A 53-year-old woman with cutaneous thickening and eosinophilia

Article Abstract:

A 53-year-old woman was admitted to the hospital because of extensive swelling, thickening and pain of the skin, and an abnormally high number of eosinophils, a type of white blood cell. Five months earlier, she developed swelling in both legs with a purplish discoloration and complained of itching throughout her body. Within a month, her skin was leathery, and her legs were painful and burning. She had an enlarged liver and edema or fluid accumulation in both legs. Three and a half months before admission, she was found to have abnormalities of the bone marrow, including an increased number of eosinophils, or eosinophilia. One month later, the patient had calcium deposits in her abdominal blood vessels, and a biopsy of her calf muscle showed the presence of inflammatory cells. The steroid prednisone and diuretic agents improved the edema and eosinophilia but caused loss of appetite, nausea and vomiting. The patient continued to have paresthesias, which are sensations of numbness, prickling or tingling pain, hardening of the skin, edema, and eosinophilia. She was diagnosed as having eosinophilia fascitis. It is more frequent in adults than children and occurs equally in both sexes. Eosinophilia fascitis has been related to strenuous exercise or other physical stress. The patient demonstrated the skin changes, edema, eosinophilia, and pain associated with this disease. Corticosteroids are often used to treat the skin inflammation, joint paint and eosinophilia associated with eosinophilia fascitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Development and progression, Skin diseases, Eosinophil disorders, Canoso, Juan J., Byers, H. Randolph

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A 74-year-old woman with subxiphoid pain and narrowing of the esophagus

Article Abstract:

A 74-year-old woman came to the hospital because of lower chest pain after eating breakfast. She had a previous history of breast cancer and chronic heartburn. The next day, the patient vomited blood and had difficulty swallowing. A series of upper gastrointestinal X-rays to visualize the esophagus and stomach revealed a dilated area in the esophagus. The patient's esophagus revealed an old blood clot when it was evaluated under anesthesia. Further examination found that the esophagus had perforated, causing the bleeding. There was no aneurysm, a bulging of a blood vessel which may eventually rupture. Swallowing a foreign body, a tear at the junction of the stomach and esophagus, and tumors were all considered unlikely causes in this patient. Barrett's esophagus, the narrowing of the lower end of the esophagus due to abnormal tissue, was also considered. However, biopsy was difficult due to the large amount of blood. A portion of the esophagus that was filled with a blood clot was removed by surgery. The eventual diagnosis was spontaneous esophageal hemorrhage (esophageal apoplexy), the cause unknown.

Injuries, Causes of, Esophagus, Heartburn, column, Orringer, Mark B.

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