AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Treating the 'Outsides' of the Inpatient: Pediatric Consults for the General Dermatologist

Description

Dr. Nora Gawi, currently a fellow at Cincinnati Children's Hospital, discusses important pediatric dermatology cases that general dermatologists may encounter, focusing on infectious mucocutaneous eruptions. The presentation highlights an 11-year-old boy diagnosed with reactive infectious mucocutaneous eruption (RHYME), triggered by infections such as mycoplasma. Emphasis is placed on the disease's symptoms, management, and treatment, including the use of cyclosporine and systemic corticosteroids. Dr. Gawi then recounts a case involving a three-day-old girl with congenital lesions, linked to aplasia cutis congenita type 5, a condition associated with intrauterine fetal demise. The lecture also addresses the complexities in diagnosing skin ailments in a 27-year-old woman with a history of hematopoietic stem cell transplantation and chronic graft-versus-host disease (GVHD). Biopsy results indicated lichenoid dermatitis, making differentiation from autoimmune diseases crucial. Rapid-fire cases included examples of common viral infections like Coxsackie virus, emphasizing the importance of PCR testing to confirm diagnoses and dismiss more severe conditions. Throughout, Dr. Gawi stresses the necessity for thorough investigations, collaboration among specialties, and tailored treatment approaches for pediatric dermatological challenges.

View more

Conclusions

  • Reactive infectious mucocutaneous eruption (RHYME) is a condition triggered by viral or bacterial infections, with mycoplasma being a common cause.
  • The diagnosis of RHYME can be supported by distinct clinical presentations, including cough, fever, and mucosal lesions.
  • Investigation protocols at Cincinnati Children's Hospital include viral panels and swabs to rule out HSV and other pathogens in cases of RHYME.
  • Therapeutic options for RHYME include cyclosporine and etanercept to halt disease progression, decrease pain, and improve nutritional intake.
  • Supportive care is crucial for RHYME patients, particularly catering to their nutritional needs due to the condition's high mucosal involvement.
  • Antibiotics may be required for underlying respiratory infections but do not affect the course of RHYME itself.
  • Aplasia Cutis Congenita type 5 is associated with fetal demise and presents with specific lesions on newborns, warranting further diagnostic investigation.
  • Patients with chronic graft-versus-host disease (GVHD) show symptoms that may resemble those of autoimmune diseases, requiring thorough evaluation for appropriate treatment.
  • Anti-MDA5 autoantibodies can be present after allogeneic bone marrow transplant and may signal an autoimmune-like phenomenon rather than GVHD alone.
  • Rui Pedro Santos 1, Marta Silva 2, Ana Paula Vieira 1, Celeste Brito 1. Mycoplasma pneumoniae- induced rash and mucositis: a recently described entity.
  • Heidi Oi-Yee Li 1, Sophia Colantonio 1, Michele L Ramien 2 3. Treatment of Mycoplasma pneumoniae-Induced Rash and Mucositis With Cyclosporine.
  • Melanie M Miller 1,8, Sonia Kamath 1,2, Meagan Hughes 1,2, Nicole Harter 1,2, Minnelly Luu 1,2. Evaluation of Etanercept for Treatment of Reactive Infectious Mucocutaneous Eruption.
  • Theresa N Canavan 1, Erin F Mathes 2, llona Frieden 2, Kanade Shinkai 3. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review.
  • Daniel Olson 1 2, Jordan Abbott 3, Clara Lin 1, Lori Prok 1, Samuel R Dominguez 1. Characterization of Children With Recurrent Episodes of Stevens Johnson Syndrome.
  • Gutierrez, D. MD; Krueger, L. MD; Peterson, Erik BA, BS; Franks, A. G. Jr MD; Sicco, K. Lo MD. Dermatomyositis-like Chronic Graft-Versus-Host Disease With MDA5 Autoantibodies. JCR: Journal of Clinical Rheumatology 26(7):p e240-e241, October 2020. | DOI: 10.1097/RHU.0000000000001099.
  • M Trendelenburg, M Gregor, J Passweg, A Tichelli, A Tyndall & A Gratwohl. 'Altered immunity syndrome', a distinct entity in long-term bone marrow transplantation survivors? Bone Marrow Transplantation 28, 1175-1176 (2001).