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Eosinophilic Cellulitis

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81. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Diagnosis)

are used to reduce inflammation. Additional treatment includes proper hygiene, with washing and drying of the prepuce. Circumcision is usually effective and may be indicated if medical therapy fails. [ ] The outcome in treated patients is favorable, and serious complications are rare. Uncommonly, untreated cases can result in cellulitis and gangrene. Treatment failures should prompt further clinical examination and consideration of other etiologies. Failure of response in the setting of appropriate (...) confocal microscopy. [ ] The histopathologic features show a thinned epidermis or epithelium and a dense, superficial, bandlike, predominantly plasmacytic, inflammatory infiltrate in the dermis. The dermal infiltrate also contains lymphocytes, neutrophils, histiocytes, and eosinophils. Dilated capillaries and associated extravasated red cells and hemosiderin deposition may also develop. Differential diagnoses The clinical presentation of Zoon balanitis can mimic erythroplasia of Queyrat (see ). Biopsy

2014 eMedicine.com

82. Dermatologic Manifestations of Pulmonary Disease (Diagnosis)

effusions. Laboratory findings include striking peripheral eosinophilia, usually more than 1.5 X 10 9 cells/L. Eosinophilia is also common in patients with asthma; however, the magnitude is greater in patients with the Churg-Strauss syndrome. Eosinophils are the dominant cell in pleural or pericardial effusions. Other laboratory findings may include a positive perinuclear ANCA serology and elevated immunoglobulin E levels. Cutaneous findings As many as 70% of patients with Churg-Strauss syndrome have (...) cutaneous manifestations. [ ] A variety of lesions may be seen, the most common of which are palpable purpura, subcutaneous nodules, urticarial rashes, and livedo reticularis. Palpable purpura usually involves the lower extremities and is common but nonspecific. Biopsy of these lesions reveals leukocytoclastic vasculitis. The most distinctive lesions are tender subcutaneous nodules occurring on the limbs and scalp, or, less frequently, on the trunk. Biopsies of these lesions reveal an eosinophilic

2014 eMedicine.com

83. Dermatologic Manifestations of Hematologic Disease (Diagnosis)

with painful, necrotic skin ulcers. Histopathology evaluation reveals medial calcification and intimal hyperplasia of small and medium-sized arteries of dermal and subcutaneous tissues. [ ] The differential diagnosis includes vasculitis, cholesterol embolization syndrome, warfarin-induced skin necrosis, nephrogenic fibrosing dermopathy, ecthyma, cryofibrinogenemia, cellulitis, necrotizing fasciitis, coagulation disorders, and adverse drug effects. Treatment options are limited. [ ] Next: Cutaneous (...) walls and without evidence of vasculitis. Eosinophilic thrombi or fibrin can occlude some capillaries. In patients with small-vessel thrombosis induced by cold agglutinin disease, the differential diagnoses must include (DIC), (TTP), warfarin (Coumadin)–induced skin necrosis, cryofibrinogenemia, and (PNH). The best treatment of cold agglutinin disease is avoidance of cold temperatures. In contrast to the treatment of other hemolytic anemias, steroids and splenectomy have no role in the treatment

2014 eMedicine.com

84. Granulocytopenia (Diagnosis)

, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. The risk of serious infection increases as the absolute neutrophil count (ANC) falls to the severely neutropenic range (< 500/µL). The duration and severity of neutropenia directly correlate with the total incidence of all infections and of those infections that are life threatening. Tuberculosis (see (...) ). [ , ] Granulocytopenia is defined as a reduced number of blood granulocytes, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. Neutropenia is defined in terms of the absolute neutrophil count (ANC). The ANC is calculated by multiplying the total white blood cell (WBC) count by the percentage of neutrophils (segmented neutrophils or granulocytes) plus the band forms

2014 eMedicine.com

85. Bedbug Bites (Diagnosis)

, such as erythema, wheals, vesicles, or hemorrhagic nodules. Repeated bites may sensitize individuals, leading to more pronounced cutaneous manifestations or systemic hypersensitivity reactions. The local trauma from bedbug bites can lead to secondary bacterial infection, causing ecthyma, cellulitis, or lymphangitis. There is some evidence that bedbugs may also be a vector for hepatitis B and Chagas disease. Histologic findings from bite-site biopsy specimens typically show eosinophilic infiltrates, which (...) to arthropod allergens. The site of the bite can also become secondarily infected with bacteria infection and lead to ecthyma, cellulitis, and/or lymphangitis. See the image below. Bedbug bites themselves are typically painless. However, the subsequent allergic reaction that may develop can cause intense pruritus. While feeding, bedbugs may inject one of several pharmacologically active substances, including hyaluronidase, proteases, and kinins. These compounds may induce different skin reactions

2014 eMedicine.com

86. Campylobacter Infections (Diagnosis)

. Such adherence would promote gut colonization. PEB 1 is a superficial antigen that appears to be a major adhesin and is conserved among C jejuni strains. Some strains of C jejuni produce a heat-labile, choleralike enterotoxin, which is important in the watery diarrhea observed in infections. Infection with the organism produces diffuse, bloody, edematous, and exudative enteritis. The inflammatory infiltrate consists of neutrophils, mononuclear cells, and eosinophils. Crypt abscesses develop in the epithelial (...) in Campylobacter jejuni. Antimicrob Agents Chemother . 2008 Nov. 52(11):3947-54. . Carbone KM, Heinrich MC, Quinn TC. Thrombophlebitis and cellulitis due to Campylobacter fetus ssp. fetus. Report of four cases and a review of the literature. Medicine (Baltimore) . 1985 Jul. 64(4):244-50. . Crushell E, Harty S, Sharif F, Bourke B. Enteric campylobacter: purging its secrets?. Pediatr Res . 2004 Jan. 55(1):3-12. . Drake AA, Gilchrist MJ, Washington JA 2nd, et al. Diarrhea due to Campylobacter fetus subspecies

2014 eMedicine.com

87. Angioimmunoblastic Lymphadenopathy With Dysproteinemia (Diagnosis)

in an elderly patient who presented with generalized pruritic maculopapular eruption and fever after taking doxycycline. [ ] Renner et al described eosinophilic cellulitis (Wells syndrome) in association with angioimmunoblastic lymphadenopathy. [ ] Physical examination All organ systems can be affected by AILD. Typical findings at presentation include the following: Rash (50% of cases) Pruritus (30%) Edema (40%) Pleural effusion (40%) Arthritis (20%) Ascites (25%) Skin involvement in AILD manifests (...) with angioimmunoblastic T-cell lymphoma and proliferative glomerulonephritis. Ann Hematol . 2004 Jul. 83(7):455-9. . Batinac T, Zamolo G, Jonjic N, Gruber F, Nacinovic A, Seili-Bekafigo I, et al. Angioimmunoblastic lymphadenopathy with dysproteinemia following doxycycline administration. Tumori . 2003 Jan-Feb. 89(1):91-5. . Renner R, Kauer F, Treudler R, Niederwieser D, Simon JC. Eosinophilic cellulitis (Wells' syndrome) in association with angioimmunoblastic lymphadenopathy. Acta Derm Venereol . 2007. 87(6):525-8

2014 eMedicine.com

88. Angioedema (Diagnosis)

also been associated with certain conditions or syndromes, such as the following: Cytokine-associated angioedema syndrome (ie, Gleich syndrome or episodic angioedema with eosinophilia) [ ] Well syndrome or eosinophilic cellulitis (ie, granulomatous dermatitis with eosinophilia) [ ] Hypersensitivity angioedema Hypersensitivity (allergic) angioedema is often associated with urticaria. It is typically observed within 30 minutes to 2 hours after exposure to the allergen. Mast cell–mediated angioedema (...) episodic angioedema with eosinophilia (Gleich's Syndrome). Immunol Allergy Clin North Am . 2006 Nov. 26(4):769-81. . Ferreli C, Pinna AL, Atzori L, Aste N. Eosinophilic cellulitis (Well's syndrome): a new case description. J Eur Acad Dermatol Venereol . 1999 Jul. 13(1):41-5. . Brown AF, McKinnon D, Chu K. Emergency department anaphylaxis: A review of 142 patients in a single year. J Allergy Clin Immunol . 2001 Nov. 108(5):861-6. . Yang MS, Lee SH, Kim TW, et al. Epidemiologic and clinical features

2014 eMedicine.com

89. Angioedema (Treatment)

angioedema with eosinophilia (Gleich's Syndrome). Immunol Allergy Clin North Am . 2006 Nov. 26(4):769-81. . Ferreli C, Pinna AL, Atzori L, Aste N. Eosinophilic cellulitis (Well's syndrome): a new case description. J Eur Acad Dermatol Venereol . 1999 Jul. 13(1):41-5. . Brown AF, McKinnon D, Chu K. Emergency department anaphylaxis: A review of 142 patients in a single year. J Allergy Clin Immunol . 2001 Nov. 108(5):861-6. . Yang MS, Lee SH, Kim TW, et al. Epidemiologic and clinical features of anaphylaxis

2014 eMedicine.com

90. Angioimmunoblastic Lymphadenopathy With Dysproteinemia (Treatment)

in an elderly patient who presented with generalized pruritic maculopapular eruption and fever after taking doxycycline. [ ] Renner et al described eosinophilic cellulitis (Wells syndrome) in association with angioimmunoblastic lymphadenopathy. [ ] Physical examination All organ systems can be affected by AILD. Typical findings at presentation include the following: Rash (50% of cases) Pruritus (30%) Edema (40%) Pleural effusion (40%) Arthritis (20%) Ascites (25%) Skin involvement in AILD manifests (...) with angioimmunoblastic T-cell lymphoma and proliferative glomerulonephritis. Ann Hematol . 2004 Jul. 83(7):455-9. . Batinac T, Zamolo G, Jonjic N, Gruber F, Nacinovic A, Seili-Bekafigo I, et al. Angioimmunoblastic lymphadenopathy with dysproteinemia following doxycycline administration. Tumori . 2003 Jan-Feb. 89(1):91-5. . Renner R, Kauer F, Treudler R, Niederwieser D, Simon JC. Eosinophilic cellulitis (Wells' syndrome) in association with angioimmunoblastic lymphadenopathy. Acta Derm Venereol . 2007. 87(6):525-8

2014 eMedicine.com

91. Id Reaction (Autoeczematization) (Treatment)

. . Brenner S, Ophir J, Krakowski A. Pediculid. An unusual -id reaction to pediculosis capitis. Dermatologica . 1984. 168(4):189-91. . Chao SC, Lee YP, Lee JY. Eosinophilic cellulitis and panniculitis with generalized vesicular pustular id reaction after a molten aluminum burn. Dermatitis . 2010 Jun. 21(3):E11-5. . Cunningham MJ, Zone JJ, Petersen MJ, Green JA. Circulating activated (DR-positive) T lymphocytes in a patient with autoeczematization. J Am Acad Dermatol . 1986 Jun. 14(6):1039-41. . Kasteler

2014 eMedicine.com

92. Bedbug Bites (Treatment)

. Repeated bites may sensitize individuals, leading to more pronounced cutaneous manifestations or systemic hypersensitivity reactions. The local trauma from bedbug bites can lead to secondary bacterial infection, causing ecthyma, cellulitis, or lymphangitis. There is some evidence that bedbugs may also be a vector for hepatitis B and Chagas disease. Histologic findings from bite-site biopsy specimens typically show eosinophilic infiltrates, which are indicative of the allergic nature of the reaction

2014 eMedicine.com

93. Papular Urticaria (Treatment)

, dock workers, packers, and indoor workers. These mites are invisible to the naked eye. [ ] The histopathologic pattern in papular urticaria consists of mild subepidermal edema, extravasation of erythrocytes, interstitial eosinophils, and exocytosis of lymphocytes. These findings suggest a pathophysiologic process that is immunologically based. [ ] Morphologic and immunohistochemical evidence suggest that a type I hypersensitivity reaction plays a central role in the pathogenesis of papular (...) persisting after resolution. [ ] Scratching may produce erosions and ulcerations. Secondary impetigo or pyoderma is common. Having pets and the use of colognes were identified as predisposing factors for insect bite dermatitis in one large study, whereas atopy was not. [ ] Papular urticaria. Previous Next: Differential Diagnosis When evaluating a patient with papular urticaria, the following conditions should also be considered: True cellulitis [ ] Histopathologic differentials The histopathologic

2014 eMedicine.com

94. Paraneoplastic Diseases (Treatment)

are the usual manifestations. These changes may progress to the point that the nail sheds. Diagnosis Histopathologic analysis of samples from the affected sites reveals nonspecific changes, including hyperkeratosis, acanthosis, parakeratosis, and dyskeratotic keratinocytes. Perivascular lymphocytic infiltrates are variably present with eosinophils and neutrophils. Direct immunofluorescence is also nonspecific. The diagnosis is based on the characteristic distribution of skin changes. The main entity

2014 eMedicine.com

95. Papular Urticaria (Overview)

, dock workers, packers, and indoor workers. These mites are invisible to the naked eye. [ ] The histopathologic pattern in papular urticaria consists of mild subepidermal edema, extravasation of erythrocytes, interstitial eosinophils, and exocytosis of lymphocytes. These findings suggest a pathophysiologic process that is immunologically based. [ ] Morphologic and immunohistochemical evidence suggest that a type I hypersensitivity reaction plays a central role in the pathogenesis of papular (...) persisting after resolution. [ ] Scratching may produce erosions and ulcerations. Secondary impetigo or pyoderma is common. Having pets and the use of colognes were identified as predisposing factors for insect bite dermatitis in one large study, whereas atopy was not. [ ] Papular urticaria. Previous Next: Differential Diagnosis When evaluating a patient with papular urticaria, the following conditions should also be considered: True cellulitis [ ] Histopathologic differentials The histopathologic

2014 eMedicine.com

96. Paraneoplastic Diseases (Overview)

are the usual manifestations. These changes may progress to the point that the nail sheds. Diagnosis Histopathologic analysis of samples from the affected sites reveals nonspecific changes, including hyperkeratosis, acanthosis, parakeratosis, and dyskeratotic keratinocytes. Perivascular lymphocytic infiltrates are variably present with eosinophils and neutrophils. Direct immunofluorescence is also nonspecific. The diagnosis is based on the characteristic distribution of skin changes. The main entity

2014 eMedicine.com

97. Granulocytopenia (Overview)

, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. The risk of serious infection increases as the absolute neutrophil count (ANC) falls to the severely neutropenic range (< 500/µL). The duration and severity of neutropenia directly correlate with the total incidence of all infections and of those infections that are life threatening. Tuberculosis (see (...) ). [ , ] Granulocytopenia is defined as a reduced number of blood granulocytes, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. Neutropenia is defined in terms of the absolute neutrophil count (ANC). The ANC is calculated by multiplying the total white blood cell (WBC) count by the percentage of neutrophils (segmented neutrophils or granulocytes) plus the band forms

2014 eMedicine.com

98. Bedbug Bites (Overview)

, such as erythema, wheals, vesicles, or hemorrhagic nodules. Repeated bites may sensitize individuals, leading to more pronounced cutaneous manifestations or systemic hypersensitivity reactions. The local trauma from bedbug bites can lead to secondary bacterial infection, causing ecthyma, cellulitis, or lymphangitis. There is some evidence that bedbugs may also be a vector for hepatitis B and Chagas disease. Histologic findings from bite-site biopsy specimens typically show eosinophilic infiltrates, which (...) to arthropod allergens. The site of the bite can also become secondarily infected with bacteria infection and lead to ecthyma, cellulitis, and/or lymphangitis. See the image below. Bedbug bites themselves are typically painless. However, the subsequent allergic reaction that may develop can cause intense pruritus. While feeding, bedbugs may inject one of several pharmacologically active substances, including hyaluronidase, proteases, and kinins. These compounds may induce different skin reactions

2014 eMedicine.com

99. Sinusitis, Chronic (Overview)

contribute to inflammation include the following: Persistent infection (including biofilms and osteitis) [ , ] Allergy and other immunologic disorders Intrinsic factors of the upper airway Superantigens Colonizing fungi that induce and sustain eosinophilic inflammation Metabolic abnormalities such as aspirin sensitivity All of these factors can play a role in disruption of the intrinsic mucociliary transport system. This is because an alteration in sinus ostia patency, ciliary function, or the quality (...) implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis. BMC Ophthalmol . 2016 Sep 21. 16 (1):165. . Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol . 2008 Aug. 57:1015-7. . Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am . 2007 Jun. 21(2):427-48, vii. . Brook I. Bacteriology of chronic maxillary sinusitis in adults. Ann Otol

2014 eMedicine.com

100. Septic Shock (Overview)

into a morphologic picture termed diffuse alveolar damage (DAD). The clinical and pathologic evolution can be categorized into the following 3 overlapping phases [ ] : Exudative phase (edema and hemorrhage) Proliferative phase (organization and repair) Fibrotic phase (end-stage fibrosis) The exudative phase of DAD occurs in the first week and is dominated by alveolar edema and hemorrhage (see the images below). Other histologic features include dense eosinophilic hyaline membranes and disruption of the capillary

2014 eMedicine.com

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