Flagellate Erythema in a Patient With Fever

Ciliberto, Heather; Kumar, Monique G.; Musiek, Amy

doi:10.1001/jamadermatol.2013.4457

Cited by 18 publications

(28 citation statements)

References 10 publications

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“…This type of eruption often has a linear configuration, possibly because of the Koebner phenomenon, thus resembling a flagellate erythema. [6–19] Other commonly reported morphologic patterns include urticarial papules, lichenoid papules, pigmented plaques, prurigo pigmentosa-like, dermatomyositis-like, and lichen amyloidosis-like rashes. [6–18,20–27] More than 1 morphology or distribution pattern was observed in several patients.…”

Section: Discussionmentioning

confidence: 99%

“…The great majority of patients with AOSD and atypical cutaneous lesions had persistent and severe disease, with a considerable frequency (23%) of clinical complications, including serositis, myopericarditis, lung involvement, abdominal pain, neurologic involvement, and reactive hemophagocytic syndrome [7,10,16–19,24,29,30,31,37] . Thus, most patients required medium or high doses of glucocorticoids (including intravenous methylprednisolone pulse therapy in some cases) and, in nearly 40%, a more potent or maintenance immunotherapy consisting of immunosuppressant drugs (including methotrexate, azathioprine, cyclosporine A, and hydroxychloroquine) [6,8–10,12,15,16,18–20,24,25,28,29,31,34,39,40] and/or biologic agents (mainly anakinra or tocilizumab) [8,10,15,21] to control or manage symptoms because they had an intermittent/polycyclic or chronic systemic course.…”

Section: Discussionmentioning

confidence: 99%

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Adult-onset Still's disease with atypical cutaneous manifestations

García¹,

Pascual²,

Recalde³

et al. 2017

Medicine

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The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests available, and diagnosis is usually based on a symptom complex and the well-described typical evanescent rash seen in the majority of patients. However, in recent years, other atypical cutaneous manifestations of AOSD have been reported. These atypical skin eruptions often present in addition to the typical evanescent rash but may also be the only skin manifestation, resulting in delayed diagnosis because of under-recognition.In this study, we present 3 new cases of AOSD with atypical cutaneous manifestations diagnosed during a 30-year period in our department and review 78 additional cases previously reported (PubMed 1990–2016). These 81 patients form the basis of the present analysis.The overall prevalence of atypical cutaneous manifestations in our AOSD population was 14%. These manifestations may appear at any time over the course of the disease, and usually occur in patients who have persistent and severe disease, with a considerable frequency of clinical complications (23%), including serositis, myopericarditis, lung involvement, abdominal pain, neurologic involvement, and reactive hemophagocytic syndrome.The most representative and frequent lesion among the nonclassical skin rashes is the development of persistent pruritic papules and/or plaques. Interestingly, these lesions show a distinctive histological pattern. Other, less frequently observed lesions include urticaria and urticaria-like eruptions, generalized or widespread non-pruritic persistent erythema, vesiculopustular eruptions, a widespread peau d’orange appearance of the skin, and edema of the eyelids mimicking dermatomyositis without any accompanying skin lesion.The great majority of these patients required medium or high doses of glucocorticoids (including intravenous methylprednisolone pulse therapy in some cases) and, in nearly 40%, a more potent or maintenance immunotherapy with immunosuppressant drugs and/or biologic agents (mainly anakinra or tocilizumab) to control or manage symptoms because of a polycyclic or chronic course. The development of atypical cutaneous manifestations seems to be associated with a potentially worse prognosis, with a mortality rate reaching 8% primarily because of infectious complications related to immunosuppressive therapy.In conclusion, the appearance of atypical cutaneous manifestations is not uncommon in AOSD. Recognition of this clinical variant is crucial for the early diagnosis of AOSD, as it might imply persistent disease activity and the need for more aggressive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adult-onset Still's disease with atypical cutaneous manifestations

García¹,

Pascual²,

Recalde³

et al. 2017

Medicine

View full text Add to dashboard Cite

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“…Flagellate erythema can also present with linear lesions during the active phase of the disease. These lesions are very similar to flagellate erythema of bleomycin, dermatomyositis, or shiitake mushroom dermatitis . Less than 30 cases of AOSD presenting with flagellate erythema have been reported in literature.…”

Section: Discussionmentioning

confidence: 78%

“…Unlike dermographism, these lesions are persistent for several days. Linearity may represent a Koebner phenomenon because typically the mid‐back of these patients tends to be spared . Histopathology shows dyskeratosis in the upper layers of the epidermis, which is a relatively specific finding in persistent rashes of AOSD …”

Section: Discussionmentioning

confidence: 99%

Dermographism in a patient with fever

2017

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“…A similar linear cutaneous eruption has been associated with dermatomyositis (DM) (12) and adult-onset Still's disease (13). Cases associated with human immunodeficiency virus infection were in fact related to bleomycin (14) and hypereosinophilic syndrome (15).…”

Section: Discussionmentioning

confidence: 92%

Flagellate Dermatitis in a Child Most Likely Secondary to Doxorubicin

Lim

Aussedat

Maillet-Lebel

et al. 2017

Pediatric Dermatology

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Flagellate dermatitis, a cutaneous eruption in which the patient appears to have been whipped, has been described with antineoplastic agents and shiitake mushroom ingestion. A 15-year-old girl with metastatic Ewing sarcoma developed pruritic erythematous linear lesions on her trunk that became hyperpigmented over time during her first cycle of chemotherapy with doxorubicin, vincristine, cyclophosphamide, and ganitumab. Flagellate dermatitis was diagnosed based on clinical and histologic findings. Flagellate dermatitis (FD) is a rare cutaneous eruption named for its appearance, in which the patient appears to have been whipped. It has been associated with chemotherapeutic agents such as bleomycin . We report FD in a child that occurred during chemotherapy treatment that included doxorubicin.

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Flagellate Erythema in a Patient With Fever

Cited by 18 publications

References 10 publications

Adult-onset Still's disease with atypical cutaneous manifestations

Adult-onset Still's disease with atypical cutaneous manifestations

Dermographism in a patient with fever

Flagellate Dermatitis in a Child Most Likely Secondary to Doxorubicin

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