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American Journal of Case Reports is ranked the World leading among journals dedicated to publishing clinical case reports. AJCR is indexed in Web of Science, PubMed/ PMC, Scopus

(1) CiteScore (Impact Factor - like by Scopus, Elsevier) is the number of citations received by a journal in one year to documents published in the three previous years, divided by the number of documents indexed in Scopus published in those same three years.

(2) SNIP (Source Normalized Impact per Paper) measures a source’s contextual citation impact by weighting citations based on the total number of citations in a subject field. It helps you make a direct comparison of sources in different subject fields. SNIP takes into account the characteristics of the source's subject field, which is the set of documents citing that source.

(3) SJR is weighted by the prestige of a journal. Subject field, quality, and reputation of the journal have a direct effect on the value of a citation. SJR assigns relative scores to all of the sources in a citation network. Its methodology is inspired by the Google PageRank algorithm, in that not all citations are equal. A source transfers its own 'prestige', or status, to another source through the act of citing it. A citation from a source with a relatively high SJR is worth more than a citation from a source with a lower SJR. 

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Clinical case reports are an invaluable first-hand source of evidence in medicine and a tool most often used in practice to exchange information and generate a more expanded search for evidence. In addition to the “evidence of what happened”, single or multiple cases are an important basis for further and more advanced research on diagnosis, treatment effectiveness, causes and outcomes of disease. However limited their conclusions may be, case reports remain a fundamental component of medicine, contributing greatly to the advancement of health care. In today's ever-expanding Evidence-Based Medicine, case reporting require a well-defined focus, content, and structure.

Presently, only a fraction of case reports is useful for clinical decision-making and bedside-decision oriented research. Therefore, the aim of the Journal is to gather case reports across medical disciplines, thereby integrating interdisciplinary, international medical knowledge.


Published: 2019-09-20

Diffuse Exfoliative Rash with Sepsis and Eosinophilia: A Case of Erythroderma?

Jake Cho, Selsabeel A. Elyaman, Stephen A. Avera, Kenneth Iyamu

(Graduate Medical Education, University of Central Florida College of Medicine, Orlando, USA)

Am J Case Rep 2019; 20:1387-1393

DOI: 10.12659/AJCR.917427


BACKGROUND: Erythroderma is an exfoliative dermatitis that manifests as generalized erythema and scaling that involves 90% of the body surface. If untreated, erythroderma can be fatal because of its metabolic burden and risk of secondary infections.
CASE REPORT: The patient was a 56-year-old male with prior rash attributed to group A Streptococcal cellulitis and discharged on Augmentin, Clindamycin with hydrocortisone cream, and Bactrim, but he had been noncompliant. He was admitted again for rash involving the face, torso, and extremities characterized by diffuse, desquamative, dry scales in morbilliform pattern. The patient was septic with Staphylococcus aureus bacteremia and compromised skin barrier. He was started on vancomycin and switched to Cefazolin IV due to concern for drug reaction. Autoimmune workup included antibodies for anti-Jo-1, anti-dsDNA, anti-centromere, and ANCA. However, only antinuclear antibody and scleroderma antibody were positive. Given the unclear workup results and lack of response to antibiotics, the patient was started on prednisone 60 mg PO and topical Triamcinolone 0.1% cream. A skin biopsy revealed psoriasiform hyperplasia with atypical T cell infiltrate and eosinophils, but negative for T cell gene rearrangement. The rash resolved after day 12 of application of topical Triamcinolone.
CONCLUSIONS: This case is unique in terms of the rarity of erythroderma and the diagnostic challenge given confounding factors such as noncompliance and drug reaction. Serious causes, such as SLE and cutaneous T cell lymphoma, were ruled out. Fortunately, the rash responded well to steroids; however, given the adverse effects of long-term use of topical steroids, the patient will need follow up with Dermatology.

Keywords: Dermatitis, Atopic, Dermatitis, Exfoliative, Exanthema, Lymphoma, T-Cell, Cutaneous, Sepsis, Triamcinolone



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