Publications by authors named "Bridget E Shields"

21 Publications

  • Page 1 of 1

Granulomatous Dermatitis Associated With Rubella Virus Infection in an Adult With Immunodeficiency.

JAMA Dermatol 2021 May 26. Epub 2021 May 26.

Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.

Importance: Immunodeficiency-related, vaccine-derived rubella virus (RuV) as an antigenic trigger of cutaneous and visceral granulomas is a rare, recently described phenomenon in children and young adults treated with immunosuppressant agents.

Objective: To perform a comprehensive clinical, histologic, immunologic, molecular, and genomic evaluation to elucidate the potential cause of an adult patient's atypical cutaneous granulomas.

Design, Setting, And Participants: A prospective evaluation of skin biopsies, nasopharyngeal swabs, and serum samples submitted to the Centers for Disease Control and Prevention was conducted to assess for RuV using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) and viral genomic sequencing. The samples were obtained from a man in his 70s with extensive cutaneous granulomas mimicking both cutaneous sarcoidosis (clinically) and CD8+ granulomatous cutaneous T-cell lymphoma (histopathologically). The study was conducted from September 2019 to February 2021.

Main Outcomes And Measures: Identification and genotyping of a novel immunodeficiency-related RuV-associated granulomatous dermatitis.

Results: Immunohistochemistry for RuV capsid protein and RT-PCR testing for RuV RNA revealed RuV in 4 discrete skin biopsies from different body sites. In addition, RuV RNA was detected in the patient's nasopharyngeal swabs by RT-PCR. The full viral genome was sequenced from the patient's skin biopsy (RVs/Philadelphia.PA.USA/46.19/GR, GenBank Accession #MT249313). The patient was ultimately diagnosed with a novel RuV-associated granulomatous dermatitis.

Conclusions And Relevance: The findings of this study suggest that clinicians and pathologists may consider RuV-associated granulomatous dermatitis during evaluation of a patient because it might have implications for the diagnosis of cutaneous sarcoidosis, with RuV serving as a potential antigenic trigger, and for the diagnosis of granulomatous cutaneous T-cell lymphoma, with histopathologic features that may prompt an evaluation for immunodeficiency and/or RuV.
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http://dx.doi.org/10.1001/jamadermatol.2021.1577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156178PMC
May 2021

Vulvar Crohn disease: Diagnostic challenges and approach to therapy.

Int J Womens Dermatol 2020 Dec 17;6(5):390-394. Epub 2020 Sep 17.

Department of Dermatology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, United States.

Crohn disease (CD) may be complicated by contiguous, metastatic, or associated inflammatory cutaneous lesions. Vulvar CD is a rare phenomenon characterized by granulomatous genital inflammation that occurs independently from fistulizing CD. Left untreated, vulvar CD can result in debilitating lymphedema, disfiguring anatomic changes, secondary abscesses, cellulitis, and squamous cell carcinoma. We present a series of cases to highlight the clinical presentation of vulvar CD, the diagnostic testing required to distinguish complicating conditions, the asynchronous courses of skin and intestinal disease, and the complexities in the management of this disease and associated conditions. We review our multidisciplinary approach to care, aimed at reducing morbidity and improving patient quality of life.
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http://dx.doi.org/10.1016/j.ijwd.2020.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060678PMC
December 2020

Cutaneous Manifestations of Nutritional Excess: Pathophysiologic Effects of Hyperglycemia and Hyperinsulinemia on the Skin.

Cutis 2021 Feb;107(2):74-78

Mr. Svoboda is from the Virginia Tech Carilion School of Medicine, Roanoke. Dr. Shields is from the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison.

Hyperglycemia is defined by excess blood glucose and, when persistent, may lead to prediabetic and diabetic states. Insulin is a hormone produced by the beta cells of the pancreas in response to elevated blood glucose. Dysregulated insulin secretion or clearance results in hyperinsulinemia, which also is closely associated with type 2 diabetes mellitus (T2DM) and metabolic disturbances. Hyperglycemia and hyperinsulinemia are endemic within the United States and impart considerable morbidity and mortality. Cutaneous manifestations of chronic hyperglycemia and hyperinsulinemia include acanthosis nigricans (AN), diabetic dermopathy (DD), scleredema diabeticorum (SD), ichthyosiform skin changes, acrochordons, and keratosis pilaris (KP). Necrobiosis lipoidica (NL), bullosis diabeticorum (BD), and generalized granuloma annulare (GA) are more rarely reported in association with hyperglycemia and hyperinsulinemia; however, the strength of these associations remains unclear. It is crucial for dermatologists to recognize these cutaneous manifestations, as they may be the first signs of metabolic syndrome and insulin resistance. Early identification and management of these conditions is key to improving patient health outcomes and reducing health care costs. Herein, we review the clinical presentations of these conditions and their underlying pathophysiologic mechanisms.
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http://dx.doi.org/10.12788/cutis.0173DOI Listing
February 2021

Occipital alopecia in a young man.

Dermatol Online J 2020 Nov 15;26(11). Epub 2020 Nov 15.

Department of Dermatology, University of Wisconsin Madison, Madison, WI.

Lipedematous alopecia is a rare, non-androgenic form of alopecia that is challenging to diagnose, often requiring clinical-pathological correlation. The condition has been reported predominantly in African-American females, but more recently has been described in a broader demographic [1,2]. We describe a rare case of a young Caucasian man with isolated lipedematous alopecia who presented with a boggy, erythematous plaque with alopecia of the occipital scalp and subcutaneous thickening with lymphocytic dermal infiltrate and decreased anagen hairs on histology.
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November 2020

Left-Dominant Arrhythmogenic Cardiomyopathy, Palmoplantar Keratoderma, and Curly Hair Associated With a Rare Autosomal Dominant Truncating Variant in Desmoplakin.

Circ Genom Precis Med 2020 10 13;13(5):557-559. Epub 2020 Aug 13.

Division of Cardiovascular Medicine, Center for Inherited Cardiovascular Disease (N.R., L.H.-A., J.L.C., A.M., A.T.O.).

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http://dx.doi.org/10.1161/CIRCGEN.120.003017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583655PMC
October 2020

Generalized granuloma annulare: A widespread response to limited application of compounded 2% topical tofacitinib.

JAAD Case Rep 2020 Oct 8;6(10):1113-1115. Epub 2020 Aug 8.

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jdcr.2020.07.054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519269PMC
October 2020

Oral Granulomatous Disease.

Dermatol Clin 2020 Oct;38(4):429-439

Department of Dermatology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.

Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.
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http://dx.doi.org/10.1016/j.det.2020.05.004DOI Listing
October 2020

Nutritional dermatoses in the hospitalized patient.

Cutis 2020 Jun;105(6):296;302-308;E1;E2;E3;E4;E5

Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.

Cutaneous disease may be the first manifestation of an underlying nutritional deficiency, highlighting the importance of early recognition by dermatologists. Undernutrition occurs when there is an imbalance between nutrient intake and metabolic demand. Many hospitalized patients are in catabolic states due to chronic illness, infection, malabsorption, or medication. These patients are at an increased risk for undernutrition and therefore associated cutaneous disease. This review details the risk factors for nutritional deficiency, illustrates the presentations of cutaneous disease, reviews diagnostic workups, and provides suggestions for supplementation in the undernourished patient.
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June 2020

Dermatomal necrotizing infundibular crystalline folliculitis following herpes zoster in a patient on PD-1 inhibitor therapy.

J Cutan Pathol 2020 Jun;47(6):501-505

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/cup.13653DOI Listing
June 2020

Characteristics of patients with celiac disease and connective tissue disease overlap.

Int J Dermatol 2020 Aug 25;59(8):e309-e312. Epub 2020 Apr 25.

Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.

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http://dx.doi.org/10.1111/ijd.14892DOI Listing
August 2020

Intralesional corticosteroid-induced hypopigmentation and atrophy.

Dermatol Online J 2020 Jan 15;26(1). Epub 2020 Jan 15.

University of Wisconsin Department of Dermatology, Madison, WI.

Intralesional corticosteroids are associated with various, uncommon, local adverse events [1]. Atrophy and hypopigmentation most commonlyremain localized to sites of injection. However, outward radiation in a linear, streaky pattern has been reported and is termed "perilesional/perilymphatic hypopigmentation or atrophy [2]." We report a case of this rare adverse event.
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January 2020

Angioinvasive fungal infections impacting the skin: Background, epidemiology, and clinical presentation.

J Am Acad Dermatol 2019 Apr 10;80(4):869-880.e5. Epub 2018 Aug 10.

Department of Dermatology and Pathology, University of Iowa, Iowa City, Iowa. Electronic address:

Angioinvasive fungal infections cause significant morbidity and mortality because of their propensity to invade blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. While occasionally seen in immunocompetent hosts, opportunistic fungi are emerging in immunosuppressed hosts, including patients with hematologic malignancy, AIDS, organ transplant, and poorly controlled diabetes mellitus. The widespread use of antifungal prophylaxis has led to an "arms race" of emerging fungal resistance patterns. As the at-risk population expands and new antifungal resistance patterns develop, it is critical for dermatologists to understand and recognize angioinvasive fungal pathogens, because they are often the first to encounter the cutaneous manifestations of these diseases. Rapid clinical recognition, histopathologic, and culture confirmation can help render a timely, accurate diagnosis to ensure immediate medical and surgical intervention. Superficial dermatophyte infections and deep fungal infections, such as blastomycosis and histoplasmosis, have been well characterized within the dermatologic literature, and therefore this article will focus on the severe infections acquired by angioinvasive fungal species, including an update on new and emerging pathogens. In the first article in this continuing medical education series, we review the epidemiology and cutaneous manifestations. The second article in the series focuses on diagnosis, treatment, and complications of these infections.
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http://dx.doi.org/10.1016/j.jaad.2018.04.059DOI Listing
April 2019

Angioinvasive fungal infections impacting the skin: Diagnosis, management, and complications.

J Am Acad Dermatol 2019 Apr 10;80(4):883-898.e2. Epub 2018 Aug 10.

Department of Dermatology and Pathology, University of Iowa, Iowa City, Iowa. Electronic address:

As discussed in the first article in this continuing medical education series, angioinvasive fungal infections pose a significant risk to immunocompromised and immunocompetent patients alike, with a potential for severe morbidity and high mortality. The first article in this series focused on the epidemiology and clinical presentation of these infections; this article discusses the diagnosis, management, and potential complications of these infections. The mainstay diagnostic tests (positive tissue culture with histologic confirmation) are often supplemented with serum biomarker assays and molecular testing (eg, quantitative polymerase chain reaction analysis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry) to ensure proper speciation. When an angioinvasive fungal infection is suspected or diagnosed, further workup for visceral involvement also is essential and may partially depend on the organism. Different fungal organisms have varied susceptibilities to antifungal agents, and knowledge on optimal treatment regimens is important to avoid the potential complications associated with undertreated or untreated fungal infections.
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http://dx.doi.org/10.1016/j.jaad.2018.04.058DOI Listing
April 2019

Increasing Access to High Value Care: Preventing Complications in Common Disorders.

Telemed J E Health 2019 05 10;25(5):423-424. Epub 2018 Aug 10.

1 Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

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http://dx.doi.org/10.1089/tmj.2018.0003DOI Listing
May 2019

A Hairy Situation: Laser Hair Removal after Oral Reconstruction.

Ann Otol Rhinol Laryngol 2018 Mar 31;127(3):205-208. Epub 2017 Dec 31.

4 Department of Dermatology and Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Objectives: To present a case series of 4 patients who underwent postoperative hair removal using the long-pulsed Alexandrite or Nd:YAG laser following intraoral cutaneous flap reconstruction.

Methods: Patients underwent epilation in dermatology clinic with long-pulsed Alexandrite or Nd:YAG lasers, spaced 8 weeks apart, until hair removal was achieved.

Results: All patients achieved improvement in hair removal regardless of initial flap donor site with significant improvement in quality of life and minimal side effects.

Conclusions: The long-pulsed Alexandrite and Nd:YAG represent safe and effective treatment options to improve patient quality of life following intraoral flap repair following excision of malignancy.
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http://dx.doi.org/10.1177/0003489417750930DOI Listing
March 2018

: An emerging cutaneous pathogen.

JAAD Case Rep 2016 Nov 4;2(6):428-429. Epub 2016 Dec 4.

Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

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http://dx.doi.org/10.1016/j.jdcr.2016.08.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143409PMC
November 2016

Transesophageal echocardiography: a novel technique for guidance and placement of an epidural catheter in infants.

Anesthesiology 2013 Jan;118(1):219-22

Department of Anesthesia, University of Iowa Hospitals and Clinics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.

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http://dx.doi.org/10.1097/ALN.0b013e318277a554DOI Listing
January 2013

The transcription factor ATF4 promotes skeletal myofiber atrophy during fasting.

Mol Endocrinol 2010 Apr 2;24(4):790-9. Epub 2010 Mar 2.

Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa 52242, USA.

Prolonged fasting alters skeletal muscle gene expression in a manner that promotes myofiber atrophy, but the underlying mechanisms are not fully understood. Here, we examined the potential role of activating transcription factor 4 (ATF4), a transcription factor with an evolutionarily ancient role in the cellular response to starvation. In mouse skeletal muscle, fasting increases the level of ATF4 mRNA. To determine whether increased ATF4 expression was required for myofiber atrophy, we reduced ATF4 expression with an inhibitory RNA targeting ATF4 and found that it reduced myofiber atrophy during fasting. Likewise, reducing the fasting level of ATF4 mRNA with a phosphorylation-resistant form of eukaryotic initiation factor 2alpha decreased myofiber atrophy. To determine whether ATF4 was sufficient to reduce myofiber size, we overexpressed ATF4 and found that it reduced myofiber size in the absence of fasting. In contrast, a transcriptionally inactive ATF4 construct did not reduce myofiber size, suggesting a requirement for ATF4-mediated transcriptional regulation. To begin to determine the mechanism of ATF4-mediated myofiber atrophy, we compared the effects of fasting and ATF4 overexpression on global skeletal muscle mRNA expression. Interestingly, expression of ATF4 increased a small subset of five fasting-responsive mRNAs, including four of the 15 mRNAs most highly induced by fasting. These five mRNAs encode proteins previously implicated in growth suppression (p21(Cip1/Waf1), GADD45alpha, and PW1/Peg3) or titin-based stress signaling [muscle LIM protein (MLP) and cardiac ankyrin repeat protein (CARP)]. Taken together, these data identify ATF4 as a novel mediator of skeletal myofiber atrophy during starvation.
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http://dx.doi.org/10.1210/me.2009-0345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852358PMC
April 2010