Exfoliative erythroderma is an uncommon entity with guarded prognosis. Our aim is to report a case study with conclusive clinical and histopathological data, emphasizing diagnosis challenges. We report the case of a year-old man presenting with exfoliative erythroderma. He had a history of alcoholism, arterial hypertension, and plaque psoriasis, and he had rapidly reduced his daily oral corticosteroid dose. After a period of clinical improvement, he had a recurrence of exfoliative erythroderma and died due to bacterial sepsis. The infectious agent that caused sepsis was a carbapenem-resistant strain of Pseudomonas aeruginosa.
|Published (Last):||13 June 2017|
|PDF File Size:||17.51 Mb|
|ePub File Size:||5.95 Mb|
|Price:||Free* [*Free Regsitration Required]|
Exfoliative erythroderma is an uncommon entity with guarded prognosis. Our aim is to report a case study with conclusive clinical and histopathological data, emphasizing diagnosis challenges. We report the case of a year-old man presenting with exfoliative erythroderma.
He had a history of alcoholism, arterial hypertension, and plaque psoriasis, and he had rapidly reduced his daily oral corticosteroid dose. After a period of clinical improvement, he had a recurrence of exfoliative erythroderma and died due to bacterial sepsis. The infectious agent that caused sepsis was a carbapenem-resistant strain of Pseudomonas aeruginosa.
Because of frequent diagnosis challenges involving this uncommon and severe clinical entity, main features, predisposing factors, and precipitating factors should be highlighted to enhance the index of suspicion, which contributes to early diagnosis. Keywords: Dermatitis; exfoliative; erythroderma; erythema; psoriasis. Relata-se o caso de um homem de 68 anos com eritrodermia esfoliativa. Detailed anamnesis is necessary to identify possible risk factors like infections, ingestion or topic use of medicines e.
These lesions had a rapid onset and affected almost all his body surface in less than a week. He was taking captopril to control hypertension and prednisone for plaque-type psoriasis.
He denied personal and family history of atopy, photo- sensibility, as well as arthralgia. On admission, he was eutrophic body mass index: Confluent scaling plaques were scattered on his face, neck, trunk and limbs Figure 1 , and involved flexural areas, palms and soles. His clinical features were strongly suggestive of exfoliative erythroderma; worth of note was the absence of changes on the nails and mucous membranes.
The electrocardiogram revealed signs of moderate left ventricle hypertrophy, and the image of chest radiography was normal. Remarkable laboratory findings were anemia, leukocytosis, eosinophilia and renal insufficiency Table. Skin biopsy studies supported the diagnosis of acute generalized exanthematic dermatosis due to severe erythrodermic psoriasis Figure 2. Superficial derma showed edema, vasodilation and congestion, with lymphohistiocytic and eosinophilic perivascular infiltrates.
Initially, he evolved with worsening and dissemination of the skin changes, and development of pitting edema in the lower limbs. His treatment schedule included prednisone, methotrexate During hospitalization, the patient presented with respiratory symptoms and chest radiography images of inflammatory infiltrate on the right lung, which was successfully treated by levofloxacin.
An acute episode of gouty arthritis uric acid: 8. His general improvement was gradually achieved, and the erythematous desquamation of the skin completely subsided without any remarkable sequel 35 days after his hospital admission. After hospital discharge, he was referred to specialized outpatient surveillance. A new episode of exfoliative erythroderma flared up seven months later, and he received clinical, nutritional and intensive care support during three weeks.
Notwithstanding, his death occurred following a severe bacterial sepsis, which was unresponsive to treatment. Exfoliative erythroderma constitutes a severe and uncommon condition, with high morbidity and mortality rates. With diagnosis of plaquetype psoriasis, he was under treatment with prednisone in other service.
Fernandes et al performed a study about erythroderma in Brazilian patients aging from 30 to 80 years, 92 Other causes included drug adverse effect Many of our findings are in accordance with the data of that study, like male gender, psoriasis, pruritus, lower limb edema, anemia, high erythrocyte sedimentation rate, leukocytosis, and eosinophilia.
There could be an additional concern in the present case study regarding the previous use of captopril, because this drug may be a rare precipitant factor for exfoliative erythroderma in individuals with psoriasis. Stopping local or oral corticosteroid has been an usual triggering factor for psoriasic erythroderma. Because of renal impairment, drug dosage was adjusted according to creatinine clearance. Although the diagnosis of gouty arthritis seemed clinically characterized in the present case, histopathological confirmation is lacking because of the risk-benefits of invasive procedures; in fact, there was no clinical or imaging data to support the possibility of psoriatic arthritis.
Our patient had the dry form of exfoliative erythroderma, 3 without mucous changes or deformities on nails or joints. Therefore, hypotheses like papuloerythroderma of Ofuji and osteo arthropatic psoriasis were ruled out. In conclusion, exfoliative erythroderma is a clinical syndrome with guarded prognosis and most of cases are due to previous skin diseases; moreover, it often constitutes a diagnosis challenge and the prognosis is under influence of potential risk factors.
Based on early clinical suspicion, three simultaneous biopsies must be performed to confirm the diagnosis. Erythroderma of unknown etiology. Dermatol Online J. An Bras Dermatol. Erythrodermic psoriasis: epidemiological clinical and therapeutic features about 60 cases. Tunis Med. A severe case of erythrodermic psoriasis associated with advanced nail and joint manifestations: a case report. J Med Case Rep. Coexisting gout, erythrodermic psoriasis and psoriatic arthritis. Eur J Dermatol.
Recebido em 7 de Fevereiro de A year-old man with exfoliative erythroderma: a diagnostic dilemma? Figure 1. Confluent scaling plaques are disseminated on the trunk and limbs in a subject with exfoliative erythroderma. Figure 2. Dilated tortuous vessels in the superficial derma, with lymphohistiocytic and eosinophilic perivascular infiltrates and edema. Tel: 55 61 , ramal
ERITRODERMIA ESFOLIATIVA DA SALAZOPIRINA
You are currently viewing the original 'fpnotebook. Internet Explorer 8. If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.
A 68-year-old man with exfoliative erythroderma: a diagnostic dilemma?
These images are a random sampling from a Bing search on the term "Erythroderma. Search Bing for all related images. Started in , this collection now contains interlinked topic pages divided into a tree of 31 specialty books and chapters. Content is updated monthly with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. Toggle navigation.