Multiple Skin Necroses (Arteriolar)

Ingram, John T.

doi:10.1001/archderm.1957.01550180034009

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Arch Dermatol

1957

DOI: 10.1001/archderm.1957.01550180034009

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Multiple Skin Necroses (Arteriolar)

John T. Ingram¹

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1957

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Cited by 9 publications

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“…However, the histological picture described by Degos shows thromboses of vessels and necrosis without cellular reaction in the dermis. In a recent case described by Ingram and Sutherland (1957) the lesions were also necrotic.…”

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confidence: 90%

Cases

1957

Proceedings of the Royal Society of Medicine

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aged 49, Three years ago this patient had a severe pyrexial illness which was not diagnosed. Eighteen months ago she started to develop crops of papules on her legs, which, having broken down centrally, were very slow to heal and left scars. These have been recurring ever since and have become worse lately.Apart from a slight cough in recent weeks, her general health has been good. General physical examination revealed no abnormality except the necrotic and scarred lesions on her legs which appeared to be papulonecrotic tuberculides.Investigations.-X-ray of the chest revealed a fine reticular mottling throughout the whole of both lung fields, with a diffuse hilar flare but without obvious glandular enlargement, which was thought to be miliary tuberculosis. X-ray of the abdomen showed no calcified glands. The blood picture and erythrocyte sedimentation rate were normal, as were the plasma protein estimation and the cerebrospinal fluid. Biopsy of a skin lesion taken from the leg showed central caseation with a surrounding tuberculous reaction. No tubercle bacilli were found in the sputum or in gastric washings. The Mantoux test was negative 1:'10,000 but positive 1 : 1,000.Treatment.-Following bed rest, together with streptomycin 1 gram i.m., PAS 15 grams, and prednisolone 15 mg. daily, the lung lesions cleared up in six weeks and no new tuberculides have appeared on the legs.Comment.-Opinion has been divided as to the nature of the changes in the lung fields, particularly as to whether they are early or late miliary tuberculosis. The patient's relatively good health, normal erythrocyte sedimentation rate and the long history of lesions on the legs, make one feel that this might be chronic healed miliary tuberculosis, as described by Hoyle and Vaisey (1937, Chronic Miliary Tuberculosis, London), the original dissemination having taken place three years ago when she had her severe pyrexial illness. Against this, however, is the fact that no calcification has taken place, and the response to antitubercular therapy has been rapid, indicating perhaps, changes of a more recent origin.Dr. B. C. Tate: I wonder if Dr. Hodgson-Jones looked for tubercle bacilli in the sections? Dr. Hodgson-Jones: No, we did not look for bacilli in the sections because one so seldom finds them in papulonecrotic tiiberculides. They were looked for in the sputum and gastric washings but were not found. Dr. C. H. Whittle: One can have a completely silent tuberculosis which is both active and widespread. I once saw a hernial sac, removed from a boy aged 4, which was studded with tubercles in which were found acid-fast-bacilli and the histology showed miliary tuberculosis. The patient was perfectly well, but similar tubercles were present and were felt by the surgeon's finger over the abdominal peritoneal surface.

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confidence: 90%

Cases

1957

Proceedings of the Royal Society of Medicine

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Atheroembolism

Carvajal¹,

Anderson²,

Weiss³

et al. 1967

Arch Intern Med

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Malignant Atrophic Papulosis (Degos' Syndrome)

Howard¹,

Klaus²,

Savin³

et al. 1968

Archives of Ophthalmology

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Multiple Skin Necroses (Arteriolar)

Cited by 9 publications

References 0 publications

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Atheroembolism

Malignant Atrophic Papulosis (Degos' Syndrome)

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