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Eosinophilic Cellulitis

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101. 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

102. 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

103. 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

104. Neutropenia (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

105. 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

106. Id Reaction (Autoeczematization) (Overview)

, 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 JS, Petersen MJ, Vance JE, Zone JJ. Circulating activated T lymphocytes in autoeczematization. Arch Dermatol . 1992 Jun. 128(6):795-8

2014 eMedicine.com

107. Dermatologic Manifestations of Pulmonary Disease (Overview)

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 granuloma, characterized by a necrotic core surrounded by densely packed

2014 eMedicine.com

108. Dermatologic Manifestations of Hematologic Disease (Overview)

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

109. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Overview)

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 treatment suggests (...) . [ ] 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 is necessary to differentiate

2014 eMedicine.com

110. Dirofilariasis (Overview)

Thighs Abdominal wall Male genitalia Ophthalmic involvement may be periorbital, [ , ] subconjunctival, [ ] subtenon, [ ] or intraocular. [ ] See for more detail. Diagnosis Studies used in the diagnosis and evaluation of dirofilariasis include the following: Complete blood count (CBC) - Using a CBC, eosinophilia may be detected in up to 20% of cases of HPD Sputum cytology - The presence of eosinophils may support a diagnosis of HPD in patients with a coin lesion observed on radiography, although (...) in endemic areas of northeastern Italy indicated that the mosquito host Culex pipiens fed on dogs 70% of the time and on humans 26% of the time. [ ] D immitis is most often associated with coin lesions of the lung (human pulmonary dirofilariasis, or HPD), but isolated reports exist of D immitis or D immitis –like worms causing cutaneous or conjunctival disease. Extrapulmonary D immitis infections described in the literature include a hepatic nodule, [ ] eosinophilic meningitis, [ ] intraocular infection

2014 eMedicine.com

111. Upper Respiratory Tract Infection (Overview)

that respond to pathogens. Humoral immunity (immunoglobulin A) and cellular immunity act to reduce infections throughout the entire respiratory tract. Resident and recruited macrophages, monocytes, neutrophils, and eosinophils coordinate to engulf and destroy invaders. A host of inflammatory cytokines mediates the immune response to invading pathogens. Normal nasopharyngeal flora, including various staphylococcal and streptococcal species, help to defend against potential pathogens. Patients (...) , but immunocompromised persons may have a more severe course. Untreated group A streptococcal pharyngitis can result in the following: Acute rheumatic fever Acute glomerulonephritis Peritonsillar abscess Toxic shock syndrome Impetigo Cellulitis or abscess Otitis Sinusitis Conjunctivitis Bronchitis Mortality from group A streptococcal pharyngitis is rare, but serious morbidity or death may result from one of its complications. Streptococcal pharyngitis without complications rarely poses significant risk for morbidity

2014 eMedicine.com

112. Traction Alopecia (Overview)

a clinically noninflammatory patchy alopecia. The most common condition to produce this appearance is lichen planopilaris. The term “idiopathic pseudopelade” refers to a distinct fibrosing alopecia characterized by a thin dermis, with dense eosinophilic dermal collagen and thick recoiled elastic fibers. The fibrous tracts are broad and may contain granulomas, but the surrounding elastic sheath is preserved. Traction alopecia As the name implies, traction alopecia is alopecia secondary to physical traction (...) predominate are as follows: Folliculitis decalvans: Folliculitis decalvans presents with recurrent crops of follicular pustules that result in permanent epilation. Staphylococci are often cultured from pustules, but this condition does not respond the standard antibiotic regimens. The best results are obtained by long-term use of topical corticosteroids together with an oral tetracycline. Perifolliculitis capitis abscedens et suffodiens: Other terms used for include dissecting cellulitis and Hoffman

2014 eMedicine.com

113. Toxicity, Cocaine (Overview)

aspiration pneumonitis or after an intravenous injection of bacteria or toxic organic or inorganic materials Aneurysm or pseudoaneurysm: May be noted with mainlining (ie, directly injecting into a central artery or vein); this finding is an indication for further imaging studies In addition, radiography may be useful for evaluating cellulitis, an abscess, or a nonhealing wound in an intravenous drug user; it may reveal a foreign body or subcutaneous emphysema produced by gas-forming organisms (...) producing these effects are unknown, but hypotheses include a direct effect on lymphocyte activity, myocardial cell cytotoxicity secondary to an increase in the activity of natural killer cells, hypersensitivity reactions (suggested by eosinophilic infiltrate), and induction of focal myocarditis from catecholamine administration. Cocaine causes a direct negative inotropic effect on cardiac muscle, resulting in transient toxic cardiomyopathy. In one small series, 8 of 10 subjects who used cocaine long

2014 eMedicine.com

114. Paraneoplastic Diseases (Follow-up)

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

115. Papular Urticaria (Follow-up)

, 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

116. Angioimmunoblastic Lymphadenopathy With Dysproteinemia (Overview)

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

117. Angioedema (Overview)

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

118. Agranulocytosis (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

119. 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

120. Id Reaction (Autoeczematization) (Follow-up)

. . 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

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