Glenn G. Russo

Propylthiouracil hypersensitivity: Report of two patients with vasculitis and review of the literature

Two patients with a hypersensitivity vasculitis in association with propylthiouracil (PTU) administration are described. Although both patients presented with a cutaneous eruption, our first patient suffered severe systemic manifestations and the second patients involvement was primarily limited to the skin. Patients with a vascular hypersensitivity reaction to PTU typically present with constitutional symptoms, acral purpuric skin lesions, and variable involvement of multiple organ systems. The reaction is treated by urgent withdrawal of PTU and implementation of supportive measures and immunosuppressive agents, as necessary. Prompt recognition of this condition and initiation of appropriate therapy lead to complete recovery in most cases.

Mycobacterium chelonae/abscessus complex infection in a liver transplant patient

A 25‐year‐old woman presented in October 1999 with fever, nausea, vomiting, and a nodular eruption that had developed over the previous 7 days. Her past medical history was significant for chronic sclerosing cholangitis, which necessitated a liver transplantation in 1994 and a second one in 1998 due to graft rejection. Upon admission, she was taking the following medications: prednisone 20 mg q.d., cyclosporine 375 mg p.o. b.i.d., sirolimus 10 mg p.o. q.d., levofloxacin 500 mg p.o. q.d., and ganciclovir 1000 mg p.o. t.i.d.

DERMATOLOGIC DISORDERS ASSOCIATED WITH VIRAL HEPATITIS INFECTIONS

Viral hepatitis infections can produce various dermatologic findings in patients who are known to have been infected or are unaware they have been exposed to these viruses. The following is a review of the literature to give the dermatologist a survey of cutaneous findings and syndromes that may necessitate serologic testing to seek out a hepatitis virus as an etiologic agent for the dermatologic pathology.

Cutaneous and noncutaneous disorders treated with extracorporeal photopheresis

Extracorporeal photopheresis (ECP) is a procedure that combines leukopheresis with the administration of either oral 8-methoxypsoralen (8-MOP) prior to leukopheresis or the injection of liquid methoxypsoralen into a leukocyterich cell extract. After a peripheral line has been established, the patients blood is removed and undergoes centrifugation in order to separate it into a fraction that is depleted of leukocytes, which is immediately returned to the patient, and a leukocyte-rich fraction. The leukocyterich or buffy coat fraction is then exposed to UVA light within the ECP unit and re-infused back into the patient. The entire procedure takes approximately 3 h to complete. The photopheresis system is produced by the Therakos Company.

Immunoenzyme techniques in dermatopathology

The advantages and disadvantages of the immunofluorescence and immunoperoxidase techniques and an introductory description of the major variations of the basic immunoperoxidase method are discussed. The ability to identify intermediate filaments, T and B lymphocyte cell markers, S-100 proteins, myelin basic protein, and carcinoembryonic antigen in tissue sections can assist the dermatopathologist in classifying undifferentiated or histologically similar-appearing tumors. A systematic approach to the diagnosis of a majority of these tumors with the use of immunoenzyme staining is provided.