Planar xanthoma due to cholestasis in graft versus host disease

Moriue, Tetsuya; Yoneda, Kozo; Katsuura, Junko; Matsuoka, Yoshie; Nakai, Kozo; Yokoi, Isao; Matsuda, Yoko; Nibu, Natsuko; Miyamoto, Izumi; Demitsu, Toshio; Kubota, Yoshihiro

doi:10.1111/j.1365-2133.2007.07878.x

Cited by 7 publications

(3 citation statements)

References 3 publications

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“…10 This may explain its tendency to accumulate in macrophages in the skin, thus giving rise to the development of planar xanthomas in cholestasis. 8 In this context, accumulation of lipoprotein X in dermal macrophages may also be responsible for the presence of foamy macrophages in the cases of acute GVHD with hepatic involvement described by Gamé et al 6 as well as in our case of IM with antibiotic-induced exanthema and associated acute liver disease.…”

Section: Discussionsupporting

confidence: 53%

“…Cholestasis is a known cause of secondary hypercholesterolemia, and the development of planar xanthomas has been described in this setting. [7][8][9] Since cholesterol cannot be excreted into bile, it is regurgitated into the circulation, where it binds to albumin and phospholipids to form an abnormal lipoprotein called lipoprotein X. In contrast to LDL, lipoprotein X lacks apolipoprotein B100 and thus cannot be taken up by the LDL receptor in the liver.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to LDL, lipoprotein X lacks apolipoprotein B100 and thus cannot be taken up by the LDL receptor in the liver. 8,9 As this lipoprotein is resistant to hepatic clearance, it is taken up instead by macrophages via scavenger receptors. 10 This may explain its tendency to accumulate in macrophages in the skin, thus giving rise to the development of planar xanthomas in cholestasis.…”

Section: Discussionmentioning

confidence: 99%

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Foamy Macrophages in a Case of Mononucleosis With Amoxicillin-Induced Rash, Hyperlipidemia, and Hemophagocytic Lymphohistiocytosis

Gonzalez-Lopez,

Fried,

Schadelbauer

et al. 2023

The American Journal of Dermatopathology

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A 38-year-old man presented with fever, cough, and jaundice. Four days before, he had started taking amoxicillin/clavulanic acid. He subsequently developed a morbilliform rash, and, according to clinical features and blood analyses, a diagnosis of mononucleosis with Epstein–Barr virus–associated antibiotic-induced exanthema and secondary hemophagocytic lymphohistiocytosis was made. A skin biopsy revealed a superficial perivascular lymphohistiocytic infiltrate with interface dermatitis and many foamy macrophages in the papillary dermis and around the vessels of the superficial dermal plexus. A blood lipid test uncovered marked hypercholesterolemia and hypertriglyceridemia. After treatment with dexamethasone and immunoglobulin, the skin rash, liver function, and lipid profile progressively improved. Xanthomatous cells have been observed in skin biopsies of acute graft-versus-host disease with liver involvement, and these cells have been suggested to represent a clue to the presence of hepatic disease. In our case, underlying cholestatic hepatopathy with hyperlipidemia was present. We believe that the incidental finding of foamy cells in graft-versus-host disease cases and in our case are likely related to the presence of severe liver disease with cholestatic hepatopathy and secondary hyperlipidemia in different background conditions.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%