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A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis

Autoeczematization, the dissemination of a local eczematous reaction to a distal site, is closely associated with lower extremity edema. Our patient is a 50-year-old man with a past medical history of drug-induced lupus to hydralazine and recent bilateral cellulitis in his lower extremities. He was...

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Autores principales: Bhagat, Yash V, Otles, Merve, Salmon, Brittany, Graham, Roshaye, Micheal, Miriam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9236631/
https://www.ncbi.nlm.nih.gov/pubmed/35774716
http://dx.doi.org/10.7759/cureus.25310
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author Bhagat, Yash V
Otles, Merve
Salmon, Brittany
Graham, Roshaye
Micheal, Miriam
author_facet Bhagat, Yash V
Otles, Merve
Salmon, Brittany
Graham, Roshaye
Micheal, Miriam
author_sort Bhagat, Yash V
collection PubMed
description Autoeczematization, the dissemination of a local eczematous reaction to a distal site, is closely associated with lower extremity edema. Our patient is a 50-year-old man with a past medical history of drug-induced lupus to hydralazine and recent bilateral cellulitis in his lower extremities. He was presented with complaints of vesicles on his palms and soles and a scaling rash that had spread over his torso, arms, and trunk. Laboratory studies found no evidence of an active rheumatological condition with complement C3 and C4 levels being normal and no anti-dsDNA, anti-histone, anti-Smith, anti-ribonucleoprotein (anti-RNP), anti-centromere, anti-neutrophil cytoplasmic antibodies (ANCA), anti-Ro, or anti-La antibodies present. Moreover, syphilis, HIV, gonorrhea, chlamydia, rickettsia antibody, and Borrelia burgdorferi antibody testing was negative suggesting a non-infectious etiology of the rash. Hypothesizing a dermatologic origin of the rash, a skin biopsy was performed that revealed intermittent foci of moderate hyperparakeratosis and mild hypergranulosis indicative of eczematous dermatitis. Unfortunately, treatment of the disseminated rash with 10 mg of daily oral prednisone and topical triamcinolone acetonide 0.1% ointment proved inefficient, and methotrexate therapy was advised. We posit that cellulitis, a soft tissue infection under the skin, is a potential cause of disruption of the skin barrier that leads to activation of autosensitized T cells. These activated T cells circulate to distal areas of the skin and may lead to autoeczematization. The treatment of these id reactions with corticosteroids - both topical and oral - may be insufficient at reducing dermatitis and require the application of systemic methotrexate or cyclosporine. Through this case, we demonstrate the importance of treating id reactions by stepping up the intensity of treatment due to the severity of autosensitization-driven eczema.
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spelling pubmed-92366312022-06-29 A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis Bhagat, Yash V Otles, Merve Salmon, Brittany Graham, Roshaye Micheal, Miriam Cureus Dermatology Autoeczematization, the dissemination of a local eczematous reaction to a distal site, is closely associated with lower extremity edema. Our patient is a 50-year-old man with a past medical history of drug-induced lupus to hydralazine and recent bilateral cellulitis in his lower extremities. He was presented with complaints of vesicles on his palms and soles and a scaling rash that had spread over his torso, arms, and trunk. Laboratory studies found no evidence of an active rheumatological condition with complement C3 and C4 levels being normal and no anti-dsDNA, anti-histone, anti-Smith, anti-ribonucleoprotein (anti-RNP), anti-centromere, anti-neutrophil cytoplasmic antibodies (ANCA), anti-Ro, or anti-La antibodies present. Moreover, syphilis, HIV, gonorrhea, chlamydia, rickettsia antibody, and Borrelia burgdorferi antibody testing was negative suggesting a non-infectious etiology of the rash. Hypothesizing a dermatologic origin of the rash, a skin biopsy was performed that revealed intermittent foci of moderate hyperparakeratosis and mild hypergranulosis indicative of eczematous dermatitis. Unfortunately, treatment of the disseminated rash with 10 mg of daily oral prednisone and topical triamcinolone acetonide 0.1% ointment proved inefficient, and methotrexate therapy was advised. We posit that cellulitis, a soft tissue infection under the skin, is a potential cause of disruption of the skin barrier that leads to activation of autosensitized T cells. These activated T cells circulate to distal areas of the skin and may lead to autoeczematization. The treatment of these id reactions with corticosteroids - both topical and oral - may be insufficient at reducing dermatitis and require the application of systemic methotrexate or cyclosporine. Through this case, we demonstrate the importance of treating id reactions by stepping up the intensity of treatment due to the severity of autosensitization-driven eczema. Cureus 2022-05-24 /pmc/articles/PMC9236631/ /pubmed/35774716 http://dx.doi.org/10.7759/cureus.25310 Text en Copyright © 2022, Bhagat et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Dermatology
Bhagat, Yash V
Otles, Merve
Salmon, Brittany
Graham, Roshaye
Micheal, Miriam
A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis
title A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis
title_full A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis
title_fullStr A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis
title_full_unstemmed A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis
title_short A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis
title_sort case of severe disseminated autoeczematization secondary to cellulitis
topic Dermatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9236631/
https://www.ncbi.nlm.nih.gov/pubmed/35774716
http://dx.doi.org/10.7759/cureus.25310
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