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Me > (Ch19) figurate Erythema > Flashcards

(Ch19) figurate Erythema Flashcards

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
Q

What factor can accentuate Erythema Marginatum rash

A

Heat

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26
Q

Erythema Marginatum As/w carditis and arthritis MC in?

A

kids <5y
younger the higher the risk

typical age of RF (5-15y)

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27
Q

prognosis of Erythema Marginatum

A

resolves spontaneously unrelated to acute RF course

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28
Q

Diagnostic criteria of RF

A

JONES criteria

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29
Q

evidence of preceding pharyngitis can be identified in jones criteria by?

A

+ve cx
or
elev ASO
or
elev anti-DNase B

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30
Q

Jones criteria diagnosis requirements

A

evidence of GA strep
+
2 major (JONES)

or

evidence of GA strep
+
1 major
+
2 minor

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31
Q

what percentage of untreated strep throat evolve into RF

A

3%

32
Q

figurate erythema can present as paraneoplastic

A

EAC
Erythema gyratum repenes

33
Q

Erythema Gyratum Repens pthogensis

A

Cross-reaction b/w tumor & cutaneous antigens

possibly glutamine metabolism within skin

34
Q

Erythema Gyratum Repens clinical features

A

Have a wood-grain or zebra-like pattern▸ “rings w/in rings”

Multiple, annular or polycyclic, red lesions w/ peripheral scale +/= pruritus

35
Q

MC malignancy As/w Erythema Gyratum Repens

A
  1. Lung
  2. Breast
  3. Esophagus
  4. Gastric
35
Q

percentage of Erythema Gyratum Repens as/w Malignancies

A

70%

36
Q

Conditions As/w Erythema Gyratum Repens

A

Neoplasms
pulmonary TB
Acquired ichthyosis
PPK
Hypereosinophilia

37
Q

what condition when resolving can appear like Erythema Gyratum Repens

A

PRP

38
Q

how rapidly does Erythema Gyratum Repens advance

A

1cm/day

39
Q

percentage of Lyme with Erythema migrans

A

60-90%

40
Q

What is the initial manifestation of Lyme

A

Erythema migrans

41
Q

Organism causing Lyme and its type

A

Borrelia burgdorferi

a spirochete

42
Q

Borrelia burgdorferi reservoir ?

A

White footed mice
White footed deer
Chipmunks
Birds

43
Q

Tick/vector transimitting Borrelia burgdorferi

A

Ixodes deer ticks

44
Q

How long does the tick needs to be attached to transmit Borrelia burgdorferi?

A

> 1 day
mostly >48h

45
Q

Lyme percentages ?

A

EM 60-90%
Spirochetemia 45%
Multiple lesions 20 - 25%

46
Q

on the lesion where can you find B. burgdorferi

A

centre and periphery of the lesion

47
Q

List few co-infection with B. burgdorferi can be carried by Ixodes tick

A

Babesia microti (babesiosis)
Anaplasma phagocytophilum (Anaplasmosis)
Borrelia miyamotoi

48
Q

when to consider co-infection in Lyme?

A

Prolonged/severe manifestation
Cytopenias
High fever

49
Q

Which protein produced by tick to enhance transmission of B. burgdorferi?

A

tick salivary protein (Salp15)

50
Q

tick salivary protein (Salp15) function?

A
  1. protection against antibody-mediated killing.
  2. inhibits adaptive immune responses
51
Q

where does Salp15 binds in B. burgdorferi?

A

outer surface protein C

52
Q

What size the primary lesion in Lyme must be ?

A

≥5 cm

53
Q

Clinical appearance of Erythema migrans ?

A

Bull’s eye
Large annular red expanding patch

54
Q

percentage of Lyme with multiple Erythema migrans and what is the proposed hypothesis?

A

(20 - 25%)
2/2 multiple tick bites
or
Spirochetemia (lymphatic/ hematologic spread)

appear days-wks after appearance of primary EM

54
Q

When does Erythema migrans appear after tick bite ?

A

7–15 days after tick detachment (range 3-30 days).

55
Q

Common locations for Erythema migrans

A

Trunk and intertriginous areas

56
Q

Phases of Lyme disease ?

A
  1. Early localized disease
  2. Early disseminated disease
  3. Chronic disease
57
Q

Timing of the year with increase Lyme and geographic location?

A

↑ spring and summer, (outdoors, woods)

US (Northeast, mid-Atlantic, and Great Lakes regions) and in northern and eastern Europe.

58
Q

Early localized disease phase of Lyme presents with?

A

Flu like sx
lymphadenopathy

59
Q

Early disseminated disease of Lyme presents with?

A

Bell’s palsy
Arthritis
AV block
Iritis

60
Q

Which Lyme phases have Erythema migrans

A
  1. Early localized disease
  2. Early disseminated disease
61
Q

Chronic disease phase of Lyme presents with?

A
  1. chronic arthritis (usually monoarticular of large joints
  2. Encephalopathy
  3. Acrodermatitis chronica atrophicans (chronic sclerosing dermatitis)
62
Q

which phase of Lyme presents with cardiac sx

A

Early disseminated disease

63
Q

what type of rash presents with chronic phase of Lyme

A

Acrodermatitis chronica atrophicans (chronic sclerosing dermatitis)

64
Q

which phase of Lyme presents with meningitis/encephalopathy?

A

Chronic

65
Q

definition of Confirmed Lyme requires ?

A

EM + exposure hx
or
EM + lab evidence (no exposure)
or
1 or more late manifestation + lab evidence

66
Q

Probable Lyme definition requires ?

A

Physician opinion + lab

67
Q

Suspected Lyme

A

EM + no lab + no hx

68
Q

name of Agar for Borrelia

A

Barbour-Stoenner-Kelly medium

69
Q

Lyme Rx

A

Doxycycline

Ampicillin: if pregnant or <8y

Ceftriaxone if:
-Cardiac
- Meningitis
- Persistent Arthritis

All for 14 days

70
Q

prognosis of Lyme ?

A

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
Q

Diagnosis of Borrelia?

A
  1. PCR: skin bx or urine
  2. Culture in Agar
  3. Serology:
    - ElISA confirmed by Western blot
    - IgM
72
Q

Prophylaxis for Lyme indications?

A

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
Q

When does Erythema Gyratum Repens appears in relation to neoplasms ?

A

Cutaneous lesions appear 1 year prior to 1 year after the development of the neoplasm

74
Q

Name 3 stains for spirochetes?

A

Warthin-Starry silver stain
Dieterle
Steiner

Me (13 decks)

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