Article

Amlodipine-associated bullous pemphigoid with erythema multiforme-like clinical features.

International journal of dermatology (impact factor: 1.18). 05/2011; 50(5):637-9. DOI:10.1111/j.1365-4632.2009.04417.x pp.637-9
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    Article: NEURAL REACTIVITY DETECTED BY IMMUNOFLUORESCENCE IN A PATIENT WITH A LOCALIZED BLISTERING DISEASE
    Abreu-Velez AM, Howard MS
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    ABSTRACT: Introduction: Multiple clinical etiologies exist for rapidly appearing skin blisters are multiple. Case report: A 69-year-old male from a rural area of Georgia, USA, was evaluated for the presence of suddenly appearing, localized erythema and edema on his leg with a skin blister. At presentation, the patient was taking multiple medications for other medical issues. Methods: Skin biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence, indirect immunofluorescence and immunohistochemistry studies were performed. Results: H&E staining demonstrated a subepidermal blistering process. Within the dermis, a mild, superficial, perivascular and perineural infiltrate of lymphocytes, histiocytes and eosinophils was seen. Direct and indirect immunofluorescence revealed focal dermal perineural and free epidermal nerve fiber staining utilizing antibodies to human Complement/C1q, C3, C4, kappa and lambda light chains. Immunohistochemistry studies revealed IgG, IgE, C3, fibrinogen, albumin and kappa deposition inside and around the blister. Conclusions: Our case has some clinical and epidemiological features that resemble localized bullous pemphigoid, however, the most interesting findings were the neural reactivity without concomitant diabetes or peripheral neuropathy. Notably, a concomitant leak of ricin was simultaneously detected in same geographic area as the patient. We suggest that ricin environmental toxicity may have contributed to the observed neural reactivity.
    Our Dermatol Online. 01/2013; 4(1):91-94.
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    Article: N-TRAPS AND C-ANCAS IN A LUPUS ERYTHEMATOSUS-SCLERODERMA OVERLAP SYNDROME WITH VASCULITIS AND PANNICULITIS
    Abreu-Velez AM, Brown VM, Shipp L, Smoller B, Howard MS
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    ABSTRACT: Introduction: Histologic vasculitis must be interpreted with caution, as there is considerable overlap in its clinical, histologic and immunologic presentations. Case report: A 42 year old woman presented with an plaque on the buttock that was tender to palpation, and had been present for six weeks. Physical examination revealed a large, erythematous plaque with focal areas of atrophy, pigmentation, small crusts, and small blisters. Skin biopsies for routine histology, direct immunofluorescence and immunohistochemical examination were taken. Methods: Skin biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence, indirect immunofluorescence and immunohistochemistry studies were performed. Results: Examination of the tissue sections demonstrated an inflammatory process involving capillaries and small blood vessels within the dermis and panniculitic adipose tissue. Focal extravasation of red blood cells into the dermal interstitial tissue was also observed. A mild, focal, lobular panniculitis was also present. Direct immunofluorescence and immunohistochemistry demonstrated deposits of several antibodies on vessels throughout the dermis. In addition, anti-neutrophilic cytoplasmic antibodies and neutrophil extracellular traps were identified. Conclusions: Few vasculitic processes have pathognomonic histologic findings. Often, the dermatopathologist and clinician must work together, combining clinical, histologic and other laboratory data to determine the nature of the primary disease process. In our case, a diagnosis of vasculitis with autoimmune overlapping auoimmune syndromes represented the consensus diagnostic conclusion.
    Our Dermatol Online. 01/2013; 4(1).
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Kui Young Park