Pancreatic panniculitis is a rare complication occurring in 0.3-3%of patients with pancreatic disease. Clinical features include erythematous painful subcutaneous nodules usually on the lower leg and foot. A 72-year-o...Pancreatic panniculitis is a rare complication occurring in 0.3-3%of patients with pancreatic disease. Clinical features include erythematous painful subcutaneous nodules usually on the lower leg and foot. A 72-year-old man was diagnosed in 2002 with a neuroendocrine carcinoma of the head of the pancreas. In 2003 following surgery and radiation therapy, he developed liver metastases and painful nodules on his legs. Lipase was found to be markedly elevated;amylase andα1-antitrypsin were in the normal range. Histopathologic examination of a nodule showed subcutaneous fat necrosis with ghost cells surrounded by an acute inflammatory infiltrate.The pathogenesis of pancreatic panniculitis is unclear. The pancreatic enzyme lipase may induce lipolysis and fat necrosis with secondary tissue inflammation.展开更多
Background: Based on the increasing knowledge of T cellmediated pathogenesis in atopic dermatitis (AD). systemic immunosuppressive drugs are increasingly applied. The chronic, relapsing course of severeADnecessitates ...Background: Based on the increasing knowledge of T cellmediated pathogenesis in atopic dermatitis (AD). systemic immunosuppressive drugs are increasingly applied. The chronic, relapsing course of severeADnecessitates a drug, both efficacious and safe in long term application. Leflunomide is a pyrimidine de novo synthesis inhibiting immunosuppressant exhibiting an extremely long in vivo half life of its active metabolite. Objectives: To evaluate the efficacy of leflunomide in long term treatment of AD. Methods: As a proof of principle, we treated two patients with severe AD, recalcitrant to different systemic treatment modalities, for 20 months with leflunomide (loading dose 100 mg daily during 3 days; maintenance dose 20 mg daily). At regular visits physical examination, eczema area and severity index (EASI), visual analogue scale (VAS) for itching, and laboratory findings were assessed with according adjustment of the leflunomide dose. Results: At the initiation of leflunomide therapy, both patients presented with almost erythrodermic AD (patient 1, EASI 40.0, VAS 10; patient 2, EASI 43.0, VAS 8). Partial remission was observed within 4 and 7 weeks, respectively, and maintained over 20 months (patient 1, median EASI 4.2, median VAS 2; patient 2, median EASI 8.4, median VAS 2) except for one episode of exacerbation in each case. In one patient, remissionwas stable even after cessation of drug dosing. Severe adverse eventswere ot observed. Conclusions: Leflunomide was efficient in the long term treatment of recalcitrant AD. Controlled studies will be necessary to evaluate the subset of severe AD patients benefitingmost from this drug.展开更多
文摘Pancreatic panniculitis is a rare complication occurring in 0.3-3%of patients with pancreatic disease. Clinical features include erythematous painful subcutaneous nodules usually on the lower leg and foot. A 72-year-old man was diagnosed in 2002 with a neuroendocrine carcinoma of the head of the pancreas. In 2003 following surgery and radiation therapy, he developed liver metastases and painful nodules on his legs. Lipase was found to be markedly elevated;amylase andα1-antitrypsin were in the normal range. Histopathologic examination of a nodule showed subcutaneous fat necrosis with ghost cells surrounded by an acute inflammatory infiltrate.The pathogenesis of pancreatic panniculitis is unclear. The pancreatic enzyme lipase may induce lipolysis and fat necrosis with secondary tissue inflammation.
文摘Background: Based on the increasing knowledge of T cellmediated pathogenesis in atopic dermatitis (AD). systemic immunosuppressive drugs are increasingly applied. The chronic, relapsing course of severeADnecessitates a drug, both efficacious and safe in long term application. Leflunomide is a pyrimidine de novo synthesis inhibiting immunosuppressant exhibiting an extremely long in vivo half life of its active metabolite. Objectives: To evaluate the efficacy of leflunomide in long term treatment of AD. Methods: As a proof of principle, we treated two patients with severe AD, recalcitrant to different systemic treatment modalities, for 20 months with leflunomide (loading dose 100 mg daily during 3 days; maintenance dose 20 mg daily). At regular visits physical examination, eczema area and severity index (EASI), visual analogue scale (VAS) for itching, and laboratory findings were assessed with according adjustment of the leflunomide dose. Results: At the initiation of leflunomide therapy, both patients presented with almost erythrodermic AD (patient 1, EASI 40.0, VAS 10; patient 2, EASI 43.0, VAS 8). Partial remission was observed within 4 and 7 weeks, respectively, and maintained over 20 months (patient 1, median EASI 4.2, median VAS 2; patient 2, median EASI 8.4, median VAS 2) except for one episode of exacerbation in each case. In one patient, remissionwas stable even after cessation of drug dosing. Severe adverse eventswere ot observed. Conclusions: Leflunomide was efficient in the long term treatment of recalcitrant AD. Controlled studies will be necessary to evaluate the subset of severe AD patients benefitingmost from this drug.
