Multiple cerebral infarctions with severe atopic dermatitis : a case report

Abstract

A 56–year–old man underwent treatment for severe atopic dermatitis at the department of dermatology at our hospital in 2016. Left hemiparesis appeared in 2017, causing a progressively worsening gait disturbance and by late 2018, he could not walk by himself. In January 2019, he was found in a coma at home and was hospitalized. Physical examination showed disturbance of consciousness, left pyramidal signs, and generalized lichen. Blood examination revealed severe dehydration and IgE elevation of 81,399U/ml. In brain magnetic resonance images, acute and old cerebral infarctions coexisted in the cerebral cortex, white matter, cerebellum, and brainstem. There was no apparent arterial lesion, cardiac embolic source, coagulopathy, or connective tissue disease ; he was diagnosed with multiple cerebral infarctions associated with atopic dermatitis. After we administered cilostazol, rupatadine, and steroid ointments, the skin lesions were ameliorated dramatically. There was no clinical relapse of cerebral infarction for one year. Atopic dermatitis is reported to increase the risk of cerebral infarction. There are several case reports on infections or inflammation due to atopic dermatitis leading to embolization. We considered that skin treatment prevented cerebral infarction from recurring and reported this case as a valuable clinical lesson.