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Lyme Disease as a Cause of Acropapular Dermatitis of Childhood
Abstract
Acropapular dermatitis of childhood is a symmetric self-limited papulovesicular exanthem that classically occurs on the cheeks, extensor extremities, and buttocks in young children. The eruption of acropapular dermatitis of childhood represents a reaction to a variety of infections usually of viral origin. We present a child with typical findings of acropapular dermatitis of childhood whose serologic workup revealed an acute Lyme infection.
Viral diseases are common in children and may manifest in the skin as exanthems or specific lesions such as vesicles, bullae, erosions, ulcers, papules, plaques, and tumors. These illnesses range from serious and life-threatening in the case of smallpox to innocuous and cosmetically concerning as in flat warts. The incidence of certain viral diseases like rubella, measles, and varicella has been dramatically decreased in the developing world through immunization programs. For others, like Herpes simplex virus 1 and 2 and herpes zoster, we have targeted antiviral therapies. Human papilloma virus-induced warts and poxvirus-induced molluscum lesions are extremely common pediatric problems without specific antiviral therapies, and thus numerous possible, but often ineffective, treatments exist. There are viral-associated childhood exanthems with distinctive morphologies in which we can only offer observation, symptomatic treatment, and supportive care. These include unilateral laterothoracic exanthem, Gianotti-Crosti syndrome, erythema infectiosum, papular purpuric gloves and socks syndrome, roseola, Epstein Barr Virus-induced mononucleosis, and many of the enteroviral illnesses. Finally, we have progress to make in the management of rarer cutaneous viruses such as orf and cowpox. The management of all of these viruses will be discussed in this chapter.
A 7-year-old boy from suburban Baltimore who presented with cerebellar ataxia and headaches was found by magnetic resonance imaging to have multiple cerebellar enhancing lesions. He had no history of tick exposure. He was initially treated with steroids for presumptive postinfectious encephalitis. Lyme disease was diagnosed 10 weeks later after arthritis developed. Testing of the cerebrospinal fluid obtained at the time cerebellar ataxia was diagnosed revealed intrathecal antibody production to Borrelia burgdorferi. Treatment with intravenous antibiotics led to rapid resolution of persistent cerebellar findings.
Rosai-Dorfman disease is a rare idiopathic histiocytic proliferation disorder that typically presents with painless cervical lymphadenopathy. We report our experience with the management of a case of Rosai-Dorfman disease with compressive optic neuropathy.
Rosai-Dorfman disease involving the bilateral orbital and paranasal sinuses was diagnosed in a 14-year-old boy. Diagnosis was based on the characteristic histopathologic features of sinus histiocytosis, composed of large, round S-100 protein-positive histiocytes with striking emperipolesis. The boy received chemotherapy to resolve the bilateral proptosis and compressive optic neuropathy in the right eye, but this treatment failed. Orbital debulking surgery using the Lynch approach was performed.
Corneal exposure was resolved and visual acuity recovered from 14/20 to 20/20 after partial removal of the tumor mass. There were no complications after surgery. During the 22 months of follow-up, orbital tumor masses redeveloped to cause lagophthalmos again, but did not cause visual impairment.
Rosai-Dorfman disease is a rare disorder, especially in Asia. The disease is usually chronic with spontaneous remission and is refractory to treatment. Partial removal of tumor masses is a workable way to improve visual acuity and correct corneal exposure. Before carrying out this procedure, we discussed with the parents of the patient the potential complications that might follow surgery and secured their permission before proceeding further.
To report a case of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) in an extranodal site with unusual presentation.
A 19-year-old girl presented with bilateral upper eyelid swellings of 2 years duration due to tumor. The masses were excised and sent for histopathological examination. Microscopic examination revealed similar features in both masses in the form of a collection of large histiocytic cells showing emperipolesis (lymphocytophagocytosis). The histiocytic cells stained positively with S-100 protein and CD68. The background comprised small lymphocytes and plasma cells. Based on the overall features a diagnosis of sinus histiocytosis with massive lymphadenopathy or Rosai-Dorfman disease was made.
The present case highlights one of the forms in which extranodal Rosai-Dorfman disease can manifest itself. It is important to keep this differential diagnosis in mind whenever such histopathological features are encountered.
Lyme Dis-ease http://emedicine.medscape.com/ article/1168285-overview 2007. Medscape
- Miravalle Aa
- Schneck Mj
- Puotinen
- Jl
Miravalle AA, Schneck MJ, Puotinen JL et al. Lyme Dis-ease. In: Shah AK, Talavera F, Thomas FP et al., eds. e-Medicine neurology. http://emedicine.medscape.com/ article/1168285-overview 2007. Medscape. New York, NY. Accessed October 8, 2008. CAITLIN E. KENNEDY, M.D.* RAHAT S. AZFAR, M.D. PAUL J. HONIG, M.D.à *Department of Medicine, University of California, San Diego, Department of Dermatology & Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and àDepartment of Dermatology, University of Pennsylvania and Division of Dermatology, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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