Paraneoplastic pemphigus in a patient with a thymoma

A 76-year-old woman, with a history of thymoma, presented with a painful extensive stomatitis, painful paronychia, lichenoid papules on the hands and superficial erosions on the neck and the trunk. Histological examination showed lichenoid changes, acantholytic blister formation and apoptotic keratinocytes. Direct immunofluorescence was positive for IgG both in the epidermal intercellular spaces and along the basement membrane zone. Indirect immunofluorescence was similarly positive in a pemphigus vulgaris pattern. There was only a partial response to intravenous corticoids. These findings allowed the diagnosis of paraneoplastic pemphigus. The diagnostic characteristics, histopathology and the differential diagnosis of this disease are discussed.     

Tinea capitis in Madagascar: a survey in a primary school in Antsirabe

BACKGROUND: Tinea capitis is a common infection among schoolchildren in developing countries. This condition is still under-reported in Madagascar. In order to assess the prevalence of Tinea capitis in Madagascar, we conducted a study in a primary school in Antsirabe, a town located in the country's high central territories. METHODS: Samples were taken from 210 children in the 4 school classes aged between 6 and 14 years. Only children with scaling lesions or with alopecia were sampled. No microsporic gray-patch ringworm was found in any of the children. Samples were obtained from a total of 83 children. Cotton swabs moistened with distilled sterilized water were rubbed on the children's scalps for 15 seconds and the scales thus collected were then seeded on 2 separate tubes of Sabouraud-Dextrose-Agar media containing chloramphenicol, one with and the other without cycloheximide. The tubes were incubated at a temperature of 27 degrees C for 4 weeks. All the micromycetes were identified (dermatophytes, yeasts and molds). RESULTS: Three species of dermatophytes were isolated: one anthropophilic species, responsible for black-dot ringworm (Trichophyton tonsurans), and 2 geophilic dermatophytes, unusual in human disease (Microsporum boullardii and Trichophyton terrestre). Of the 83 children sampled, 17 had 20 dermatophytes (in 3 children, 2 different species of dermatophytes were associated). We collected 15 Trichophyton tonsurans (2 Trichophyton tonsurans were associated with Microsporum boullardii, and 1 with Trichophyton terrestre), and 2 Microsporum boullardii. The prevalence of carriers of dermatophytes was 8 p. 100 for all children and 20.5% for the sampled children. DISCUSSION: Children in Madagascar, unlike those in Central Africa, do not develop microsporic gray-patch ringworm caused by Microsporum langeronii. However, they may present tinea capitis with small alopecic lesions, or they may frequently have Trichophyton tonsurans and seem to have healthy scalps. In contrast with Central Africa, where T. soudanense is the main cause of black-dot ringworm, and with North Africa, where T. violaceum is most frequently seen, these 2 species are not found in Antsirabe. Studies carried out in coastal regions with a more tropical climate could perhaps show other dermatophytes responsible for tinea capitis. Anthropophilic tinea capitis caused by Trichophyton tonsurans is endemic in the Antsirabe area. The lesions are inconspicuous with diffuse scaling, like those reported in surveys conducted in the USA. Mycological investigation followed up by topical treatment with a fungicide could diminish the spread of this anthropophilic, and thus contagious, dermatophyte. Trichophyton tonsurans has also reappeared regularly in France over the past few years.     

幼儿疥疮一例

患儿,男,3岁。臀部皮疹伴痒2个月余。皮肤科情况:臀部、双下肢、躯干可见红斑、丘疹、结节;阴茎可见单发暗红色结节。皮肤镜示:镜下可见隧道,隧道一端可见棕色小三角形结构。反射式共聚焦显微镜示:镜下可见开口于表皮的中高折光隧道结构;境界清楚疥螨虫体;椭圆形,轮廓清楚的虫卵结构;圆形高折光粪便结构。诊断:疥疮。     

Preliminary study of a Mycobacterium leprae bacterin vaccine in a human volunteer population in a nonendemic area

Seventeen volunteers who had never resided in areas with significant transmission of leprosy (Hansen's disease) were inoculated intradermally with 1.5 X 10(8) killed, purified armadillo-derived Mycobacterium leprae in a standardized preparation being tested for possible vaccine use. The peak of local skin responses, consisting of induration with or without ulceration similar to the post-lepromin Mitsuda reaction, occurred between the 21st and 28th days after injection. The maximum mean induration diameter was 17.2 mm, the minimum, 6.1 mm. Sera tested with the ELISA technique revealed no humoral response to either the sonicated bacilli, M. leprae-specific phenolic glycolipid I antigen, or three semi-synthetic analogues reactive with lepromatous patients' sera. The dose of M. leprae inoculated appeared to be safe and without unacceptable reactions at the injection site. One volunteer developed a generalized skin rash parallel to the local reaction, but the relationship of the former to the inoculation was unclear.     

Cryoglobulinemia in a child

Cryoglobulinemia is a rare condition. We report a case of cryoglobulinemia in 1.5-year-old boy, who presented with bluish black discoloration of hands and feet. Serum was positive for cryoglobulins. The serum cryoglobulin level was 70 μg/ml (normal <20 μg). Serum protein electrophoresis revealed the presence of M-spike. Serum immunofixation and assessment of clonality could not be done as these specialized investigations are not available here. Investigations did not reveal any systemic involvement. He was treated with anticoagulants, broad-spectrum antibiotics, and systemic steroids with which he recovered completely.     

Scleroedema in a Child

A 3-year-old Japanese girl with scleroedema was reported. She had had no signs of diabetes but did have a preceding bacterial infection in the tonsils three weeks before the skin lesion appeared. The skin on the face, shoulders, extensor aspect of the upper arms, and proximal half of the forearms was indurated. The skin lesions expanded from the middle part of the forearms to the wrists during the observation period. Thereafter, the induration gradually disappeared. A literature review revealed there were only six reports of scleroedema in children under 15 years old before 1996 in Japan; a total of 166 cases of the disease was reported in the same period. Five out of these six cases were not diabetes-associated. All but one of these six patients were female. Juvenile scleroedema seems to be rare in Japan.     

Trichoblastoma in a Child

Abstract:   A trichoblastoma is a benign adnexal neoplasm composed of follicular germinative cells. It most commonly presents as a solitary nodule on the scalp, face, or perineum and occurs equally in males and females. It is diagnosed most commonly between the fourth and the sixth decades, and it is extremely rare in childhood. To our knowledge there is no prior case report of a primary trichoblastoma occurring outside the setting of a nevus sebaceous of Jadassohn in a child before adolescence. Herein we report a case of trichoblastoma of the right cheek in an 11-year-old Korean girl.