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Allergic contact dermatitis and mercury exanthem due to mercury chloride in plastic boots.

We report a 5-year-old child with previous skin intolerance from Mercurochrome (merbromin), who developed a severe allergic contact dermatitis of both feet when wearing new polyvinyl chloride (PVC) boots. Within a few days, he developed a mercury exanthem involving both legs, groins and lateral parts of the trunk. Patch tests showed strong reactions to organic and inorganic mercury compounds, in particular to mercury chloride (mercury chloride; HgCl2), 0.01% pet., which was identified by atomic absorption spectrometry and polarography in the boots worn. New hidden sources of mercury in consumer goods may represent a potential source of danger for the future, if its use is not more strictly regulated.

Anti-Infective Agents, Local↗

Ultrastructural and immunological findings in Graves' disease with pretibial myxedema.

This is a report on a 67-year-old female patient with Graves' disease and extensive pretibial myxedema. Linear IgM deposits were observed in the basement membrane zone by direct immunofluorescence. These deposits were found, by immunoelectron microscopy, to be haphazardly distributed in the uppermost dermis without any correlation to preexisting structures. An amorphous material that coated not only the surface of fibroblasts and collagen bundles but was also present within the dilated endoplasmic reticulum of the fibroblasts was the predominating pathological finding at the ultrastructural level. Mast cells were morphologically normal. These results support previous in vivo and recent in vitro findings indicating that the fibroblast plays a major role in the pathogenesis of pretibial myxedema.

Aged↗

An ultrastructural study of pretibial myxedema utilizing improved ruthenium red stain.

A case of pretibial myxedema associated with Graves' diseases has been studied by electron microscopy utilizing an improved ruthenium red stain. An organized network of microfibrils with knobs were found within the widened interfibrous spaces. This network was clearly demonstrated by the ruthenium red stain, but only a weak trace could be observed when conventional staining techniques were utilized. Knobs of the network seemed to be composed of ruthenium red-positive granules which surrounded normal fibers and granules of degrading collagen fibers. Many fibroblasts showed dilated rough endoplasmic reticulum containing much amorphous material which indicated a significant role of fibroblasts in the pathogenesis of this disease.

Aged↗

Subcutaneous sarcoidosis with extensive caseation necrosis.

We report a 24-year-old male patient with sarcoidosis who developed subcutaneous nodules on his thighs and buttocks at the sites of repeated intramuscular injections. Histologically, there were extensive areas of caseation necrosis surrounded by typical sarcoidal granuloma. The nodules regressed spontaneously over a period of 4 months, concurrently, both his bilateral hilar adenopathy and the results of immunological tests, returned to normal. We think that these lesions developed at the sites of subcutaneous scar tissue induced by frequent injections in childhood. We believe the pathomechanism to be similar to that for scar sarcoidosis, and that the extensive caseation necrosis reflected a regressing stage of the disease.

Adult↗

The interstitial granulomatous drug reaction: a distinctive clinical and pathological entity.

We present 20 patients in whom drug therapy was associated with interstitial histiocytic infiltrates with variable degeneration of collagen and elastic fibers mimicking early lesions of granuloma annulare (GA). Most patients had a reproducible clinical presentation comprising erythematous-to-violaceous, nonpruritic plaques, often with an annular pattern, predominantly involving inner aspects of the arms, medial thighs and intertriginous areas. The most frequent clinical differential diagnoses included cutaneous T cell lymphoma, erythema annulare centrifigum (EAC), GA, and lupus erythematosus. A drug reaction was suspected in only 3 cases. The implicated drug classes included calcium channel blockers, angiotensin converting enzyme inhibitors, beta-blockers, lipid-lowering agents, antihistamines, anticonvulsants and antidepressants. Patients were often on two or more of these drugs; all have been associated with pseudolymphomatous infiltrates of the skin, the presumptive basis of which is iatrogenic pertubation of immune function. The defining histomorphology was diffuse infiltration of the interstitium by lymphocytes and histiocytes with piecemeal fragmentation of collagen and elastic fibers in concert with a vacuolar interface dermatitis. Ten cases showed intermediate and transformed lymphocytes with hyperchromatic convoluted nuclei disposed interstitially within the dermis or along the dermoepiderma junction with variable epidermotropism. In the 15 patients who discontinued the implicated drug, lesional resolution occurred. We propose the designations interstitial granulomatous drug reaction for this novel cutaneous reaction pattern.

Aged↗