Wednesday 30 August 2017

Cutaneous Vasculitis as A First Sign of Isolated Peptoniphilus Spp in Urinary Tract Infection: A Case Report





Cutaneous vasculitis (CV) is a disease that may occur as a primary pro¬cess or be secondary to a wide and het¬erogeneous group of disorders, including drug reactions, infections, connective tissue diseases, autoimmune disorders and malignancies. There are several different cutaneous manifestations, including palpable purpura, urticarial papules and plaques, nodules, ulcers, and livedo reticularis. Skin biopsy is the gold standard for the diagnosis of CV. However, the presence of a leukocytoclastic vasculitis is not sufficient to establish the specific underlying aetiology. Herein, we summarize a case report of a 15-year-old woman affected with non-pruriginous skin lesions, predominantly in the lower limbs (up to thighs), without fever or signs of systemic or localized infection. The hysthopatological study of skin lesions showed orthokeratotic epidermis with underlying dermis with vascular changes with slight proliferation of capillaries, small vessels lesions, endothelial cell swelling, deposits of eosinophilic fibrin bands, and fibrinoid degradation. Neutrophil polymorphonuclear predominant inflammatory infiltrate around vessels with endothelial damage and nuclear dust (leukocytoclastia). In addition, an urine cultura showed a Peptoniphilus spp infection. With the diagnosis of of CV caused by a Peptoniphilus spp isolated in an urinary tract infection, the patient was treated with corticosteroids and amoxicilin. After 1 week, all the skins lesions were resolved.

nancies. Clinically, it is mainly characterised by palpable purpura, involving usually the lower extremities with histopathologic findings that have in common vascular inflammation and blood vessel damage. Skin biopsy is the gold standard for the diagnosis of CV. However, the presence of a leukocytoclastic vasculitis is not sufficient to establish the specific underlying aetiology. Current pharmacological treatment of primary CV is mainly based on corti¬costeroids, while, immunosuppressive agents can be added in the most severe cases. However, when CV is secondary to an underlying bacterial infection, this treatment may lead to a deleterious effects in patients. Herein, we describe a case of CV secondary to a urinary tract infection produced by Peptoniphilus spp with a short review of the literature. For our knowledge, this is the first case reported of CV caused by a Peptoniphilus spp isolated in an urinary tract infection. 

A previously healthy 15-year-old woman with no prior significant medical history was admitted in our Emergency Department affected with non-pruriginous skin lesions, predominantly in the lower limbs (up to thighs), without fever or signs of systemic or localized infection. No apparent possibility of insect bite. Requesting any abnormalities in the previous weeks, the patient referred a respiratory tract infection treated symptomatically 1 week ago. Attending to the physical examination, cardiopulmonary as well as abdominal explorations were anodyne. Any disturbs were observed at oropharyngeal level. The patient presented edemas in distal region of lower extremities without fovea. At skin level in lower extremities, macular and purpuric lesions of different sizes were observed. These lesions were not erasable to the digital pressure. The smallest lesions were petechiae like, while the largest lesions were confluent up to 4-5 cm in their largest diameter (Figure 1 and 2). On left forearm, the patient showed 2-3 petechiae lesions on extensor face. On right hand, 2 millimetric petechiae on the dorsal side were also observed. 

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