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Lymphoscintigraphic analysis in chromoblastomycosis.

BACKGROUND: One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema. METHODS: Lymphoscintigraphy was performed in seven patients with chromoblastomycosis, six with lesions in the lower limb and one in the upper limb. Tc-99 m dextran was injected into the interdigital spaces of the upper or lower extremities. The qualitative parameters analyzed were the visibilization of the lymph vessels and the lymph nodes, dermal backflow, and existence of collateral vessels. All patients were treated with the association of itraconazole and cryotherapy with liquid nitrogen. RESULTS: Three out of the 14 extremities examined had lymphedema clinically, and the lymphoscintigraphy showed abnormalities in the qualitative parameters; whereas these parameters were normal in the extremities without lymphedema. During the treatment of chromoblastomycosis, a second lymphoscintigraphy exam was performed on 10 limbs and did not show any improvement of the previous lymphoscintigraphic alterations. CONCLUSIONS: The qualitative lymphoscintigraphy was a reliable method to show the morphology of the lymph vessels and confirm objectively the diagnosis of lymphedema secondary to chromoblastomycosis. The association of oral itraconazole and cryotherapy did not modify the lymphatic alterations in chromoblastomycosis.

Adult↗

Recurrent erysipelas: risk factors.

BACKGROUND: Several systemic and regional risk factors have been described for erysipelas. However, those predisposing for recurrent episodes are not well defined. MATERIALS AND METHODS: We performed a retrospective analysis of 574 patients hospitalized in our institution during a 3 year period. The analysis included demographic, epidemiologic, and medical chart review data with special attention to background disorders. The patients with single and recurrent episodes of erysipelas were compared. RESULTS: The recurrent cases occurred mainly in the lower limb with several risk factors that were statistically more common than in the single episode group including overweight, venous insufficiency, lymphedema, tinea pedis, and previous regional surgical intervention or trauma. CONCLUSIONS: Patients with erysipelas, especially when it involves the lower limb, should be instructed to reduce weight, control venous insufficiency and/or lymphedema and to emphasize prevention and treatment of tinea pedis. The role of prophylactic antibiotics requires further study.

Adolescent↗

Case report. Tinea corporis purpurea.

We report a case of tinea corporis purpurea localized to a calf in a 36-year-old woman. The patient, who was also affected by mild superficial venous insufficiency of lower limbs, complained of intense pruritus. Microsporum canis was the aetiological agent. Clinically atypical varieties of tinea corporis were sometimes reported in the literature, particularly in HIV-positive patients, although they are uncommon in immunocompetent patients; in particular, tinea corporis purpurea is very rare.

Adult↗

Case Reports. Infection due to Scedosporium apiospermum in renal transplant recipients: a report of two cases and literature review of central nervous system and cutaneous infections by Pseudallescheria boydii/Sc. apiospermum.

Two cases of infections due to Scedosporium apiospermum in renal transplant recipients, one localized in the central nervous system, the other in the skin, are presented, and a literature review of 21 cases of central nervous system and cutaneous infections due to Pseudallescheria boydii/Sc. apiospermum is given.

Biopsy↗

Acral pityriasis lichenoides.

Two patients presented with acrally located papulosquamous lesions that were polymorphic and had an identical morphology to those of pityriasis lichenoides. The lesions remained localized to the feet and ankles for years. Multiple skin biopsies had the histopathological features of pityriasis lichenoides. In one biopsy syringotropic lymphocytes and early syringolymphoid hyperplasia were observed. This rare variant of pityriasis lichenoides may be under-recognized and misdiagnosed as it resembles a variety of papulosquamous disorders particularly psoriasis.

Administration, Topical↗

Pretibial myxoedema associated with Hashimoto's thyroiditis.

Pretibial myxoedema is a cutaneous mucinosis typically associated with Graves' disease, although it may also develop in subjects with non-thyrotoxic thyroid pathologies. This report presents a rare case of pretibial myxoedema occurring in a 58-year-old woman with biopsy-proven Hashimoto's thyroiditis. The hypothetical pathogenetic link between the two disorders is discussed with particular attention to the role of thyroid stimulating hormone receptor antibodies.

Biopsy↗

Elastosis perforans serpiginosa in an adult with Down's syndrome: report of a case with symmetrical localized involvement.

Elastosis perforans serpiginosa (EPS) is a rare perforating dermatosis in which elastic fibers extrude from the papillary dermis producing umbilicated papules, characteristically arranged to form arciform or serpiginous patterns on the skin. It can be observed in patients with Down's syndrome, in whom in some cases the disease has been reported to be more widespread and to run a longer course. We present the case of a 20-year-old girl with Down's syndrome, hypothyroidism, acne and hypertrichosis, who had a 2-year history of multiple atrophic lesions with an arciform pattern on the distal extensor portions of both thighs, histologically showing the typical features of EPS.

Adult↗

Erythema induratum of Bazin and Poncet's disease -- successful treatment with antitubercular drugs.

Erythema induratum of Bazin (EIB) is considered a tuberculide reaction and consists of recurrent painful nodules predominantly on the calves. Clinically it has common features with diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. Poncet's disease is a reactive arthritis that may accompany tuberculosis. We report a case of a young woman in which the simultaneous occurrence of erythema induratum of Bazin and Poncet's disease led to a clinical picture very similar to Löfgren's syndrome. The final diagnosis was obtained by polymerase chain reaction detection of mycobacterial DNA in a skin biopsy. A systemic therapy with tuberculostatic drugs led to the disappearance of symptoms. The presented case shows the usefulness of polymerase chain reaction diagnostics in EIB patients without other clinical signs of tuberculosis and a confusing combination of symptoms, and further confirms the presence of mycobacterial DNA in EIB lesions.

Adult↗