A patient with erythema gyratum repens egr had a marked increase of his eruption, with uncontrollable pruritus that was unresponsive to steroid therapy. Annular, erythematous rash lined by trailing edge of scale, characteristic of erythema gyratum repens in this patient with cholangiocarcinoma. Annular erythema, childhood, erythema gyratum repens. Erythema gyratum repens egr, first described by gammel,1 in 1952, is a rare paraneoplastic syndrome typically associated with an underlying malignancy. Selfassembled multiring formations of glutamine and a possible link to erythema gyratum repens. Erythema gyratum repens with metastatic adenocarcinoma jama. A computed tomographic scan revealed a pulmonary mass measuring 59 by 43 mm panel b. Erythema gyratum repens egr is a rare, and characteristic, paraneoplastic rash associated with a variety of malignancies, most notably lung, esophageal, and breast cancers. Erythema annulare centrifugumlike eruption associated with pegylated interferon treatment for hepatitis c. Volume 47, issue 5, supplement, november 2002, pages s254s256. Erythema gyratum repens has also been noted in association with several nonmalignant conditions such as tuberculosis, linear iga dermatosis, psoriasis, pityriasis rubra pilaris, pemphigus vulgaris, bullous pemphigoid, ichthyosis, and hypereosinophilic syndrome. Annular erythema mimicking sweets syndrome and sometimes resembling erythema gyratum repens 14 has been reported to occur among japanese patients with sjogren syndrome. Bullous lupus erythematosus is an autoantibodymediated subepidermal blistering disease that occurs in patients with systemic lupus erythematosus sle. Josef feit, hana jedlickova, gunter burg, ludek matyska, spasoje radovanovic et al.
Erythema gyratum repens like eruption in a patient with epidermolysis bullosa acquisita associated with ulcerative colitis. It can be caused by a variety of conditions, and typically resolves spontaneously within 30 days. The leading primary care society for dermatology and skin surgery. Erythema gyratum repens and undifferentiated carcinoma jama. May 08, 2015 the abdomen should be examined for tenderness, masses, or hepatosplenomegaly. Leukocytoclastic vasculitis presenting as an erythema gyratum repens like eruption on a patient with systemic lupus erythematosus. Selfassembled multiring formations of glutamine and a possible link to erythema gyratum repens this item was submitted to loughborough universitys institutional repository by thean author. Nevertheless, a diagnosis of erythema gyratum repens warrants an in depth search for possible underlying malignancies. Erythema gyratum repens egr is an uncommon condition defining a type of skin lesion pattern, in which red skin rashes composed of concentric rings annular erythema moves to different parts of the body. Erythema gyratum repens egr is a rare and characteristic, paraneoplastic rash associated with a variety of malignancies, most notably lung, esophageal, and breast cancers. Erythema gyratum repens egr is a rare paraneoplastic dermatosis known to be associated with internal. Erythema gyratum repens definition of erythema gyratum. Erythema gyratum repens egr is a rare paraneoplastic skin condition characterized by the eruption of expanding, concentric. Erythema is a common side effect of radiotherapy treatment due to patient exposure to ionizing radiation.
Download churchills pocketbook of differential diagnosis pdf. Neutrophilic dermatosis, bullous dermatoses, and systemic lupus erythematous gyratum repens 3. This case report details the appearance, epidemiology, diagnosis, and treatment. Darier in 1916 was the first to use the term erythema annulare centrifugum 1 eac, although similar lesions had been described previously under other names. Erythema anulare centrifugum eac, is a descriptive term for a class of skin lesion presenting redness in a ring form anulare that spreads from a center centrifugum. A case of erythema gyratum repens egr associated with early gastric cancer in a 97yearold man is presented. Selfassembled multiring formations of glutamine and a.
The lesions usually appear in the hands, feet, extremities, and face. Histopathologic examination showed neutrophilic nuclear dust. Institute for pathology georg schmorl academic teaching hospital dresdenfriedrichstadt, stadtisches klinikum, dresden, germany. All our watermarked images are free for use for education, teaching and other purposes, providing they abide by our image licence. The second specific type, erythema chronicum migrans, is caused by a spirochete transmitted by the i. Erythema gyratum repens is rare and is the most distinctive of the gyrate erythemas. Pdf on feb 1, 2005, benjamin khan durani and others published. Erythema gyratum repens like eruption in mycosis fungoides. Mar 27, 2019 erythema gyratum repens egr is a figurate erythema that is believed to be a paraneoplastic process. Get a printable copy pdf file of the complete article 97k, or click on a page image below to browse page by page. Leukocytoclastic vasculitis presenting as an erythema gyratum. Erythema gyratum repens egr is a rare cutaneous eruption characterized by serpiginous morphology and a migrating scaly border. In addition to other features, characteristic concentric erythematous bands forming a woodgrain appearance help distinguish erythema gyratum repens from other figurate erythemas, such as erythema annulare centrifugum, erythema migrans, and e.
Erythema gyratum repens primary care dermatology society uk. Erythema gyratum repens is a slowly expanding, mildly scaling dermatosis with a woodgrain pattern and is seen in patients with an underlying malignancy. Histological features of erythema gyratum repens are not diagnostic and include hyperkeratosis, parakeratosis, acanthosis and. Erythema annulare centrifugum erythema marginatum erythema migrans erythema gyratum repens. Erythema gyratum repens induced by pegylated interferon. The most common include lung carcinoma, oesophageal carcinoma and breast carcinoma. Erythema disappears on finger pressure, while purpura or bleeding in the skin and pigmentation do not. Erythema gyratum repens and undifferentiated carcinoma. Although most cases of egr are associated with underlying malignancy, several nonparaneoplasticassociated cases of egr have. Pdf erythema gyratum repenslike eruption occuring in. Pdf erythema gyratum repens egr is a rare, and characteristic, paraneoplastic rash associated with a variety of. Erythema gyratum repens like figurate erythema responding to.
While there are many dermatoses that have an annular appearance, the term annular erythema is sometimes reserved for a group of uncommon skin conditions that include erythema chronicum migrans, erythema annulare centrifugum eac, enapositive annular erythemas, and erythema gyratum repens. Erythema gyratum repens erythema gyratum repens egr is a rare dermatosis. The photos of erythema gyratum repens below are not recommended for people with a weak psyche. Erythema annulare centrifugumlike eruption associated. Erythema gyratum repens egr often is associated with an underlying malignancy, but it is not an obligate paraneoplastic syndrome.
Erythema gyratum repens induced by pegylated interferon alfa. Erythema gyratum repens egr presents as rapidly advancing, erythematous, concentric bands that can be figurate, gyrate, or annular, with fine trailing scale. Erythema gyratum repens an immunological paraneoplastic. Direct immunofluorescence revealed granular deposits of immunoglobulins at the basement membrane zone bmz in the skin, and in the. Later he developed bilateral severe pneumonia community acquired pneumonia with pancytopenia, mildly raised astalt, hypoproteinemia table 1, and mildly raised ptinr 1.
Erythema gyratum repens egr is exceptionally rare but clinically distinctive condition characterized by multiple, annular, rapidly growing erythematous. The latter two entities, namely egr and ecm, are associated with potentially deadly underlying disorders and thus will be discussed in greater detail. A clinical diagnosis of erythema gyratum repens was made. Erythema nodosum en, is an inflammatory condition characterized by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps that are usually seen on both shins. This is the first case of erythema gyratum repens in which there was erythema annulare centrifugum, vesicular erythema annulare centrifugum, and. Scaly annular and concentric plaques mdedge dermatology. Erythema gyratum repens in a case of resolving psoriasis. Autopsy revealed an undifferentiated metastatic malignancy of the brain, mediastinum, and cauda equina. They are characterized by erythematous papules growing centrifugally to form annular or polycyclic figures. Erythema gyratum repens egr is a figurate erythema that is believed to be a paraneoplastic process.
Erythema gyratum repenslike eruption in sezary syndrome. Nov 22, 2011 erythema gyratum repens egr is a rare and characteristic, paraneoplastic rash associated with a variety of malignancies, most notably lung, esophageal, and breast cancers. A cavitating mass at the right lung apex was resected and proved to be tuberculous. We report a patient with erythema gyratum repens egr, in whom a bronchial carcinoma was found. Erythema gyratum repens egr is a rare, and characteristic, rash strongly associated with malignancy. Erythema gyratum repens with pulmonary tuberculosis barber. Please retain the watermark and acknowledge the source, dermnet nz. Transformation from pityriasis rubra pilaris to erythema. Erythema gyratum repens associated with diffuse bcell lymphoma. Erythema gyratum repens is a rare facultative cutaneous paraneoplasia.
Wood grain pattern characteristic of erythema gyratum repens. Erythema gyratum repens an overview sciencedirect topics. Erythema gyratum repens associated with pityriasis rubra. There are many types of erythema, or conditions causing rash and reddening of the skin, but erythema gyratum repens typically appears because of an underlying condition. Erythema gyratum repenslike atypical and persistent figurate. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Egr is associated with malignancy, most commonly bronchial, esophageal, and breast, in more than 80% of cases.
Although egr typically is associated with underlying malignancy, it is not an obligate paraneoplastic syndrome. A succinct summary of the patients history, examination and initial investigations, including fullcolour images showing presentation, is followed. Apr 26, 2020 you can easily download 100 cases in dermatology pdf by clicking the direct link given in this postread reaview. Erythema gyratum repens erg is a distinctive dermatitis often associated with paraneoplastic syndrome. This page was last edited on 30 decemberat back links pages that link to this page. Autoantibodies and complement at the basement membrane zone of the skin was found which suggest that erythema gyratum repens may have an immunological pathogenesis but the nature of the antigen should be further characterised. The eruption is rapidly migrating and composed of concentric rings forming a woodgrain pattern. The authors present a patient with erythema gyratum repens who had a bronchogenic carcinoma. Nonwatermarked, highdefinition images are available for purchase.
It occurs with any skin injury, infection, or inflammation. There is no temperature elevation, unless it is associated with the dilation of arteries in the deeper layer of the skin. This case report details the appearance, epidemiology, diagnosis, and treatment of egr. Diffuse large bcell lymphoma, erythema gyratum repens, woodgrain pattern.
The third specific type, erythema gyratum repens, is uncommon, morphologically distinctive, and an indicator of serious disease, usually internal malignancy, in. Erythema gyratum repens like eruption occuring in resolving psoriasis during methotrexate therapy. Leukocytoclastic vasculitis presenting as an erythema. These may represent liver disease, lymphoma or pregnancy associated with erythema annulare centrifugum eac. Erythema gyratum repens egr is a rare paraneoplastic skin condition characterized by the eruption of expanding, concentric, erythematous patches and plaques.
Many different terms have been used to classify these types of lesions and it is still controversial on what exactly defines eac. It was first described in 1952 by gammel in a patient nine months before the appearance of a breast adenocarcinoma. Although most cases of egr are associated with underlying malignancy, several. Pdf neutrophilic dermatosis with an erythema gyratum repenslike. Erythema gyratum repens associated with pityriasis rubra pilaris.
Initial symptoms can be uncharacteristic, wood grain pattern lesions develop only in mature stages. Erythema gyratum repens egr, considered one of the most specific cutaneous paraneoplastic phenomena, is characterized by a serpiginous morphology and a migrating scaly border. Erythema gyratum repens in longterm smoker fulltext case. The borders can advance up to 1 cm daily and show nonspecific findings on histopathology. Erythema gyratum repens is a figurate erythema that is rapidly moving and usually a marker of underlying cancer. Following the resection, the skin lesions cleared within a few days. Erythema gyratum repens has not previously been described in association with non. Prompt identification of egr is essential, as the rash often precedes the diagnosis of malignancy by several months. Erythema gyratum repens associated with early gastric. Egr in the trunk had appeared with erythematous papules, which had spread peripherally to extremities 3 years before, and a malignancy workup revealed an early gastric cancer in the lower corpus and antrum. The bands of egr usually cover the trunk and proximal extremities, sparing the hands, feet, and face. Erythema gyratum repens is distinguished by rapidly moving 1 cmd, scaly, erythematous bands that form concentric rings resulting in a woodgrain appearance fig 2.
Erythema gyratum repens associated with early gastric cancer. The eruption is rapidly migrating and composed of concentric rings forming a woodgrain pattern histology of erythema gyratum repens. An erythema gyratum repens variant of bullous lupus. Erythema gyratum repens with pulmonary tuberculosis. Symptomatic primary selective igm immunodeficiency b.
We wish you a cure and never get sick of this disease. This case demonstrates the potential role of dermatophyte infection in an egrlike eruption observed in sezary syndrome. An erythema gyratum repens variant of bullous lupus erythematosus. In this case report, we describe the condition of a 61 year. Annular erythema primary care dermatology society uk. Erythema gyratum repens is not an obligate paraneoplastic disease. You can learn some useful dermatology quickly by studying the photographs and get a current idea about treatments, pathophysiology, and presentation.
In about of cases the disease is not tumorassociated. Erythema gyratum repens unknown etiology, malignancy association 80% cases, i. Erythema gyratum repens is a clinically distinctive figurate or annular erythema that is usually associated with underlying malignancy. In the majority of instances cancer is the culprit, however, certain autoimmune diseases or infections may give rise to the. Table 431 lists the figurate erythemas and the differential diagnoses to consider. Gammel syndrome paraneoplastic disorder resulting in erythematous lesions associated with neoplasms of internal organs. In addition, there is some types of gyrate erythema could be misdiagnosed as egr such as. Tight superficial and deep perivascular lymphocytic infiltrate coat sleeve. The gyrate erythemas consist of the entities erythema annulare centrifugum eac, erythema marginatum rheumaticum emr, erythema gyratum repens egr, and erythema chronicum migrans ecm. It is one of the most specific cutaneous paraneoplastic phenomena, and is associated with.
975 462 891 1656 16 1607 983 887 483 1508 840 550 1182 1064 774 742 1412 1376 877 1648 1329 15 848 1124 1648 1063 1426 768 125 280 1307 244 747 192 1382