Biomedical subjects
Publications and source records attributed to J Toribio.
Eccrine angiomatous hamartoma is a rare cutaneous lesion. Histologically it is characterized by the proliferation of eccrine glands, vascular structures and occasionally other elements in the middle and deep dermis; we now report seven further cases of this condition, two with lipomatous involvement and also discuss its nosology.
A 74-year-old man presented with a tumor on his scalp that he had since birth. The authors observed a verrucous pink crusted plaque. The tumor was clinically diagnosed as nevus sebaceus and was removed. Histopathologic study showed, arising from nevus sebaceus, a lobular neoplasm with the classic features of trichilemmoma. Desmoplasia was present in the center of the trichilemmomatous area. This description is typical of a special, uncommon type of trichilemmoma that histologically mimics invasive carcinoma.
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Milia en plaque typically occurs in the retroauricular area. We report the case of an 84-year-old woman with this disorder occurring bilaterally in the submandibular region. The diagnosis was confirmed by histological examination.
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We performed a retrospective analysis of the records of 16 patients diagnosed in our dermatology service as Sweet's syndrome (SS), with the aim of describing their clinical findings and associations, and comparing our results with previous ones. The mean age was 51, and 82% were female. A previous infection was recorded in 5 cases (31%) (gastroenteritis, primary pulmonary tuberculosis, upper airways infection, wound infection, and streptococcal pharyngitis). Two patients (12%) suffered from a malignant neoplasia (acute myeloid leukemia and prostatic neoplasia), another patient had a coincident bout of acute ulcerative colitis with pyoderma gangrenosum, and a third one referred previous ingestion of diclofenac and intense sun exposure. Most patients had their lesions localized on the upper extremities (75%), fever was present in 8 cases (50%), arthralgia in six (37%), and erythema nodosum in five (31%). The most frequent laboratory finding was an elevated sedimentation rate (93% had values over 20 mm/h), and only 44% of patients had leukocyte counts over 10 x 10(9)/l. Urinanalysis was abnormal in one third of the patients, and chest roentgenograms, performed in ten patients, were all normal. Most of the patients were treated with low doses of oral prednisone (30 mg/day) with good results. The disease recurred in 25% of the patients.
We report a case of favus affecting the temporal region of the scalp in a 22-month-old boy. Mycological study of hairs and crusts identified Trichophyton mentagrophytes var. quinckeanum (T. quinckeanum), the causative agent of mouse favus. Treatment with oral griseofulvin led to healing.
The adherence of yeasts to oral mucous cells is one of the main characteristics of the pathogenicity of this fungus. We studied adherence by means of a radiometric test to improve the method. We compared a sample of 40 strains of Candida albicans isolated from the buccal mucosa of HIV-infected patients with 40 strains isolated from non-HIV patients. We found that buccally isolated C. albicans strains from patients in the initial stages of AIDS adhered to oral mucous cells less than the buccally isolated C. albicans strains from subjects without HIV infection. Adherence among the strains of HIV patients increased with the disease stage until it exceeded that of the normal subjects in proportion to the decrease in the CD4/CD8 ratio. The selection of resistant strains by the preliminary antifungal treatments gave us a partial explanation for this increase. Further research should be carried out to compare these results with those obtained from atypical strains and species with high pathogenic potential, such as Candida dubliniensis, which is frequently isolated from advanced AIDS, in order to prevent systemic infections in these patients.
Generalized (diffuse) plane xanthoma (GPX) is a normolipaemic xanthomatosis that is very frequently associated with a haematological disorder, and especially with monoclonal gammapathies, which it may precede by several months or years. Here, we report a case of GPX associated with idiopathic Bence-Jones proteinuria, a very rare type of monoclonal gammopathy of undetermined significance. To our knowledge, this association has not been previously described.
Hair follicle nevus has been variously defined as a specific type of neoplasm with follicular differentiation or as a synonym for trichofolliculoma; the latter view has predominated in recent years. We report a nodular lesion that was identified histopathologically as a hamartoma with follicular differentiation and that systematic serial sectioning showed not to be a trichofolliculoma. After reviewing previous descriptions of lesions diagnosed as hair follicle nevus, and in the light of our own observations, we believe that hair follicle nevus is a distinct type of adnexal hamartoma.
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A 42-year-old woman presented with a well-defined pruritic erythematous scaly plaque on the sole of each foot. The lesions, first noted about 15 years previously, were located in the medial plantar region and extended laterally. Mycological study revealed infection by Scopulariopsis brevicaulis. Treatment with oral itraconazole led to temporary improvement, but the symptoms returned after treatment had been stopped (presumably due to re-infection from ungual foci). Similar results were subsequently obtained with oral terbinafine. S. brevicaulis is an aetiologic agent of onychomycosis, panophthalmia following a penetrating eye injury and generalized infections in immunocompromised patients, but it is not considered as habitual fungal pathogen of the skin. Cutaneous lesions caused by S. brevicaulis are very rare. Our case was resistant to terbinafine and itracomazole.
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We report a case of and review the literature on eosinophilic ulcer of the tongue. This is a benign entity frequently unrecognized in clinical practice, with only occasional mention in the literature, the clinical signs of which are easily confused with those of squamous cell carcinoma. Although the histopathologic appearance of this entity is distinctive, its clinical course and rapid healing without therapy themselves constitute strong diagnostic clues, making diagnostic or therapeutic bloody methods generally unnecessary.
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Type 2 human immunodeficiency virus (HIV-2), originally confined to West Africa, has lately appeared with increasing frequency in Europe. Oral lesions affect a large proportion of patients with AIDS. Hairy leucoplakia (HL), a clinical expression of Epstein-Barr virus (EBV), is a lesion of the oral mucosa (usually the lateral margin of the tongue) that is observed in patients who are immunocompromised due to HIV or, more rarely, due to immunosuppressive medication or other causes. We review the definition, clinical signs, histopathology, diagnosis, prognosis and treatment of HL, and report the (to our knowledge) first detailed description of an HIV-2-seropositive patient with HL, which affected the lateral and dorsal tongue and was the first clinical sign of HIV infection (this patient was at that time only the second native Spaniard in whom unique HIV-2 infection had been detected). EBV detection and subtyping by in situ hybridization and polymerase chain reaction were performed in paraffin-embedded tissue from the HL lesion of the dorsal tongue; EBV-1 and EBV-2 were detected by the latter technique.