11/410. HTLV-I associated infective dermatitis may be an indolent HTLV-I associated lymphoma. When present for a first time blood donation, a 28-year-old Brazilian white female reported a pruritic eczema of the scalp and retroauricular areas since childhood that had been frequently infected. Her mother had been diagnosed as having HTLV-I-associated myelopathy (HAM), and the patient was found to be a human T-lymphotropic virus type-I (HTLV-I) carrier. The patient had been breast-fed for 6 months. The patient had a complete examination, and a biopsy was taken from eczema in the retroauricular area. The biopsy indicated chronic lymphohistiocytic dermatitis with no abnormal lymphocytes. Eleven months later, the patient had an infiltration in the skin of the retroauricular area and a new biopsy revealed atypical lymphocytes. Nested polymerase chain reaction (PCR) was positive for HTLV-I and immunohistochemistry of the tissue at this time confirmed adult T-cell leukemia/lymphoma (ATLL). Retrospective immunohistochemistry showed that the first fragment submitted from the biopsy 11 months before was also compatible with the diagnosis of ATLL. This case fulfilled all major criteria for diagnosis of HTLV-I-associated infective dermatitis (HTLV-I-ID). We postulate that the patient had indolent ATLL associated with HTLV-I infective dermatitis since childhood. We recommend that tissue immunohistochemistry analysis be done in any patient with HTLV-associated infective dermatitis. ( info) |
| Cutaneous lesions arising in herpes zoster (HZ) scars are rare. We report a 34-year-old woman with acute lymphoblastic leukemia underwent allogenic bone marrow transplant (BMT). Ten days after the BMT, she developed clusters of vesicles over the right neck, scapula, shoulder and chest. She was treated with intravenous acyclovir and foscarnet. One month after the vesiculous episode of HZ she showed 5 mm to 2 cm clustered flat violaceous lichenoid papules and confluent plaques within the HZ scars. Histopathologic examination revealed a inflammatory infiltrate present in the papillary dermis with granulomatous aggregated formed by histiocytes, multinucleated giant cells and lymphocytes. She was treated with topic steroids with significant improvement. Pathologic findings are similar to those of an unusual lichenoid reaction named "giant cell lichenoid dermatitis". We present the first reported case of giant cell lichenoid dermatitis at the sites of HZ scars. ( info) |
13/410. Delayed generalized allergic reactions to corticosteroids. A 37-year-old patient presented with a severe allergic local reaction upon inhalation of budesonide for asthma. skin tests were positive for budesonide and amcinonide (group B) and elicited a strong local reaction and a disseminated macular exanthema. Corticosteroids from other groups were well tolerated. A 38-year-old male patient had first an allergic contact dermatitis to topically applied prednisolone acetate and then a disseminated eczematous exanthema upon oral intake of prednisone. A delayed-type sensitization to corticosteroids from group A such as hydrocortisone, prednisone and tixocortol pivalate was identified. A detailed diagnosis in patients with allergic reactions to corticosteroids is crucial with regard to their use in emergency therapy. ( info) |
| Reports of histologically proven low-dose methotrexate (MTX)-induced vasculitis are uncommon and mostly found for patients with rheumatoid arthritis. Herein we present a patient with ankylosing spondylitis who developed large atypical erythematopurpuric cutaneous lesions after the second oral dose of 7.5 mg MTX therapy. The histological findings of a cutaneous lesion were consistent with vasculitis. The skin lesions regressed significantly after the discontinuation of MTX therapy. As the clinical picture of the patient's rheumatological condition became progressively severe, prednisolone therapy was initiated 8 days later and the skin rash resolved completely in a couple of weeks. ( info) |
15/410. Treatment of self-mutilation with olanzapine. BACKGROUND: Self-mutilation or dermatitis artefacta is a facet of a much broader spectrum of factitial disease. Three nonpsychotic patients with self-mutilation are presented in this article who were successfully treated with low dose olanzapine when all other modalities of therapy had failed, including trials with numerous antidepressants and antipsychotics. OBJECTIVE: The patients were simultaneously evaluated and treated by a dermatologist and a psychiatrist who run the psychodermatology or consultation-liaison clinic based at McMaster University. After dermatologic conditions had been excluded as a cause of the clinical findings, olanzapine was prescribed on a trial basis due to its low risk of parkinsonian side-effects and its antihistaminic properties. CONCLUSIONS: The excellent clinical response of the patients can be attributed to the low side-effect profile of the drug but also to the anti-impulsive effect which stems not only from antihistaminic properties but also from its antidopamine and serotonin-blocking action. ( info) |
| A case of dermatitis caused by the Northern fowl mite is presented. Fowl mites and their clinical significance are discussed. ( info) |
17/410. Avian mite bites acquired from a new source--pet gerbils: report of 2 cases and review of the literature. BACKGROUND: Cutaneous manifestations of avian mite bites are not well recognized by physicians or patients. Clinical signs and symptoms are usually caused by bites from avian mites that have infested domestic poultry or birds nesting in or near human habitation. This report details 2 cases of pruritic papules acquired from avian mites that had infested pet gerbils and reviews the dermatologic literature about avian mites. OBSERVATIONS: An 11-year-old boy and an unrelated 10-year-old girl each had mysterious, pruritic papules for many months before their pet gerbils were found to be infested with Ornithonyssus sylviarum (the northern fowl mite) and Dermanyssus gallinae (the chicken mite), respectively. Symptoms resolved when the gerbils were removed from the home. CONCLUSIONS: Because infestation of pet gerbils with avian mites has never been reported, cases of avian mite bites and dermatitis may have gone unrecognized or misdiagnosed. Inquiry about ownership of pet gerbils may be helpful in patients with mysterious bites. ( info) |
18/410. Marjolin's ulcer presenting in the neck. 'Marjolin's ulcer' is a term that has come to be used for epidermal squamous cell carcinomas that have developed in areas of chronic inflammation. To our knowledge this is the first ever report of a Marjolin's ulcer developing following long-term irritation of the skin of the neck. The history of the eponym is traced and reveals that Marjolin probably never actually described this pathological process. ( info) |
19/410. The CINCA syndrome: a rare cause of chronic arthritis and multisystem inflammatory disorders. Chronic infantile neurological cutaneous articular (CINCA) syndrome is a rare disorder with neonatal onset characterised by a chronic progressive inflammatory process with skin rash, articular and central nervous system involvement. This primary systemic inflammatory disorder should be distinguished from juvenile rheumatoid arthritis (JRA). Although the articular findings are characteristic features of CINCA syndrome, there is a certain degree of variability in the articular involvements which are not always symmetrical nor is the degree of severity uniform. The etiology of CINCA syndrome remains unknown. No single treatment has been found to be effective. This syndrome is known in the American medical literature as infantile onset multisystem inflammatory disease (IOMID). ( info) |
20/410. Human T-cell lymphotropic virus-1-associated renal disease in Jamaican children. This report documents the clinicopathological features in two Jamaican children who presented with infective dermatitis, glomerulonephritis, renal failure and human T-cell lymphotropic virus (HTLV-1) seropositivity. Severe hypertension with hypertensive encephalopathy was the most impressive clinical feature. Histological findings from renal biopsy specimens in both cases revealed significant glomerulosclerosis with fibrosis, chronic inflammatory cell infiltrates in the interstitium, and arteriolar hypertensive changes. Membranoproliferative glomerulonephritis (MPGN) was demonstrable in case 1 and marked focal glomerulosclerosis in case 2. Case 1 developed end stage renal failure and died within 3 years of diagnosis. Case 2 remains hypertensive and in chronic renal failure. Although a causal relationship between HTLV-1 infection and renal disease cannot be proven by these two cases, it appears that renal involvement in children with HTLV-1 infection is severe, with the potential for chronic renal failure and malignant hypertension. HTLV-1 nephropathy should be suspected in children with infective dermatitis and renal disease. ( info) |