Lobular capillary hemangioma post-chemotherapy for T-cell leukemia treated with an antibiotic: a case report

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Abstract

Background

Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus membranes. Although the exact pathogenesis of PG is unknown, many theories discussed the potential of an angiogenic stimulus and an imbalance of inducers and inhibitors triggering the hyperplastic and neovascular response. The most frequently used modality for treatment of PG is surgical treatment. The proposed case represents an unexpected evolution to a possible therapeutic measure.

Case Description

We represent a case of a 32-year-old male, known to have T-cell acute lymphoblastic leukemia treated successfully with chemotherapy, currently maintained on methotrexate (MTX) 40 mg and 6-mercaptopurine, 100 mg, presented with 1-month history of painful rapidly growing ulcerated nodules on his right-hand palm and middle finger. Both skin lesions developed approximately 3 months following patient initiation of maintenance treatment. Physical examination revealed two crusted nodules. A proximal lesion was observed over the palmar aspect between the second and third fingers, with the other one occurring alongside the distal phalanx of the third finger, measuring 2.5 cm × 1.5 cm, and 2.5 cm × 3.5 cm respectively. Skin biopsy was obtained from both lesions. The results of the histologic examination both revealed inflamed PG. Tissue cultures of both specimens tested positive for Pseudomonas aeruginosa growth while no fungal and tuberculosis were cultured. Ciprofloxacin 500 mg twice daily, a 2-week course was started. Both lesions completely resolved at 10 ^th-day of antibiotic course with no recurrence.

Conclusions

This is a case of a patient with lobular capillary hemangioma of the hand treated successfully with no recurrence using an oral antibiotic. The proposed case represents an unexpected evolution to a possible therapeutic measure. The unexpected role of a conservative measure rather than the conventional surgical method in treating vascular tumors has been highlighted. Moreover, the contribution to an excellent cosmetic outcome has also been demonstrated.

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Ciprofloxacin and levofloxacin attenuate microglia inflammatory response via TLR4/NF-kB pathway

Morena Zusso, Valentina Lunardi, Davide Franceschini … (2019)

Background Neuroinflammation is the response of the central nervous system to events that interfere with tissue homeostasis and represents a common denominator in virtually all neurological diseases. Activation of microglia, the principal immune effector cells of the brain, contributes to neuronal injury by release of neurotoxic products. Toll-like receptor 4 (TLR4), expressed on the surface of microglia, plays an important role in mediating lipopolysaccharide (LPS)-induced microglia activation and inflammatory responses. We have previously shown that curcumin and some of its analogues harboring an α,β-unsaturated 1,3-diketone moiety, able to coordinate the magnesium ion, can interfere with LPS-mediated TLR4–myeloid differentiation protein-2 (MD-2) signaling. Fluoroquinolone (FQ) antibiotics are compounds that contain a keto-carbonyl group that binds divalent ions, including magnesium. In addition to their antimicrobial activity, FQs are endowed with immunomodulatory properties, but the mechanism underlying their anti-inflammatory activity remains to be defined. The aim of the current study was to elucidate the molecular mechanism of these compounds in the TLR4/NF-κB inflammatory signaling pathway. Methods The putative binding mode of five FQs [ciprofloxacin (CPFX), levofloxacin (LVFX), moxifloxacin, ofloxacin, and delafloxacin] to TLR4–MD-2 was determined using molecular docking simulations. The effect of CPFX and LVFX on LPS-induced release of IL-1β and TNF-α and NF-κB activation was investigated in primary microglia by ELISA and fluorescence staining. The interaction of CPFX and LVFX with TLR4–MD-2 complex was assessed by immunoprecipitation followed by Western blotting using Ba/F3 cells. Results CPFX and LVFX bound to the hydrophobic region of the MD-2 pocket and inhibited LPS-induced secretion of pro-inflammatory cytokines and activation of NF-κB in primary microglia. Furthermore, these FQs diminished the binding of LPS to TLR4–MD-2 complex and decreased the resulting TLR4–MD-2 dimerization in Ba/F3 cells. Conclusions These results provide new insight into the mechanism of the anti-inflammatory activity of CPFX and LVFX, which involves, at least in part, the activation of TLR4/NF-κB signaling pathway. Our findings might facilitate the development of new molecules directed at the TLR4–MD-2 complex, a potential key target for controlling neuroinflammation. Electronic supplementary material The online version of this article (10.1186/s12974-019-1538-9) contains supplementary material, which is available to authorized users.

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Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases.

J Mulliken, K Wiss, J Patrice (1991)

Pyogenic granuloma (lobular capillary hemangioma) is a common acquired vascular lesion of the skin and mucous membranes in the pediatric age group. This is a retrospective analysis of 178 patients, 17 years of age and younger (mean age 6.7 yrs). Forty-two percent of the lesions occurred in the first five years of life; only 12% appeared in infants less than 1 year old. The male:female ratio was 3:2. Most patients (74.2%) had no history of trauma or predisposing dermatologic condition. The mean lesional size was 6.5 mm and the mean duration at diagnosis was 3.8 months. The granulomas were most commonly located in the head and neck area (62.4%), followed in order of decreasing frequency by trunk (19.7%), upper extremity (12.9%), and lower extremity (5.0%). The preponderance (88.2%) occurred on the skin, the remaining ones involved the mucous membranes of the oral cavity and conjunctivae. Histologic examination demonstrated normal numbers of mast cells, in contrast to increased mast cells characteristic of proliferative phase hemangiomas. Most lesions (n = 149) were treated by full-thickness skin excision and linear closure; there were no recurrences in this group. The recurrence rate in 23 lesions treated by shave (intradermal) excision and cautery or cautery alone was 43.5%.

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Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes.

Daniel S Mills, R Fechner, Marcus P. Cooper (1980)

Pyogenic granuloma (PG) has a diagnostic, lobular arrangement of capillaries at its base. The lobules consist of discrete clusters of endothelial cells, and the lumina vary from indistinct to prominent. The superficial portions of the lesion may undergo secondary, nonspecific changes including stromal edema, capillary dilation, inflammation, and a granulation tissue reaction. PG has often been equated with these inflammatory changes but objective diagnostic criteria have not been presented. To avoid confusion and focus on the intrinsic nature of PG we suggest the accurate, descriptive term, lobular capillary hemangioma (LCH). A review of 639 vascular lesions of the oral cavity and upper respiratory tract yielded 73 cases with the characteristic features of LCH. The lip was the most common site (38%), followed by the nose (29%), oral mucosa (18%), and tongue (15%). LCH usually presents as a spontaneous, painless, bleeding mass. There is a predilection for males less than 18 years old, females in the reproductive years, and an equal sex distribution beyond 40 years of age. No examples of LCH were found in 68 vascular lesions from the larynx or trachea.

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Author and article information

Journal

Journal ID (nlm-ta): AME Case Rep

Journal ID (iso-abbrev): AME Case Rep

Journal ID (publisher-id): ACR

Title: AME Case Reports

Publisher: AME Publishing Company

ISSN (Electronic): 2523-1995

Publication date (Electronic): 22 March 2024

Publication date Collection: 2024

Volume: 8

Electronic Location Identifier: 44

Affiliations

[1 ]deptDivision of Dermatology , King Saud University , Riyadh, Kingdom of Saudi Arabia;

[2 ]deptDivision of Dermatology , Prince Sultan Military Medical City , Riyadh, Kingdom of Saudi Arabia;

[3 ]deptDivision of Dermatology, Imam Abdulrahman Alfaisal Hospital , Ministry of Health , Riyadh, Kingdom of Saudi Arabia

Author notes

Contributions: (I) Conception and design: TN Almughera, A Alsalh, M Al-Haddab; (II) Administrative support: TN Almughera, A Alsalh, M Al-Haddab; (III) Provision of study materials or patients: TN Almughera, A Alsalh, M Al-Haddab; (IV) Collection and assembly of data: TN Almughera, A Alsalh, M Al-Haddab; (V) Data analysis and interpretation: TN Almughera, A Alsalh, M Al-Haddab; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Tharaa N. Almughera, MD. Division of Dermatology, Prince Sultan Military Medical City, Makkah Al Mukarramah Rd., As Sulimaniyah, Riyadh 1223, Kingdom of Saudi Arabia. Email: Tharaalmughera@ 123456gmail.com .

Article

Publisher ID: acr-08-23-159

DOI: 10.21037/acr-23-159

PMC ID: 11070979

PubMed ID: 38711894

SO-VID: 40324c32-c39a-4bf0-9e7e-ccd749113125

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Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Lobular capillary hemangioma post-chemotherapy for T-cell leukemia treated with an antibiotic: a case report

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Most cited references 13

Ciprofloxacin and levofloxacin attenuate microglia inflammatory response via TLR4/NF-kB pathway

Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases.

Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes.

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