The acquired immunodeficiency syndrome patients with compromised immunity are prone to hemophagocytic syndrome secondary to opportunistic infections.This paper reports a rare case of hemophagocytic syndrome secondary to human parvovirus B19 infection in an acquired immunodeficiency syndrome patient,and analyzes the clinical characteristics,aiming to improve the diagnosis and treatment of the disease and prevent missed diagnosis and misdiagnosis.
Humans ; Lymphohistiocytosis, Hemophagocytic/drug therapy* ; Erythema Infectiosum/complications* ; Acquired Immunodeficiency Syndrome/complications* ; Parvoviridae Infections/diagnosis* ; Parvovirus B19, Human

Systemic lupus erythematosus (SLE) associated macrophage activation syndrome (MAS) is clinically severe, with a high mortality rate and rare neuropsychiatric symptoms. In the course of diagnosis and treatment, it is necessary to actively determine whether the neuropsychiatric symptoms in patients are caused by neuropsychiatric systemic lupus erythematosus (NPSLE) or macrophage activation syndrome. This paper retrospectively analyzed the clinical data of 2 cases of SLE associated MAS with neuropsychiatric lesions, Case 1: A 30-year-old female had obvious alopecia in 2019, accompanied by emaciation, fatigue and dry mouth. In March 2021, she felt weak legs and fell down, followed by fever and chills without obvious causes. After completing relevant examinations, she was diagnosed with SLE and given symptomatic treatments such as hormones and anti-infection, but the patient still had fever. The relevant examinations showed moderate anemia, elevated ferritin, elevated triglycerides, decreased NK cell activity, and a perforin positivity rate of 4.27%, which led to the diagnosis of "pre-hemophagocytic syndrome (HPS)". In May 2021, the patient showed mental trance and babble, and was diagnosed with "SLE-associated MAS"after completing relevant examinations. After treatment with methylprednisolone, anti-infection and psychotropic drugs, the patient's temperature was normal and mental symptoms improved. Case 2: A 30-year-old female patient developed butterfly erythema on both sides of the nose on her face and several erythema on her neck in June 2019, accompanied by alopecia, oral ulcers, and fever. She was diagnosed with "SLE" after completing relevant examinations, and her condition was relieved after treatment with methylprednisolone and human immunoglobulin. In October 2019, the patient showed apathy, no lethargy, and fever again, accompanied by dizziness and vomiting. The relevant examination indicated moderate anemia, decreased NK cell activity, elevated triglycerides, and elevated ferritin. The patient was considered to be diagnosed with "SLE, NPSLE, and SLE-associated MAS". After treatment with hormones, human immunoglobulin, anti-infection, rituximab (Mabthera), the patient's condition improved and was discharged from the hospital. After discharge, the patient regularly took methylprednisolone tablets (Medrol), and her psychiatric symptoms were still intermittent. In November 2019, she developed symptoms of fever, mania, and delirium, and later turned to an apathetic state, and was given methylprednisolone intravenous drip and olanzapine tablets (Zyprexa) orally. After the mental symptoms improved, she was treated with rituximab (Mabthera). Later, due to repeated infections, she was replaced with Belizumab (Benlysta), and she was recovered from her psychiatric anomalies in March 2021. Through the analysis of clinical symptoms, imaging examination, laboratory examination, treatment course and effect, it is speculated that the neuropsychiatric symptoms of case 1 are more likely to be caused by MAS, and that of case 2 is more likely to be caused by SLE. At present, there is no direct laboratory basis for the identification of the two neuropsychiatric symptoms. The etiology of neuropsychiatric symptoms can be determined by clinical manifestations, imaging manifestations, cerebrospinal fluid detection, and the patient's response to treatment. Early diagnosis is of great significance for guiding clinical treatment, monitoring the condition and judging the prognosis. The good prognosis of the two cases in this paper is closely related to the early diagnosis, treatment and intervention of the disease.
Humans ; Female ; Adult ; Rituximab/therapeutic use* ; Macrophage Activation Syndrome/etiology* ; Retrospective Studies ; Lupus Erythematosus, Systemic/drug therapy* ; Methylprednisolone/therapeutic use* ; Lupus Vasculitis, Central Nervous System ; Fever/drug therapy* ; Erythema/drug therapy* ; Hormones/therapeutic use* ; Anemia ; Alopecia/drug therapy* ; Triglycerides/therapeutic use* ; Ferritins/therapeutic use*

The stomach is the most common primary site of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, which is characterized by an indolent clinical course. A diagnosis of gastric MALT lymphoma requires an endoscopic biopsy that should be confirmed by an experienced pathologist. Gastric MALT lymphoma shows a variable endoscopic appearance, including erosion, erythema, discoloration, atrophy, ulcer, and subepithelial lesion. The distribution is often multifocal. Therefore, clinical suspicion and multiple biopsies are essential for an accurate diagnosis. Gastric MALT lymphoma is almost invariably associated with a Helicobacter pylori (H. pylori) infection. H. pylori eradication therapy is the mainstay of treatment, which must be delivered to all patients regardless of the H. pylori infection status or stage. For patients who have failed to achieve remission following eradication therapy, radiotherapy or chemotherapy can be considered. Radiotherapy is an effective treatment modality for a localized stage and shows excellent outcomes. In the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD20 monoclonal antibody, rituximab, can be applied. Treatment should be individualized according to the stage and symptoms, as well as the patients' preference. Given that the clinical course of gastric MALT lymphoma is usually indolent, watchful waiting may be an adequate strategy in selected cases where scheduled follow-up is guaranteed.
Atrophy ; Biopsy ; Diagnosis ; Drug Therapy ; Erythema ; Follow-Up Studies ; Helicobacter pylori ; Humans ; Immunotherapy ; Lymphoma, B-Cell, Marginal Zone ; Radiotherapy ; Rituximab ; Stomach ; Ulcer ; Watchful Waiting

Vinorelbine, a vinca alkaloid anticancer drug, is widely used to treat various cancers. Several dermatological side effects of vinorelbine, such as acral erythema, phlebitis, and severe extravasation reactions, have been reported. Vinorelbine is categorized as non-DNA binding vesicant that undergoes high metabolism and clearance, which limits the degree of tissue injury if extravasation occurs. A 73-year-old male presented with erythematous linear patches on his left wrist and a 51-year-old male presented with erythematous eroded patches and bullae on his right forearm. Histopathologic study showed interface changes with basal vacuolar degeneration and epidermal dysmaturation. Separation of the dermis from the epidermis was observed, as well as interstitial and perivascular inflammatory infiltrates in the dermis. Both patients were being treated with vinorelbine for lung cancer. Before the onset of the skin lesions, accidental intravenous extravasation of vinorelbine had occurred. Herein, we report two cases of chemotherapy induced drug reaction due to extravasation of vinorelbine.
Aged ; Cytochrome P-450 CYP1A1 ; Dermis ; Drug Therapy ; Epidermis ; Erythema ; Forearm ; Humans ; Lung Neoplasms ; Male ; Metabolism ; Middle Aged ; Phlebitis ; Skin ; Vinca ; Wrist

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.
Adrenal Cortex Hormones ; Adult ; Brain ; Brain Neoplasms ; Cranial Irradiation ; Dermatitis, Exfoliative ; Drug Therapy ; Edema ; Erythema Multiforme* ; Erythema* ; Exanthema ; Extremities ; Female ; Humans ; Neck ; Phenytoin* ; Radiotherapy ; Skin ; Steroids ; Stevens-Johnson Syndrome ; Thorax ; Urticaria

Chemotherapy-induced acral erythema (CIAE) is an uncommon, self-limited local skin reaction that usually occurs after high-dose chemotherapy. There is no specific treatment for this disease and it disappears within three to five weeks. In this case report, we present a 16-year-old female with acute lymphoblastic leukemia who developed severe CIAE. The lesions appeared as a well-defined erythema of the hands, feet, and back with symmetrically well-defined borders 5 days after low-dose MTX treatment. The erythema progressed to bullae formation and desquamation. It resolved spontaneously within 2 weeks. CIAE is very uncommon in children; however we should consider acral erythema as a differential diagnosis when bullous skin reaction occurs in a patient who receives chemotherapy.
Adolescent ; Child ; Diagnosis, Differential ; Drug Therapy ; Erythema ; Female ; Foot ; Hand ; Hand-Foot Syndrome ; Humans ; Methotrexate ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Skin

Toxic erythema of chemotherapy (TEC) refers to a group of chemotherapy-induced cutaneous toxicities. We present a case of TEC in an 11-year-old girl who received gemcitabine and docetaxel for osteosarcoma of the femur.
Antineoplastic Agents ; adverse effects ; Axilla ; Bone Neoplasms ; drug therapy ; Child ; Deoxycytidine ; adverse effects ; analogs & derivatives ; Erythema ; chemically induced ; Female ; Femur ; pathology ; Humans ; Hyperpigmentation ; Lung Neoplasms ; drug therapy ; secondary ; Mouth ; drug effects ; Orbit ; drug effects ; Osteosarcoma ; drug therapy ; Taxoids ; adverse effects ; Treatment Outcome

Marginal zone B-cell lymphoma of the gastrointestinal tract most commonly affects the stomach. Endoscopic findings of primary gastrointestinal lymphoma are various and heterogeneous. Lesions may appear as ulcers, erosions, or erythemas. Gastrointestinal lymphomas presenting as multiple polyps on endoscopy are rare. No case of marginal zone B-cell lymphoma manifesting as multiple polyps has been reported on the stomach, although a few cases have been reported in the colon. We present a rare case of a 77-year-old female patient diagnosed as primary gastric marginal zone B-cell lymphoma presenting as multiple polyps. She was fully treated by combination chemotherapy.
Aged ; Colon ; Drug Therapy, Combination ; Endoscopy ; Erythema ; Female ; Gastrointestinal Tract ; Humans ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Polyps ; Stomach ; Ulcer

Rosacea is a common chronic cutaneous disorder that primarily occurs on the convex surfaces of the central face and is often characterized by exacerbations and remissions. A case of a 52-yr-old woman visited our clinic in February 2008 complaining typical features of rosacea including multiple pinhead to rice-sized erythematous papules. We applied various conventional treatments including topical benzoyl peroxide and metronidazole as well as oral metronidazole, isotretinoin, and doxycycline. The lesions were not controlled but were rather aggravated by complications from these treatments. Therefore, we prescribed oral azithromycin, which has anti-inflammatory effects and reduces reactive oxygen species. Ten weeks after the administration of oral azithromycin, 500 mg per day for 2 weeks, the lesions had mostly disappeared and no specific side effects related to the azithromycin were noted. Oral azithromycin dosing 500 mg/day for 2 weeks is effective for treatment of intractable rosacea.
Administration, Oral ; Azithromycin/administration & dosage/pharmacology/*therapeutic use ; Erythema/diagnosis/drug therapy ; Female ; Humans ; Middle Aged ; Reactive Oxygen Species ; Rosacea/diagnosis/*drug therapy ; Skin Diseases/drug therapy

Erythema nodosum is the most common form of septal panniculitis and the most frequent skin manifestation associated with inflammatory bowel disease, affecting up to 15% of Crohn's disease patients. Since the development of erythema nodosum is closely related with a variety of disorders and condition, it can serve as an important early sign of systemic disease. Here, we present the occurrence of erythema nodosum as an early sign of Cronh's disease in a 16-year-old woman.
Adolescent ; Anti-Inflammatory Agents/therapeutic use ; Azathioprine/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis/drug therapy ; Erythema Nodosum/complications/*diagnosis/pathology ; Female ; Humans ; Mesalamine/therapeutic use ; Prednisolone/therapeutic use ; Skin/pathology