{"id":9096,"date":"2009-06-19T20:02:29","date_gmt":"2009-06-20T00:02:29","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=9096"},"modified":"2009-06-19T22:16:40","modified_gmt":"2009-06-20T02:16:40","slug":"240-consulta-a-un-colega-no-1-caso-clinico-para-discusion-diagnostica-y-terapeutica","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/9096","title":{"rendered":"240 -Consulta a un colega No 1: Caso cl\u00ednico para Discusi\u00f3n Diagn\u00f3stica y Terape\u00fatica"},"content":{"rendered":"<p><em><strong>Caso cl\u00ednico para Discusi\u00f3n Diagn\u00f3stica y Terape\u00fatica. Enviado por Dra. Carmen Elena Kanee. <br \/>\nInstituto de Biomedicina. Caracas , Venezuela<\/strong><\/em><\/p>\n<p>Paciente masculino de 57 a\u00f1os. <strong>Enfermedad Actual:<\/strong> Erupci\u00f3n p\u00e1pulo-vesicular   recurrente, muy pruriginosa, predominio en tronco de 8 a\u00f1os de evoluci\u00f3n.   Lesiones p\u00e1pulo-vesiculares\u00a0   iniciales evolucionan a p\u00e1pulas marrones consistencia firme. Mejor\u00eda   parcial con esteroides t\u00f3picos y antihistam\u00ednicos VO. Exacerbaci\u00f3n con calor,   sudoraci\u00f3n.<\/p>\n<p><!--more-->Refiere que en los \u00faltimos meses las lesiones han aumentado y el   tratamiento con esteroides y antihistam\u00ednicos \u201cya lo ayuda poco\u201d; lo asocia a   tratamiento de hiperplasia prost\u00e1tica benigna desde diciembre 2008 con Doxazosin.<\/p>\n<p><strong>Antecedentes   Personales:<\/strong><\/p>\n<ul>\n<li>Apnea del   sue\u00f1o tratamiento con CPAP (dispositivo de presi\u00f3n positiva continua en la v\u00eda   a\u00e9rea)<\/li>\n<li>Carcinoma   basocelular s\u00f3lido pigmentado en regi\u00f3n lumbar, ex\u00e9resis en Enero   2008.<\/li>\n<li>Hiperplasia Prost\u00e1tica Benigna,   tratamiento desde diciembre 2008 con Doxazosin<\/li>\n<li>(Cardura\u00ae)..<\/li>\n<li>Eccema   numular con imp\u00e9tigo y celulitis secundaria en\u00a0 2009, mejor\u00eda posterior a tratamento con   esteroide+antibi\u00f3tico t\u00f3pico y antibi\u00f3tico v\u00eda oral.<\/li>\n<\/ul>\n<p><strong><em>IDx: Enfermedad de   Grover<\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/p>\n<div id='gallery-1' class='gallery galleryid-9096 gallery-columns-2 gallery-size-thumbnail'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-1mp-torax-ant.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-1mp-torax-ant-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-2-mp-torax-post.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-2-mp-torax-post-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-3mp-hemitorax-d.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-3mp-hemitorax-d-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-4-mp-hemitorax-i.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-4-mp-hemitorax-i-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-5-abdomen.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/foto-5-abdomen-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-detalle-torax-1.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-detalle-torax-1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-detalle-torax-2.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-detalle-torax-2-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-detalle-torax-3.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-detalle-torax-3-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesion-papular-firme.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesion-papular-firme-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesion-papulo-vesicular.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesion-papulo-vesicular-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesion-papulo-vesicular-2.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesion-papulo-vesicular-2-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesiones-excoriadas.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/mp-lesiones-excoriadas-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/p1010667.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/p1010667-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/p1010668.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/06\/p1010668-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\n<p><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong><em><\/em><\/strong><\/p>\n<p><strong>Biopsia 07\/09\/2002: <\/strong><\/p>\n<p>Dermis superficial y profunda con marcado   infiltrado linfocitario en forma difusa (linfocitos t\u00edpicos maduros), compatible   con <em>Linfocitoma   cutis<\/em>.<\/p>\n<p>Nota: paciente refiere que la biopsia fue   realizada en lesiones cl\u00ednicamente iguales a las que presenta   actualmente.<\/p>\n<p><strong>Revisi\u00f3n de l\u00e1minas de biopsia de 07\/09\/2002   (01\/2008): <\/strong>dermatitis espongi\u00f3tica perivascular   superficial y media intersticial.<\/p>\n<p><strong>Nueva biopsia de lesi\u00f3n p\u00e1pulo-vesicular   (01\/2008):<\/strong><\/p>\n<ul type=\"disc\">\n<li>Ortoqueratosis en     cesta<\/li>\n<li>Hiperplasia epitelial irregular     leve con un foco de espongiosis y exocitosis de linfocitos y escasos     neutr\u00f3filos.<\/li>\n<li>Infiltrado inflamatorio muy focal     con predominio de linfocitos en el intersticio, con escasos     neutr\u00f3filos.<\/li>\n<li>Edema leve en dermis     papilar.<\/li>\n<li>No se observan atipias     citol\u00f3gicas<\/li>\n<\/ul>\n<p>CONCLUSION: dermatitis espongi\u00f3tica focal   perivascular superficial<\/p>\n<p>Est\u00e1 de acuerdo con diagn\u00f3stico cl\u00ednico?, Cree   que el tratamiento de HPB puede exacerbar el cuadro?<\/p>\n<p><strong>Realizar\u00eda nueva biopsia?<\/strong><\/p>\n<p><strong>C\u00f3mo lo tratar\u00eda?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Caso cl\u00ednico para Discusi\u00f3n Diagn\u00f3stica y Terape\u00fatica. Enviado por Dra. Carmen Elena Kanee. Instituto de Biomedicina. Caracas , Venezuela Paciente masculino de 57 a\u00f1os. Enfermedad Actual: Erupci\u00f3n p\u00e1pulo-vesicular recurrente, muy pruriginosa, predominio en tronco de 8 a\u00f1os de evoluci\u00f3n. Lesiones p\u00e1pulo-vesiculares\u00a0 iniciales evolucionan a p\u00e1pulas marrones consistencia firme. Mejor\u00eda parcial con esteroides t\u00f3picos y antihistam\u00ednicos &hellip;<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25],"tags":[],"class_list":["post-9096","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/9096","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=9096"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/9096\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=9096"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=9096"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=9096"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}