Biomedical subjects
Publications and source records attributed to R B Odom.
Transepithelial elimination of granulomas was observed in histologic specimens taken from involved skin of a patient with disseminated tuberculosis and two patients with sarcoidosis. This phenomenon, previously also observed in other granulomatous disorders, represents one of the skin's several mechanisms to rid itself of endogenous or exogenous waste material.
We report a case of fixed drug eruption secondary to sulindac (Clinoril). Owing to the drug's current popularity we believe that physicians should be made aware of this phenomenon. We present a patient who had the unusual feature of hypopigmentation associated with healing of his lesion. A brief review of clinical features and pathophysiology of fixed drug eruption is also presented.
Papulosquamous diseases are a heterogeneous group of disorders whose etiology primarily is unknown. The nosology of these disorders is based on a descriptive morphology of clinical lesions characterized by scaly papules and plaques. The major entities in this group include psoriasis, parapsoriasis (including pityriasis lichenoides et varioliformis acuta), lichen planus, lichen nitidus, lichen striatus, pityriasis rosea, pityriasis rubra pilaris, seborrheic dermatitis, and the Gianotti-Crosti syndrome. Many other conditions may become papulosquamous and should be considered in the differential diagnosis.
Pyomyositis, better known as tropical pyomyositis in other areas of the world, is a relatively rare condition in temperate climates such as the United States. The disease is a bacterial infection of muscle with abscess formation usually caused by Staphylococcus aureus. Skin findings are rare until late in the course of the disease. We present a 3-week-old male infant in whom skin findings were an early presentation. This is the first known case of pyomyositis in a neonate in the United States and the only known case of pyomyositis reported in the dermatologic literature. A high index of suspicion is needed, because considerable delay in accurate diagnosis can occur.
Menkes's syndrome (trichopoliodystrophy) is an x-linked, recessive genodermatosis characterized by hair defects, severe retardation, convulsions, progressive neurologic deterioration, and early death. Recent studies in copper metabolism suggest that Menkes's syndrome may be a storage disease in which copper is irreversibly trapped in some tissues by metallothionein, a heavy-metal-binding protein. This then gives rise to a deficiency elsewhere, particularly in the brain, causing irreversible damage in the fetus. We present a patient with Menkes's syndrome and review the clinical and metabolic aspects of this disease.
A new case of infantile acropustulosis and a review of previous cases disclose an uncommon pustular dermatosis that occurs primarily in black male infants. This condition consists of intermittent and recurrent crops of intensely pruritic, 1- to 3-mm vesiculopustules that appear predominantly on distal extremities. The onset is from birth to 1 year of age, with spontaneous resolution occurring between the ages of 2 and 3 years. This eruption does not respond to routine therapies, and the only effective treatment has been dapsone. Because similar clinical features have been found in several other pediatric cutaneous diseases, we discuss the differential diagnosis.
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Increasing numbers of persons are undergoing bone marrow transplantation for severe aplastic anemia and hematologic malignant neoplasms, and the proportion of those surviving has increased. Graft-v-host disease (GVHD) will, therefore, be seen with increasing frequency in the future. Graft-v-host disease occurs when immunocompetent donor lymphoid cells recognize and attack antigens of the immunocompromised host. We describe the clinical and histologic appearance of the different types of GVHD and discuss treatment, pathogenesis, and prevention of this entity.
White piedra, a fungal infection caused by Trichosporon cutaneum, has been reported in Europe, South America, and the Orient. A few cases have also been reported in the United States, all of them acquired as well in this country. A patient whose condition was diagnosed in California apparently contracted white piedra while visiting Panama, demonstrating that tropical diseases may occasionally be found at great distances from their point of origin. Therapy with topical clotrimazole and removal of infected hairs by shaving failed to produce a clinical or culturally confirmed cure in this patient.
Two patients with bullous pemphigoid treated with erythromycin demonstrated improvement. This response suggests that erythromycin may be a fairly safe supplemental drug which may allow a lower dose of systemic steroid, or may be of benefit when used alone or in combination with topical steroids in treating patients who are not ideal candidates for a systemic steroid. Erythromycin appears to have a significant anti-inflammatory effect, and possible mechanisms for this effect are proposed. One of the patients was a 4 1/2-year-old girl whose disease manifested several unusual features, making diagnosis difficult. A brief summary of differential immunofluorescent findings in childhood bullous diseases is also presented.
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A 65-year-old man had a diffuse, asymptomatic, cutaneous eruption of 5- to 15-mm reddish-brown, nonscaling papules in arcuate, annular, and serpiginous patterns for one year. The morphologic, light microscopic, and ultrastructural features of the skin lesions were typical of multicentric reticulohistiocytosis; however, the patient had no historic, clinical, laboratory, or roentgenographic evidence of arthritis. Spontaneous involution of the eruption occurred 17 months after onset. Several weeks later subacute myelogenous leukemia developed. The reported occurrence of isolated and multiple reticulohistiocytomas, diffuse cutaneous reticulohistiocytosis without systemic involvement, and multicentric reticulohistiocytosis with identical light microscopic and ultrastructural findings suggests that these conditions probably represent a spectrum of clinical expressions of similar etiologic and pathogenetic mechanisms.
Keratoacanthomas (KAs) in 14 patients were treated with 20% fluorouracil ointment, two or three times daily, for two to four weeks. All lesions responded promptly and cleared in an average period of 3.4 weeks (range, one to seven weeks). Allergic contact dermatitis to fluorouracil occurred in two patients. This treatment response suggests that topical application of fluorouracil ointment is an effective alternative to conventional methods of treating KA.
A 35-year-old man had the insidious onset of an asymptomatic cyst-like swelling of the auricle. Serous fluid was evacuated but continued to reaccumulate. Application of a pressure dressing resulted in resolution without deformity. Distinguishing features of seroma, pseudocyst, and hematoma are discussed.
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