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Biomedical subjects

E Goerttler

Publications and source records attributed to E Goerttler.

10 recordsLinked to original sources
PubMed1999

Methotrexate-induced papular eruption in patients with rheumatic diseases: a distinctive adverse cutaneous reaction produced by methotrexate in patients with collagen vascular diseases.

BACKGROUND: In the past few years, low doses of methotrexate have been used for treatment of patients with rheumatoid arthritis and other collagen vascular diseases, mainly as an immunosuppressive and corticosteroid-sparing drug. Several cutaneous adverse reactions have been described in association with methotrexate therapy. OBJECTIVE: We describe the clinical and the histopathologic features of distinctive cutaneous lesions that appeared in 4 patients with acute bouts of collagen vascular diseases who were receiving methotrexate therapy. METHODS: We clinically and histopathologically evaluated cutaneous lesions caused by methotrexate therapy in 4 patients, 2 with systemic lupus erythematosus, 1 with rheumatoid arthritis, and 1 with Sharp syndrome. RESULTS: Clinically, lesions consisted of erythematous indurated papules most commonly located on proximal areas of the extremities. Histopathologic examination of these papules showed an inflammatory infiltrate mainly composed of histiocytes interstitially arranged between collagen bundles of the dermis, intermingled with few neutrophils. In some foci of deeper reticular dermis, small rosettes composed of clusters of histiocytes surrounding a thick central collagen bundle were seen. Cutaneous lesions showed a direct chronologic relationship with methotrexate therapy, and they disappeared when the drug was tapered or withdrawn and corticosteroids were increased. CONCLUSION: Patients receiving low doses of methotrexate for acute bouts of collagen vascular diseases may experience characteristic cutaneous lesions with distinctive clinical and histopathologic findings shortly after methotrexate administration. We discuss the differential diagnosis with other dermatoses showing similar histopathologic findings that have been described in patients with collagen vascular diseases.

Adult↗
PubMed1996

Histopathological and epidemiological characteristics of patients with erythema exudativum multiforme major, Stevens-Johnson syndrome and toxic epidermal necrolysis.

The clinical and histopathological classification of erythema exudativum multiforme major (EEMM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are difficult, due to the lack of clear-cut criteria. Based on a new clinical classification, 149 of 219 (68%) histopathological specimens, from a total of 534 patients with EEMM, SJS and TEN, have been reviewed. A comparison was made with the clinical picture, and any past history of infection or drug intake. All patients had been included in the German Registry of Severe Skin Reactions between April 1990 and December 1993. No differences could be found between the biopsies examined and the total number of histopathological specimens, concerning clinical diagnosis, gender and age. Sections from 28 of 149 specimens were not diagnostic or were too old to be properly evaluated. In nine cases, other diagnoses were proposed. One hundred and eleven of the histological slides with the diagnosis of EEMM (n = 16), SJS (n = 34) and TEN (n = 61), were classified as epidermal type of erythema multiforme. In these 111 slides, necrotic keratinocytes could be found, ranging from individual cells to confluent epidermal necrosis. The epidermo-dermal junction showed changes ranging from vacuolar alteration up to subepidermal blisters. The dermal infiltrate was superficial and mostly perivascular. It was sparse in SJS and TEN, and more pronounced in EEMM. Oedema in the papillary dermis was evident occasionally in all clinical groups. In 59 of 111 cases (53%), at least one eosinophil was present in the dermis. In 11 of 111 (10%), more than 10 eosinophils per field could be seen. Eosinophils were less common in the patients with the most severe forms of TEN, in whom there was detachment of more than 30% of the skin surface area. No differences in the history for drug intake, or for infection with Mycoplasma pneumoniae, herpes simplex and other organisms, could be detected between patients with or without eosinophils in their skin sections. This dermatopathological study of patients with EEMM, SJS and TEN indicates that the epidermal type of erythema multiforme is the pathological correlate for these diseases.

Biopsy↗
PubMed1990

[Cutaneous leishmaniasis: treatment with cryotherapy and intramuscular injections of meglumine antimonate (glucantime)].

A 37-year-old female patient with cutaneous leishmaniasis of the helix of the left ear is reported. The diagnosis was based on her past history, clinical appearance and histological examination (detection of Leishman-Donovan bodies). Initial cryotherapy failed to cure the lesions completely. Treatment with intramuscular injections of meglumine antimonate (Glucantime) was successful. The discussion focuses on the pathophysiology, diagnosis and therapy.

Adult↗
PubMed1987

[Fistulous pyoderma caused by Serratia liquefaciens].

Human infections with Serratia liquefaciens are rare. We therefore present a patient with fistulous pyoderma due to this pathogen. The success of the therapy of Serratia infections depends on determination of the resistance and sensitivity to antibiotics. Following the tentative diagnosis of dermal tuberculosis, histological, microbiological and X-ray examinations were performed. Serratia liquefaciens was identified by culture as the only cause of the skin lesions. After therapy with sulfamethoxazole trimethoprim, the lesions disappeared.

Adult↗
PubMed1984

[Eprazinone exanthema with subcorneal pustulosis].

A drug eruption with subcorneal pustulation is presented, occurring in a patient during treatment with eprazinone . The biopsy of the initial lesions showed changes as in pustulosis subcornealis . The aetiopathogenetic relationship between administration of eprazinone and the pustular eruption was confirmed by patch test.

Exanthema↗
PubMed1976

[Nodular cutaneous amyloidosis. Clinical, histopathological and ultrastructural findings].

A case of nodular amyloidosis cutis of the face with minimal deposits of amyloid in the rectum is reported with respect to clinical, histopathological, and ultrastructural findings. A discussion of the problem of systematization in nodular amyloidoses is included. By electron microscopy, the principal similarity of the ultrastructure of amyloid is stressed again. Amyloid in this case of nodular amyloidosis cutis is thought to be synthesized by plasma cells which are found especially in the growing peripheral parts of the tumors. Fibroblasts with extremely dilated endoplasmic reticulum are almost totally surrounded by the fibrillar masses of amyloid within the tumor. Unusual spindle-formed cisternae of Golgi bodies containing oriented coarse fibrils are found in the fibroblasts. They are thought to represent a disturbance of the secretion of tropocollagen to the interstitium due to the surrounding amyloid masses.

Amyloid↗