Primary cutaneous coccidioidomycosis in agricultural workers.

Each of two Filipino agricultural workers experienced coccidioidal infection, characterized by a solitary skin lesion, by regional lymphadenopathy, and by a benign clinical course, without evidence of involvement of the lungs or other viscera. It is believed that these are cases of primary cutaneous coccidioidomycosis incurred under "natural" conditions. A similar interpretation seems acceptable for at least six other reported cases.     

Disseminated cutaneous coccidioidomycosis masquerading as lupus pernio

Coccidioides immitis, a pathogenic fungus endemic to arid regions, is the etiologic agent of cutaneous coccidioidomycosis. Primary cutaneous coccidioidomycosis is rare. The majority of cutaneous coccidioidomycosis infections are caused by dissemination of the fungus from the lungs to the skin. Diagnosing cutaneous coccidioidomycosis often can be difficult because it can mimic a variety of other clinical conditions. We present a case of a 45-year-old man presenting with cutaneous coccidioidomycosis on the tip of his nose. This patient had pulmonary symptoms in addition to his cutaneous findings, leading to a diagnosis of disseminated coccidioidomycosis.     

Primary cutaneous coccidioidomycosis. Reevaluation of its potentiality based on study of three new cases.

The data derived from these three young patients would indicate the need for: (1) Early recognition of the primary cutaneous skin infection as being due to Coccidioides immitis. (2) The prompt use of suppressive intravenous amphotericin B therapy until such time as local tissue resistance and systemic immunity become manifest and sufficient to contain the pathogenic fungus within the initial cutaneous site of infection as manifested by complete healing of this primary lesion and its associated lymphadenopathy. It is apparent that there is a need to reassess present concepts which have been based on insufficient data, and to revise conclusions derived from the study of the eight previously reported instances of primary cutaneous coccidioidomycosis. The traumatic cutaneous inoculation of C immitis into a previously uninfected person, contrary to earlier impressions, can result not only in prolonged illness but in serious dissemination of the disease, and in one reported instance has resulted in coccidioidal meningitis.     

Clinicopathologic spectrum of specific cutaneous lesions of disseminated coccidioidomycosis.

BACKGROUND: Disseminated coccidioidomycosis merits greater attention because the number of persons living and traveling in endemic areas is increasing. OBJECTIVE: Our purpose was to study the clinical and histopathologic findings in patients with specific cutaneous disseminated coccidioidomycosis. METHODS: In six patients with specific skin lesions of disseminated coccidioidomycosis, the diagnosis was confirmed by identification of the organism in tissue or by positive results of tissue culturing. RESULTS: Clinical lesions included solitary granulomatous plaques in two patients and multiple papular, nodular, or pustular lesions in four patients, two of whom also had subcutaneous abscesses. Identifying organisms directly in tissue was possible in only 8 of 17 biopsy specimens and in five of six patients. The histopathologic features showed various degrees of three primary patterns: (1) abscess formation with necrosis, (2) epithelial hyperplasia and granuloma formation with microabscesses, and (3) vascular and perivascular proliferative and inflammatory cell reactions at times suggesting vasculitis. Tissue eosinophilia, present in all patients, was striking in two (eosinophilic abscess formation) and notable in another (vascular inflammation with eosinophilia). CONCLUSION: Cutaneous manifestations of disseminated coccidioidomycosis may be more common and varied than usually recognized.     

Successful treatment of relapsing disseminated coccidioidomycosis with cutaneous involvement with posaconazole

A 52‐year‐old woman with pulmonary sarcoidosis on immunosuppressive therapy developed pulmonary infiltrates and cutaneous granulomatous abscesses after a trip to the USA in April 2005. A hyphomycete was identified, further characterized by a gene probe as Coccidioides spp. and then definitively identified as Coccidioides posadasii by polymerase chain reaction and sequencing. Antibodies towards Coccidioides spp. were detected. The infection was successfully treated with posaconazole (Noxafil^®), 2 x 400 mg/d.     

Primary cutaneous nocardiosis

A case of primary cutaneous nocardiosis due to Nocardia asteroides occurring in a steroid-dependent asthmatic with no history of trauma is presented. He had a 5 month history of painful nodules on his right shin and calf. He was initially treated with a 6 week course of oral cephalexin 500 mg four times daily, followed by a 2 week course of minocycline 100 mg twice daily with worsening of the infection. A 12 week course of oral clarithromycin 500 mg twice daily led to complete resolution. A discussion of the problems associated with antimicrobial susceptibility testing and nocardia resistance is presented.     

Primary cutaneous leiomysarcoma

Primary cutaneous leiomyosarcoma of the skin is a rare soft tissue neoplasm, accounting for about 2-3% of all superficial soft tissue sarcomas. It arises between the ages of 50 and 70 years, and shows a greater predilection for the lower extremities. Clinically, it presents with solitary, well-circumscribed nodule and, microscopically, consists of fascicles of spindle-shaped cells with "cigar-shaped" nuclei. Local recurrence is known in this tumor. We document a case of primary cutaneous leiomyosarcoma in a 77-year-old man and discuss the histological features and immunohistochemical profile of this uncommon neoplasm.     

Primary cutaneous Plasmacytomas

Primary cutaneous plasmacytoma arising in the skin is very rare. The case of a young man suffering from primary cutaneous plasmacytomas, without an underlying disorder, is reported. The clinical, histopathological, electron microscopical and laboratory findings from the case are described.     

Primary cutaneous leiomyosarcoma

Primary leiomyosarcomas of the superficial soft tissues are very rare neoplasms. Because of the different biological behaviour, they should be divided into cutaneous and subcutaneous tumours. Differential diagnosis includes leiomyomas, skin metastases from extracutaneous leiomyosarcomas, and other spindle-cell tumours of the skin. Ultrastructural and immunohistochemical investigations are useful when light microscopic features do not allow an unequivocal diagnosis. Although local recurrences develop in almost half the patients with cutaneous leiomyosarcomas, the prognosis is predominantly good. In contrast, metastatic spread is more common in patients with subcutaneous leiomyosarcomas. Treatment for superficial leiomyosarcomas consists in wide excision. We report on a 76-year-old women with a local recurrence of a primary cutaneous leiomyosarcoma.     

Primary cutaneous phaeohyphomycosis

A rare case of phaeohyphomycosis presenting with a solitary nodule on right lower leg of 2 years duration is being reported. The disease showed marked response to oral fluconazole.     

Primary cutaneous amyloidosis

Three cases of primary cutaneous amyloidosis are reported. Family history was negative. Systemic involvement was ruled out. Histopathology was confirmed by congored stain. Patients responded to oral colchicine.