Possible association of cutaneous telangiectasia with cardiac myxoma

Article Abstract:

Primary atrial myxoma (soft tissue tumor in the atrial chamber of the heart) is associated with non-cardiac symptoms. Changes in skin pigmentation, freckling and erythematous (red) rashes have been reported with myxoma. This case describes a 47-year-old white female who had extensive telangiectasia (formed by the dilation of a group of small blood vessels) on her face and upper body which resolved shortly after removal of the atrial myxoma. The patient had a six-month history of fatigue, palpitations, vague chest pain and orthopnea (difficulty in breathing when lying down) and a red rash covering her face and shoulders that went away when she pressed on it. On examination she was diagnosed with telangiectasia and was found to have abnormal heart sounds. Echocardiogram (the use of sound waves to obtain an image of the structures of the heart) revealed a large mass in the left atrium (upper chamber) that moved into the mitral valve and left ventricle during the relaxation phase of the heartbeat. Three months after successful surgical removal of a 5 cm myxoma the telangiectasia had almost disappeared; six months following her operation the patient had only a few telangiectasia and she was doing well. Primary telangiectasia arises in middle-aged women, but persist and are usually confined to the legs. Secondary telangiectasia (associated with or caused by another disease process) is often found in patients who have connective tissue diseases, liver disease, are exposed to the elements or take certain medications. The fact that this patient's telangiectasia rapidly resolved after removal of the myxoma suggests that there was a relationship between the two.

Usage, Causes of, Heart diseases, Echocardiography, Ataxia telangiectasia, Myxoma

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Efficacy of ketoconazole against Leishmania braziliensis panamensis cutaneous leishmaniasis

Article Abstract:

Cutaneous leishmaniasis is a skin infection with the protozoon Leishmania and is commonly treated with pentavalent antimony, a type of elemental metal. However, the effectiveness of antimony treatment has never been examined. The effects of the antifungal agent ketoconazole given orally were assessed in patients with Panamanian cutaneous leishmaniasis due to infection with the species Leishmania braziliensis panamensis. The results were compared to those of antimony or placebo. Ketoconazole was effective in 16 of 21 patients, with lesions healing within one month in nine patients and within three months in seven others. Liver enzymes were slightly elevated in 27 percent of patients and blood levels of the male hormone testosterone were decreased in 70 percent of patients. The antimony preparation was effective in 13 of 19 patients, with lesions healing by the end of therapy in seven patients and within one month after the end of therapy in four patients. Liver enzymes were mildly elevated in 47 percent of patients and adverse effects due to 20 injections into the muscle developed in all patients. The placebo was completely ineffective in 11 patients, and resulted in the development of new or larger lesions within one month after the end of the treatment period. These findings show that ketoconazole and antimony are both effective against L. braziliensis panamensis cutaneous leishmaniasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Leishmaniasis, Ketoconazole, Antimony potassium tartrate

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Varicella zoster virus transverse myelitis without cutaneous rash

Article Abstract:

Infection with varicella zoster virus (VZV) has been associated with various nerve complications, including inflammation of the brain, membranes in the brain and spinal cord, the spinal cord itself, and the spinal nerve roots; paralysis of half of the body; nerve pain; and nerve disorders associated with the cranium or skull. These nerve disorders are usually associated with skin rash. A case is described of a 31-year-old man with myelitis, inflammation of the spinal cord, due to VZV infection who did not develop a skin rash. The patient developed pain within the lower back and back of thighs, was unable to retain feces, and retained urine. Within the next eight days, function of his lower extremities deteriorated. The patient was treated with dexamethasone and his condition improved gradually. VZV was detected in his spinal fluid, and the patient was given the antiviral agent acyclovir. The patients was able to regain his walking ability, although his urinary retention persisted. This case shows that infection with VZV can cause nerve disease without evidence of skin rash or without triggering the production of antibodies, immune system proteins. Under such conditions, the presence of VZV may be determined by analysis of spinal fluid. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Acyclovir, Inflammation, Spinal cord, Cutaneous manifestations of general diseases, Skin manifestations, Shingles (Disease), Herpes zoster, Cerebrospinal fluid

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