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Eosinophilic Cellulitis

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21. Neutrophilic and eosinophilic dermatitis caused by contact allergic reaction to paraphenylenediamine in hair dye. (PubMed)

Neutrophilic and eosinophilic dermatitis caused by contact allergic reaction to paraphenylenediamine in hair dye. Paraphenylenediamine (PPD) in hair dyes can cause systemic as well as cutaneous allergic reactions such as neutrophilic and eosinophilic dermatitis. The symptoms are often severe. The acute lesion is normally histologically indistinguishable from any eczematous reaction with marked spongiosis.We report a case of allergic contact dermatitis caused by the use of hair dye containing (...) PPD that developed in a patient who had been using the same hair dye for many years. Her symptoms included scalp dermatitis and widespread skin lesions as well as lymphadenopathy and quite possibly dyspnea resembling asthma. What is most remarkable about this case is the histopathologic finding of neutrophilic cellulitis and a marked neutrophilic infiltrate with variable spongiosis. This unique finding was confirmed by histologic analysis of a patch test lesion specimen.It is always important

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2012 Archives of Dermatology

22. Assessment of eosinophilia

Allergic rhinitis Clonorchiasis Fascioliasis Fasciolopsiasis Opisthorchiasis Filariasis Gnathostomiasis Toxocariasis Paragonimiasis Ancylostoma caninum infestation Coccidioidomycosis Herpes gestationis Drug hypersensitivity Allergic bronchopulmonary aspergillosis Eosinophilic granulomatosis with polyangiitis Eosinophilic oesophagitis Eosinophilic gastroenteritis Eosinophilic cellulitis (Wells syndrome) Chronic eosinophilic leukaemia Other leukaemias Non-Hodgkin's lymphoma Hodgkin's lymphoma Non (...) Assessment of eosinophilia Assessment of eosinophilia - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of eosinophilia Last reviewed: February 2019 Last updated: August 2018 Summary Eosinophilia is defined as an increase in the peripheral blood eosinophil count. The upper limit of normal is usually taken as about 0.6 × 10⁹/L (600/microlitre), but it is lower (about 0.4 × 10⁹/L [400/microlitre]) if people

2018 BMJ Best Practice

25. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

. If BP is diagnosed, it may be possible to avoid long-term use of systemic corticosteroids and treat with rituximab as an alternative approach to treating the irAE. Seek infectious disease consultation if patient might have secondary cellulitis or if patient has other infection risk factors, such as neutropenia, etc. It is recommended that clinicians manage grade 4 toxicities as follows: Should permanently discontinue ICPi. Should admit patient immediately and place under supervision (...) of a dermatologist. Should administer IV (methyl)prednisolone (or equivalent) 1 to 2 mg/kg/d. When toxicity improves to grade 2 or less, start corticosteroid taper. Taper should be at least 4 weeks. If BP is diagnosed, it may be possible to avoid long-term use of systemic corticosteroids and treat with rituximab as an alternative approach to treating the irAE. Seek infectious disease consultation if patient might have secondary cellulitis or if patient has other infection risk factors, such as neutropenia, etc

2018 American Society of Clinical Oncology Guidelines

27. CRACKCast E109 – CNS Infections

a CSF infection is suspected: remember that typical signs and symptoms may be absent! Contraindications: There are no absolute contraindications, just relative contraindications (need to weigh the risk benefits out!): The bottom line according to Rosen’s is: “we recommend against LP in patients who have rapid neurological deterioration, seizures, or signs of herniation.” Here’s the longer version: SSTI at the puncture site (cellulitis or spinal epidural abscess) Anyone with signs of increased ICP (...) by pretreatment with ABx) < 5 leukocytes / mm3 eosinophils See formula below table in question 14 for calculating true CSF WBC in cases of a traumatic tap Gram stain, and bacterial culture (affected by pretreatment with ABx) No organisms Antigen testing ● Cryptococcal antigen ( replaced India-Ink stain ) ● Stain for acid-fast bacilli ● VDRL (syphilis test) May be measured in CSF, serum

2017 CandiEM

28. Investigation and management of eosinophilia

). The eosinophilia usually resolves with control of the underlying condition. Dermatological causes (non-allergic) Wells syndrome (eosinophilic cellulitis) is a recurring granulomatous dermatitis with eosinophilia (Wells 1971) characterised by (i) sudden onset annular or circinate erythematous-oedematous patches that rapidly evolve to morphoea-like slate-blue plaques, (ii) a histological appearance characterized by the presence of 'flame figures' and (iii) an inconstant blood eosinophilia. Similar histological (...) clinical responses when ciclosporin is added to prednisolone in previously steroid-resistant idiopathic HES (Akiyama et al, 1997; Fukuta et al, 2001, Zabel & Schlaak 1991) and when used as a steroid-sparing agent in idiopathic paediatric HES (Hosoki et al, 2011; Nadarajah et al, 1997) (and also in cases of eosinophilic cellulitis and fasciitis (Kim et al, 2013, Tahara et al, 2008)). A variety of effective ciclosporin doses have been reported, generally with gradual tapering following clinical response

2016 British Committee for Standards in Haematology

29. Retinoblastoma Treatment (PDQ®): Health Professional Version

is the second most common presenting sign and usually correlates with macular involvement. Very advanced intraocular tumors present with pain, orbital cellulitis, glaucoma, or buphthalmos. As the tumor progresses, patients may present with orbital or metastatic disease. Metastases occur in the preauricular and laterocervical lymph nodes, in the CNS, or systemically (commonly in the bones, bone marrow, and liver). In the United States, children of Hispanic origin and children living in lower socioeconomic (...) ; these structures consist of a cluster of low columnar cells arranged around a central lumen that is bounded by an eosinophilic membrane analogous to the external membrane of the normal retina. The lumen contains rosettes that are seen in 70% of tumors. Homer Wright rosettes are composed of irregular circlets of tumor cells arranged around a tangle of fibrils with no lumen or internal-limiting membrane. Horner Wright rosettes are infrequently seen in retinoblastoma and are most often seen in other neuroblastic

2018 PDQ - NCI's Comprehensive Cancer Database

30. Literature review - Twitter summary from #ACAAI18 meeting

of IgG level. Many of the links are via NFKb. Decreased NFKB1 phenotypes (AD, 60% penetrant): aphthous ulcers, Behcet-like and hypog (H67R); inflammatory GI tract disease and hypogam (I553M); NO hypogam, decreased switched B cells, necrotizing cellulitis (R157X). APDS1: sinopulmonary infections, LAN/splenomegaly, bronchiectasis/bronchitis/tracheal nodules, EBV/CMV, HSV, VZV infections; High IgM, IgM+ but not IgG+ B cells in tissue. CGD carriers can get disease like CGD lite, especially if DHR (...) improve survival in scleroderma. Asthma Dr. Li on asthma and lower respiratory diseases. Dupilumab was more effective for asthma if eosinophils were greater than 300. Eosinophilia can occur in 4.1% and hypereosinophilia 1.2% on dupilumab for asthma. Increased FeNO predicted better response to dupilumab. Dupilumab recently approved for moderate-severe asthma: if eosinophils are higher than 300 or FeNO is elevated, see better response to treatment with this biologic. Hypereosinophilia complication

2019 Allergy Notes blog

31. Xeljanz (tofacitinib citrate)

routes were determined to be 500 mg/kg and >3 mg/kg, respectively, and the approximate lethal dose in monkeys by the oral route was determined to be >1000 mg/kg. In the rat oral study, the clinical signs included slow respiration, labored respiration, decreased activity, lethargy, and cold to the touch and clinical chemistry and histopathological changes included decreased eosinophils, increased BUN, decreased fibrinogen, increases in alanine aminotransferase (ALT), aspartate aminotransferase (AST (...) twice daily. 3.(iii).A.(2).1) Six-week oral toxicity study in rats (4.2.3.2.3) Male and female SD rats were orally administered tofacitinib at 0 (vehicle), 1, 10, or 100 mg/kg/day 12 for 6 weeks. Hematologic findings included reductions in eosinophil counts, lymphocyte counts, and red blood cell parameters, etc. at all dose levels and reductions in the percent reticulocytes, etc. at ?10 mg/kg/day. All parameters tended to recover over the 4-week recovery period and these findings were considered

2013 Pharmaceuticals and Medical Devices Agency, Japan

32. Richard Lehman’s journal review—30 May 2017

gain either. It’s hard to know how this drug may or may not fit into the future treatment of people with severe eosinophilic asthma: you could call it an example of uncertain benralizability. JAMA 23/30 May 2017 Vol 317 Combining antibiotics for cellulitis Between-country variations in drug availability are a complete mystery to me. In the UK we use flucloxacillin as first-line treatment for most skin infections, but when I mentioned this agent to US doctor friends, they looked blankly. It isn’t (...) better at maintaining blood pressure in this group than placebo. This often allowed doses of catecholamines to be reduced, but the trial was not powered to measure effects on mortality or organ failure. Benralizumab for asthma requiring oral steroids Some people have terrible asthma with lots of eosinophils in their airways, and cannot get by without continuous oral steroids. Benralizumab is an antibody designed to kill eosinophils, or, to put it more amply, a humanized, afucosylated (engineered

2017 The BMJ Blog

33. Adult Sinusitis

to diagnose and manage adults with rhinosinusitis and applies to any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline, however, does not apply to patients younger than 18 years or to patients of any age with complicated rhinosinusitis. The guideline will not consider management of the following clinical presentations, although differential diagnosis for these conditions and bacterial rhinosinusitis will be discussed: allergic rhinitis, eosinophilic (...) . The importance of ABRS relates not only to prevalence but also to the potential for uncommon, but serious, complications that include meningitis, brain abscess, orbital cellulitis, and orbital abscess. , National ambulatory care data from 2006 to 2010 revealed that rhinosinusitis accounted for more outpatient antibiotic prescriptions than any other diagnosis. Despite guidelines that encourage judicious antibiotic use for ARS, , they are prescribed in about 82% of visits. From 2006 to 2010, rhinosinusitis

2015 American Academy of Otolaryngology - Head and Neck Surgery

38. Conditioning SCID Infants Diagnosed Early

to antigen was not performed, but at least 4 of the following 8 supportive criteria, at least one of which must be among those marked with an asterisk (*) below are present, the patient is eligible as Omenn Syndrome. Hepatomegaly Splenomegaly Lymphadenopathy Elevated IgE Elevated absolute eosinophil count *Oligoclonal T cells measured by CDR3 length or flow cytometry (upload report) *Proliferation to PHA is reduced to < 50% of lower limit of normal (LLN) or SI < 30 *Low TRECs and/or percentage of CD4+/RA (...) a sterile site (e.g. blood, CSF, etc.): Repeat culture(s) from same site must be negative and patient has completed appropriate course of antibacterial therapy (typically at least 10 days). ii. Tissue-based clinical infection (e.g. cellulitis): Complete resolution of clinical signs (e.g. erythema, tenderness, etc.) and patient has completed appropriate course of antibacterial therapy (typically at least 10 days). iii. Pneumonia, organism not identified by bronchoalveolar lavage: Complete resolution

2018 Clinical Trials

39. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

be urgently referred to a setting with appropriate imaging facilities and qualified specialty care. Red flags for urgent referral include: Systemic toxicity Altered mental status Severe headache Swelling of the orbit or change in visual acuity. Orbital and intracranial complications are the most feared complications of both acute and chronic rhinosinusitis. In the pre-antibiotic era, 20% of patients with orbital cellulitis went blind and 17% of patients died from intracranial sepsis [ ]. Even (...) in the current era, complications can result in permanent blindness or death if not treated appropriately and aggressively. Visual loss from sinusitis was reported at a rate of up to 10% in a 1991 study [ ]. Periorbital or orbital cellulitis is the most common complication of ABRS and most often caused by acute ethmoid and/or frontal disease [ , ]. Infection spreads from the sinuses to the orbit with relative ease [ , ]. Periorbital cellulitis is seen on CT as soft tissue swelling and manifests as orbital

2011 CPG Infobase

40. Wells' Syndrome Successfully Treated with Colchicine (PubMed)

Wells' Syndrome Successfully Treated with Colchicine Eosinophilic cellulitis is an uncommon, inflammatory and chronic disorder of unknown etiology. Corticosteroids are currently considered as the first-line treatment but they are not without significant disadvantages such as contraindications in steroid-resistant cases and patients with frequent recurrences. We report a patient suffering from Wells' syndrome with a 24-year history of symptomatic and generalized skin lesions. After consultation

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2017 Case reports in dermatology

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