Biomedical subjects
Publications and source records attributed to A Srebrnik.
Three weeks after completing a 4-pulse course of itraconazole for toenail onychomycosis, a 25-year-old woman patient developed severe liver crisis and required an emergency liver transplant. We report the case and discuss the use of itraconazole in onychomycosis and dermatomycoses.
Pemphigus is an autoimmune disease that results from the interaction between predisposing genetic factors and exogenous factors, the most common environmental factors being drugs and food. Topical phenol has induced pemphigus in one patient. Drugs and foods that induce pemphigus are divided into three main groups according to their chemical structure: thiols (containing a sulfhydryl group), phenol, nonthiol nonphenol. Thiol and phenol compounds can induce acantholysis in tissue cultures in vitro. The suggested mechanisms for thiol acantholysis include direct biochemical impairment of cell adhesion, protease activation and immunological reaction with the formation of a neoantigen. Possible mechanisms of phenol-induced pemphigus include the induction of IL-1alpha and TNF-alpha release by keratinocytes. These cytokines have been shown to be relevant in the regulation and synthesis of complement and proteases, like plasminogen activator, which has been implicated in the pathogenesis of acantholysis in pemphigus vulgaris. Avoiding exposure of genetically predisposed individuals to these factors is important in treating and preventing this disease.
A case of a pyoderma gangrenosum (PG)-like eruption due to the antipsychotic drug sulpiride, a form of risperidone, is described. The contribution of sulpiride to the etiology of the PG-like lesion is based on the reduction and healing of the ulcer upon cessation of the drug and the formation of a bulla following the drug's re-administration. The literature on drug-induced PG or PG-like eruptions is discussed. The selectivity of sulpiride for dopamine receptors and its limited effect on other neuronal pathways differentiates sulpiride from other types of antispychotic drugs commonly used in Israel, including phenothiazine, butyrophenone, and thioxanthene. Adverse systemic and cutaneous reactions to sulpiride and to risperidone are described. To our knowledge, this is the first report of a PG-like eruption due to the former.
Dorfman-Chanarin syndrome, or neutral lipid storage disease with ichthyosis, is a rare inherited metabolic disorder characterized by accumulation of neutral lipids in different tissues. Variability in dermatologic severity is not understood. We report two new cases, compare their features with other reported cases, and examine the possible relationship between the severity of the dermatologic condition and lipid accumulation in various types of skin cells. The localization of lipid droplets was determined in various dermal and epidermal cells by light microscopy of epoxy resin semithin sections and electron microscopy in four cases of Dorfman-Chanarin syndrome. Lipid droplets in the dermis were detected in fibroblasts, Schwann cells in both myelinated and unmyelinated nerves, smooth muscle cells, and sweat gland cells, but not in endothelial cells of blood capillaries. The droplets were not surrounded by a membrane. Findings indicate that there is no correlation between the clinical severity of the disease and the microscopic findings.
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Fusarium oxysporum was isolated from a large foot ulcer in an otherwise healthy 69-year-old man. Although tissue invasion could not be proven histologically, systemic antifungal treatment was administered with satisfactory response. Fusarium species are common soil-inhabiting organisms and plant pathogens. In humans, Fusarium is considered an opportunistic agent in skin ulcers, interdigital spaces, and burned skin, but can also cause mycotic keratitis, onychomycosis, and rarely deep-seated or disseminated infections, especially in an immunocompromised host. The distinction between skin infection and saprophytic growth, as well as optimal treatment regimens for the two types of infection, have not been clearly defined. We describe a case of leg ulcers caused by Fusarium oxysporum in a 69-year-old man treated successfully with oral ketoconazole. "Silent" immunologic disturbances were found in this apparently healthy patient. The case illustrates a relatively benign infection caused by Fusarium that responded to systemic antifungal drug treatment.
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This article reviews the adverse cutaneous reactions due to psychotropic medications. The prevalence of skin reactions to these agents is about 5%.
A twenty-nine-year-old woman who had been taking lithium carbonate for seven years experienced ulcerated lesions of the vaginal mucosa and acneiform eruption on both thighs. Histopathologic appearance of the skin biopsy specimens was consistent with lichenoid cutaneous changes. The cutaneous lesions cleared when use of the drug was discontinued.
Epidemiological data indicate that patients suffering from diabetes, hypothyroidism, obesity, or following prolonged treatment with antibiotics, corticosteroids or oral contraceptives, have an increased tendency to develop cutaneous candidiasis. Since it is generally believed that attachment of microorganisms to host cells is an initial step in the evolution of infection, the aim of the present study was to investigate whether cells from susceptible individuals have increased capacity to bind the fungus. Corneocytes collected from the forearms of individuals of these susceptible groups were exposed in vitro to Candida albicans and adhesion to the cells was evaluated in comparison with adherence to cells from a non-susceptible population. Adherence in vitro was assayed microscopically and evaluated quantitatively by two parameters: 1) percentage of adherence - number of corneocytes with adhering yeasts on their surface, and 2) the total number of adhered yeasts. Results of the study revealed that the mean percentage of adherence and the mean total number of yeasts adhering to cells from individuals of the susceptible populations was twice as high as values in a healthy population. Statistical analysis of the data by Student's t-test indicated that the difference was significant (p less than 0.001).
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Dorfman-Chanarin syndrome in two sisters of Jewish Iraqi origin is reported. This heritable disorder of the metabolism of neutral lipids was manifested by congenital ichthyosis, vacuoles in the leukocytes, and variable involvement of liver, muscle, central nervous system, and the auditory system. In two asymptomatic members of the family leukocyte vacuoles were found as the only sign of the syndrome. Clinical, pathologic, ultrastructural, and biochemical findings are described. Previous reported cases are reviewed.
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A case of acute cutaneous leishmaniasis is reported in which skin biopsy of the lesion revealed deposits of IgM, fibrinogen and C3 in the blood vessel wall and granular deposits of IgG and C3 at the dermoepidermal junction. No immune complexes were detected in the healthy unaffected skin in the same patient and no circulating immune complexes were found in the blood. This case demonstrates tissue-bound immune complexes in cutaneous leishmaniasis.
Skin lesions of acute cutaneous leishmaniasis were found in three healthy men. A smear for Leishman-Donovan (LD) bodies as well as histopathologic studies of the lesions confirmed the diagnosis. Direct immunofluorescent studies of the lesions revealed deposits of immunoglobulins and complement in dermoepidermal junctions and fibrinogen in dermal blood vessels.