, N. Kansal
{"title":"Oral Lichen Planus-like Lesions in Pemphigus Vulgaris","authors":"Anant Kumar Singh, Ravi Phulware, N. Hazarika, N. Kansal","doi":"10.4103/cdr.cdr_97_23","DOIUrl":"https://doi.org/10.4103/cdr.cdr_97_23","url":null,"abstract":"","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prajna P Vernekar, Sweta R. Prabhu, Pavithra A Jain, K. Naveen
Dermatophytosis is a fungal disease characterized by the infection of skin, hair, and nails. There is an upsurge of complicated superficial dermatophytosis and an increase in the incidence of chronic, relapsing, recurrent cases in India that are also often unresponsive to conventional doses of drugs. The aim of this study was to study the prevalence of dermatophyte species in the particular study area and it is susceptibility to itraconazole, terbinafine, and fluconazole. All dermatophytes isolates obtained were subjected to 10% KOH mount, fungal culture, and antifungal sensitivity testing for fluconazole, itraconazole, and terbinafine. Newly diagnosed cases of dermatophytosis without treatment for the past 3 months were included in the study. KOH preparation was observed and subjected to fungal culture. Then, the susceptibility of the dermatophytes to oral antifungals (itraconazole, terbinafine, and fluconazole) was done. Out of 28 patients with tinea, 14 males and 12 females were tested KOH positive. Out of them, 23 patients showed positive for dermatophyte growth. In them, 15 isolates were Trichophyton mentagrophytes and 8 isolates were Trichophyton rubrum. Antifungal drug susceptibility testing data indicated that, for the two species, MIC of itraconazole ranged between 0.03 and 16 μg/ml, terbinafine between 0.03 and 16 μg/ml, and fluconazole between 0.25 and 64 μg/ml. The study provided information regarding the prevalent species of dermatophyte in our study area and it is high sensitivity to itraconazole compared to terbinafine and the lowest for fluconazole. This gives us guidance as to which antifungal to use empirically in our clinical practice to treat tinea infection.
{"title":"Clinicomycological Study of Dermatophyte Infections in Patients Attending Dermatology Outpatient Department in a Tertiary Care Hospital","authors":"Prajna P Vernekar, Sweta R. Prabhu, Pavithra A Jain, K. Naveen","doi":"10.4103/cdr.cdr_112_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_112_22","url":null,"abstract":"\u0000 \u0000 Dermatophytosis is a fungal disease characterized by the infection of skin, hair, and nails. There is an upsurge of complicated superficial dermatophytosis and an increase in the incidence of chronic, relapsing, recurrent cases in India that are also often unresponsive to conventional doses of drugs.\u0000 \u0000 \u0000 \u0000 The aim of this study was to study the prevalence of dermatophyte species in the particular study area and it is susceptibility to itraconazole, terbinafine, and fluconazole.\u0000 \u0000 \u0000 \u0000 All dermatophytes isolates obtained were subjected to 10% KOH mount, fungal culture, and antifungal sensitivity testing for fluconazole, itraconazole, and terbinafine.\u0000 \u0000 \u0000 \u0000 Newly diagnosed cases of dermatophytosis without treatment for the past 3 months were included in the study. KOH preparation was observed and subjected to fungal culture. Then, the susceptibility of the dermatophytes to oral antifungals (itraconazole, terbinafine, and fluconazole) was done.\u0000 \u0000 \u0000 \u0000 Out of 28 patients with tinea, 14 males and 12 females were tested KOH positive. Out of them, 23 patients showed positive for dermatophyte growth. In them, 15 isolates were Trichophyton mentagrophytes and 8 isolates were Trichophyton rubrum. Antifungal drug susceptibility testing data indicated that, for the two species, MIC of itraconazole ranged between 0.03 and 16 μg/ml, terbinafine between 0.03 and 16 μg/ml, and fluconazole between 0.25 and 64 μg/ml.\u0000 \u0000 \u0000 \u0000 The study provided information regarding the prevalent species of dermatophyte in our study area and it is high sensitivity to itraconazole compared to terbinafine and the lowest for fluconazole. This gives us guidance as to which antifungal to use empirically in our clinical practice to treat tinea infection.\u0000","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Dhinoja, Shubhangi Hirma, P. Bodar, Rita Vipul Vora
Palmoplantar erythrodysesthesia also known as hand-foot syndrome is an intense, painful erythema of the palms and soles due to chemotherapeutic drugs. The most commonly implicated drugs are multi-kinase inhibitors such as sorafenib, sunitinib, doxorubicin, cytarabine, and docetaxel. The most effective management is withdrawal or reduction of drugs. Oral and topical corticosteroids and dimethyl sulfoxide are other treatment options. A 67-year-old male patient of hepatocellular carcinoma taking tablet lenvatinib presented with multiple tender erythematous plaques and patches over the bilateral palms and dorsum of the fingers after 1 month of initiation of therapy. The patient was successfully treated with dose reduction of lenvatinib and topical corticosteroids and is maintained on medium potency corticosteroid.
{"title":"Palmoplantar Erythrodysesthesia: An Unusual Side Effect of Lenvatinib","authors":"N. Dhinoja, Shubhangi Hirma, P. Bodar, Rita Vipul Vora","doi":"10.4103/cdr.cdr_63_23","DOIUrl":"https://doi.org/10.4103/cdr.cdr_63_23","url":null,"abstract":"Palmoplantar erythrodysesthesia also known as hand-foot syndrome is an intense, painful erythema of the palms and soles due to chemotherapeutic drugs. The most commonly implicated drugs are multi-kinase inhibitors such as sorafenib, sunitinib, doxorubicin, cytarabine, and docetaxel. The most effective management is withdrawal or reduction of drugs. Oral and topical corticosteroids and dimethyl sulfoxide are other treatment options. A 67-year-old male patient of hepatocellular carcinoma taking tablet lenvatinib presented with multiple tender erythematous plaques and patches over the bilateral palms and dorsum of the fingers after 1 month of initiation of therapy. The patient was successfully treated with dose reduction of lenvatinib and topical corticosteroids and is maintained on medium potency corticosteroid.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JP Prathibha, J. Madhukara, Pernaje Ishwara Bhat, Inchara Gowda
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of uncertain etiology characterized by rapidly progressive, painful skin ulcers, and is often difficult to diagnose. The common underlying disease associations include rheumatoid arthritis (RA), inflammatory bowel disease (IBD), autoimmune inflammatory conditions, and malignancies, both hematological and solid organ tumors. Assess the demographics, clinical presentation and associated systemic diseases, and response to treatment of patients with pyoderma gangrenosum. In this retrospective study, all cases diagnosed as PG were evaluated along with disease associations and outcomes over a 5-year period. A total of 42 patients’ charts were studied of which, ulcerative PG was seen in 86.4%, pustular in 16.8%, bullous in 14.4%, and vegetative in 2.4% patients, respectively. Thirty-six percentage of them had RA, 12% had non-RA connective tissue disease, 9.6% had IBD, 9.6% had chronic liver disease, and 4.8% had malignancy. Positive pathergy was seen in 57% of our study patients. Multiple morphological types with recurrences were more common in patients with positive pathergy. Mortality was seen in 9.6% of patients. Statistics: Descriptive statistics were reported as mean with standard deviation, number, and percentages. Association between the clinical characteristics of the variables was done using Chi-square test. PG with multiple morphological types with multifocality is frequently associated with exacerbation of the underlying disease. RA was the most common association found. Recurrent disease was more common in older patients (>40 years).
{"title":"Unresolved Malady of Pyoderma Gangrenosum: A Study of its Profile and Outcome in a Tertiary Care Center","authors":"JP Prathibha, J. Madhukara, Pernaje Ishwara Bhat, Inchara Gowda","doi":"10.4103/cdr.cdr_113_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_113_22","url":null,"abstract":"\u0000 \u0000 Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of uncertain etiology characterized by rapidly progressive, painful skin ulcers, and is often difficult to diagnose. The common underlying disease associations include rheumatoid arthritis (RA), inflammatory bowel disease (IBD), autoimmune inflammatory conditions, and malignancies, both hematological and solid organ tumors.\u0000 \u0000 \u0000 \u0000 Assess the demographics, clinical presentation and associated systemic diseases, and response to treatment of patients with pyoderma gangrenosum.\u0000 \u0000 \u0000 \u0000 In this retrospective study, all cases diagnosed as PG were evaluated along with disease associations and outcomes over a 5-year period.\u0000 \u0000 \u0000 \u0000 A total of 42 patients’ charts were studied of which, ulcerative PG was seen in 86.4%, pustular in 16.8%, bullous in 14.4%, and vegetative in 2.4% patients, respectively. Thirty-six percentage of them had RA, 12% had non-RA connective tissue disease, 9.6% had IBD, 9.6% had chronic liver disease, and 4.8% had malignancy. Positive pathergy was seen in 57% of our study patients. Multiple morphological types with recurrences were more common in patients with positive pathergy. Mortality was seen in 9.6% of patients. Statistics: Descriptive statistics were reported as mean with standard deviation, number, and percentages. Association between the clinical characteristics of the variables was done using Chi-square test.\u0000 \u0000 \u0000 \u0000 PG with multiple morphological types with multifocality is frequently associated with exacerbation of the underlying disease. RA was the most common association found. Recurrent disease was more common in older patients (>40 years).\u0000","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dapsone, once a fabric dye, is a versatile pharmaceutical for treating diseases like leprosy, malaria, and HIV-AIDS-related pneumonia. Discovered in 1908 but not utilized for its antimicrobial properties until the 1930s, dapsone faced initial setbacks due to toxicity, prompting the development of a safer derivative, Promin. Chemically, dapsone's lipid-soluble nature allows for extensive distribution throughout the body and involves complex metabolism, with a variable elimination half-life. Its clinical efficacy is due to its bacteriostatic action, inhibiting dihydrofolic acid synthesis, and its anti-inflammatory effects on neutrophils. Dapsone's dosing is tailored to the individual's condition and is approved for various dermatological conditions. However, its use is limited by contraindications in certain anemic conditions and potential side effects such as hemolytic anemia and methemoglobinemia, necessitating careful monitoring and management strategies to mitigate risks. Despite these challenges, dapsone's broad therapeutic utility and ongoing research into its mechanisms maintain its status as a significant medical therapy.
{"title":"Dapsone – Reinventing the Wheel or Rekindling Possibilities?","authors":"Ramesh M Bhat, M. Madhumita, R. Monteiro","doi":"10.4103/cdr.cdr_109_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_109_21","url":null,"abstract":"Dapsone, once a fabric dye, is a versatile pharmaceutical for treating diseases like leprosy, malaria, and HIV-AIDS-related pneumonia. Discovered in 1908 but not utilized for its antimicrobial properties until the 1930s, dapsone faced initial setbacks due to toxicity, prompting the development of a safer derivative, Promin. Chemically, dapsone's lipid-soluble nature allows for extensive distribution throughout the body and involves complex metabolism, with a variable elimination half-life. Its clinical efficacy is due to its bacteriostatic action, inhibiting dihydrofolic acid synthesis, and its anti-inflammatory effects on neutrophils. Dapsone's dosing is tailored to the individual's condition and is approved for various dermatological conditions. However, its use is limited by contraindications in certain anemic conditions and potential side effects such as hemolytic anemia and methemoglobinemia, necessitating careful monitoring and management strategies to mitigate risks. Despite these challenges, dapsone's broad therapeutic utility and ongoing research into its mechanisms maintain its status as a significant medical therapy.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shiva Shankar Marri, Mohnish Sekar, Keshavmurthy A Adya, A. Inamadar, Ajit B Janagond
Acute methotrexate (MTX) toxicity is most commonly due to overdose of the drug, which may be due to the patient's noncompliance to doctor's orders or physician's prescription error. Other causes include acute renal failure, concomitant use of other drugs, and genetic susceptibility. MTX toxicity presents with pancytopenia, mucositis, hepatotoxicity, pulmonary toxicity, and acute renal failure. Treatment involves a polypragmatic approach which includes vigorous hydration, urinary alkalinization, administration of leucovorin, and glucarpidase. Administration of granulocyte colony-stimulating factor should be considered in cases of severe neutropenia. Here, we present two cases of acute MTX toxicity in chronic plaque psoriasis presenting with ulceration of psoriatic lesions and mucosal ulceration successfully treated with leucovorin and pegylated granulocyte colony-stimulating factor (G-CSF). This case report demonstrates that G-CSF might be lifesaving by contributing to rapid reconstitution of leukopoiesis.
{"title":"Acute Methotrexate Toxicity Managed with Leucovorin and Pegylated Granulocyte Colony-stimulating Factor: A Report of Two Cases and Review of Literature","authors":"Shiva Shankar Marri, Mohnish Sekar, Keshavmurthy A Adya, A. Inamadar, Ajit B Janagond","doi":"10.4103/cdr.cdr_35_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_35_22","url":null,"abstract":"Acute methotrexate (MTX) toxicity is most commonly due to overdose of the drug, which may be due to the patient's noncompliance to doctor's orders or physician's prescription error. Other causes include acute renal failure, concomitant use of other drugs, and genetic susceptibility. MTX toxicity presents with pancytopenia, mucositis, hepatotoxicity, pulmonary toxicity, and acute renal failure. Treatment involves a polypragmatic approach which includes vigorous hydration, urinary alkalinization, administration of leucovorin, and glucarpidase. Administration of granulocyte colony-stimulating factor should be considered in cases of severe neutropenia. Here, we present two cases of acute MTX toxicity in chronic plaque psoriasis presenting with ulceration of psoriatic lesions and mucosal ulceration successfully treated with leucovorin and pegylated granulocyte colony-stimulating factor (G-CSF). This case report demonstrates that G-CSF might be lifesaving by contributing to rapid reconstitution of leukopoiesis.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sweta R. Prabhu, M. Madhusudhana, Soumya Bhute, K. Naveen, S. Athanikar
Hair loss is the one of the most common complaints in dermatologic patients. The proper cause of female pattern hair loss is still unclear. Many studies have been done on the individual patterns of hair loss but there are very few studies available about the different clinical patterns of hair loss in females in a single study. To evaluate the clinical patterns of hair loss in females which manifest in various disorders. 120 subjects were studied in a hospital based descriptive study with detailed history, general physical examination, detailed hair, scalp, cutaneous examination, clinical tests, routine haematological investigations, biopsy where indicated. Maximum subjects were in the age group of 20 – 40 years (66.6%). Majority of the subjects presented with a diffuse hair loss (55.8%). In our study although majority of the cases were not associated with any illness (52.5%), among the ones associated with illness the most common associated illness was history of COVID-19 (25.8%). Very few presented with scarring hair loss (5%). Telogen Effluvium was the most common cause of hair loss with maximum prevalence among females aged 20 to 40 years, with majority having hair loss over a period of 6 weeks to 6 month without any concurrent illness. The findings of this study provide baseline information on common clinical presentation of hair loss among women in our setting, thus helping in early clinical diagnosis and planning appropriate treatment.
{"title":"A Study of the Clinical Patterns of Hair Loss in Female Patients","authors":"Sweta R. Prabhu, M. Madhusudhana, Soumya Bhute, K. Naveen, S. Athanikar","doi":"10.4103/cdr.cdr_97_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_97_22","url":null,"abstract":"\u0000 \u0000 Hair loss is the one of the most common complaints in dermatologic patients. The proper cause of female pattern hair loss is still unclear. Many studies have been done on the individual patterns of hair loss but there are very few studies available about the different clinical patterns of hair loss in females in a single study.\u0000 \u0000 \u0000 \u0000 To evaluate the clinical patterns of hair loss in females which manifest in various disorders.\u0000 \u0000 \u0000 \u0000 120 subjects were studied in a hospital based descriptive study with detailed history, general physical examination, detailed hair, scalp, cutaneous examination, clinical tests, routine haematological investigations, biopsy where indicated.\u0000 \u0000 \u0000 \u0000 Maximum subjects were in the age group of 20 – 40 years (66.6%). Majority of the subjects presented with a diffuse hair loss (55.8%). In our study although majority of the cases were not associated with any illness (52.5%), among the ones associated with illness the most common associated illness was history of COVID-19 (25.8%). Very few presented with scarring hair loss (5%).\u0000 \u0000 \u0000 \u0000 Telogen Effluvium was the most common cause of hair loss with maximum prevalence among females aged 20 to 40 years, with majority having hair loss over a period of 6 weeks to 6 month without any concurrent illness. The findings of this study provide baseline information on common clinical presentation of hair loss among women in our setting, thus helping in early clinical diagnosis and planning appropriate treatment.\u0000","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. R. Babu, P. Mathew, Bifi Joy, Sridharan Rajiv, P. A. Praveen
Pemphigus vulgaris is an autoimmune bullous disorder caused by autoantibodies directed against desmogleins. There is an increased risk for developing herpes zoster in pemphigus vulgaris due to the prolonged and high doses immunosuppressant therapy. Here, we present a 52-year-old female patient with extensive pemphigus vulgaris who developed herpes zoster while on treatment which resulted in a diagnostic confusion and a Tzanck smear acted as a lifesaver revealing both multinucleated giant cells and acantholytic cells. Hence, a prompt decision of reducing the immunosuppressant and initiation of IV acyclovir helped the patient to recover faster. This case highlights the relevance of simple bedside investigation like Tzanck smear and reminds the clinician once again to be open to all possibilities.
{"title":"A Case of Herpes Zoster Simulating Pemphigus Vulgaris Flare","authors":"C. R. Babu, P. Mathew, Bifi Joy, Sridharan Rajiv, P. A. Praveen","doi":"10.4103/cdr.cdr_126_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_126_21","url":null,"abstract":"Pemphigus vulgaris is an autoimmune bullous disorder caused by autoantibodies directed against desmogleins. There is an increased risk for developing herpes zoster in pemphigus vulgaris due to the prolonged and high doses immunosuppressant therapy. Here, we present a 52-year-old female patient with extensive pemphigus vulgaris who developed herpes zoster while on treatment which resulted in a diagnostic confusion and a Tzanck smear acted as a lifesaver revealing both multinucleated giant cells and acantholytic cells. Hence, a prompt decision of reducing the immunosuppressant and initiation of IV acyclovir helped the patient to recover faster. This case highlights the relevance of simple bedside investigation like Tzanck smear and reminds the clinician once again to be open to all possibilities.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140773506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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