Dawsonlim7480

BACKGROUND Verrucous or hypertrophic lichen planus is a chronic inflammatory skin disease characterized by extremely pruritic thick hyperkeratotic plaques and is resistant to topical treatment. PATIENTS AND METHODS Herein, we report three clinical cases of hypertrophic lichen planus successfully treated with a combination of topical steroids daily in occlusion and trichloroacetic acid (TCA) 50% with peeling every week. DISCUSSION TCA is involved in regulating inflammation and scarring. Through its keratolytic properties it enhances the efficacy of topical steroids, whose action is hindered by hyperkeratosis. CONCLUSION The combination of TCA and topical steroids offers a good alternative for the treatment of hypertrophic lichen planus. INTRODUCTION An original case of DRESS syndrome is reported herein with a particular cutaneous presentation and etiology. OBSERVATION A 52-year-old man developed a febrile pustular rash after being treated with methotrexate and celecoxib for inflammatory rheumatism and with amoxicillin-clavulanic acid over the previous 2 days. Eighty percent of his body surface was covered with pustular infiltrated plaques. On the following days, the patient developed persistent fever, with polyadenopathy, hepatic cytolysis, eosinophilia, interstitial lung disease and cardiac involvement. Cutaneous biopsy was consistent with a drug eruption. Epstein Barr Virus PCR was positive. PKA peptide A diagnosis of DRESS syndrome was made with a RegiSCAR score above 5. Systemic corticosteroids were given, resulting in cessation of the fever and complete recovery with regard to dermatosis, laboratory abnormalities and cardiac function. DISCUSSION The present case is original, with a febrile pustular eruption mimicking acute generalized exanthematous pustulosis and cardiac anomalies with electrical changes and impairment of ventricular function. Epstein Barr Virus may have played a role in the presentation. No previous cases of DRESS syndrome caused by methotrexate have been described. Amoxicillin was probably not involved in the present case of DRESS syndrome as it was taken for only two days, but its role as a co-factor in association with the EBV viral reactivation should not be ruled out. CONCLUSION We report an original case of DRESS syndrome in terms of pustular cutaneous presentation and cardiac impairment. EBV reactivation associated with amoxicillin may be suspected. Basal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload. The impact of localized hypertrophy on left ventricular (LV) and left atrial (LA) function is still unclear. Our aim is to investigate if BSH is a marker of a more pronounced impact of hypertension on cardiac function in the early stages of hypertensive heart disease. An echocardiogram was performed in 163 well-controlled hypertensive patients and 22 healthy individuals. BSH was defined by a basal-to-mid septal thickness ratio ≥1.4. LV dimensions and mass were evaluated. LV global and regional deformation was assessed by 2-dimensional (2D) speckle tracking echocardiography, and LV diastolic function by 2D and Doppler imaging. LA function was evaluated with phasic volume indices calculated from 2D and 3-dimensional volumes, as well as speckle tracking echocardiography. The population was 54% men, mean age 57 (53 to 60) years. BSH was seen in 20% (n = 32) of the hypertensive cohort. Patients with BSH showed decreased regional LV systolic deformation, impaired LV relaxation with a higher proportion of indeterminate LV diastolic function, and LA functional impairment defined by a reduction of reservoir strain and a change in LA functional dynamics. In conclusion, in well-controlled hypertension impairment of LV and LA function is present in patients with early LV remodeling and localized hypertrophy. BSH might be useful as an early marker of the burden of hypertensive heart disease. OBJECTIVE To describe the clinical and radiological characteristics of neuromyelitis optica spectrum disorders (NMOSD) patients from the Arabian Gulf relative to anti-aquaporin 4 antibody serostatus. METHODS Retrospective multicentre study of hospital records of patients diagnosed with NMOSD based on 2015 International Panel on NMOSD Diagnosis (IPND) consensus criteria. RESULTS One hundred forty four patients were evaluated, 64.3% were anti-AQP4 antibody positive. Mean age at onset and disease duration were 31±12 and 7 ± 6 years respectively. Patients were predominantly female (4.71). Overall; relapsing course (80%) was more common than monophasic (20%). Optic neuritis was the most frequent presentation (48.6%), regardless of serostatus. The proportion of patients (54.3%) with visual acuity of ≤ 0.1 was higher in the seropositive group (p = 0.018). Primary presenting symptoms of transverse myelitis (TM) were observed in 29% of patients, and were the most significant correlate of hospitalization (p less then 0.001). Relative to anti-APQ4 serostatus, there were no significant differences in terms of age of onset, course, relapse rates or efficacy outcomes except for oligoclonal bands (OCB), which were more often present in seronegative patients (40% vs.22.5%; p = 0.054). Irrespective of serostatus, several disease modifying therapies were instituted including steroids or immunosuppressives, mostly, rituximab and azathioprine in the cohort irrespective of serostatus. The use of rituximab resulted in reduction in disease activity. CONCLUSION This is the first descriptive NMOSD cohort in the Arabian Gulf region. Seropositive patients were more prevalent with female predominance. Relapsing course was more common than monophasic. However, anti-AQP4 serostatus did not impact disease duration, relapse rate or therapeutic effectiveness. These findings offer new insights into natural history of NMOSD in patients of the Arabian Gulf and allow comparison with patient populations in different World regions. The study of innate immunity and its link to inflammation and host defense encompasses diverse areas of biology, ranging from genetics and biophysics to signal transduction and physiology. Central to our understanding of these events are the Toll-like receptors (TLRs), an evolutionarily ancient family of pattern recognition receptors. Herein, we describe the mechanisms and consequences of TLR-mediated signal transduction with a focus on themes identified in the TLR pathways that also explain the operation of other immune signaling pathways. These themes include the detection of conserved microbial structures to identify infectious agents and the use of supramolecular organizing centers (SMOCs) as signaling organelles that ensure digital cellular responses. Further themes include mechanisms of inducible gene expression, the coordination of gene regulation and metabolism, and the influence of these activities on adaptive immunity. Studies in these areas have informed the development of next-generation therapeutics, thus ensuring a bright future for research in this area.