Case Letter
Eruptive superficial porokeratosis in a patient with nephrotic syndrome
Masato Ishikawa
, Toshiyuki Yamamoto
Autor para correspondência
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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4551
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"https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222000443?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622000319?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000003/v1_202205170747/S0365059622000319/v1_202205170747/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Eruptive superficial porokeratosis in a patient with nephrotic syndrome" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "399" "paginaFinal" => "400" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Masato Ishikawa, Toshiyuki Yamamoto" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Masato" "apellidos" => "Ishikawa" "email" => array:1 [ 0 => "ishimasa@fmu.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 522 "Ancho" => 900 "Tamanyo" => 44409 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Physical examination revealed multiple reddish keratotic lesions on the right lower extremity.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old female was referred to our department, complaining of multiple asymptomatic lesions that appeared two weeks previously. Physical examination revealed multiple well-circumscribed rounds of flat brownish plaques with slightly elevated borders, some of which were covered by scales (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The number of lesions was nine in total: six lesions on the right lower leg, and a solitary lesion on the left lower leg, left thigh and right upper extremity. Skin biopsy specimens showed dyskeratotic cells in the thinned epidermis with cornoid lamella, and the absence of a granular cell layer. Superficial perivascular lymphocytic infiltrate in the dermis was also observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The lupus band test was negative, and immunostaining for human papillomavirus was also negative. The patient was hospitalized to the Department of Nephrology and Hypertension in our university hospital for nephrotic syndrome and treated with oral prednisolone (25 mg/day), cyclosporine (50 mg/day), and mizoribine (150 mg/day). The patient did not have steroid-induced diabetes. Laboratory data showed abnormal levels of triglyceride (701 mg/dL), total cholesterol (607 mg/dL) and low-density lipoprotein cholesterol (405 mg/dL). Serum immunoglobulin (Ig) G, complements, antinuclear antibodies, anti-DNA antibodies, anti-Sm antibodies, and rheumatoid factor were all within normal ranges. Although the kidney function was normal, proteinuria with hyaline casts was observed, and immunofluorescence examination of renal biopsy revealed granular deposition of IgM and IgG on the basement membrane. Because deposition of complement component 1q was additionally detected, she was initially suspected of lupus nephritis; however, she lacked other symptoms compatible with systemic lupus erythematosus. Topical corticosteroid ointment was applied, but she discontinued the topical therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Eruptive porokeratosis is characterized by rapid onset of porokeratosis, which occasionally presents with more than 100 lesions involving multiple regions, in association with paraneoplastic, immunosuppressive, inflammatory, and other conditions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is known that porokeratosis develops in association with systemic immunosuppression or under immunosuppressant therapies; however, it is still unclear as to how immunosuppression is associated with the development of porokeratosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> One possible mechanism is that immunosuppression induces an epidermal keratinocyte population either directly or indirectly.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The abnormal clone of keratinocytes proliferates in a disorderly manner and disturbs the normal growth of the epidermis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Patients with renal failure rarely develop multiple porokeratosis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Since renal dysfunction can induce various immune regulatory alterations, these cases are suggested to be a new subtype of porokeratosis related to immunosuppression.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present case, the patient was initially diagnosed with lupus nephritis. She may develop systemic lupus erythematosus in the future; however, the criteria of lupus nephritis have not been fulfilled as of this moment. In any case, the patient had active nephritis with nephrotic syndrome and was treated with immunosuppressive therapies. The development of porokeratosis was therefore considered to be related to immunosuppressive therapy or the activity of nephritis. Although we are uncertain as to what was the direct trigger for rapid onset of multiple keratosis, given that the patient still showed normal kidney function despite having proteinuria, immunosuppressive therapies may have led to the development of multiple porokeratosis in the present case.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1005">Financial support</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Masato Ishikawa: Designed the study; performed the research and contributed to analysis and interpretation of data; wrote the initial draft of the manuscript; read and approved the final version of the manuscript.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto: Designed the study; assisted in the preparation of the manuscript; read and approved the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:3 [ "identificador" => "xres1711212" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 3 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-07-06" "fechaAceptado" => "2020-08-08" "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A 34-year-old female was referred to our department, complaining of multiple asymptomatic lesions that appeared two weeks previously. The patient had active nephritis with nephrotic syndrome and was treated with immunosuppressive therapies. Physical examination revealed multiple well-circumscribed rounds of flat brownish plaques with slightly elevated borders, some of which were covered by scales. The number of lesions was nine in total. Skin biopsy specimens showed dyskeratotic cells in the thinned epidermis with cornoid lamella, and the absence of a granular cell layer. The development of porokeratosis was considered to be related to immunosuppressive therapy or the activity of nephritis.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Fukushima Medical University, Fukushima, Japan.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 522 "Ancho" => 900 "Tamanyo" => 44409 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Physical examination revealed multiple reddish keratotic lesions on the right lower extremity.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 962 "Ancho" => 750 "Tamanyo" => 81038 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Close-up view showed well-circumscribed, slightly elevated reddish macule with scales.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 597 "Ancho" => 900 "Tamanyo" => 152806 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological examination showed dyskeratotic cells in the thinned epidermis with cornoid lamella, and absence of granular cell layer. Superficial perivascular lymphocytic infiltrate in the dermis was also observed (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eruptive disseminated porokeratosis: a new classification system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Shoimer" 1 => "L.H. Robertson" 2 => "G. Storwick" 3 => "R.M. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 28 | 10 | 38 |
| 2024 Outubro | 131 | 106 | 237 |
| 2024 Setembro | 166 | 117 | 283 |
| 2024 Agosto | 168 | 145 | 313 |
| 2024 Julho | 190 | 105 | 295 |
| 2024 Junho | 133 | 71 | 204 |
| 2024 Maio | 90 | 63 | 153 |
| 2024 Abril | 119 | 79 | 198 |
| 2024 Março | 89 | 58 | 147 |
| 2024 Fevereiro | 91 | 81 | 172 |
| 2024 Janeiro | 50 | 53 | 103 |
| 2023 Dezembro | 66 | 58 | 124 |
| 2023 Novembro | 64 | 93 | 157 |
| 2023 Outubro | 52 | 70 | 122 |
| 2023 Setembro | 67 | 85 | 152 |
| 2023 Agosto | 58 | 34 | 92 |
| 2023 Julho | 79 | 38 | 117 |
| 2023 Junho | 56 | 41 | 97 |
| 2023 Maio | 50 | 37 | 87 |
| 2023 Abril | 21 | 22 | 43 |
| 2023 Março | 54 | 50 | 104 |
| 2023 Fevereiro | 35 | 35 | 70 |
| 2023 Janeiro | 43 | 34 | 77 |
| 2022 Dezembro | 56 | 36 | 92 |
| 2022 Novembro | 75 | 57 | 132 |
| 2022 Outubro | 78 | 59 | 137 |
| 2022 Setembro | 56 | 59 | 115 |
| 2022 Agosto | 52 | 64 | 116 |
| 2022 Julho | 51 | 47 | 98 |
| 2022 Junho | 91 | 69 | 160 |
| 2022 Maio | 90 | 92 | 182 |
| 2022 Abril | 29 | 46 | 75 |
| 2022 Março | 20 | 39 | 59 |
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