1/419. Cutaneous manifestations of disseminated cryptococcosis. Five patients with disseminated cryptococcosis had lesions on the extremities resembling cellulitis, which evolved into areas of blistering and ulceration in three patients. All had underlying disease and were medically immunosuppressed. Disseminated cryptococcosis appears to present with cellulitis or herpes-like vesiculation more commonly than is currently appreciated. india ink preparations of aspirates from areas of cellulitis or Tzanck preparations from blisters may show characteristic organisms, and make possible an immediate diagnosis of cutaneous cryptococcosis. If cutaneous infection is confirmed by performing biopsies and growing cultures, dissemination must be presumed and the patient treated with a full course of systemic antifungal therapy. With increasing awareness of cutaneous involvement, some cases of disseminated cryptococcosis will be diagnosed sooner, leading to earlier therapy and improved prognosis. ( info) |
| Protothecosis is an infection caused by achloric algae of the genus prototheca. These organisms have been isolated from water, sewage, soil, and the slime flux of trees, and are a known cause of disease in other mammals. Infection in humans occurs after traumatic inoculation, producing localized olecranon bursal or, rarely, systemic disease. Only two previous cases of disseminated cutaneous disease have been reported in patients with defective neutrophil function. We describe a rare case of widespread cutaneous dissemination occurring after an arthropod bite in an immunocompromised patient. ( info) |
3/419. Cutaneous infections by papillomavirus, herpes zoster and candida albicans as the only manifestation of idiopathic CD4 T lymphocytopenia. BACKGROUND: Selective depletion of CD4 T lymphocytes is common in both primary and secondary immunodeficiencies. Idiopathic CD4 T lymphocytopenia (ICL) cases are defined as a persistent CD4 T lymphocyte count of less than 300x10(6) cells/L and/or less than 20% of the total T-cell count. METHOD: A 40-year-old woman, with a history of psoriasis and paracetamol allergy, presented with persistent warts of the hands and condylomas of the ano-genitalia. Histological and virological analysis was carried out on genital and cutaneous lesions and peripheral blood. RESULTS: serology for hiv-1, hiv-2, Epstein-Barr virus and parvovirus B19 were negative. There was lymphopenia of 10% CD4 cells, with normal numbers of total leukocytes; there were no other-abnormal immunological findings. dna analysis of cutaneous lesions revealed HPV-49 and HPV-3 in the hands and HPV-6 in the genital region. CONCLUSIONS: The cause of the ICL in this patient is unknown. HPV is not known to be an immunosuppressive agent; it remains to be determined whether the HPV-associated lesions are the cause or the result of immunosuppression. ( info) |
| Oral cefadroxil in doses of 0-6-1-8 g per day given on twice or three times daily schedules was effective in the treatment of thirty-six patients with infections such as abscesses, carbuncles, cellulitis, furunculosis and impetigo. staphylococcus aureus strains and beta-haemolytic streptococci, alone or in combination, were cultured from lesions before treatment. in vitro studies with test discs showed that all the organisms were sensitive to cefadroxil, but twenty-three of twenty-nine S aureus strains and one of the seven streptococci strains were resistant to penicillin g. Pre- and post-treatment laboratory tests of renal, hepatic and haematopoietic functions produced no evidence of drug toxicity. The cefadroxil dosage effective in this study is lower than that recommended for currently available oral cephalosporins, which must be given on a four times daily schedule. ( info) |
5/419. mycobacterium marinum infection from a tropical fish tank. Treatment with trimethoprim and sulphamethoxazole. A paronychial granuloma on the left thumb, in a man who kept tanks of tropical fish, was followed by cutaneous nodules on the left upper limb and tender lymph nodes in the left axilla. mycobacterium marinum was isolated from the lesion on the thumb and also from the tank water. Subsidence of the lesions followed administration of trimethoprim and sulphamethoxazole. ( info) |
6/419. Perineal reconstruction for severe sequela of ecthyma gangrenosum: report of a case. ecthyma gangrenosum is a cutaneous gangrenous disorder which usually follows Pseudomona aeruginosa infection and is found mainly in immunosuppressed children. We describe a case of a five-year-old female with leukemia with a severe perineal ecthyma gangrenosum resulting in a cloaca-like deformity. One year later a perineoplasty with puborectalis interposition and overlapping external anal sphincteroplasty was successfully performed, achieving satisfactory continence. ( info) |
7/419. Reconstruction of large defects in the scalp with fasciocutaneous flaps. Although recent reports have emphasised free microsurgical transfer for reconstruction of extensive defects in the scalp, in our experience a carefully planned scalp flap is a simpler and safer method than a free transfer. Twenty-one patients with defects as large as 10%-60% of the scalp surface area were reconstructed; the calvarium was resected in five cases and the dura mater in two. In 18 cases the flaps were based on a single pedicle: the superficial temporal artery. In three cases the blood supply of the flaps was based on three major homolateral arteries: the superficial temporal, the posterior auricular, and the occipital. The blood supply of all scalp flaps was based on the interconnected network of the aponeurotic plexus and the pedicles were included into flap in 18 cases. The principles of fasciocutaneous flaps were applied for all 21 scalp flaps. The reconstruction of the skull was delayed in all cases, and the dura was replaced by free autogenous periosteum. The donor area was covered with a skin graft in all cases. In all patients the aesthetic and functional results were considered excellent by them and by us. There were no postoperative complications. ( info) |
8/419. case reports of nocardiosis in patients with human immunodeficiency virus (HIV) infection. INTRODUCTION: We present 4 local cases of nocardiosis in HIV-infected patients and discuss the diagnosis, clinical syndromes and therapy of nocardiosis. CLINICAL PICTURE: Two cases presented with pulmonary nocardiosis, one had a cervical lymph node abscess and one had disseminated nocardiosis with pulmonary, cerebral and soft tissue involvement. TREATMENT: Combination therapy is often employed. Sulphonamides or co-trimoxazole, amikacin, imipenen, minocycline and ceftriaxone are some of the drugs that could be used. OUTCOME: Outcome hinges on the early recognition and optimal treatment of this infection. CONCLUSIONS: Clinical presentations vary and diagnosis is difficult and frequently delayed. Nocardiosis should be suspected in patients who present with pulmonary lesions with soft tissue and/or cerebral abscesses. ( info) |
9/419. Type 1 diabetes mellitus masking primary antibody deficiency. A patient with a history of recurrent cutaneous and pulmonary infections, nephrotic syndrome, and an established diagnosis of type 1 diabetes was found to have unsuspected and unrecognised primary immunodeficiency. On review of the case, previous investigations pointed to the correct diagnosis over 10 years earlier. This combination of diagnoses has not previously been reported. The patient is now well on replacement intravenous immunoglobulin therapy, urinary loss of IgG having been specifically excluded before treatment. This case highlights how antibody deficiency can easily be missed despite an obvious infection history unless results are interpreted carefully and in context. ( info) |
10/419. Common and unusual cases seen by an inpatient dermatology consult service. This article describes common consult requests and presents case studies from the dermatology consult service of an academic hospital. ( info) |