We present the case of an 80-year-old lady known to be sensitive to chlorocresol(4-chloro-3-methyl phenol)who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcu...We present the case of an 80-year-old lady known to be sensitive to chlorocresol(4-chloro-3-methyl phenol)who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin.All medications except insulin were stopped,without major improvement.It was noted that the insulin containedm-cresol(m-methyl phenol)so a parabens-based insulin was substituted.There was a significant improvement in her clinical condition within 72hr.Further patch and intradermal testing to the insulin and mcresol was planned,but she developed a nosocomial infection and died.We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity,given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol,particularly as cross-reactivity between different low molecular weight methyl phenols is documented.Local injection site reactions and systemic side-effects including nausea,diarrhoea and vomiting have previously been reported with cresol-containing insulins,although to our knowledge,this is the first reported case of a severe cutaneous reaction.It is important to be aware of m-cresol as a potential allergen,as it is contained in most commercially available insulins.展开更多
Chromomycosis is a chronic, localized infection of the cutaneous and subcutaneous tissues caused by dematiaceous fungi of several genera. It has distinctive clinical, pathological and mycological characteristics. Exop...Chromomycosis is a chronic, localized infection of the cutaneous and subcutaneous tissues caused by dematiaceous fungi of several genera. It has distinctive clinical, pathological and mycological characteristics. Exophiala spinifera is a well-established aetiological agent of phaeohyphomycosis, but there are only two reported cases worldwide of this dematiaceous fungus causing chromomycosis. We report the first known case in the UK of E. spinifera causing chromomycosis.展开更多
文摘We present the case of an 80-year-old lady known to be sensitive to chlorocresol(4-chloro-3-methyl phenol)who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin.All medications except insulin were stopped,without major improvement.It was noted that the insulin containedm-cresol(m-methyl phenol)so a parabens-based insulin was substituted.There was a significant improvement in her clinical condition within 72hr.Further patch and intradermal testing to the insulin and mcresol was planned,but she developed a nosocomial infection and died.We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity,given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol,particularly as cross-reactivity between different low molecular weight methyl phenols is documented.Local injection site reactions and systemic side-effects including nausea,diarrhoea and vomiting have previously been reported with cresol-containing insulins,although to our knowledge,this is the first reported case of a severe cutaneous reaction.It is important to be aware of m-cresol as a potential allergen,as it is contained in most commercially available insulins.
文摘Chromomycosis is a chronic, localized infection of the cutaneous and subcutaneous tissues caused by dematiaceous fungi of several genera. It has distinctive clinical, pathological and mycological characteristics. Exophiala spinifera is a well-established aetiological agent of phaeohyphomycosis, but there are only two reported cases worldwide of this dematiaceous fungus causing chromomycosis. We report the first known case in the UK of E. spinifera causing chromomycosis.
