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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
.
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