1/7. Secondary cutaneous amyloidosis in disseminated superficial porokeratosis: a case report.Disseminated superficial porokeratosis (DSP) is a rare cause of secondary cutaneous amyloidosis. An 83-year-old male patient showed an increase in both size and number of DSP lesions after contracting pulmonary tuberculosis. The DSP lesions of the patient consisted of numerous annular eruptions on both sun-exposed and sun-protected areas, which occurred over a period of 20 years. Multiple skin biopsies were taken from normal or lesional/sun-exposed or sun-protected skin samples. Histopathologic examination included routine H&E stains, congo red stains, thioflavin-T stains and anticytokeratin antibodies (AE1, AE3). And the results were as follows; 1) Positive staining with congo red and thioflavin-T indicated an amyloid nature for the deposits, 2) confinement of the amyloid deposition just below the lesional epidermis (while sparing the neighboring uninvolved or distant normal skin) indicated some role of the lesional epidermis, and 3) positive staining with AE3 further indicated an epidermal origin-type II epithelial keratin-of the amyloid. We present a case of DSP with a local amyloid deposit, characterized by association of positive familial background, severe pruritus and pulmonary tuberculosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/7. Successful treatment of recalcitrant necrotizing eosinophilic folliculitis using indomethacin and cephalexin.A 56-year-old man presented with a 4-month history of a painful and pruritic eruption consisting of crusted plaques and blisters on his face, scalp and chest. The patient suffered from headaches and malaise but was afebrile. Two skin biopsies revealed an epidermis which was eroded and covered by locules of serum and neutrophils. In the underlying dermis, there was a marked mixed inflammatory reaction including lymphocytes, neutrophils and numerous eosinophils. There was exocytosis of eosinophils into several follicles with areas of follicular mucinosis. A diagnosis of necrotizing eosinophilic folliculitis was made based upon the clinical and histopathological findings. The diagnosis was supported by the rapid response to a combination of indomethacin and cephalexin. The patient has taken continuous indomethacin (with rabeprazole and misoprostol cover) and cephalexin for 2 years. If treatment is withdrawn he experiences a flare of his disease within 2 weeks. This case highlights the potentially chronic nature of this disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/7. Case 31: eosinophilia and pruritus.A 39-year-old man presented with a pruritic rash, abdominal pain, weight loss and eosinophilia. A subsequent emergency laparotomy disclosed the nature of his underlying illness and the cause of the eosinophilia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/7. Autoimmune progesterone dermatitis.Seven patients had autoimmune progesterone dermatitis. The morphological findings illustrate the polymorphous nature of the disease in which urticaria, erythema multiforme, and dyshidrosiform lesions were seen. recurrence of the eruption five to ten days prior to the menses with spontaneous resolution following the menses was present in all cases. Intradermal skin testing to progesterone was done to confirm the diagnosis. Six of the seven patients has a history of use of artificial progestational hormones prior to the beginning of their eruption. It is postulated that the artificial progesterones may have been the trigger for the development of their autosensitivity. Treatment with conjugated estrogens resulted in remission of the disease in five of the seven cases reported.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/7. Crusted (Norwegian) scabies in patients with AIDS: the range of clinical presentations.Crusted (Norwegian) scabies in AIDS patients can be manifested in both typical and atypical forms. Although the classic, hyperkeratotic, nonpruritic lesions are most common, reported cases have ranged in spectrum from crusting with pruritus to a pruritic, papular dermatitis to those resembling Darier's disease or psoriasis. We report two additional cases of crusted scabies in AIDS patients, one with typical crusted, hyperkeratotic though pruritic lesions and one with severe pruritis and rare papules, initially misdiagnosed as "pruritus of AIDS." Because of the extremely contagious nature of crusted scabies, as well as its potential for complete cure with appropriate therapy, a high degree of suspicion for this disorder should be maintained in AIDS patients, even when the lesions do not have the classical appearance. The discovery of crusted scabies, whether in its common or its atypical form should prompt testing for the human immunodeficiency virus (hiv).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/7. Unresectable malignant obstruction of the bile ducts.Over a 13-year period we encountered 135 patients with malignant obstruction of the bile ducts, and in 81 of these patients only palliative surgery was possible. The type of operation was largely determined by the site and nature of the obstruction and the condition of the patient. The operative mortality of palliative operation was 37%. Relief of jaundice or pruritus was obtained in 68%, and this figure included a number of patients who died in the first 30 days. The majority of survivors lived for between three and four months after operation, although occasional patients have lived for more than one year.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/7. Examination of cutaneous macroglobulinosis by immunoelectron microscopy.Cutaneous macroglobulinosis is a rare cutaneous manifestation of Waldenstrom's disease. Lesions are though to result from accumulation of macroglobulin in the dermis and are therefore called IgM storage papules. Ultrastructural findings in the previously reported cases were contradictory and the nature of the deposits was not established by electron microscopy. The purpose of this study was to analyse such deposits by the use of immunoelectron microscopy. A 60-year-old woman had multiple erythematous papules for 1 year. The histopathological changes consisted of plasmocytic infiltration of the dermis and eosinophilic deposits. The skin changes and other investigations led to a diagnosis of Waldenstrom's disease. Samples from normal and diseased skin were analysed by electron microscopy and by immunogold labelling with anti-IgM antibodies, after Lowicryl K4M embedding. An extracellular electron dense granular and filamentous material was observed in the mid- and upper dermis, between and within the collagen bundles. No periodicity was noted and no deposits were seen at the dermoepidermal junction. Immunoelectron microscopy showed a positive labelling located only on these deposits, in both normal-appearing skin and in lesions. In this patient, immunoelectron microscopy clearly demonstrated the presence of large amounts of IgM in the dermis, which were found in the lesions of cutaneous macroglobulinosis and in normal skin. These results suggest that the IgM storage papules result from a greater density of deposits rather than a site-specific accumulation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |