TAILIEUCHUNG - Chapter 054. Skin Manifestations of Internal Disease (Part 21)

Red Lesions Cutaneous lesions that are red in color have a wide variety of etiologies; in an attempt to simplify their identification, they will be subdivided into papules, papules/plaques, and subcutaneous nodules. Common red papules include arthropod bites and cherry hemangiomas; the latter are small, bright-red, domeshaped papules that represent benign proliferation of capillaries. In patients with AIDS, the development of multiple red hemangioma-like lesions points to bacillary angiomatosis, and biopsy specimens show clusters of bacilli that stain positive with the Warthin-Starry stain; the pathogens have been identified as Bartonella henselae and B. quintana. Disseminated visceral disease is seen primarily. | Chapter 054. Skin Manifestations of Internal Disease Part 21 Red Lesions Cutaneous lesions that are red in color have a wide variety of etiologies in an attempt to simplify their identification they will be subdivided into papules papules plaques and subcutaneous nodules. Common red papules include arthropod bites and cherry hemangiomas the latter are small bright-red domeshaped papules that represent benign proliferation of capillaries. In patients with AIDS the development of multiple red hemangioma-like lesions points to bacillary angiomatosis and biopsy specimens show clusters of bacilli that stain positive with the Warthin-Starry stain the pathogens have been identified as Bartonella henselae and B. quintana. Disseminated visceral disease is seen primarily in immunocompromised hosts but can occur in immunocompetent individuals. Multiple angiokeratomas are seen in Fabry disease an X-linked recessive lysosomal storage disease that is due to a deficiency of a-galactosidase A. The lesions are red to red-blue in color and can be quite small in size 1-3 mm with the most common location being the lower trunk. Associated findings include chronic renal failure peripheral neuropathy and corneal opacities cornea verticillata . Electron photomicrographs of angiokeratomas and clinically normal skin demonstrate lamellar lipid deposits in fibroblasts pericytes and endothelial cells that are diagnostic of this disease. Widespread acute eruptions of erythematous papules are discussed in the section on exanthems. There are several infectious diseases that present as erythematous papules or nodules in a lymphocutaneous or sporotrichoid pattern . in a linear arrangement along the lymphatic channels. The two most common etiologies are Sporothrix schenckii sporotrichosis and M. marinum mycobacteria other than tuberculosis atypical mycobacteria . The organisms are introduced as a result of trauma and a primary inoculation site is often seen in addition to the lymphatic nodules. .

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