Background
Scleromyxedema is a rare, para-neoplastic, chronic, progressive condition of the Lichen myxedematosus (LM) family. The clinical picture consists of generalized confluent papular eruptions with possible systemic manifestations, which may be fatal as it still constitutes a therapeutic dilemma. Histologically, it is characterized by dermal mucin deposition, fibroblast proliferation with fibrosis, with monoclonal gammopathy in the absence of thyroid disease. Some atypical forms of the disease were reported in the literature, but none were reported in acute leukemia.
Case presentation
Herein, we report a case of a 21 years old female patient, known case of acute lymphoblastic leukemia (ALL), who developed numerous hyper-pigmented erythematous papules and plaques, mainly over her thighs, lower abdomen, and sub-mammary flexures. Histopathology of skin lesions confirmed the diagnosis of atypical scleromyxedema. Her symptoms significantly improved with the use of high dose intravenous immunoglobulin (IVIG).
Conclusions
Despite that scleromyxedema is associated with many hematologic disorders, it is very rarely associated with acute lymphoblastic leukemia, and a high index of suspicion is needed for diagnosis. IVIG remains a reasonable management of such a disabling disease.
Vitamin B12 (cobalamin) deficiency is common in developing countries. Its dermatologic manifestations include hair and nail changes and glossitis. Cases of generalized hyperpigmentation associated with vitamin B12 deficiency have rarely been reported. Localized hyperpigmentation is less frequently described, affecting palms, soles, and flexural areas. We report a rare case of reversible melasma-like cutaneous hyperpigmentation associated with pernicious anemia and discuss the possible mechanisms of this association.
Background: Chronic kidney disease associated-pruritus (CKD-aP) is a common cutaneous complication and an important prognostic factor in patients with chronic kidney disease. The mechanism of Pruritus in those patients is poorly understood. This study aims to assess the burden of CKD-aP among patients receiving dialysis and the role of interleukin -31 in the development of Pruritus.Methods: This cross-sectional study included 183 patients, 172 on hemodialysis and 11 on peritoneal dialysis. Each patient underwent a physical examination and was assessed for Pruritus. The 12-item pruritus severity scale determined the severity of Pruritus. Interleukin -31 levels were measured by ELISA using a special kit. All patients had other lab tests, including hemoglobin, platelets, WBCs, BUN, creatinine, albumin, ALP, total bilirubin, phosphate, calcium, ferritin, iron, transferrin, total iron-binding capacity, parathyroid hormone. Calculation of Kt/V and corrected calcium with albumin were also doneResults: The mean level of interleukin -31 was higher in patients with CKD-aP than in those without Pruritus (4936.6 ±33611.5 vs 3919.2 ±15914.4), but it wasn't statistically significant (p value>0.05). About 52.1% of diabetic patients have CKD-aP (p value=0.01). Phosphate level was significantly higher in patients with CKD-aP compared to those without (4.8 ±1.3 vs 4.4 ±1.3) (p value= 0.002), whereas Albumin level was significantly lower in patients with CKD-aP compared to those without (3.6 ±0.4 vs 3.7±0.4) (p value=0.008). Conclusion: In this study, there was no statistically significant association between interleukin -31 and CKD-aP. We recommend that further research be conducted to determine the role of inflammation in the development of Pruritus in patients with chronic renal disease.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.