Biomedical subjects
Publications and source records attributed to J E Fitzpatrick.
A 56-year-old man with a 7-year history of well-documented mycosis fungoides is reported. Because the patient was a treatment failure with topical nitrogen mustard due to severe allergic contact dermatitis, and because of recent reports of the efficacy of retinoid compounds, he was treated with a 6-month course of isotretinoin with total clearing of his skin lesions. Previous case reports and possible mechanisms of action are reviewed.
The occurrence of a malignant melanoma in a small congenital nevus is a rare event. A malignant melanoma arising intradermally in a small congenital nevus in an adult has not been previously reported. The clinical implications and known information about the prognosis of intradermal malignant melanomas are discussed.
Systemic histiocytosis was found in a patient who presented with chronic, nodular, and ulcerative skin lesions. The patient's hospital course was complicated by persistent fever, thrombocytopenia, severe neutropenia, and coagulation abnormalities. Treatment consisted only of splenectomy and supportive care. Postoperatively, the patient's skin lesions and the fever, pancytopenia, and coagulopathy resolved. Marked proliferation of histologically benign macrophages was observed in dermal, splenic, hepatic, and lymphoid tissues; leukophagocytosis and erythrophagocytosis were clearly demonstrated. This illness is most consistent with cytophagic histiocytic panniculitis, a newly described syndrome.
Two-thousand, five-hundred and twenty-four bacterial isolates were tested against 11 new beta-lactam antibiotics in a prospective study conducted in a cancer center. E. coli, P. aeruginosa, and K. pneumoniae were the most common gram-negative organisms isolated, while S. aureus and Enterococcus were the most common organisms among the gram-positive. The new cephalosporins were more active than the semisynthetic penicillins against E. coli, P. aeruginosa, and K. pneumoniae (p less than 0.001). Mezlocillin had better activity than the other semisynthetic penicillins against most of the gram-negative organisms as well as the enterococci. As a result, mezlocillin was preferred as a beta-lactam agent to be employed with an aminoglycoside as empiric antibiotics for febrile patients with neoplasia.
A commercial kit (Cordia-IC) from Cordis Laboratory, Miami, Fla., was compared with the Raji cell radioimmunoassay for its ability to detect circulating immune complexes (CIC) in sera from 30 control subjects and 118 patients with infectious diseases. The 118 patients were categorized into the following groups: (i) 23 patients with bacterial endocarditis, (ii) 41 patients with bacteremia from an infected intravascular catheter or access device, and (iii) 54 patients with Staphylococcus aureus bacteremia related to a deep tissue infection. The Cordia-IC was comparable to the Raji cell radioimmunoassay in intraassay variability (4.0 versus 8.0%) and interassay reproducibility (8.7 versus 20.0%). Neither assay found CIC amounts above 12.5 micrograms equivalents (eq) of aggregated human gamma globulin (AHG) per ml in any of the 30 control individuals. In group 1, Cordia-IC detected 19 of 23 positives (mean, 73.6 micrograms eq of AHG per ml), whereas the Raji cell detected 16 of 23 positives (mean, 54.8 micrograms eq of AHG per ml). In group 2, Cordia-IC detected 19 of 41 positives (mean, 20.6 micrograms eq of AHG per ml), whereas the Raji cell detected 16 of 41 positives (mean, 15.1 micrograms eq of AHG per ml). In group 3, Cordia-IC found 38 of 54 positives (mean, 28.0 micrograms eq of AHG per ml), whereas the Raji cell found 32 of 54 positives (mean, 23.9 micrograms eq of AHG per ml). Statistically, these findings were not significantly different in any of the three patient groups (P> 0.15), and there was an overall good correlation between the results obtained by the two assays (r+0.64, P<0.001). The Cordia-IC provided a suitable assay for the detection of CIC and might find application in routine clinical laboratories.
A case report of photosensitive recurrent erythema multiforme occurring in a 31-year-old man is presented herein. Lesions clinically and histologically resembling erythema multiforme were reproduced with light testing. The patient's lesions appeared to respond to both oral prednisone and hydroxychloroquine.
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Thirty-five men with chancroid were randomly treated with oral sulfisoxazole, sulfisoxazole and tetracycline, sulfamethoxazole-trimethoprim, or intramuscular streptomycin. The highest rate of cures were obtained in 13 of 13 patients treated with streptomycin and in ten of ten patients treated with sulfamethoxazole-trimethoprim. Only seven of nine patients treated with sulfisoxazole and five of eight treated with sulfisoxazole and tetracycline were cured. We conclude that the sulfamethoxazole-trimethoprim combination is as efficacious as streptomycin and probably superior to sulfisoxazole and tetracycline in the treatment of chancroid.
A case report of a gonococcal pustule of the middle finger, presumably acquired from digital-genital contact, is presented herein. Gram stain and positive culture of the contents confirmed the diagnosis. The lesion resolved with drainage of the pustule and did not require systemic antibiotic therapy.
One hundred twelve apneic spells of at least 4 seconds' duration were monitored in 15 neonates; 77 episodes were associated with convulsive discharges on the electroencephalogram and 35 were not. Convulsive apnea did not occur in conjunction with bradycardia. Nonconvulsive apnea of less than 20 seconds' duration occurred in the presence of variable heart rates, but nonconvulsive apnea of 20 seconds or longer was nearly always associated with bradycardia.
Malignancy may be associated with impairment of the immune system. In children with acute leukemia, an impaired immunoglobulin M (IgM) antibody response to poliovirus was documented previously. It was of interest, therefore, to determine the immunoclass of antibodies produced against the O antigens of bacteria causing bacteremia in patients with leukemia and other malignancies. For control purposes, parallel studies were carried out in patients without maligancies but with infections caused by gram-negative bacteria. The patients with malignancies were adults, and those without malignancies were children. The serum specimens were selected from patients mounting an antibody response. IgG and IgM antibodies were identified by mercaptoethanol reduction and chromatography. Antibody titers against the O antigens of enteric bacteria were determined by the hemagglutination procedure. Antibodies of both IgM and IgG immunoclasses were produced by all but 1 of 16 patients with leukemia and by all but 1 of 12 subjects with other malignancies. Thus, a specific IgM immune deficiency in adult patients with leukemia or other malignancies complicated by bacteremia was not present; however, the magnitude of the antibody response of the patient with leukemia was less than that of the subjets with other maligancies, with the median antibody titers of the former being 320 and those of the latter being 2,560.
The association of Fanconi's anemia (FA) and growth hormone (-gh) deficiency is not commonly reported. These children may have the typical features of the FA syndrome, or may exhibit much variability in clinical and hematological findings. In a single family, members may have FA with or without GH deficiency. The genetic basis for this heterogeneity is unknown. We describe here two siblings with FA, one of whom had dwarfism due to GH deficiency. Combined treatment with GH and androgen (oxymetholone) resulted in strikingly greater acceleration of growth than did the use of GH alone. Pancytopenia was not influenced by hormone therapy.
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The antibody response to the O antigens of the patients' own gram-negative bacteria causing bloodstream infection in patients with malignancies was investigated using the hemagglutination test. Of the 87 patients, 42 (48%) produced specific antibodies in significant titers. Differences were noted between the various microorganisms. Of 44 patients with E. coli bacteremia 26 (59%) had an antibody response, whereas only 5 (33%) out of 15 subjects with Pseudomonas aeruginosa infection did. The antibody response of patients with solid tumors (61%) was significantly better than that of subjects with RES malignancies (30%). Documentation of the humoral immune response of patients to isolates from blood cultures excludes laboratory contamination and supports the relevance of the isolated microorganisms. Thus, for diagnostic purposes documentation of the immunoglobulin response supplements bacteriologic findings.
Three cases of an unusual Pseudomonas skin infection acquired from a health spa whirlpool were reported, and an epidemiologic survey showed 17 additional cases. This dermatosis is characterized by the abrupt onset of urticarial papules and superficial and deep papulopustules that spare only the head and neck and occur eight to 48 hours after using the whirlpool. Cultures from one patient's pustules and from the spa whirlpool environment were positive for P aeruginosa, serotype O-11. The condition cleared in all but one patient, without treatment, within seven to ten days. This patient continues to have recurrent follicular pustules three months after exposure. Samples from whirlpools at six other selected establishments were also positive for P aeruginosa.
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In a Caucasian woman who had had a giant follicular lymphoma for 21 months a small lesion developed in the upper lobe of the left lung. Excision, histologic study, and culture of the lesion were performed. Of the many stained sections, only one revealed endospore-containing spherules within the caseous necrosis of a granuloma, and only four spherules were identified. On agar medium the same tissue yielded a fast-growing fungus that produced arthrospores alternating with empty cells, typical of Coccidioides immitis. The arthrospore suspension was inoculated intraperitoneally into a mouse and into a medium of human pleural fluid at 40 C. Spherules containing endospores developed in the internal organs of the mouse and in the pleural fluid medium. The phylogeny of C. immitis is briefly discussed.