- Email: [email protected]
Kaposi's sarcoma in a patient with temporal arteritis treated with corticosteroid
Volume 24 Number 6, Part 1 June 1991
Brief communications
1027
2. Lopez-Ibor B, Schwartz AD. Neuroblastoma. Pediatr Clin North Am 1985;32:755-78. 3. Edwards L, Goldberg GN, Bangert JL, et al. Benign neoplasms, premalignant conditions and malignancy. In: Schachner LA, Hansen RC, eds. Pediatric dermatology. New York: Churchill Livingstone, 1988:1090-2. 4. Enzinger FM, Weiss SW, eds. Soft tissue tumors. St. Louis: CV Mosby, 1983;657-68. 5. Bader JL, Miller RW. U.S. cancer incidence and mortality in the first year of life. Am J Dis Child 1979;133:157-9. 6. Gross RE, Farber S, Martin LW. Neuroblastoma sympathicum. Pediatrics ] 959;23:1179-91. 7. Schneider KM, Becket JM, Krasna IH. Neonatal neuroblastoma. Pediatrics 1965;36:359-66. 8. Wieberdink J. Metastasis in neonatal neuroblastoma. In: Pochedly C, ed. Neuroblastoma. Clinical and biological manifestations. New York: Elsevier Science, 1982:13-20. 9. Van Erp IFR. Cutaneous metastasis in neuroblastoma. Dermatologica 1968;136:265-9. 10. Shown TE, Durfee MF. Blueberry muffin baby: neonatal neuroblastoma with subcutaneous metastasis. J Urol 1970; 104:193-5. 11. Lucky AW, McGuire J, Komp DM. Infantile neuroblastoma presenting with cutaneous blanching nodules. J AM ACAD DERMATOL1982;6:389-91. 12. Hawthorne HC, Nelson JS, Witzleben CL, et al. Blanching subcutaneous nodule in neonatal neuroblastoma. J Pediatr 1970;77:297-300. 13. Mackay B, Luna MA, Butler JJ. Adult neuroblastoma. Cancer 1976;37:1334-51.
Kaposi's sarcoma in a patient with temporal arteritis treated with corticosteroid
Fig. 1. Purple patches and nodules on chest.
Caridad Sofia, MD, a Carlos M. Gonzfilez-Herrada, MD, a Domingo Garcia-Almagro, MD, a Rosa Diaz, MD, a Miguel A. Piris, MD, b and Juan L. Orradre, MD b Toledo, Spain Kaposi's sarcoma (KS) has been associated with irnmunosuppressive therapy. ~We describe a patient with temporal arteritis in whom KS developed after long-term therapy with prednisone. As far as we know, this is the second case of KS complicating corticosteroid therapy for temporal arteritis) Case report. A 45-year-old woman with temporal arteritis was treated with prednisone orally (40 to 60 mg/day). After 3 years, she noted the acute onset of multiple, irregular red-brown and purple macules, nodules and plaques, on the face, chest (Fig. 1), back, arms, hands, and legs. A biopsy specimen of a nodule on the leg showed dense proliferation of spindle cells, numerous endothelium-lined vascular slits, extravasated RBCs, and hemosiderin deposits characteristic of KS (Fig. 2). The KS lesions From the Section of Dermatology~ and Department of Pathology,b Hospital "Virgen de la Salud." Reprint requests: Caridad Soria, MD, Secci6n de Dermatologia, Hospital "Virgen de la Salud," Avda. de Barber, s/n, 45004 Toledo,
Spain. 16/4/26936
Fig. 2. Proliferation of spindle cells with several mitoses, vascular slits, extravasated RBCs, and hernosiderin deposits. (Hematoxylin-eosin stain; •
stabilized when the prednisone dose was decreased to 20 mg/day. Later vincristine and radiotherapy caused regression of several of her lesions.
Discussion. The majority of patients with KS as a complication of immunosuppressive therapy have been transplant recipients treated with high doses of several immunosuppressive drugs) However, KS has also devel-
1028
Journal of the American Academy of Dermatology
Brief communications
oped in patients with other underlying disorders that have been treated w i t h immunosuppressive agents. T h e agents implicated include azathioprine, corticosteroids, cyclophosphamide, melphalan, cyclosporin, a n d radiotherapy.I, 4 m few cases of K S after t r e a t m e n t with prednisone alone h a v e been reported. 5 T h e duration of i m m u nosuppressive t h e r a p y before the development of K S has been considerably shorter with combined t h e r a p y than with corticosteroids alone (16.4 m o n t h s vs 61.2 months, respectively), l As far as we know, this is t h e second case o f K S in a patient with t e m p o r a l arteritis t r e a t e d with corticosteroid. L e u n g et al. 2 described a patient who had stable K S for 7 years, in w h o m dissemination o f cutaneous lesions of K S occurred during prednisone t h e r a p y for temporal arteritis. Reduction o f the prednisone dosage was followed by regression of t h e tumor. However, our patient d i d not have K S before beginning corticosteroid therapy. Regression of nonvisceral K S after a decrease or discontinuation
o f immunosuppressive therapy or after substitution of an alternative immunosuppressive agent m a y occur.1 When the tumor does not regress or when the underlying disease is not controlled, radiotherapy, chemotherapy, a n d / o r surgical excision is indicated. REFERENCES 1. Gange RW, Wilson-Jones E. Kaposi's sarcoma and immunosuppressive therapy: an appraisal. Clin Exp Dermatol 1978;3:135-46. 2. Leung F, Faro AG, Osoba D. Kaposi's sarcoma complicating corticosteroid therapy for temporal arteritis. Am J Med 1981;71:320-2. 3. Penn E. Kaposi's sarcoma in organ transplant recipients: report of 20 cases. Transplantation 1979;27:8-11. 4. Ledley GS, Sulic VI, Kao GF. Case repor t: Kaposi's sarcoma in a renal transplant patient receiving eyclosporine. Am J Med Sci 1987;294:211-3. 5. Hoshaw RA, Schwartz RA. Kaposi's sarcoma after immunosuppressive therapy with prednisone. Arch Dermatol 1980;116:1280-2.
ABSTRACTS
Cutaneous leishmaniasis: treatment with cryotherapy and intramuscular injections of meglumine antimonate (Glucantime) Rzany B, Krutmann J, Goerttler E, et al. Hautarzt 1990;41:98101 (German) The case of a 37-year-old woman with leishmaniasis of the helix of the left ear is reported. The diagnosis was based on history, clinical appearance, and histologic examination (detection of Leishman-Donovan bodies). Initial cryotherapy failed to cure the lesion. Treatment with intramuscular injections of meglumine antimonate (Glucantime) was successful. Yehudi M. Fehnan, MD
Kyrle's disease associated with juvenile diabetes mellitus and chronic renal failure Detmar M, Ruszczak ZB, Imck~ E, et al. Z Hautkr 1990;65:5361 (German) The authors report a 32-year-oldwoman with chronic diabetes mcllitus type I and chronic renal failure in whom hyperkeratosis follicularis et para follieularisin cutem penetrans (Kyrle's disease) developed. Histologic examination revealed defective epidermal differentiation with hyperkeratosisand parakeratc~is as well as premature keratinization as early as in the epidermal basal cell layer. Studies on leetin binding showed that glyeosylationwas impaired in both the epidermis and the
basement membrane zone of lesionalskin. Electron microscopicinvestigation revealeddiabetic microangiopathyof the dermal vesselsas well as marked ultrastructural alterations in the dermoepidermalbasal lamina. These findings confirm the association of diabetes mellitus with Kyrle's disease.They also suggest that Kyrle's disease may be characterized by a defectivedifferentiationof the epidermisand the dermoepidermal junction caused by some alteration in the glycosylationprocess rather than by a local disorder of keratinization. Yehudi M. Felman, AID
Human leukocyte interferon therapy in herpes simplex: a multicenter study Crespi H, DeMora E, Pueyo S, et al. Med Cutan Ibero Lat Am 1988;16:459-65 (Spanish) A multi-institutionaldouble-blindstudy was performed in 66 patients to evaluate the action of human leukocyte interferon-a in lesions produced by herpes simplex virus. Lesionswere localized in the genital area in 34 patients and on the face in 32. Thirty-eight patients were treated with 7000 IU/gm interferon ointment and 28 with carbowax 4000 as a placebo. Signs and symptomswere evaluated on days 3 and 7 &treatment. Results showed a rapid relief from pain and paresthesia and accelerated healingof vesiclesin patients treated with interferon.A tendency toward a reduction in the duration of the disease in those patients treated with interferon was also observed. Yehudi M. Felman, MD
Brief communications
1027
2. Lopez-Ibor B, Schwartz AD. Neuroblastoma. Pediatr Clin North Am 1985;32:755-78. 3. Edwards L, Goldberg GN, Bangert JL, et al. Benign neoplasms, premalignant conditions and malignancy. In: Schachner LA, Hansen RC, eds. Pediatric dermatology. New York: Churchill Livingstone, 1988:1090-2. 4. Enzinger FM, Weiss SW, eds. Soft tissue tumors. St. Louis: CV Mosby, 1983;657-68. 5. Bader JL, Miller RW. U.S. cancer incidence and mortality in the first year of life. Am J Dis Child 1979;133:157-9. 6. Gross RE, Farber S, Martin LW. Neuroblastoma sympathicum. Pediatrics ] 959;23:1179-91. 7. Schneider KM, Becket JM, Krasna IH. Neonatal neuroblastoma. Pediatrics 1965;36:359-66. 8. Wieberdink J. Metastasis in neonatal neuroblastoma. In: Pochedly C, ed. Neuroblastoma. Clinical and biological manifestations. New York: Elsevier Science, 1982:13-20. 9. Van Erp IFR. Cutaneous metastasis in neuroblastoma. Dermatologica 1968;136:265-9. 10. Shown TE, Durfee MF. Blueberry muffin baby: neonatal neuroblastoma with subcutaneous metastasis. J Urol 1970; 104:193-5. 11. Lucky AW, McGuire J, Komp DM. Infantile neuroblastoma presenting with cutaneous blanching nodules. J AM ACAD DERMATOL1982;6:389-91. 12. Hawthorne HC, Nelson JS, Witzleben CL, et al. Blanching subcutaneous nodule in neonatal neuroblastoma. J Pediatr 1970;77:297-300. 13. Mackay B, Luna MA, Butler JJ. Adult neuroblastoma. Cancer 1976;37:1334-51.
Kaposi's sarcoma in a patient with temporal arteritis treated with corticosteroid
Fig. 1. Purple patches and nodules on chest.
Caridad Sofia, MD, a Carlos M. Gonzfilez-Herrada, MD, a Domingo Garcia-Almagro, MD, a Rosa Diaz, MD, a Miguel A. Piris, MD, b and Juan L. Orradre, MD b Toledo, Spain Kaposi's sarcoma (KS) has been associated with irnmunosuppressive therapy. ~We describe a patient with temporal arteritis in whom KS developed after long-term therapy with prednisone. As far as we know, this is the second case of KS complicating corticosteroid therapy for temporal arteritis) Case report. A 45-year-old woman with temporal arteritis was treated with prednisone orally (40 to 60 mg/day). After 3 years, she noted the acute onset of multiple, irregular red-brown and purple macules, nodules and plaques, on the face, chest (Fig. 1), back, arms, hands, and legs. A biopsy specimen of a nodule on the leg showed dense proliferation of spindle cells, numerous endothelium-lined vascular slits, extravasated RBCs, and hemosiderin deposits characteristic of KS (Fig. 2). The KS lesions From the Section of Dermatology~ and Department of Pathology,b Hospital "Virgen de la Salud." Reprint requests: Caridad Soria, MD, Secci6n de Dermatologia, Hospital "Virgen de la Salud," Avda. de Barber, s/n, 45004 Toledo,
Spain. 16/4/26936
Fig. 2. Proliferation of spindle cells with several mitoses, vascular slits, extravasated RBCs, and hernosiderin deposits. (Hematoxylin-eosin stain; •
stabilized when the prednisone dose was decreased to 20 mg/day. Later vincristine and radiotherapy caused regression of several of her lesions.
Discussion. The majority of patients with KS as a complication of immunosuppressive therapy have been transplant recipients treated with high doses of several immunosuppressive drugs) However, KS has also devel-
1028
Journal of the American Academy of Dermatology
Brief communications
oped in patients with other underlying disorders that have been treated w i t h immunosuppressive agents. T h e agents implicated include azathioprine, corticosteroids, cyclophosphamide, melphalan, cyclosporin, a n d radiotherapy.I, 4 m few cases of K S after t r e a t m e n t with prednisone alone h a v e been reported. 5 T h e duration of i m m u nosuppressive t h e r a p y before the development of K S has been considerably shorter with combined t h e r a p y than with corticosteroids alone (16.4 m o n t h s vs 61.2 months, respectively), l As far as we know, this is t h e second case o f K S in a patient with t e m p o r a l arteritis t r e a t e d with corticosteroid. L e u n g et al. 2 described a patient who had stable K S for 7 years, in w h o m dissemination o f cutaneous lesions of K S occurred during prednisone t h e r a p y for temporal arteritis. Reduction o f the prednisone dosage was followed by regression of t h e tumor. However, our patient d i d not have K S before beginning corticosteroid therapy. Regression of nonvisceral K S after a decrease or discontinuation
o f immunosuppressive therapy or after substitution of an alternative immunosuppressive agent m a y occur.1 When the tumor does not regress or when the underlying disease is not controlled, radiotherapy, chemotherapy, a n d / o r surgical excision is indicated. REFERENCES 1. Gange RW, Wilson-Jones E. Kaposi's sarcoma and immunosuppressive therapy: an appraisal. Clin Exp Dermatol 1978;3:135-46. 2. Leung F, Faro AG, Osoba D. Kaposi's sarcoma complicating corticosteroid therapy for temporal arteritis. Am J Med 1981;71:320-2. 3. Penn E. Kaposi's sarcoma in organ transplant recipients: report of 20 cases. Transplantation 1979;27:8-11. 4. Ledley GS, Sulic VI, Kao GF. Case repor t: Kaposi's sarcoma in a renal transplant patient receiving eyclosporine. Am J Med Sci 1987;294:211-3. 5. Hoshaw RA, Schwartz RA. Kaposi's sarcoma after immunosuppressive therapy with prednisone. Arch Dermatol 1980;116:1280-2.
ABSTRACTS
Cutaneous leishmaniasis: treatment with cryotherapy and intramuscular injections of meglumine antimonate (Glucantime) Rzany B, Krutmann J, Goerttler E, et al. Hautarzt 1990;41:98101 (German) The case of a 37-year-old woman with leishmaniasis of the helix of the left ear is reported. The diagnosis was based on history, clinical appearance, and histologic examination (detection of Leishman-Donovan bodies). Initial cryotherapy failed to cure the lesion. Treatment with intramuscular injections of meglumine antimonate (Glucantime) was successful. Yehudi M. Fehnan, MD
Kyrle's disease associated with juvenile diabetes mellitus and chronic renal failure Detmar M, Ruszczak ZB, Imck~ E, et al. Z Hautkr 1990;65:5361 (German) The authors report a 32-year-oldwoman with chronic diabetes mcllitus type I and chronic renal failure in whom hyperkeratosis follicularis et para follieularisin cutem penetrans (Kyrle's disease) developed. Histologic examination revealed defective epidermal differentiation with hyperkeratosisand parakeratc~is as well as premature keratinization as early as in the epidermal basal cell layer. Studies on leetin binding showed that glyeosylationwas impaired in both the epidermis and the
basement membrane zone of lesionalskin. Electron microscopicinvestigation revealeddiabetic microangiopathyof the dermal vesselsas well as marked ultrastructural alterations in the dermoepidermalbasal lamina. These findings confirm the association of diabetes mellitus with Kyrle's disease.They also suggest that Kyrle's disease may be characterized by a defectivedifferentiationof the epidermisand the dermoepidermal junction caused by some alteration in the glycosylationprocess rather than by a local disorder of keratinization. Yehudi M. Felman, AID
Human leukocyte interferon therapy in herpes simplex: a multicenter study Crespi H, DeMora E, Pueyo S, et al. Med Cutan Ibero Lat Am 1988;16:459-65 (Spanish) A multi-institutionaldouble-blindstudy was performed in 66 patients to evaluate the action of human leukocyte interferon-a in lesions produced by herpes simplex virus. Lesionswere localized in the genital area in 34 patients and on the face in 32. Thirty-eight patients were treated with 7000 IU/gm interferon ointment and 28 with carbowax 4000 as a placebo. Signs and symptomswere evaluated on days 3 and 7 &treatment. Results showed a rapid relief from pain and paresthesia and accelerated healingof vesiclesin patients treated with interferon.A tendency toward a reduction in the duration of the disease in those patients treated with interferon was also observed. Yehudi M. Felman, MD