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(Ch19) figurate Erythema Flashcards

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1
Q

Erythema annular Centrifugum (EAC) As/w

A
  1. Hypersensitivity
  2. Infections
  3. Drugs
  4. other disorders
  5. Paraneoplastic
  6. Pregnancy
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2
Q

infections As/w EAC

A
  1. Fungal/Dermatophyte:
    -Tinea Pedis, Candida, Penicllium
  2. Viruses: pox, EBV, VZV, HIV
  3. Bacteria: pseudomonas
  4. Parasite: phithirus pubis
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3
Q

Disorders As/w EAC

A

Crohn’s
AI-Endo
HES

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4
Q

Which figurate erythema can be triggered by pregnancy?

A

EAC

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5
Q

How fast does EAC lesion grows

A

> 6cm in 1-2w

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6
Q

Clinical characteristics of EAC rash?

A

annular expand centrifugally
with trialing scales in the inner ring

resolves with PIH and no scar

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7
Q

Common sites for EAC

A

Thighs and hips

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8
Q

Superficial vs Deep EAC

A

Superficial: trailing scales and pruritic
Deep: no scales , no pruritus but elevated edge

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9
Q

How to associate EAC with a disease clinically?

A

Flares correlate with disease recurrence

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10
Q

which Histopth findings correlates with trailing scales of EAC

A

Spongiosis +focal parakeratosis

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11
Q

characteristic sign of EAC in histopath?

A

Coat sleeves
PV aggregate of inflammation cells

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12
Q

Rx of EAC

A

Symptomatic:
Topical antipruritics & sedating Anti-H

Therapeutic:
* Rx underlying disease
* TCS to the advancing border
* SCS (can induce remission) However a/w↑recurrence after D/C
* Empiric antibiotics or antifungals (Macrolides)

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13
Q

at what age EAC increases ?

A

5th decade

Famillial variant AD

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14
Q

what malignancies as/w EAC

A

hematologic
leukemia/lymphoma

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15
Q

Drugs As/w EAC

A

Diuretics
NASIADs
Ustekinumab
Rituximab
Antimalaria

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16
Q

what percentage of acute RF develop Erythema Marginatum

A

10%

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17
Q

pathogenesis of Erythema Marginatum

A

Molecular mimicry/cross reactivity of Group A B-hemolytic strep antigens with Myosin,Actin, tropomyosin and keratin

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18
Q

Virulence factors for strep pyogenes

A
  1. M protein and mucoid colony –> Acute RF
  2. Cysteine proteases: exotoxin B and IgG degrading enzyme
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19
Q

which virulence factor of GAB strep As/w Cardiotoxicity

A

cysteine proteases

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20
Q

skin lesions As/w RF

A
  1. Erythema Marginatum (Asx)
  2. Subcutaneous nodules (painless)
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21
Q

Erythema Marginatum latency period after strep pharyngitis

A

2-5w

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22
Q

Erythema Marginatum clinical presentation

A

ASx Red macules spread peripherally into larger patches or plaques

NO scales

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23
Q

Erythema Marginatum migration speed

A

1-12mm over 12h

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24
Q

Which part of the body spared by Erythema Marginatum

A

Face

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25
What factor can accentuate Erythema Marginatum rash
Heat
26
Erythema Marginatum As/w carditis and arthritis MC in?
kids <5y younger the higher the risk typical age of RF (5-15y)
27
prognosis of Erythema Marginatum
resolves spontaneously unrelated to acute RF course
28
Diagnostic criteria of RF
JONES criteria
29
evidence of preceding pharyngitis can be identified in jones criteria by?
+ve cx or elev ASO or elev anti-DNase B
30
Jones criteria diagnosis requirements
evidence of GA strep + 2 major (JONES) or evidence of GA strep + 1 major + 2 minor
31
what percentage of untreated strep throat evolve into RF
3%
32
figurate erythema can present as paraneoplastic
EAC Erythema gyratum repenes
33
Erythema Gyratum Repens pthogensis
Cross-reaction b/w tumor & cutaneous antigens possibly glutamine metabolism within skin
34
Erythema Gyratum Repens clinical features
Have a wood-grain or zebra-like pattern▸ “rings w/in rings” Multiple, annular or polycyclic, red lesions w/ peripheral scale +/= pruritus
35
MC malignancy As/w Erythema Gyratum Repens
1. Lung 2. Breast 3. Esophagus 4. Gastric
35
percentage of Erythema Gyratum Repens as/w Malignancies
70%
36
Conditions As/w Erythema Gyratum Repens
Neoplasms pulmonary TB Acquired ichthyosis PPK Hypereosinophilia
37
what condition when resolving can appear like Erythema Gyratum Repens
PRP
38
how rapidly does Erythema Gyratum Repens advance
1cm/day
39
percentage of Lyme with Erythema migrans
60-90%
40
What is the initial manifestation of Lyme
Erythema migrans
41
Organism causing Lyme and its type
Borrelia burgdorferi a spirochete
42
Borrelia burgdorferi reservoir ?
White footed mice White footed deer Chipmunks Birds
43
Tick/vector transimitting Borrelia burgdorferi
Ixodes deer ticks
44
How long does the tick needs to be attached to transmit Borrelia burgdorferi?
>1 day mostly >48h
45
Lyme percentages ?
EM 60-90% Spirochetemia 45% Multiple lesions 20 - 25%
46
on the lesion where can you find B. burgdorferi
centre and periphery of the lesion
47
List few co-infection with B. burgdorferi can be carried by Ixodes tick
Babesia microti (babesiosis) Anaplasma phagocytophilum (Anaplasmosis) Borrelia miyamotoi
48
when to consider co-infection in Lyme?
Prolonged/severe manifestation Cytopenias High fever
49
Which protein produced by tick to enhance transmission of B. burgdorferi?
tick salivary protein (Salp15)
50
tick salivary protein (Salp15) function?
1. protection against antibody-mediated killing. 2. inhibits adaptive immune responses
51
where does Salp15 binds in B. burgdorferi?
outer surface protein C
52
What size the primary lesion in Lyme must be ?
≥5 cm
53
Clinical appearance of Erythema migrans ?
Bull's eye Large annular red expanding patch
54
percentage of Lyme with multiple Erythema migrans and what is the proposed hypothesis?
(20 - 25%) 2/2 multiple tick bites or Spirochetemia (lymphatic/ hematologic spread) appear days-wks after appearance of primary EM
54
When does Erythema migrans appear after tick bite ?
7–15 days after tick detachment (range 3-30 days).
55
Common locations for Erythema migrans
Trunk and intertriginous areas
56
Phases of Lyme disease ?
1. Early localized disease 2. Early disseminated disease 3. Chronic disease
57
Timing of the year with increase Lyme and geographic location?
↑ spring and summer, (outdoors, woods) US (Northeast, mid-Atlantic, and Great Lakes regions) and in northern and eastern Europe.
58
Early localized disease phase of Lyme presents with?
Flu like sx lymphadenopathy
59
Early disseminated disease of Lyme presents with?
Bell’s palsy Arthritis AV block Iritis
60
Which Lyme phases have Erythema migrans
1. Early localized disease 2. Early disseminated disease
61
Chronic disease phase of Lyme presents with?
1. chronic arthritis (usually monoarticular of large joints 2. Encephalopathy 3. Acrodermatitis chronica atrophicans (chronic sclerosing dermatitis)
62
which phase of Lyme presents with cardiac sx
Early disseminated disease
63
what type of rash presents with chronic phase of Lyme
Acrodermatitis chronica atrophicans (chronic sclerosing dermatitis)
64
which phase of Lyme presents with meningitis/encephalopathy?
Chronic
65
definition of Confirmed Lyme requires ?
EM + exposure hx or EM + lab evidence (no exposure) or 1 or more late manifestation + lab evidence
66
Probable Lyme definition requires ?
Physician opinion + lab
67
Suspected Lyme
EM + no lab + no hx
68
name of Agar for Borrelia
Barbour-Stoenner-Kelly medium
69
Lyme Rx
Doxycycline Ampicillin: if pregnant or <8y Ceftriaxone if: -Cardiac - Meningitis - Persistent Arthritis All for 14 days
70
prognosis of Lyme ?
Self resolves < 6 weeks (median 4 weeks). * 60% arthritis (usually knee) * 10% neurologic issues (usually Bell’s palsy) * 5% cardiac issues (usually AV block
71
Diagnosis of Borrelia?
1. PCR: skin bx or urine 2. Culture in Agar 3. Serology: - ElISA confirmed by Western blot - IgM
72
Prophylaxis for Lyme indications?
prophylaxis with Doxy for (must all be present) : - Adult non pregnant -Attached tick identified - Tick attached for >36h -prophylaxis begain <72h of tick removal
73
When does Erythema Gyratum Repens appears in relation to neoplasms ?
Cutaneous lesions appear 1 year prior to 1 year after the development of the neoplasm
74
Name 3 stains for spirochetes?
Warthin-Starry silver stain Dieterle Steiner

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