We recently observed a comparable patient who initially presented with NSAID hypersensitivity, developed chronic urticaria 4 years later and eventually lost both conditions after eradication of the intestinal protozoan Blastocystis hominis. 3 ASA hypersensitivity preceding the development of chronic urticaria has been reported by others, but a possible association of these conditions with infectious triggers was not assessed. 4 In some food-allergic patients, systemic immediate type reactions develop only when they are exposed to the respective allergen and concomitantly to ASA. 5 It can be speculated that here the allergic reaction is enhanced by pharmacologic actions of the NSAID (e.g. by an increase of intestinal antigen absorption or by facilitated mediator release). Transferring this to our patient, NSAIDs might have enhanced a subthreshold reaction to antigens from H. pylori, thus leading to clinical symptoms.
Cutaneous dipththeria is an infectious bacterial disease endemic in tropical regions, but rarely diagnosed in Germany. Following travel in Sri Lanka, a 60-year-old German presented to our dermatological clinic with a skin ulcer and extensive erythematous erosive edema of his left foot. Corynebacterium diphtheriae was isolated from a swab of the lesion. There were no clinical signs of toxic diphtheria. The patient was treated with penicillin G and erythromycin, followed by a slow healing of the lesion. The isolated strain could be identified as toxigenic C. diphtheriae mitis. Due to increased travel activity, dermatologists should have uncommon infections like cutaneous diphtheria in mind.
!Das Ulcus cruris gilt in den Industrieländern als Volkskrankheit. Laut der "Bonner Venenstudie" aus dem Jahr 2003 liegt die Prävalenz des Ulcus cruris in Deutschland bei 0,2 %. Diese ist stark altersabhängig. So steigt sie ab dem 70. Lebensjahr auf 2,5 % und Frauen sind häufiger betroffen. Allein die Zahl der therapieresistenten venösen Ulzera in Deutschland wird auf über 25 000 geschätzt [7,12]
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