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      Piezogenic Pedal Papules with Mitral Valve Prolapse

      case-report

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          Abstract

          Piezogenic pedal papules (PPP) are herniations of subcutaneous adipose tissue into the dermis. PPP are skin-colored to yellowish papules and nodules on lateral surfaces of feet that typically become apparent when the patient stands flat on his/her feet. Some connective tissue diseases and syndromes have been reported in association with PPP. Mitral valve prolapse (MVP) is a myxomatous degeneration of the mitral valve, characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. MVP may be isolated or part of a heritable connective tissue disorder. PPP, which is generally considered as an isolated lesion, might be also a predictor of some cardiac diseases associated with connective tissue abnormalities such as MVP. A detailed systemic investigation including cardiac examination should be done in patients with PPP. Since in the literature, there are no case reports of association of PPP with MVP, we report these cases.

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          Prevalence and clinical outcome of mitral-valve prolapse.

          David J. Evans, Joy Larson, Christina Fuller … (1999)
          Mitral-valve prolapse has been described as a common disease with frequent complications. To determine the prevalence of mitral-valve prolapse in the general population, as diagnosed with the use of current two-dimensional echocardiographic criteria, we examined the echocardiograms of 1845 women and 1646 men (mean [+/-SD] age, 54.7+/-10.0 years) who participated in the fifth examination of the offspring cohort of the Framingham Heart Study. Classic mitral-valve prolapse was defined as superior displacement of the mitral leaflets of more than 2 mm during systole and as a maximal leaflet thickness of at least 5 mm during diastasis, and nonclassic prolapse was defined as displacement of more than 2 mm, with a maximal thickness of less than 5 mm. A total of 84 subjects (2.4 percent) had mitral-valve prolapse: 47 (1.3 percent) had classic prolapse, and 37 (1.1 percent) had nonclassic prolapse. Their age and sex distributions were similar to those of the subjects without prolapse. None of the subjects with prolapse had a history of heart failure, one (1.2 percent) had atrial fibrillation, one (1.2 percent) had cerebrovascular disease, and three (3.6 percent) had syncope, as compared with unadjusted prevalences of these findings in the subjects without prolapse of 0.7, 1.7, 1.5, and 3.0 percent, respectively. The frequencies of chest pain, dyspnea, and electrocardiographic abnormalities were similar among subjects with prolapse and those without prolapse. The subjects with prolapse were leaner (P<0.001) and had a greater degree of mitral regurgitation than those without prolapse, but on average the regurgitation was classified as trace or mild. In a community based sample of the population, the prevalence of mitral-valve prolapse was lower than previously reported. The prevalence of adverse sequelae commonly associated with mitral-valve prolapse in studies of patients referred for that diagnosis was also low.
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            The spectrum of cardiac defects in the Ehlers-Danlos syndrome, types I and III.

            C Leier, T Call, P K Fulkerson … (1980)
            Nineteen patients with types I and III Ehlers-Danlos syndrome were hospitalized at our institution between 1973 and 1978. Chest roentgenogram, electrocardiogram, and echocardiogram were done; 11 patients underwent cardiac catheterization. Thirty-five cardiac or great vessel abnormalities were detected. Fifteen patients had nitral valve prolapse; six also had tricuspid valve prolapse. Dilatation of the aortic root or extasia of the sinuses of Valsalva, or both, occurred in six patients. Dilatation of the pulmonary artery and annulus caused pulmonary regurgitation in one patient. Congenital heart defects included bicuspid aortic valve (two), pulmonary valvular stenosis (one), ventricular septal defect (two), and an atrial septal defect (one). The apparent high prevalence of cardiovascular abnormalities in hospitalized patients with types I and III Ehlers-Danlos syndrome necessitates a careful cardiovascular evaluation. Conversely, Ehlers-Danlos syndrome types I and III should be excluded in patients with mitral or tricuspid valve prolapse, great vessel dilatation, and congenital heart defects.
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              Prevalence and clinical features of mitral valve prolapse.

              Angela Levy, D Savage (1987)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Dermatol
                Journal ID (iso-abbrev): Indian J Dermatol
                Journal ID (publisher-id): IJD
                Title: Indian Journal of Dermatology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0019-5154
                ISSN (Electronic): 1998-3611
                Publication date (Print): Mar-Apr 2016
                Volume: 61
                Issue: 2
                Page: 234
                Affiliations
                [1] From the Department of Cardiology, Faculty of Medicine, University of Baskent, İzmir, Turkey
                [1 ] Department of Dermatology, Faculty of Medicine, University of Baskent, İzmir, Turkey
                [2 ] Department of Radiology, Faculty of Medicine, University of Baskent, İzmir, Turkey
                [3 ] Department of Cardiology, Faculty of Medicine, University of Baskent, Ankara, Turkey
                Author notes
                Address for correspondence: Dr. Cihan Altin, 6471/5 Sokak, No. 7, Yali Mahallesi, Bostanli, Karşiyaka/İzmir, Turkey. E-mail: drcihanaltin@ 123456gmail.com
                Article
                Publisher ID: IJD-61-234d
                DOI: 10.4103/0019-5154.177803
                PMC ID: 4817466
                PubMed ID: 27057041
                SO-VID: b854c693-5b53-459b-a7cb-7c7a85e0c550
                Copyright © Copyright: © 2016 Indian Journal of Dermatology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : November 2013
                Date accepted : October 2015
                Categories
                Subject: E-IJD Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: connective tissue disorders,mitral valve prolapse,piezogenic pedal papules
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: connective tissue disorders, mitral valve prolapse, piezogenic pedal papules

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