ro13-9904 and Skin-Diseases

Because calcinosis cutis is a rare syndrome, there is a notable lack of controlled clinical trials on its treatment. The efficacy of calcinosis treatment has only been reported in single cases or small case series. No treatment has been generally accepted as standard therapy, although various treatments have been reported to be beneficial, including warfarin, bisphosphonates, minocycline, ceftriaxone, diltiazem, aluminium hydroxide, probenecid, intralesional corticosteroids, intravenous immunoglobulin, curettage, surgical excision, carbon dioxide laser, and extracorporeal shock wave lithotripsy.

Topics: Biopsy, Needle; Calcinosis; Ceftriaxone; Combined Modality Therapy; Drug Therapy, Combination; Education, Medical, Continuing; Evidence-Based Medicine; Female; Humans; Immunoglobulins, Intravenous; Immunohistochemistry; Laser Therapy; Lasers, Gas; Male; Minocycline; Prognosis; Recurrence; Risk Assessment; Severity of Illness Index; Skin Diseases; Treatment Outcome; Warfarin

Stomatococcus mucilaginosus, a normal inhabitant of the human oral cavity and upper respiratory tract, can cause fatal sepsis and meningitis in neutropenic patients. We identified eight cases of bacteremia due to S. mucilaginosus in children with cancer, of whom five developed complications despite receiving appropriate antibiotics. At the time cultures were positive, seven patients had profound neutropenia (< 100 neutrophils and band forms/mm3) and four had mucositis; five had central venous catheters. In two cases, there was unequivocal evidence of catheter-related sepsis. Bacteremia was eradicated in all patients within 48 hours after initiation of antibiotics. Despite prompt instigation of effective antibiotic therapy, the complication rates in this series were high: septic shock (50%), pneumonia (50%), dermatologic manifestations (38%), altered neurological status (25%), meningitis (13%), and adult respiratory distress syndrome (13%). No fatalities were attributable to S. mucilaginosus infection. These cases illustrate the virulence of S. mucilaginosus organisms in neutropenic children and suggest a substantial risk of sequelae even when adequate antibiotic therapy is given.

Topics: Adolescent; Bacteremia; Ceftazidime; Ceftriaxone; Child; Child, Preschool; Female; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neoplasms; Neutropenia; Pneumonia; Respiratory Distress Syndrome; Shock, Septic; Skin Diseases; Vancomycin

There are still no definite patterns for antibiotic therapy of Lyme borreliosis. Recent studies have shown that ceftriaxone or tetracyclines are superior to the conventional penicillin. Against erythema chronica migrans (stage I) oral therapy, preferably with tetracycline, is sufficient. In cases with stage II symptoms, such as arthritis or neurological affections, high dose parenteral treatment, preferably with ceftriaxone, is recommended, although its effect on the neurologic symptoms is not yet proven. Carditis also calls for high dose parenteral administration of antibiotics, even though there are no published studies on this treatment as yet. Opinion is divided on the cutaneous symptoms such as acrodermatitis chronica atrophicans, morphea, lichen sclerosus et atrophicus (acute inflammatory stage) and lymphadenitis cutis benigna. Even if oral penicillin or tetracycline can cure existing symptoms, in the absence of longterm observations, it remains an open question whether oral treatment can prevent further complications or evolution to chronicity (stage III). For these clinical pictures there is also a tendency to give high dose parenteral antibiotics, and ceftriaxone is likely to win favour. In stage II Lyme borreliosis, autoimmune processes occur which scarcely respond to antibiotics any longer. Nevertheless, parenteral administration of high dose antibiotics remains sensible as a means of eradicating pathogens from the tissues, CSF or synovial fluids, and to avoid further complications. Evaluation of the therapeutic effects of corticosteroids or other immunosuppressive agents would require prospective studies.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Erythema Chronicum Migrans; Humans; Lyme Disease; Nervous System Diseases; Skin Diseases; Tetracyclines

Topics: Arthritis, Infectious; Ceftriaxone; Drug Administration Schedule; Erythema; Humans; Lyme Disease; Nervous System Diseases; Penicillins; Skin Diseases; Tetracycline

Twenty children with meningococcal disease (15 with meningococcal meningitis and 5 with meningococcemia without meningitis) were treated with ceftriaxone, 80 to 100 mg/kg/day for 4 days. An additional 22 patients with meningococcal disease (13 with meningitis, 9 with meningococcemia without meningitis) were treated with penicillin G. On the basis of the Damrosch-Stiehm scoring system, 19 patients were classified in the poor prognostic group and were treated with antishock therapy. Clinical recovery time and normalization of CSF were compared in two groups. When the complications were compared, necrotic skin lesions were more frequently seen in the penicillin G group than in those who received ceftriaxone. Ceftriaxone is an effective and safe drug and offers the advantage of once daily administration for treatment of meningococcal disease in pediatric patients.

Topics: Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Penicillin G; Prognosis; Skin Diseases

Malakoplakia (from the Greek malakos, 'soft' and plakos 'plaque') is a granulomatous inflammatory condition, commonly presenting as a plaque in the genitourinary system, but has been shown to affect a wide variety of structures including the skin. Presentation is varied and a high degree of clinical suspicion is needed to make a diagnosis. We report a case of cutaneous malakoplakia presenting as an inguinal swelling in a 48-year-old kidney transplant patient with temporally associated graft dysfunction. New groin swelling in an immunosuppressed patient often prompts investigation centred on a malignant cause. While this is often appropriate, less common infectious and inflammatory causes should be considered. This case highlights the importance of thorough workup and investigation, including histopathology, in immunosuppressed cohorts and acts as a reminder that less common and more complex diagnoses warrant consideration in this group.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Ceftriaxone; Constriction, Pathologic; Diagnosis, Differential; Edema; Groin; Humans; Immunocompromised Host; Kidney Transplantation; Malacoplakia; Male; Middle Aged; Rare Diseases; Skin; Skin Diseases; Treatment Outcome; Ureteral Diseases

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis; Humans; Intracranial Embolism; Male; Middle Aged; Occipital Lobe; Parietal Lobe; Secondary Prevention; Skin Diseases; Streptococcal Infections; Streptococcus gordonii; Treatment Outcome

Topics: Acute Disease; Adult; Bacteremia; Ceftriaxone; Female; Humans; Meningitis, Meningococcal; Neisseria meningitidis; Purpura; Skin Diseases; Vasculitis