Miriam Sandbank

The appearance of kaposi sarcoma during corticosteroid therapy

Background. Four epidemiologic types of Kaposi sarcoma (KS) are known: classic KS, endemic African KS, epidemic or acquired immunodeficiency syndrome–related KS, and KS associated with immunosuppressive therapy. In most of the latter patients, KS was reported to have developed after organ transplantation, particularly renal transplantation. Thirty‐nine patients who have not had a transplant have been reported to have KS associated with corticosteroid therapy.

The efficacy of combined treatment with prednisone and cyclosporine in patients with pemphigus: Preliminary study

BACKGROUND Cyclosporine, a potent immunosuppressive drug, has been suggested to be beneficial in the treatment of some immune-mediated dermatoses, including pemphigus. OBJECTIVE The aim of the present study was to evaluate the efficacy and safety of combined treatment with prednisone and cyclosporine compared with prednisone alone in patients with pemphigus. METHODS Sixteen hospitalized patients with pemphigus vulgaris received combined treatment with cyclosporine and prednisone for 12 months. Cyclosporine and prednisone were given orally at an initial dose of 5 mg/kg/day and 60 to 80 mg/day, respectively. The cyclosporine dose was adjusted to obtain plasma levels of 100 to 150 ng/L. A historical control group was composed of 15 patients with pemphigus who received prednisone at an initial dose of 120 mg/day, which was decreased according to clinical response. The clinical response, serum titer of autoantibodies, and frequency of side effects during a 1-year follow-up period were evaluated and compared. RESULTS The 16 patients in the combined therapy group achieved clinical remission within 25 days or less, a shorter period than for the control group, although the difference was not statistically significant. New blister formation ceased after a mean of 11.1 +/- 7.9 days of onset of treatment in the combined treatment group versus 20.5 +/- 12 days in the control group (p = 0.004). Hospital stay was shorter in the combined treatment group (mean, 32.6 +/- 12.5 days) than in the control group (mean, 50.7 +/- 17.1 days; p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Conjunctival involvement in pemphigus vulgaris: a clinical, histopathological and immunofluorescence study

Eleven patients with pemphigus vulgaris and with eye complaints had histopathological and direct immunofluorescence (DIF) studies on biopsies of their conjunctivae. In eight of the patients the ocular symptoms preceded the other manifestations of pemphigus. None of the 11 patients had any detectable conjunctival blisters or erosions. The conjunctivitis in three of the patients proved on histopathology and DIF to be a manifestation of pemphigus vulgaris. In the remaining patients, conjunctival hyperaemia with or without a mucoid discharge was observed, but there were no specific histopathological features, although one of them had a positive DIF.

Bullous pemphigoid mimicking bullous erythema multiforme: An untoward side effect of penicillins

Three young and middle-aged patients developed severe bullous eruption after receiving various penicillins. The clinical findings included high fever, prostration, widespread bullous eruption mainly on the head, face, and extremities, targetlike lesions on the palms and soles, and severe erosions in almost all the mucous membranes. Direct and indirect immunofluorescence studies were those of bullous pemphigoid. Complete clearing of the eruption occurred with prednisone therapy. We conclude that drug-induced bullous pemphigoid is a different entity from the classic bullous pemphigoid.

Etretinate treatment of the nevoid basal cell carcinoma syndrome. Therapeutic and chemopreventive effect.

ABSTRACT: A patient suffering from the nevoid basal cell carcinoma syndrome, in whom various surgical and conservative treatment modalities had been tried previously, was placed on oral etretinate therapy. A therapeutic effect of the etretinate on existing basal cell carcinomas and a prophylactic effect in inhibiting new tumor formation were well demonstrated during the T3‐montri period of treatment.

Esophageal involvement in pemphigus vulgaris: A clinical, histologic, and immunopathologic study

Eleven newly diagnosed patients and one patient with pemphigus vulgaris who relapsed underwent endoscopy of the upper gastrointestinal tract. Three patients had blisters or erosions and two had longitudinal lines of erythema in the esophageal mucosa. In four patients histopathologic examination showed findings of pemphigus vulgaris but direct immunofluorescence was positive in all patients. This study demonstrates that the immunopathologic disturbance in pemphigus vulgaris involves the entire length of the esophagus, although only some patients have clinical or histologic involvement. To the best of our knowledge this is the first histopathologic and direct immunofluorescence study of esophageal involvement in patients with untreated pemphigus vulgaris.

Bullous pemphigoid—an adverse effect of ampicillin

A young patient developed an acute self‐limited bullous eruption shortly following ampicillin ingestion, with histopathological and immunofluorescent features fulfilling the criteria of bullous pemphigoid. A review of the relevant literature is made with special emphasis on the heterogenous and sometimes misleading faces of drug‐induced bullous pemphigoid.

Circumscribed scleroderma induced by postlumpectomy radiation therapy

A 57‐year‐old woman who had undergone a lumpectomy for infiltrating duct cell carcinoma of the right breast was found to have morphea after receiving radiation therapy. The morphea occurred at the site of the irradiated field. It is suggested that the irradiation served as a provoking factor and that the morphea might be an isomorphic response to the trauma of the irradiation. Cancer 68:2131–2133.

The clinical and histopathological spectrum of IgA-pemphigus--report of two cases.

Two new cases of neutrophilic bullous disease exhibiting bound and circulating intercellular IgA in viva in both direct and indirect immunofluorescence (IF), for which the term IgA‐pemphigus was recently proposed, are presented. The first case showed a unique constellation of clinical and histopathological features not previously described for IgA‐pemphigus, resembling both dermatitis herpetiformis and pemphigus, for which the designation IgA‐herpetiform pemphigus seems most appropriate. The second case showed clinical and histopathological features mimicking subcorneal pustular dermatosis for which the previously used term IgA‐pemphigus foliaceus seems most appropriate. The previously reported 11 cases showing similar direct IF findings, as well as our two patients, illustrate the main differences between IgA‐pemphigus and classic forms of this condition: (a) different clinical manifestations with the absence of Nikolskys sign; (b) scanty acantholvsis; an abundance of neutrophils, with occasional neutrophilic spongiosis; (c) absence of C3 on direct IF; (d) the lower sensitivity of indirect IF and low levels of circulating antibodies; (e) the relatively benign course of the disease; (f) the apparent responsiveness to sulphones in many cases. It is suggested that IgA pemphigus should he considered as an entity separate from, but closely related to, classic pemphigus.

The course and prognosis of pemphigus. A review of 115 patients

ABSTRACT: A survey of 115 pemphigus patients who have been followed for 4–24 years was carried out in an attempt to analyze the possible factors influencing the course and prognosis of the disease. At the time of the study, 45 patients were in complete remission, 45 still had lesions, and 25 had died. In 12 cases, the death occurred from causes related to the disease or consequences of treatment. The comprehensive statistical analysis revealed that a good prognosis may be expected for patients who, in the initial stage of the disease, show involvement of the skin only (p < 0.05) and when systemic steroid therapy is instituted within half a year of appearance of the disease (p < 0.05). There were no significant differences in the rate of recovery and mortality between the different groups of patients in regard to the initial dose of prednisone. A daily dose of 120 mg of prednisone was sufficient to control the lesions in most of the severe cases and less contributory to death in comparison with previous studies.