Abstract | BACKGROUND: OBJECTIVE: Herein, we report another case involving a 31-year-old woman who self intravenously administered dissolved oral oxymorphone resulting in thrombotic sequelae resembling Degos disease. METHODS:
Formalin-fixed and paraffin embedded skin biopsies were prepared according to standard protocols for H&E and immunohistochemistry. RESULTS: The clinical presentation and biopsy findings were held to be indicative of Degos disease/ malignant atrophic papulosis (MAP) but with unusual clinical features including renal failure and severe respiratory insufficiency. Given the efficacy of eculizumab in the treatment of the acute thrombotic phase of Degos disease/MAP, the patient received this drug, resulting in rapid resolution of signs and symptoms associated with her multiorgan failure. Although she developed recurrent cutaneous ulcers despite complete complement inhibition with eculizumab., her other extracutaneous manifestations did not recur. The patient's pre and post eculizumab skin biopsies showed a striking pauci-inflammatory thrombogenic vasculopathy associated with marked endothelial cell injury along with deposits of C3d and C4d within the cutaneous vasculature; the C5b-9 deposits were limited to the pre- eculizumab biopsy. We discovered that her syndromic complex was a self-inflicted one related to the localized administration of dissolved oxymorphone. CONCLUSION:
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Authors | Cynthia M Magro, Aixa Toledo-Garcia, Ozlem Pala, Shabnam Momtahen, Lee Shapiro |
Journal | Dermatology online journal
(Dermatol Online J)
Vol. 21
Issue 9
(09 17 2015)
ISSN: 1087-2108 [Electronic] United States |
PMID | 26437280
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Analgesics, Opioid
- Tablets
- Oxymorphone
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Topics |
- Acute Kidney Injury
(chemically induced)
- Adult
- Analgesics, Opioid
- Diagnosis, Differential
- Female
- Humans
- Malignant Atrophic Papulosis
(diagnosis)
- Oxymorphone
- Respiratory Insufficiency
(chemically induced)
- Substance Abuse, Intravenous
(complications, diagnosis)
- Tablets
- Thrombosis
(chemically induced)
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