Internal Medicine

(Wang) #1

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18


Pelvic Inflammatory Disease Pemphigus Vulgaris and Pemphigus Foliaceus 1149

■Ofloxacin: side effects: GI intolerance, CNS stimulation, dizziness;
contraindicated in pregnancy (C) and patients < 18 years
follow-up
■Must re-examine patients receiving outpatient care in 24–72 h; if no
clinical improvement pursue additional diagnostic tests, hospital-
ization, surgical intervention; if improving, continue follow-up at 7
and 21 days
■Consider re-screening for GC and CT 4–6 weeks after completion of
therapy with cervical cultures and/or non-culture assays
complications and prognosis
■Perihepatitis: inflammation of liver capsule and adjacent peri-
toneum; presents with RUQ pain, LFTs usually normal; occurs in
5–15% of patients with acute salpingitis
■25% of cases experience long-term sequelae (tubal infertility, ectopic
pregnancy, chronic pelvic pain); increased risk with severe disease
and repeated infections; decreased risk if antibiotics are started
within 3 days of symptom onset
■Mortality is rare, usually occurs with ruptured tubo-ovarian abscess
(mortality 3–8%)

PEMPHIGUS VULGARIS AND PEMPHIGUS FOLIACEUS


DANIEL J. SHEEHAN, MD; ROBERT SWERLICK, MD; and
JEFFREY P. CALLEN, MD

history & physical
■Mucosal erosions and ulcerations are the most common initial man-
ifestation in pemphigus vulgaris.
■Flaccid bullae or erosions or crusted skin lesions may occur initially
in pemphigus foliaceus and following oral lesions in pemphigus vul-
garis.
■Pemphigus foliaceus does not involve the mucous membranes and
often follows a seborrheic distribution.
tests
Basic Blood Tests
■Electrolytes
Specific Diagnostic Tests
■Skin biopsy from small bulla or margin of larger bulla shows intra-
epidermal blistering
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