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Biomedical subjects

Sarah Brenner

Publications and source records attributed to Sarah Brenner.

46 records · Page 3Linked to original sources
PubMedDate not supplied

Pemphigus vulgaris triggered by rifampin and emotional stress.

A 56-year-old Jewish woman of Ashkenazi origin had a history of tuberculosis since the age of 1 year, contracted while she was in hiding in Poland during the Holocaust. She developed bronchiectasis in 1972 for which she was being treated 4 times a year for 1-month periods with 600 mg/d rifampin. During the Persian Gulf War in February 1991, a month after a rifampin treatment, she was admitted to the dermatology department with cutaneous and oral mucous eruptions. Physical examination revealed crusting bullae and erosions on the trunk and lower limbs. The mucous membranes were affected in the vagina, oral cavity, and pharynx. Histologic and immunofluorescence studies on a biopsy specimen confirmed the diagnosis of pemphigus vulgaris. There was no family history of the disease. Systemic treatment with prednisone,100 mg/d, resulted in regression of the eruption within a month, and the dose was tapered to 10 mg every second day. Although she received anti-tuberculosis treatment, the steroids caused an exacerbation of the tuberculosis, and after a massive hemoptysis in 1993, a right upper and middle lobectomy was performed. The operation put an end to the vicious cycle of drug-induced pemphigus outbreaks by eliminating the need for rifampin, but the patient reported the appearance of new lesions during periods of emotional stress.

Antibiotics, Antitubercular↗
PubMedDate not supplied

A possible mechanism for phenol-induced pemphigus.

A possible mechanism for phenol-induced pemphigus lesions in genetically predisposed individuals is proposed that accounts for in vitro observations and cases of biochemical acantholysis, as well as the in vivo acantholysis in pemphigus induced by phenols. The mechanism involves the induction of interleukin-1a and tumor necrosis factor-a release by keratinocytes. These cytokines in turn have been shown to be involved in the regulation and synthesis of complement and proteases like plasminogen activator, which have been implicated in the pathogenesis of acantholysis in pemphigus vulgaris.

Genetic Predisposition to Disease↗
PubMedDate not supplied

Chlorpyrifos exacerbating pemphigus vulgaris: a preliminary report and suggested in vitro immunologic evaluation model.

BACKGROUND: There is accumulating evidence on the role of pesticides in the etiology of pemphigus vulgaris (PV). OBJECTIVE: To determine whether chlorpyrifos, an organophosphate pesticide, is involved in the immunopathology of PV. METHODS: Normal human skin biopsy specimens incubated with progressively diluted chlorpyrifos solutions were used as indirect immunofluorescence substrates for sera from two PV patients previously exposed to the agent and from healthy controls. Involvement of T-cell lymphocytes was assessed by release of interferon-g in the presence of chlorpyrifos. RESULTS: In one PV patient, immunofluorescence was strongly positive for the specimen incubated with the pesticide and weakly positive for the specimen incubated with medium alone. Immunofluorescence was negative in the patient under immunosuppression with prednisolone and in all controls. Both patients tested positive on interferon-g assay; controls tested negative. CONCLUSIONS: Findings suggest an immunopathogenic role of chlorpyrifos in PV. Interferon-g cytokine assay with the pesticide combined with immunofluorescence tests may provide an in vitro diagnostic tool in suspected pesticide-induced/exacerbated pemphigus.

Adult↗
PubMedDate not supplied

Telangiectasia macularis eruptiva perstans: unusual presentation and treatment.

A 41-year-old woman presented with a 2-month history of pruritus and a generalized dermatitis that developed initially on the head and spread to the trunk, legs, and buttocks. The pruritus caused extreme discomfort and was not relieved by antihistamines or topical steroid treatment. The patient denied flushing, syncope, and vomiting. Her medical history included asthma treated with salmeterol/fluticasone propionate inhaler, and status post silicone breast augmentation. Physical examination revealed a papular dermatitis on the trunk and extremities composed of lesions up to 0.5 cm in diameter, surrounded by excoriation marks (Figure 1). There was no hepatosplenomegaly or lymphadenopathy. Darier's sign was negative. Results of complete blood count, peripheral blood film examination, and liver function tests were all with normal limits. A biopsy specimen taken from a lesion and stained with hematoxylin-eosin showed telangiectasias, with an increased number of mast cells around blood vessels (Figure 2). Positive Giemsa (Figure 3) and c-kit stain (Figure 4) indicated an increased number of mast cells. Bone marrow aspiration and total body CT performed to rule out systemic involvement showed no pathology. Protein electrophoresis was normal. Serum tryptase and histamine were within normal limits, and 24-hour urine collection for histamine was normal. Narrow-band UV-B treatment was begun 3 times weekly, reduced to twice weekly after 2 months, and then stopped. The first few treatments resulted in significant relief of the pruritus and regression of lesions. After 3 months without treatment, the patient remained free of pruritus and lesions.

Adult↗
PubMedDate not supplied

Acute generalized exanthematous pustulosis: a retrospective analysis showing a clear predilection for women.

The clinical reaction pattern acute generalized exanthematous pustulosis is increasingly recognized today as drug intake details are more meticulously recorded and diagnostic guidelines are formulated. Nevertheless, the diagnosis and etiology remain unclear. This examination of the clinical and histologic features of acute generalized exanthematous pustulosis, undertaken in a retrospective study of 13 patients in an urban medical center, was aimed at determining the underlying mechanism of the etiology of the disease. Findings include a female predominance and the overwhelming prevalence of acetaminophen as the culprit agent, adding two more components to what is known about acute generalized exanthematous pustulosis. The possible mechanisms of the disease are discussed, enlightened by its appearance in two women in the study who were pregnant when the reaction first erupted.

Acute Disease↗
PubMedDate not supplied

A possible additional diagnostic tool for cutaneous melanoma.

The rise in incidence of malignant melanoma and the dismal prognosis of late detection emphasize the need for early detection and recognition of the disease. The well-known ABCD method for detection of melanoma has recently been revised by adding an "E" for changes in size, shape, color, crusting, itching, bleeding, and erythema. In an observational study, 8 of 14 (57%) melanoma patients exhibited a particular reddish hue to the skin adjacent to the melanoma, with no distinguishable borders. In another study, vascular endothelial growth factor was positive in biopsy specimens from 3 of 6 (50%) patients with erythema and in 4 of 7 (57%) patients without erythema. Platelet-derived growth factor was positive in all 6 (100%) of the patients with erythema and in 4 of the 7 (57%) without erythema. This erythema can help alert the clinician to the presence of malignant melanoma and serve as a prognostic factor or an indicator of the efficacy of treatment.

Erythema↗