Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives

Abstract

Bromoderma is a rare skin disorder caused by bromide intake. It presents as single or multiple papillomatous nodules or plaques, and ulcers studded with small pustules on the face or limbs. The clinical features of bromoderma are similar to those of pyoderma gangrenosum. A 41-year-old Japanese woman was diagnosed with pyoderma gangrenosum 11 years prior to presentation. Pyoderma had repeatedly appeared over her entire body despite treatment. She also frequently complained of syncopal episodes. She was admitted to our hospital after loss of consciousness and an episode of generalized convulsion. Laboratory tests revealed a negative serum anion gap and hyperchloremia. Her serum bromide level was significantly elevated, suggesting bromide intoxication. The patient had a 10-year history of high serum bromide levels. After the intake of bromide-containing sedatives was stopped, there was no recurrence of pyoderma in the absence of treatment. In conclusion, this case was diagnosed as bromoderma with commercial sedative-induced bromide intoxication. Although the US Food and Drug Administration have banned the use of bromides, over-the-counter (OTC) treatments containing bromides are still used in Japan and other countries. Long-term use of OTC medicines containing bromvalerylurea may result in the development of bromoderma. If unclarified neurological or psychiatric symptoms are associated with pyoderma, we propose measurement of the patient's serum chloride concentration. Determination of hyperchloremia is helpful for the diagnosis of chronic intoxication with bromides.

A “seasonal bromoderma” in a farmer

“…Several bromoderma cases reported in the literature are mainly because of systemic therapies with drugs for epilepsy and sedativehypnotic drugs containing inorganic and organic agents, respectively (Jih, Khanna, & Somach, 2003;Maffeis, Musolino, & Cambiaghi, 2008;Oda et al, 2016;Scola, Kaczmarczyk, & Mollenhoff, 2012).…”

A case of generalized bullous pyoderma gangrenosum with myelodysplastic syndrome

“…The histopathologic findings depend on the PG subtype and stage of the disease. 5 Therefore, there are many diseases to be considered in the differential diagnosis of PG such as infections, vasculitis and autoimmune diseases, Sweet syndrome, vascular diseases, and insect bites. 1 The treatment depends on the location, number, and size of the lesions, extracutaneous involvement, the presence of associated diseases, comorbidities, and patient preference.…”

Bromoderma in a pituitary adenoma patient treated with bromocriptine

“…Therefore, we diagnosed the case as bromoderma because of clinical findings, administration of a bromide-containing drug and elevated blood bromide levels. Hyperchloremia is one of the laboratory findings of bromoderma, 3 but it was normal. He was treated with the discontinuation of bromocriptine and the initiation of oral potassium iodide (0.9 g/day), topical clobetasol propionate ointment and silver sulfadiazine cream.…”