Case Letter
Diffuse normolipemic plane xanthoma and hepatitis C: chance?
Maria Carolina Casa Souza, Paulo Henrique Teixeira Martins
, Analú Vivian, Laura Luzzatto
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Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "261" "paginaFinal" => "262" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Carolina Casa Souza, Paulo Henrique Teixeira Martins, Analú Vivian, Laura Luzzatto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maria Carolina Casa" "apellidos" => "Souza" ] 1 => array:4 [ "nombre" => "Paulo Henrique Teixeira" "apellidos" => "Martins" "email" => array:1 [ 0 => "phenriquemartins0@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Analú" "apellidos" => "Vivian" ] 3 => array:2 [ "nombre" => "Laura" "apellidos" => "Luzzatto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 641 "Ancho" => 855 "Tamanyo" => 118332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aggregation of foamy histiocytes in the superficial dermis between collagen fibers.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diffuse Normolipemic Plane Xanthoma (DNPX) is a rare acquired dermatosis, clinically characterized by patches and/or yellow-orange plaques symmetrically distributed. It is an uncommon type of non-Langerhans histiocytosis that occurs due to the deposition of lipids in the skin and, in almost half of cases, occur in the absence of hypercholesterolemia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> DNPX has been associated with systemic diseases such as multiple myeloma and other hematological and lymphoproliferative neoplasms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A case of diffuse normolipemic plane xanthoma with no lipid profile changes is reported in a patient with a recent diagnosis of Hepatitis C.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 61 year-old man with a history of onset of asymptomatic yellowish spots, 2 years ago, initially on the eyelids. In one year, the lesions also appeared in the armpits, in the inguinal, genital and gluteal regions. He had a recent diagnosis of Hepatitis C (HCV), without treatment. He denied other comorbidities and use of medications. On examination he had yellowish plaques with a symmetrical distribution in the periorbital region bilaterally (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and plaques with regular, well-delimited borders, yellow-orange in the armpits (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), scrotal region, inguinal, gluteal, and also in the thighs. Laboratory tests – blood count, blood glucose, renal, thyroid, protein gram and liver function – were normal and the lipid profile showed no alterations. After anatomopathological examination, a cluster of foamy histiocytes was observed in the superficial dermis between the collagen fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), concluding the diagnosis of plane xanthoma. The patient is followed up and under surveillance for the appearance of other associated diseases (such as monoclonal gammopathies), although totally asymptomatic.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">DNPX is a rare type of non-Langerhans histiocytosis that usually appears initially with a palpebral xanthelasma, as is the case, with later appearance flesions usually in the neck, trunk, upper dorsum, cubital fossae, and extremities. These distribution of xanthomatous lesions in DNPX is unique, although it varies among cases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In the histopathology, it presents with foamy cells – macrophages with lipid droplets – and variable number of giant Touton cells, lymphocytes and foamy histiocytes can be seen in the upper dermis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> No standardized treatment is available yet, but there are papers citing treatments with ablative lasers, such as the erbium-YAG4 laser.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Hepatitis C is a systemic disease that can cause manifestations in various organs and systems. It is estimated that approximately 74% of patients experience at least one extra hepatic manifestation of the disease during their lifetime, with 17% of them having dermatological manifestations. The most commonly associated dermatoses are cryoglobulinemia, lichen planus, porphyria cutanea tarda and acral necrolytic erythema. It is believed that most of these diseases present as path physiology the formation and deposition of immune complexes in the tissues, although the mechanism of these diseases is not completely understood. Other dermatological diseases also have been shown to be associated with hepatitis C, but with less consistency, such as cutaneous B-cell lymphoma, erythema multiforme, leukocytoclastic vasculitis and urticaria.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">XPDN has been associated with hematologic disorders, particularly multiple myeloma and monoclonal gammopathy; however, leukemia, lymphoma and Castleman's disease have also been associated with the disease.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> The patient in the case did not present any evidence of hematologic disorder at the time, despite being investigated. In the present XPDN case, the presence of the HCV infection was verified, which may be a coincidence; but it is important to emphasize the immunogenic importance of HCV, as it is a possible trigger of some dermatological conditions.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Maria Carolina Casa Souza: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; review of the literature; critical review of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Paulo Henrique Teixeira Martins: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; review of the literature; critical review of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Analú Vivian: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; review of the literature; critical review of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Laura Luzzatto: Obtaining, analysis, and interpretation of the data; effective participation in research orientation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-24" "fechaAceptado" => "2019-08-18" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Souza MCC, Martins PHT, Vivian A, Luzzatto L. Diffuse normolipemic plane xanthoma and hepatitis C: chance? An Bras Dermatol. 2020;95:261–2.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 955 "Tamanyo" => 139828 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Yellowish, well delimited plaques in the region of eyelids bilaterally.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1136 "Ancho" => 855 "Tamanyo" => 100468 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Orange yellow plaque in axillary region.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 641 "Ancho" => 855 "Tamanyo" => 118332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aggregation of foamy histiocytes in the superficial dermis between collagen fibers.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diffuse plane idiopathic normolipemic xanthoma with hiperesplenism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.M. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 20 | 13 | 33 |
| 2024 Outubro | 108 | 78 | 186 |
| 2024 Setembro | 152 | 65 | 217 |
| 2024 Agosto | 169 | 87 | 256 |
| 2024 Julho | 181 | 112 | 293 |
| 2024 Junho | 120 | 54 | 174 |
| 2024 Maio | 79 | 45 | 124 |
| 2024 Abril | 98 | 73 | 171 |
| 2024 Março | 96 | 68 | 164 |
| 2024 Fevereiro | 94 | 76 | 170 |
| 2024 Janeiro | 74 | 45 | 119 |
| 2023 Dezembro | 82 | 66 | 148 |
| 2023 Novembro | 112 | 80 | 192 |
| 2023 Outubro | 82 | 89 | 171 |
| 2023 Setembro | 81 | 68 | 149 |
| 2023 Agosto | 67 | 40 | 107 |
| 2023 Julho | 71 | 31 | 102 |
| 2023 Junho | 71 | 45 | 116 |
| 2023 Maio | 52 | 24 | 76 |
| 2023 Abril | 46 | 9 | 55 |
| 2023 Março | 68 | 46 | 114 |
| 2023 Fevereiro | 54 | 30 | 84 |
| 2023 Janeiro | 43 | 29 | 72 |
| 2022 Dezembro | 52 | 21 | 73 |
| 2022 Novembro | 63 | 51 | 114 |
| 2022 Outubro | 74 | 48 | 122 |
| 2022 Setembro | 48 | 52 | 100 |
| 2022 Agosto | 38 | 39 | 77 |
| 2022 Julho | 39 | 52 | 91 |
| 2022 Junho | 46 | 48 | 94 |
| 2022 Maio | 24 | 50 | 74 |
| 2022 Abril | 33 | 59 | 92 |
| 2022 Março | 38 | 64 | 102 |
| 2022 Fevereiro | 20 | 31 | 51 |
| 2022 Janeiro | 51 | 82 | 133 |
| 2021 Dezembro | 30 | 51 | 81 |
| 2021 Novembro | 45 | 50 | 95 |
| 2021 Outubro | 50 | 69 | 119 |
| 2021 Setembro | 44 | 47 | 91 |
| 2021 Agosto | 27 | 45 | 72 |
| 2021 Julho | 48 | 39 | 87 |
| 2021 Junho | 24 | 51 | 75 |
| 2021 Maio | 45 | 76 | 121 |
| 2021 Abril | 119 | 259 | 378 |
| 2021 Março | 43 | 49 | 92 |
| 2021 Fevereiro | 16 | 17 | 33 |
| 2021 Janeiro | 19 | 15 | 34 |
| 2020 Dezembro | 18 | 20 | 38 |
| 2020 Novembro | 20 | 11 | 31 |
| 2020 Outubro | 17 | 11 | 28 |
| 2020 Setembro | 16 | 9 | 25 |
| 2020 Agosto | 15 | 8 | 23 |
| 2020 Julho | 16 | 8 | 24 |
| 2020 Junho | 15 | 22 | 37 |
| 2020 Maio | 16 | 14 | 30 |
| 2020 Abril | 3 | 4 | 7 |
| 2020 Fevereiro | 0 | 1 | 1 |
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