Only a few cases of contact allergic gastritis in patients with nickel allergy have been reported. We report a case of probable contact-allergic gastritis in a 46-year-old woman. Clinical examination ...revealed lichenoid mucosal lesions of the gums adjacent to bridges and crowns that had been implanted several weeks back. Since implantation, the patient had suffered from gastrointestinal complaints (including stomach pain). Gastroscopy showed eosinophilic gastritis. Patch testing done under the diagnosis of contact allergic stomatitis showed positive reactions to: gold sodium thiosulphate; manganese (II) chloride; nickel (II) sulphate; palladium chloride; vanadium (III) chloride and zirconium (IV) chloride. The crowns and bridge contained gold, palladium and zirconium chloride, hence they were replaced by titan-based dentition. Shortly after replacing the artificial dentition, all gastrointestinal symptoms resolved spontaneously without further treatment. Delayed-type allergy against the components of artificial dentition seemed to be the cause of gastritis.
Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance ...and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.
Caterpillar dermatitis (lepidopterism) is a disease that is caused by butterflies, moths and their caterpillars. Clinical signs and symptoms vary from itchy skin lesions to conjunctivitis, ...pharyngitis, malaise and anaphylactic reactions. We present the case of two brothers with typical skin lesions of leptidopterism. The older boy showed skin lesions after playing with caterpillars in the garden, whereas his younger brother was affected without direct contact to the caterpillars but only by playing with his brother. As the mother could show two caterpillars, lepidopterism could easily be diagnosed. Under a local therapy with a medium potent corticosteroid cream and a non-sedating orally administered antihistamine, all skin lesions as well as itching disappeared within 1 week.
Rowell syndrome is a very controversial condition and though defining diagnosing criteria exist, many previously published cases lack one or more of these criteria. It represents the combination of ...cutaneous lupus erythematosus and erythema multiforme in one single individual. In order to discuss relevance of diagnostic and defining criteria the authors use a case seen in our outpatient service that was primarily diagnosed as Rowell syndrome. But due to lacking criteria, the authors rediagnosed this patient as an unusual variation of lupus erythematosus.
An 84-year-old woman presented with ulcerated scalp lesions that had been mistreated as acute haemorrhagic eczema for several months. Examination showed confluent purple-blue-grey macules, papules ...and nodules covering a great portion of the parietofrontotemporal scalp with focal areas of ulceration. Dermatopathologic examination of two 5 mm punch biopsies confirmed an invasive malignant melanoma (Breslow thickness of 5 mm, clark level V). In addition, lymphangiosis melanomatosa, intravascular tumour growth and a diffuse infiltration of the subcutaneous tissue were seen. Possible treatment options (eg, surgery, irradiation, intralesional treatment) were discussed with the patient, but declined. It is important that clinicians are aware that melanomas may be large and biopsies are mandatory to avoid delayed diagnosis. Thus, a dermatologist has a pre-eminent position in diagnostic procedure.
Delayed-type hypersensitivity reactions (DTHRs) after subcutaneous application of unfractionated heparins or low-molecular-weight heparins are not uncommon. Standard allergological testing usually ...includes intracutaneous skin tests and patch testing of different heparins, heparinoids, and thrombin inhibitors followed by subcutaneous and/or intravenous challenge with skin test-negative drugs. We present data from a single-center case series of 15 patients with DTHR after low-molecular-weight heparin administration. Intracutaneous testing that can be considered as gold standard identified the suspicious elicitor in 11 (73.4%) of 15 of the patients. Patch testing was positive in 5 (33.4%) of 15 of the patients and was only positive in patients who were also reacting in the intradermal testing. Intravenous challenge with heparin sodium was performed in 10 of 15 patients and was well tolerated in all cases, despite prior positive intracutaneous tests with the same substance. Intracutaneous documentation of DTHR was not an adequate predictor of intravenous challenge. Keywords: heparin, allergy, alternatives, pregnancy, cardiac surgery, thrombosis
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Lues maligna represents a rare form secondary syphilis and is also known as ‘malignant syphilis’ or ‘ulceronodular syphilis’. This clinical entity is predominantly found in immunodeficient patients ...such as patients with HIV or AIDS. The patient presented here suffered from unspecific symptoms such as painful joints, headache, flu-like symptoms and a disseminated exanthema presenting with ulcerating nodules for 1 week. He further reported a 7 weeks history of painless ulcer, involving his external genitals and anus. Unsafe sexual contacts were strictly denied first, but as serological investigation could prove active syphilis and HIV infection, the patient finally stated promiscuous unprotected homosexual contacts in the past. He was treated with penicillin G intravenously three times daily. The unspecific flu-like symptoms disappeared quickly within several days, all skin lesions healed, partly with scars after 2 weeks.
The authors report the case of an 81-year-old male who presented with a 3-year-history of a bluish, nodular tumour located on the extensor side of his right forearm. Subjective symptoms included ...tenderness upon palpation and spontaneous haemorrhage. In order to exclude malignant neoplasms, for example, nodular melanoma, metastatic melanoma or angiosarcoma, the tumour was surgically removed and tissue submitted for microscopic examination. Histologically, the authors diagnosed this as giant vascular eccrine spiradenoma, a rare variant of eccrine spiradenoma, which can easily be mistaken for angiomatous lesions due to the haemorrhagic features and florid vascularisation. It is our aim to help clarify the diagnosis and differentiate giant vascular eccrine spiradenoma from other painful cutaneous tumours exhibiting a high degree of vascularisation, for example, angiosarcoma or venous thrombosis, as this case represents one of only seven found in published literature.
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