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Whitney A High

Publications and source records attributed to Whitney A High.

At least 19 recordsLinked to original sources
PubMed2006

Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis.

BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a disease of unknown etiology that affects a subset of patients with renal insufficiency. Recent publications suggested an association between exposure to gadolinium-containing contrast agents and subsequent development of NSF. We sought to detect gadolinium within the skin and soft tissue of patients with NSF who were exposed to gadolinium-based contrast. METHODS: Paraffin-embedded skin and soft tissue from NSF patients exposed to gadolinium, and from negative controls, was provided by the NSF Registry (New Haven, Conn). The tissue was searched for metals using a field emission scanning electron microscope that was equipped with energy dispersive spectroscopy. The presence of gadolinium and other metals was verified through identification of unique and requisite X-ray emission spectra. RESULTS: Gadolinium was detected in 4 of 13 tissue specimens from 7 patients with documented NSF who were exposed to gadolinium-based radiographic contrast. No gadolinium was detected in a paraffin-embedded specimen from a negative control. Based upon the known exposure history of patients with detectable gadolinium, a tissue residence time of 4 to 11 months was observed. LIMITATIONS: As this was a pilot investigation, only a single control specimen and a single histological section from each block of tissue were utilized. CONCLUSION: In this pilot investigation, gadolinium was detected in the tissue of a number of patients with NSF. Although neither dispositive of a pathophysiologic mechanism, nor proof of causation, the detection of gadolinium within tissue of NSF patients is supportive of an epidemiologic association between exposure to gadolinium-containing contrast material and development of disease.

Acidosis↗
PubMed2006

Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation.

BACKGROUND: African Americans with seborrheic dermatitis may manifest associated hypopigmenation. Corticosteroids and antifungals are often used for treatment, yet chronic use of corticosteroids may be associated with skin atrophy, increased intraocular pressure, or further hypopigmenation. Pimecrolimus has been used successfully in a few patients with seborrheic dermatitis. OBJECTIVES: This open-label, pilot trial assessed the efficacy and tolerability of pimecrolimus in the treatment of seborrheic dermatitis in African Americans with hypopigmentation. METHODS: Five African American adults with seborrheic dermatitis used a thin layer of pimecrolimus on the involved areas twice per day for 16 weeks. Clinical measures of improvement included erythema, scaling, and pruritus. Hypopigmentation was measured objectively using a mexameter. RESULTS: All participants noted a marked decrease in the severity of their condition. An improvement in hypopigmentation was also noted. For all indicators, the magnitude of improvement was most marked during the initial 2 weeks of treatment. LIMITATIONS: This was an open-label pilot trial limited to just 6 participants, only 5 of whom completed the study. CONCLUSIONS: Topical pimecrolimus cream may be an excellent alternative therapeutic modality for treating seborrheic dermatitis in African Americans, particularly in those with associated hypopigmentation.

Adult↗
PubMed2006

Granulomatous reaction to titanium alloy: an unusual reaction to ear piercing.

A 68-year-old man presented with 4 firm, flesh-colored, and slightly erythematous nodules located on the superior pole and lobule of each ear. Although reluctant to provide details, it was discovered he had pierced his ears approximately 10 years earlier, and the nodules developed at the sites of the piercings. Keloids were suggested clinically and the lesions were excised. Microscopic examination demonstrated epithelialized tracts surrounded by a granulomatous infiltrate of macrophages, lymphocytes, and plasma cells. Closer examination revealed minute brown-black particles within macrophages. Dark-field microscopy confirmed the metallic nature of the particles. Environmental scanning electron microscopy with energy dispersive spectroscopy revealed the particles to be composed of titanium, aluminum, and vanadium. It would appear that in rare circumstances titanium alloy used in body piercing may engender a granulomatous dermatitis. The rarity of such a response to titanium alloy is discussed and the literature appraised.

Aged↗
PubMed2006

Is melanocytic nevus with focal atypical epithelioid components (clonal nevus) a superficial variant of deep penetrating nevus?

BACKGROUND: We compare features of two similar nevi which may be confused with melanoma: deep penetrating nevus (DPN), and nevus with focal atypical epithelioid component (NFAEC). METHODS: Clinical/demographic and histologic information regarding 146 DPN and 81 NFAEC were compared. Patient outcomes were ascertained via a questionnaire solicited to the referring physicians. RESULTS: Clinical features were similar for each type of nevus. Histologically, all lesions demonstrated identical aggregates of epithelioid melanocytes. DPN more often extended into the deep dermis or subcutaneous tissue, while NFAEC was typically confined to the superficial dermis. NFAEC more often demonstrated a junctional component (P < .001) and coexistent common nevus with congenital features (P = .035). DPN more often demonstrated adnexal spread (P < .001). A subgroup with overlapping features was identified. With an average of 6.4 years follow-up, there were just two recurrences, and no metastases. LIMITATIONS: This retrospective study utilized tissue specimens from a single reference laboratory; ergo, some inherent selection bias exists. Specimens were randomly selected for P53 immunostaining, leading also to potential sampling error. CONCLUSIONS: DPN and NFAEC show considerable similarity, differing mainly in the depth of extent for the lesion. It is possible that NFAEC represents a more superficial variant of DPN. A subgroup with overlapping features, but intermediate depth, supports such a relationship.

Adolescent↗
PubMed2005

Localized epidermolytic hyperkeratosis of the female genitalia: a case report and review of an underappreciated disorder of women.

Epidermolytic hyperkeratosis (EHK) is a distinct pathologic entity that may present as a generalized congenital disorder. A localized form occurring only upon the female genitalia may not be well appreciated by clinicians dealing with women. EHK of the female genitalia is a rare diagnosis, with just 6 cases reported within the indexed literature. Clinically, it may resemble condyloma, although involvement of human papillomavirus has never been demonstrated. Providers unfamiliar with this entity may be further confused by reports of the histopathologic features. Herein, we describe a case and review the literature with respect to EHK of the female genitalia. Familiarity with this condition is desirable, as confusion with condyloma is likely, yet the prognosis is decidedly different.

Diagnosis, Differential↗
PubMed2005

Lipedematous alopecia: an unusual sequela of discoid lupus, or other co-conspirators at work?

BACKGROUND: Lipedematous alopecia is a rare entity of uncertain origin characterized by a boggy scalp and varying alopecia. Of 11 cases in the literature, 7 occurred in African American women. Classic histopathologic findings include increased subcutaneous tissue, varying inflammation, and an absence of mucin. Some have sought to distinguish this disorder from lipedematous scalp, a condition with similar tactile features, but without alopecia. OBSERVATION: We describe a case of lipedematous alopecia in an African American woman who also had findings of discoid lupus erythematosus. Such an observation has not been made previously, and may provide insight into the cause of lipedematous alopecia. This case is contrasted with a case of lipedematous scalp. CONCLUSION: Some cases of lipedematous alopecia may represent an unusual consequence of discoid lupus erythematosus. Alternatively, it is possible that lipedematous scalp is a benign condition observed in some patients, and that a second insult results in alopecia. Finally, lipedematous alopecia might share some histopathologic and/or clinical findings with discoid lupus erythematosus, or it may represent a nonspecific reaction pattern to chronic injury.

Black or African American↗
PubMed2005

Completely regressed primary cutaneous malignant melanoma with nodal and/or visceral metastases: a report of 5 cases and assessment of the literature and diagnostic criteria.

BACKGROUND: Partial regression of primary cutaneous malignant melanoma is not uncommon and may predict a higher likelihood of metastasis and decreased survival. Complete histologic regression of a primary cutaneous melanoma is a rarer occurrence, with only 34 cases reported in the English-language or English language-summarized literature. OBSERVATION: We detail 4 cases of complete histologic regression of primary cutaneous melanoma, discovered at presentation with metastatic disease. A pigmented lesion or its remnant, coupled with historical information, was strongly suggestive of cutaneous melanoma. Histologic examination of the lesions, using multiple levels and immunohistochemical stains, failed to reveal residual melanoma. Our cases are typified by the presence of metastasis of melanoma to regional lymph nodes, with the absence of other suspect skin lesions or malignancies. In addition, we present a fifth case involving a completely regressed lesion on the scalp in a patient with cerebral melanoma metastasis and comment on the implications of this case to accepted diagnostic criteria, proposing that consideration of modification to the criteria be entertained. CONCLUSION: The concept of completely regressed primary cutaneous melanoma is reviewed and the literature critically appraised. When one considers a diagnosis of completely regressed primary cutaneous melanoma, cases must be well documented and biopsy proven. Patients with metastatic melanoma and an occult primary lesion require a thorough skin examination, with serious consideration given to the possibility of completely regressed cutaneous melanoma.

Adult↗
PubMed2005

Pruritic urticarial papules and plaques of pregnancy with unusual and extensive palmoplantar involvement.

BACKGROUND: Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a specific dermatosis of pregnancy common to primigravid women in the third trimester. The rash usually begins on the lower abdomen within striae and spreads to the proximal extremities. Involvement of face, palms, and soles is unusual. Although intensely pruritic, the fetus is unaffected, and the condition does not usually recur. It can be difficult to distinguish PUPPP from pemphigoid gestationis, an autoimmune bullous disorder with potential fetal consequences that may recur with subsequent pregnancy, menses, or hormonal therapy. CASE: A young secundagravida at 36 weeks of gestation with monochorionic twins presented with a 3-week history of a pruritic papular eruption that began on the abdomen and spread to the extremities. She had extensive involvement of the distal extremities, including the palmoplantar surfaces, with small vesicles of 2-4 mm on acral skin. Because of her unusual presentation, she was thought initially to have pemphigoid gestationis. Subsequent dermatological evaluation and a biopsy confirmed the diagnosis of PUPPP. Shortly after admission she delivered 2 healthy male infants, and her rash cleared with conservative management. CONCLUSION: Pruritic urticarial papules and plaques of pregnancy often, but not always, spares the face, palms, and soles. Small vesicles can occur in PUPPP, but formation of true bullae is not observed. Careful dermatological examination and cutaneous biopsy can assist in differentiating PUPPP from pemphigoid gestationis, which is essential for treatment and prognosis.

Adrenal Cortex Hormones↗
PubMed2005

Psoriasis guttata with palmoplantar involvement clinically mimicking secondary syphilis.

Papulosquamous eruptions involving the palms and soles are thought to be particularly suggestive of secondary syphilis. Alternative diagnoses exist, however, and include psoriasis guttata, atypical pityriasis rosea, and pityriasis lichenoides chronica (PLC). We describe the case of a patient with an abrupt onset of psoriasis guttata and extensive palmoplantar involvement. Results of serologic testing were negative for treponemicidal antibodies. Results of histopathologic examination demonstrated psoriasiform dermatitis with neutrophils in the epidermis; plasma cells were absent. Spirochetes were not demonstrated in a tissue sample using silver or immunohistochemical stains for Treponema pallidum. A broad differential diagnosis is required when evaluating papulosquamous eruptions with palmoplantar involvement. Although not well referenced in the medical literature, psoriasis guttata can indeed cause palmoplantar lesions that mimic those of secondary syphilis.

Adult↗
PubMed2004

Presentation, histopathologic findings, and clinical outcomes in 7 cases of melanoma in situ of the nail unit.

OBJECTIVE: To report on the presentation, histopathologic findings, and clinical outcomes for a case series of MIS of the nail apparatus because melanoma in situ (MIS) of the nail unit has not been well characterized in the literature. SETTING: A division of a tertiary academic center specializing in micrographic excision of cutaneous neoplasms. DESIGN: Surgical records were searched for cases of MIS of the nail unit for the period of January 1, 1997, to December 31, 2002. The patient demographics and disease presentation, treatment, and clinical course were reviewed. RESULTS: Seven cases of MIS of the nail unit in white patients were identified. Longitudinal melanonychia was present in all cases, but dyspigmentation of the proximal nail fold and onychodystrophy were uncommon. Histopathologic analysis revealed poorly circumscribed proliferations of single cells over nests with variable pagetoid spread. Atypia was variable. Mitotic activity was low. All cases were treated with micrographic surgery. Amputation was avoided in 3 cases and was limited to partial distal interphalangeal amputation in the remainder. Six cases did not recur locally after initial surgical intervention. With an average of 24 months of follow-up, all patients were free of disease. CONCLUSIONS: Longitudinal melanonychia in a white patient mandates consideration of MIS of the nail unit. Given the nondescript clinical presentation, the threshold for biopsy should be low. The histopathologic findings appear similar to those of MIS in other areas, with asymmetry and poor circumscription predominating. With additional study and further acceptance, micrographically controlled excision has the potential to minimize morbidity. Further investigation is warranted.

Adult↗
PubMed2004

Cutaneous miliary tuberculosis in two patients with HIV infection.

Cutaneous manifestations of miliary tuberculosis are rare. We report two patients with previously unknown advanced human immunodeficiency virus (HIV) infection, who presented with respiratory collapse and an erythematous papulopustular skin eruption. Skin biopsies demonstrated focal dermal microabscess in one patient, and a subcorneal vesicle with an underlying dermal microabscess in the other. Despite the lack of granulomatous inflammation, acid-fast bacilli (AFB) and Fite stains demonstrated numerous acid-fast bacilli, and Mycobacterium tuberculosis was subsequently isolated in either skin and/or sputum cultures. Pulmonary involvement was present in both cases, but was sufficiently diffuse and atypical so as not to be specific for tuberculosis upon initial clinical and radiographic examination. Our two cases illustrate the importance of careful skin examination in patients with HIV infection, since cutaneous dissemination can be an easily overlooked sign of miliary tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed2004

Is Degos' disease a clinical and histological end point rather than a specific disease?

Degos' disease is described as a rare disorder, with approximately 100 cases detailed in the literature. Nearly all are characterized by the near "pathognomonic" appearance of porcelain-white, atrophic papules with peripheral erythema and telangiectases. Many Degos' disease variants have been described including benign cutaneous Degos' disease, familial Degos' disease, atrophie blanche with Degos'-like features, and connective tissue diseases with similar findings. The course, prognosis, and treatment have substantially varied. We present four patients: the first carries a diagnosis compatible with classic Degos' disease, the second and third demonstrate cutaneous and histological findings of Degos' disease but laboratory evidence suggestive of lupus erythematosus, while the fourth has dermatomyositis with Degos'-like lesions. Because of broad overlap in clinical and histological findings, we contend that Degos' disease may not be a specific entity, but rather, may represent a common end point to a variety of vascular insults, many of which have not been fully elucidated.

Adult↗
PubMed2004

Outcome of patients with a final diagnosis of chest pain of undetermined origin admitted under the suspicion of acute coronary syndrome: a report from the Rochester Epidemiology Project.

STUDY OBJECTIVES: Patients presenting to the emergency department (ED) with chest pain after a recent negative inpatient evaluation for cardiac pathology represent a dilemma for the emergency physician. The purposes of this study were to assess the outcome of patients discharged with a diagnosis of chest pain of undetermined origin and to identify predisposing factors for further cardiac events. METHODS: The resources of the Rochester Epidemiology Project were used to identify all admitted ED patients with chest pain with suspected acute coronary syndrome who received a discharge diagnosis of chest pain of undetermined origin from 1985 through 1992. Patient records were reviewed for the occurrence of adverse cardiac events and subsequent ED visits for recurrent chest pain within 12 months of discharge. Associations between patient characteristics and an adverse cardiac event were evaluated univariately and summarized by using odds ratios (ORs). Long-term mortality was also determined. RESULTS: Among 1,973 admitted ED patients with chest pain, 230 were given a diagnosis of chest pain of undetermined origin. Ten (4.4%) of 230 patients experienced an adverse cardiac event. Factors significantly associated with an adverse cardiac event included an abnormal ECG on admission (OR 9.5; 95% confidence interval [CI] 2.0 to 45.8), preexisting diabetes mellitus (OR 7.1; 95% CI 1.8 to 27.2), and preexisting coronary artery disease (OR 28.4; 95% CI 3.5 to 229.0). Thirty-three (14%) patients returned to the ED within 12 months of discharge; 5 patients were given a diagnosis of a cardiac condition, and 5 were given a diagnosis of a gastrointestinal condition. In long-term follow-up, 46 patients died, with a mean time from hospital discharge to death of any cause of 6.1 years and an estimated 5-year survival of 91.4%. CONCLUSION: Among patients discharged from the hospital with a diagnosis of chest pain of undetermined origin, those with an initial abnormal ECG, preexisting diabetes, or preexisting coronary artery disease are at higher risk of a subsequent adverse cardiac event. In the absence of such factors, cardiac outcome is excellent.

Acute Disease↗
PubMed2004

Sclerotic fibroma-like change in various neoplastic and inflammatory skin lesions: is sclerotic fibroma a distinct entity?

Sclerotic fibroma was first described in association with Cowden's disease by Weary et al. in 1972. In 1989, Rapini and Golitz detailed 11 cases of solitary sclerotic fibroma (SFS) in the absence of Cowden's disease, suggesting the term SFS of the skin. Classic histological features include hypocellular, hyalinized bands of collagen sharply demarcated from the surrounding skin. Numerous authors have described sclerotic fibroma-like changes in other entities including melanocytic nevi, dermatofibromas, lipomas, tendon sheath fibromas, giant cell collagenomas, neurofibromas, angiofibromas, erythema elevatum diutinum, and folliculitis. Dissension has arisen, with some dermatopathologists asserting that sclerotic fibroma is just an evolutionary end-point of a previous lesion. Others contend that SFS is a distinct lesion and cite recurrent cases and/or proliferation marker studies to corroborate this view. We detail the histopathological findings of lesions consistent with the classic description of SFS and compare these to sclerotic changes observed in an intradermal nevus, blue nevus, erythema elevatum diutinum, neurofollicular hamartoma, angiofibroma, neurofibroma, accessory nipple, and dermatofibromas. Sclerotic fibroma-like change may be seen in a variety of lesions and may represent a common reaction pattern in the skin.

Adolescent↗
PubMed2004

Secondary syphilis: a histologic and immunohistochemical evaluation.

The usual method for detecting spirochetes in tissue sections is the silver stain; however, they are often difficult to detect due to marked background staining commonly seen with this technique. In certain clinical settings, such as neurosyphilis, congenital syphilis, and immunosuppressive conditions including human immunodeficiency virus (HIV) infection, a better method of detecting spirochetes in tissue sections is needed. We compare immunohistochemistry (IHC) with a monoclonal antibody to Treponema pallidum to silver staining in 19 biopsies from 17 patients with serologic evidence of secondary syphilis. IHC demonstrated a sensitivity of 71%, which was superior to the 41% sensitivity of the silver stain (p = 0.084). Furthermore, specificity was improved with IHC, as background artifacts were markedly reduced. Dermal spirochetes were visualized in all 12 positive cases, while epidermal organisms were seen in only eight cases. This finding lies contrary to accepted teaching that organisms are most commonly seen at the dermal epidermal junction. Of interest, perineural plasmacellular infiltrates were frequently seen in our cases (74%). Spirochetes were not seen in any of 14 control cases with similar histopathologic patterns. Although serologic studies remain the gold standard, IHC is more sensitive and specific than silver stain for detecting T. pallidum in biopsies of secondary syphilis.

Adult↗