title: Recurrent purpura due to alcohol-related Schamberg's disease and its association with serum immunoglobulins: a longitudinal observation of a heavy drinker.
abstract: BACKGROUND
  It is unusual for purpura to emerge as a result of drinking alcohol. Such a peculiarity was observed in a 55-year-old man with a 30-year history of heavy alcohol use.
  
  
  METHODS
  The Caucasian patient was studied for 11 years during several detoxification treatments. During the last 2 years of that period, purpuric rashes were newly observed. The asymptomatic purpura was limited to both lower limbs, self-limiting with abstinence, and reoccurring swiftly with alcohol relapse. This sequence was observed six times, suggesting a causative role of alcohol or its metabolites. A skin biopsy revealed histological features of purpura pigmentosa progressiva (termed Schamberg's disease). Additionally, alcoholic fatty liver disease markedly elevated serum immunoglobulins (immunoglobulin A and immunoglobulin E), activated T-lymphocytes, and increased C-reactive protein. In addition, moderate combined (cellular and humoral) immunodeficiency was found. Unlike the patient's immunoglobulin A level, his serum immunoglobulin E level fell in the first days of abstinence, which corresponded to the time of purpura decline. Systemic vasculitis and clotting disorders were excluded. The benign character of the purpura was supported by missing circulating immune complexes or complement activation. An alcohol provocation test with vinegar was followed by the development of fresh "cayenne pepper" spots characteristic of Schamberg's disease.
  
  
  CONCLUSIONS
  This case report demonstrates that Schamberg's disease can be strongly related to alcohol intake, in our patient most likely as a late complication of severe alcoholism with alcoholic liver disease. Immunologic disturbances thereby acquired could have constituted a basis for a hypersensitivity-like reaction after ingestion of alcohol. Schamberg's disease induction by vinegar may point to an involvement of acetate, a metabolite of ethanol.
authors: Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Grutholzallee 21, 44577, Castrop-Rauxel, Germany. udo.bonnet@uni-due.de.|Department of Psychiatry and Psychotherapy, University of Duisburg/Essen, Virchowstr. 174, 45147, Essen, Germany. udo.bonnet@uni-due.de.
authors: Udo
authors: U
authors: Bonnet
authors: Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Grutholzallee 21, 44577, Castrop-Rauxel, Germany.
authors: Claudia
authors: C
authors: Selle
authors: Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Grutholzallee 21, 44577, Castrop-Rauxel, Germany.
authors: Katrin
authors: K
authors: Isbruch
authors: Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Grutholzallee 21, 44577, Castrop-Rauxel, Germany.
authors: Katrin
authors: K
authors: Isbruch
mesh_terms: D019973:Alcohol-Related Disorders / Q000097:blood / Q000150:complications*; D006801:Humans; D007136:Immunoglobulins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000097:blood* / Q000209:etiology*; D011693:Purpura / Q000097:blood* / Q000209:etiology*; D012008:Recurrence
chemical_list: D007136:Immunoglobulins
keywords: Acetate; Alcohol; Hypersensitivity-like reaction; Purpura; Schamberg’s disease