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Effective treatment of malignant atrophic papulosis (Köhlmeier-Degos disease) with treprostinil--early experience.
[malignant atrophic papulosis]
Malignant
atrophic
papulosis
(
Köhlmeier-
Degos
disease
;
MAP
)
is
an
uncommon
endotheliopathy
with
pathological
findings
similar
to
the
vascular
lesions
of
systemic
sclerosis
.
These
two
disorders
can
overlap
.
When
associated
with
visceral
lesions
,
MAP
has
been
considered
almost
universally
and
rapidly
fatal
.
A
recent
report
described
dramatic
response
to
treatment
with
eculizumab
,
but
disease
progression
after
initial
response
to
therapy
has
occurred
.
We
describe
the
clinical
and
pathologic
findings
in
two
patients
,
one
with
MAP
and
the
other
with
MAP
like
lesions
,
who
received
treatment
with
subcutaneous
treprostinil
.
One
patient
had
an
overlap
syndrome
with
features
of
systemic
lupus
erythematosus
(
SLE
)
and
scleroderma
and
severe
pulmonary
hypertension
.
She
also
had
very
extensive
MAP
like
cutaneous
lesions
.
There
was
no
evidence
of
central
nervous
system
(
CNS
)
disease
and
laparoscopy
revealed
no
visible
MAP
lesions
on
the
serosa
of
the
small
bowel
.
The
second
patient
had
experienced
life-threatening
disease
progression
despite
ongoing
eculizumab
therapy
.
During
this
treatment
,
he
had
developed
CNS
and
bladder
involvement
with
neurologic
symptoms
and
gross
hematuria
.
Patient
one
was
placed
on
therapy
with
treprostinil
for
her
pulmonary
hypertension
,
but
in
the
months
subsequent
to
initiation
of
treatment
,
dramatic
and
complete
resolution
of
cutaneous
MAP
like
lesions
and
disabling
digital
pain
occurred
.
In
patient
two
,
therapy
with
treprostinil
was
temporally
associated
with
clearing
of
hematuria
,
resolution
of
CNS
symptoms
and
improvement
in
MRI
findings
.
Treprostinil
may
offer
a
second
effective
treatment
approach
to
individuals
with
MAP
or
"
rescue
therapy
"
to
those
in
whom
eculizumab
treatment
has
failed
to
maintain
suppression
of
disease
activity
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated