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      Miliaria-rash after neutropenic fever and induction chemotherapy for acute myelogenous leukemia Translated title: Miliária 'rash' após neutropenia febril e quimioterapia de indução para a leucemia mielóide aguda

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          Abstract

          Miliaria is a disorder of the eccrine sweat glands which occurs in conditions of increased heat and humidity. It can be associated with persistent febrile states as well as with certain drugs. We presented a 40 year-old female with myelodysplastic syndrome and progression to acute myelogenous leukemia who was admitted to the hospital for chemotherapy induction. The patient was treated with idarubicin and cytarabine. She became pancytopenic and developed neutropenic fever and was started on vancomycin and cefepime, but was persistently febrile with night sweats. Five days into her fevers, she developed diffuse, nonpruritic and fragile vesicles together with drenching nightsweats. The patient's exanthem was diagnosed as Miliaria crystallina, most probably induced by neutropenic fever and idarubucin exposure

          Translated abstract

          Miliária é uma desordem das glândulas sudoríparas écrinas, que ocorre em condições de aumento de calor e umidade. Miliária pode ser associada com estados febris persistentes bem como com certos medicamentos. Apresentamos o caso de uma mulher de 40 anos com síndrome mielodisplásica e progressão para leucemia mielóide aguda que foi admitida no hospital para quimioterapia de indução. A paciente foi tratada com idarrubicina e citarabina. Ela se tornou pancitopênica e desenvolveu neutropenia febril. Iniciou tratamento com vancomicina e cefepime, mas a febre com sudorese noturna continou. Cinco dias depois a paciente desenvolveu vesículas difusas, não pruríticas e frágeis juntamente com a persistência de sudorese noturna. O exantema do paciente foi diagnosticado como Miliária cristalina, provavelmente induzida por neutropenia febril e exposição a idarubucin

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          Dermatologic manifestations of infections in immunocompromised patients.

          Thirty-one immunocompromised patients (22 renal allograft recipients, 5 patients receiving chronic corticosteroid therapy, and 4 patients undergoing chemotherapy for acute leukemia) with significant dermatologic infection, excluding typical cellulitis and herpesvirus infections, were retrospectively identified over a 12-year period. Of these 31 patients, 15 (48%) had infection restricted to their skin, 6 (19%) appeared to have primary cutaneous infection that spread hematogenously to other parts of the body, 2 (6%) had infections of adjoining nasal tissue that spread to contiguous skin, and 8 (26%) appeared to have disseminated systemic infection that spread to the skin. In six of the eight patients with apparent secondary skin involvement, the development of the cutaneous lesion was the first clinical indication of disseminated infection. Eleven immunocompromised patients (35%) with bacterial infection of the skin or subcutaneous tissue were identified. These patients could be divided into three categories: leukemic patients with bacteremic gram-negative infection metastasizing to the skin (3 cases), renal transplant recipients with recurrent staphylococcal infection on and around the elbow ("transplant elbow") or streptococcal sepsis from a site of cellulitis (5 cases), and immunocompromised patients with opportunistic bacterial infection due to Nocardia asteroides or atypical mycobacteria (3 cases). Seventeen immunocompromised patients (55%) with fungal infection of the skin or subcutaneous tissue were identified. These included 12 patients with opportunistic fungal infection (Cryptococcus neoformans, 4 cases; Aspergillus species, 3 cases; Paecilomyces, 2 cases; Rhizopus species, 2 cases; and Candida tropicalis, 1 case) and 5 patients with extensive, confluent cutaneous dermatophyte infections. One patient with protothecosis and two patients with extensive papillomavirus infection were identified. Of these latter two cases, one had his immunosuppression discontinued, with clearing of his extensive warts; the other had confluent warts of the face and neck that subsequently underwent malignant degeneration to squamous cell carcinoma while chronic immunosuppressive therapy was continued.(ABSTRACT TRUNCATED AT 400 WORDS)
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            Miliaria crystallina in an intensive care setting.

            Drop-like, transient blisters of miliaria crystallina may develop with focal intensity of heat within the skin, such as occurs in tropical climates or during febrile episodes. Miliaria crystallina develops due to a transient poral closure of the sweat duct opening, resulting in obstruction of free flow of eccrine sweat and retention in a vesicle below the skin surface. Dual cholinergic and adrenergic sweat gland innervation is influenced by a variety of medications used in intensive care patients. We present two febrile intensive care patients in whom enhanced alpha-adrenergic stimulation of sweat gland myoepithelia may have led to miliaria crystallina.
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              Pediatric Emergency Medicine

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                Author and article information

                Journal
                abd
                Anais Brasileiros de Dermatologia
                An. Bras. Dermatol.
                Sociedade Brasileira de Dermatologia (Rio de Janeiro, RJ, Brazil )
                0365-0596
                1806-4841
                August 2011
                : 86
                : 4 suppl 1
                : 104-106
                Affiliations
                [01] Richmond Virginia orgnameVirginia Commonwealth University United States
                Article
                S0365-05962011000700027 S0365-0596(11)08600400027
                a9c4fe5e-3507-4ba3-96d5-40b27a625fb1

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 24 March 2011
                : 17 November 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 3
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Case Report

                Drug therapy,Miliaria,Idarubicin,Drug eruptions,regional perfusion,cancer,Chemotherapy,Miliária,Idarrubicina,Terapia medicamentosa,Erupções por droga,perfusão regional,câncer,Quimioterapia

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