R.U. Wahl

Perioperative Anaphylaxie aufgrund einer Rocuroniumallergie bei einem Kind

During the induction of anesthesia for strabismus correction, a six-year-old boy suffered anaphylaxis with hypotension. Midazolam, propofol, sufentanil, rocuronium, dexamethasone and ibuprofen had been administered. The boys history failed to reveal any drug allergies. Intracutaneous testings with drugs used for anesthesia and other muscle relaxants verified a positive reaction to rocuronium as well as to cisatracurium, mivacurium, vecuronium and atracurium. There was no reaction to suxamethonium.

Impfgranulom bei Spättypallergie gegen Aluminiumsalze

BACKGROUND Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques. CONCLUSIONS The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.

[Post-vaccination granulomas caused by delayed-type reaction to aluminum salts].

BACKGROUND Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques. CONCLUSIONS The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.

Perioperative anaphylaxis caused by rocuronium allergy in a child

During the induction of anesthesia for strabismus correction, a six-year-old boy suffered anaphylaxis with hypotension. Midazolam, propofol, sufentanil, rocuronium, dexamethasone and ibuprofen had been administered. The boys history failed to reveal any drug allergies. Intracutaneous testings with drugs used for anesthesia and other muscle relaxants verified a positive reaction to rocuronium as well as to cisatracurium, mivacurium, vecuronium and atracurium. There was no reaction to suxamethonium.

Congenital unilateral linear porokeratosis

ZusammenfassungPorokeratosen beruhen auf einer Störung der epidermalen Verhornung. Wir berichten über eine 27-jährige Frau, die seit Geburt an papulösen, linear angeordneten, hyperkeratotischen Hautveränderungen am rechten Fuß leidet. Im Laufe ihres Lebens breiteten sich die Herde über das ganze rechte Bein aus und dehnten sich über die rechte Seite des Stamms bis zum rechten Oberarm und dem Kinn aus. Die klinische Diagnose einer Porokeratosis linearis unilateralis wurde durch eine histopathologische Untersuchung bestätigt.AbstractPorokeratosis is a disorder of epidermal keratinization. A 27-year-old woman had papular, linearly arranged, hyperkeratotic lesions on the right foot since birth. Over the course of her life, the lesions progressed to involve the entire right leg and extended to the right side of her trunk, the right arm and chin. The clinical diagnosis of unilateral linear porokeratosis was confirmed by histopathology.Porokeratosis is a disorder of epidermal keratinization. A 27-year-old woman had papular, linearly arranged, hyperkeratotic lesions on the right foot since birth. Over the course of her life, the lesions progressed to involve the entire right leg and extended to the right side of her trunk, the right arm and chin. The clinical diagnosis of unilateral linear porokeratosis was confirmed by histopathology.

Impfgranulom bei Spättypallergie gegen Aluminiumsalze@@@Post-vaccination granulomas caused by delayed-type reaction to aluminum salts

BACKGROUND Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques. CONCLUSIONS The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.

Atypisches Fibroxanthom am Capillitium@@@Atypical fibroxanthoma of the scalp: Überblick und aktuelle Erkenntnisse@@@Overview and recent developments

Atypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.ZusammenfassungDas atypische Fibroxanthom (AFX) ist ein seltener, niedrigmaligner, mesenchymaler Tumor der Dermis und wird der Gruppe der fibrohistiozytären Tumore zugeordnet. Der Tumor tritt vor allem an lichtgeschädigter Haut im Kopfbereich älterer Männer auf. Eine klinische Diagnosestellung ist aufgrund vieler Differenzialdiagnosen (Leiomyosarkom, Plattenepithelkarzinom, spindelzelliges malignes Melanom, Dermatofibrosarcoma protuberans) nicht möglich. Zum Ausschluss der Differenzialdiagnosen ist eine immunhistochemische und histologische Diagnostik notwendig. Der Tumor zeigt eine sehr gute Prognose nach vollständiger Exzision. Die mikrografisch kontrollierte Chirurgie gilt als Therapie der Wahl.AbstractAtypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.

Atypisches Fibroxanthom am Capillitium

Atypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.ZusammenfassungDas atypische Fibroxanthom (AFX) ist ein seltener, niedrigmaligner, mesenchymaler Tumor der Dermis und wird der Gruppe der fibrohistiozytären Tumore zugeordnet. Der Tumor tritt vor allem an lichtgeschädigter Haut im Kopfbereich älterer Männer auf. Eine klinische Diagnosestellung ist aufgrund vieler Differenzialdiagnosen (Leiomyosarkom, Plattenepithelkarzinom, spindelzelliges malignes Melanom, Dermatofibrosarcoma protuberans) nicht möglich. Zum Ausschluss der Differenzialdiagnosen ist eine immunhistochemische und histologische Diagnostik notwendig. Der Tumor zeigt eine sehr gute Prognose nach vollständiger Exzision. Die mikrografisch kontrollierte Chirurgie gilt als Therapie der Wahl.AbstractAtypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.

[Atypical fibroxanthoma of the scalp: overview and recent developments].

Atypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.ZusammenfassungDas atypische Fibroxanthom (AFX) ist ein seltener, niedrigmaligner, mesenchymaler Tumor der Dermis und wird der Gruppe der fibrohistiozytären Tumore zugeordnet. Der Tumor tritt vor allem an lichtgeschädigter Haut im Kopfbereich älterer Männer auf. Eine klinische Diagnosestellung ist aufgrund vieler Differenzialdiagnosen (Leiomyosarkom, Plattenepithelkarzinom, spindelzelliges malignes Melanom, Dermatofibrosarcoma protuberans) nicht möglich. Zum Ausschluss der Differenzialdiagnosen ist eine immunhistochemische und histologische Diagnostik notwendig. Der Tumor zeigt eine sehr gute Prognose nach vollständiger Exzision. Die mikrografisch kontrollierte Chirurgie gilt als Therapie der Wahl.AbstractAtypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.

Erlotinib-assoziiertes akneiformes Exanthem

A 73-year-old man has been suffering from a pulmonary adenocarcinoma for three years. He has been treated with the EGF-inhibitor erlotinib for the past 18 months. While taking this medication he developed a progressive papulopustular rash on his face and trunk which later spread to his thighs. Topical treatment with methylprednisolone and nadifloxacin, as well as short courses of systemic doxycycline and ciprofloxacin, led to marked improvement and control of his skin condition.