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The Cutting Edge: Challenges in Medical and Surgical Therapies |

Successful Treatment of Poststreptococcal Scleredema Adultorum Buschke With Intravenous Immunoglobulins

Maximilian C. Aichelburg, MD; Robert Loewe, MD; Nikolaus Schicher, MD; Paul-Gunther Sator, MD; Franz M. Karlhofer, MD; Georg Stingl, MD; Ahmad Jalili, MD, PhD
Arch Dermatol. 2012;148(10):1126-1128. doi:10.1001/archdermatol.2012.1558.
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We report a case of rapidly progressing poststreptococcal scleredema adultorum Buschke (SAB) that successfully responded to treatment with intravenous immunoglobulins (IVIGs).

Correspondence: Ahmad Jalili, MD, PhD, Division of Immunology, Allergy, and Infectious Diseases, Department of Dermatology, Medical University of Vienna, General Hospital (AKH), Währinger Gürtel 18-20, A-1090 Vienna, Austria (ahmad.jalili@meduniwien.ac.at).

Accepted for Publication: April 7, 2012.

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Aichelburg, Sator, and Jalili. Acquisition of data: Aichelburg, Loewe, Schicher, Sator, Karlhofer, and Jalili. Analysis and interpretation of data: Aichelburg, Loewe, Sator, Stingl, and Jalili. Drafting of the manuscript: Aichelburg and Jalili. Critical revision of the manuscript for important intellectual content: Aichelburg, Loewe, Schicher, Sator, Karlhofer, Stingl, and Jalili. Statistical analysis: Aichelburg and Jalili. Obtained funding: Sator. Administrative, technical, and material support: Loewe and Sator. Study supervision: Aichelburg, Karlhofer, Stingl, and Jalili.

Financial Disclosure: None reported.

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Figure 1. Substantial improvement in skin sclerosis as seen by the reappearance of skin folds (A and C) and shoulder abduction (B and D) after 5 cycles of intravenous immunoglobulin administration. The patient is shown before (A and B) and after (C and D) treatment with intravenous immunoglobulins.

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Figure 2. Histologic manifestation of scleredema adultorum Buschke. Marked sclerosis of the dermis with greatly thickened reticular dermis and lymphocytic infiltration (A) (hematoxylin-eosin, original magnification ×20) and swollen separated collagen bundles replaced by mucin deposits (B) (alcian blue, original magnification ×40).

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Figure 3. Significant reduction of the skin thickness in the upper arm area and neck confirmed by sonographic imaging after 5 cycles of intravenous immunoglobulins. Unpaired t test, P < .05 is considered significant.

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