Intravenous cidofovir-induced resolution of disfiguring cutaneous human papillomavirus infection

Human papillomavirus infection is one of the most common and most distressing cutaneous diseases in patients with HIV infection. It is also a common, and often therapeutically challenging, infection in individuals who are immunologically competent. A wide range of therapeutic options exists for treating cutaneous human papillomavirus infections, but none is uniformly effective. In this report we describe a man with HIV-1 infection and disfiguring facial verruca vulgaris who demonstrated complete clinical response to intravenous cidofovir. Our report provides further support for the use of intravenous cidofovir as therapy for treatment-resistant and/or widespread cutaneous human papillomavirus infection.     

Characteristics of cutaneous cytomegalovirus infection in non-acquired immune deficiency syndrome, immunocompromised patients

BACKGROUND: Although cytomegalovirus (CMV) disease is a severe complication among immunocompromised patients, its cutaneous features have not been frequently reported. As herpes simple virus (HSV) infection commonly develops in CMV skin lesions, a study is needed on the pathogenetic role of CMV in cutaneous lesion formation. OBJECTIVES: The purpose of this study is to characterize the clinical and histopathological features of cutaneous CMV infection and to determine whether CMV plays a true pathogenetic role in cutaneous lesions, or if it is just an innocent bystander during HSV infection among non-AIDS (acquired immune deficiency syndrome), immunocompromised patients. PATIENTS AND METHODS: A total of nine human immunodeficiency virus-negative patients diagnosed with cutaneous CMV infection from July 1999 to February 2005 at Samsung Medical Center were analysed in terms of their clinical and histopathological characteristics. In addition, we examined for the co-presence of HSV by performing immunohistochemical analysis and polymerase chain reaction. RESULTS: All the patients were immunocompromised; five had haematological diseases and four were organ transplant recipients. The clinical and histopathological features were similar to those of previous studies of patients with AIDS. Multiple anogenital ulcerations were the most frequent cutaneous presentation (66.7%). Most cytopathic changes were found in the dermis, particularly within the vascular endothelial cells (77.8%) and macrophages (66.7%). However, the association of CMV with concurrent HSV infection was even lower than that seen in patients with AIDS. Only one patient revealed a co-existing cutaneous HSV infection. CONCLUSIONS: In non-AIDS individuals, the cutaneous lesions from CMV infection showed similar clinical and histopathological features to those of patients with AIDS. However, skin lesions may not be highly associated with HSV, and CMV does seem to contribute to lesion development as a cutaneous manifestation among the CMV infected, non-AIDS, immunocompromised patients.     

Primary cutaneous Nocardia brasiliensis infection isolated in an immunosuppressed patient: a case report

Cutaneous nocardiosis is a rare infection that may manifest as a superficial skin lesion, lymphocutaneous infection, mycetoma, or diffuse cutaneous infection from a disseminated systemic infection. We report a case of a 65-year-old immunocompromised man with persistent primary cutaneous Nocardia brasiliensis infection following a motor vehicle collision. A high degree of suspicion is needed to diagnose Nocardia infection because of its resemblance to other bacterial infections. Nocardiosis should be included in the differential diagnosis of chronic cutaneous infections, especially when the response to antibiotics is inadequate or when the patient is immunocompromised. Because Nocardia may take several weeks to grow in standard bacterial culture media, laboratories should be notified of the suspicion so that culture plates are held for longer time periods. Long-term therapy, usually with sulfonamides, often is necessary.     

Cutaneous Leukocytoclastic Vasculitis due to Salmonella enteritidis in a Child with Interleukin‐12 Receptor Beta‐1 Deficiency

Abstract: Defects in the interleukin 12 (IL‐12)/interferon gamma (IFN‐γ) pathway result in Mendelian susceptibility to mycobacterial disease (MSMD). IL‐12 receptor beta 1 (IL‐12Rβ1) deficiency, the most common form of MSMD, is associated with weakly virulent mycobacteria and salmonella. Infections in patients with this deficiency are extraintestinal, or septicemic, recurrent infections with nontyphoid salmonellae. Here we report a case of an IL‐12Rβ1 deficiency with cutaneous leukocytoclastic vasculitis due to Salmonella enteritidis.     

Primary cutaneous aspergillosis in a patient with a solid organ transplant: case report and review of the literature

GOAL: To understand primary cutaneous aspergillosis to better manage patients with the condition. OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Describe risk factors for Aspergillus infection. 2. Identify diagnostic methods for primary cutaneous aspergillosis. 3. Discuss treatment options for primary cutaneous aspergillosis. Primary cutaneous aspergillosis is an uncommon disease in immunocompetent individuals that often affects immunosuppressed hosts. We present the first reported case of primary cutaneous aspergillosis in a solid organ transplant recipient caused by Aspergillus niger. Fruiting bodies were isolated from a necrotic ulcer arising in a surgical wound. Debridement alone failed to resolve the infection, emphasizing the need for early antifungal treatment combined with surgical management of this infection.     

Rosacea-Like Lesions due to Familial Mycobacterium avium-intracellulare Infection

Mycobacterium avium-intracellulare (MAI) is a non-tuberculous, nonlepromatous or "atypical" mycobacterium now seen frequently in patients with acquired immunodeficiency syndrome (AIDS). In the past decade, the incidence appears to have increased in non-AIDS patients. Although cutaneous involvement is rare, two brothers without detectable immune defects who both presented with cutaneous MAI infection are described; the older brother also has disseminated disease. The cutaneous presentation of MAI, as well as immune and genetic defects that may predispose to mycobacterial infection, are discussed.     

Cutaneous nocardiosis: report of two cases and review of the literature

Background Cutaneous nocardiosis is an uncommon infectious disease that presents as a primary cutaneous infection or as a disseminated disease. It is often misdiagnosed because of its rarity and nonspecific clinical picture. Methods We report a case of each type. The first case is an immunocompetent patient who was infected by Nocardia while gardening and developed a superficial skin infection – one of the three clinical manifestations of primary cutaneous nocardiosis. The second case is an immunocompromised patient with pulmonary nocardiosis that extended to the skin as part of a disseminated disease. Results The immunocompetent patient with primary cutaneous nocardiosis had the classical features of a superficial skin infection. He had a nodular–pustular lesion on the right arm, which appeared 7 days after gardening with bare hands. Nocardia was identified in a skin culture taken from a pustule, unfortunately not to the species level. Treatment with minocycline for 3 months resulted in full remission of the lesion. The immunocompromised patient with disseminated nocardiosis had high fever, productive cough, hemoptysis, and erythematous nodules and pustules on the extremities. N. brasiliensis was isolated from bronchial samples and skin. Treatment with a high dose of trimethoprim and sulfamethoxazole for five months resulted in full recovery from cutaneous and pulmonary complaints. No relapse of the infection was found on follow‐up in either patient. Conclusion These cases demonstrate the need for a high degree of suspicion, focused clinical search, and appropriate laboratory procedures in the diagnosis and management of cutaneous nocardiosis.     

Clinical patterns of cutaneous nontuberculous mycobacterial infections

BACKGROUND: Cutaneous nontuberculous mycobacterial infections result from external inoculation, spread of a deeper infection, or haematogenous spread of a disseminated infection. There are two species-specific infections (fish-tank or swimming-pool granuloma, due to Mycobacterium marinum, and Buruli ulcer, caused by M. ulcerans). Most infections, however, produce a nonspecific clinical picture. OBJECTIVES: To define clinical patterns of cutaneous disease in nontuberculous mycobacterial infections. METHODS: Fifty-one patients with cutaneous nontuberculous mycobacterial infections were reviewed. Clinical and histopathological features of normal hosts and immunosuppressed patients were compared. Two subgroups of immunosuppressed patients were distinguished: patients with cutaneous infection and patients with a disseminated infection and cutaneous involvement. RESULTS: In immunosuppressed patients the number of lesions was significantly higher. Abscesses and ulceration were also more frequently observed. Different species were found in normal hosts and immunosuppressed patients. Several clinical patterns of cutaneous infection were defined: lymphocutaneous or sporotrichoid lesions; nonlymphocutaneous lesions at the site of trauma; folliculitis and furunculosis involving the lower extremities; disseminated lesions on the extremities in immunosuppressed patients. Two patterns were observed in patients with a disseminated infection: localized cutaneous lesions and disseminated cutaneous and mucosal lesions. CONCLUSIONS: Cutaneous manifestations of nontuberculous mycobacterial infections may be classified according to criteria such as cutaneous lesions and immune status.     

Subacute cutaneous lupus erythematosus presenting in twins

Subacute cutaneous lupus erythematosus is a clinically distinct form of cutaneous lupus erythematosus, with age of onset typically in the second to fifth decades. Eleven cases have been reported in childhood, and we present the first known case of subacute cutaneous lupus erythematosus in identical twins. Although flares are typically photo‐induced, we present an annular eruption typical of subacute cutaneous lupus erythematosus with concurrent pinworm infestation, with recurrence of disease with cutaneous larva migrans. The patient's identical twin had a similar eruption with pinworm infection. This case highlights the possibility of parasitic infestation as a trigger for subacute cutaneous lupus erythematosus in genetically susceptible individuals.     

Herpes zoster might be an indicator for latent COVID 19 infection

Various cutaneous manifestations have been observed in patients with COVID‐19 infection. Herpes zoster is a viral skin disease caused by varicella zoster that remains dormant in the dorsal root ganglia of cutaneous nerves following a primary chicken pox infection. In this report, we describe two cases COVID infection who first presented with herpes zoster. We are here by suggesting that the clinical presentation of HZ at the time of the current pandemic even in patients giving mild or no suggestive history of upper respiratory symptoms should be considered as an alarming sign for a recent subclinical SARS CoV2 infection.     

Bacillary angiomatosis

An infection with Bartonella henselae transmitted from domestic cats to humans by scratching normally leads to cat‐scratch disease. When the human host has severe immunosuppression or HIV infection, the potentially life‐threatening disease bacillary angiomatosis can develop. A 79‐year‐old man presented with livid‐erythematous, angioma‐like skin lesions. We considered a cutaneous infiltrate from his known chronic lymphocytic leukemia, Merkel cell carcinoma, cutaneous metastases of internal tumors, cutaneous sarcoidosis, mycobacterial infection and even atypical herpes simplex infection. The correct diagnosis was proven histologically and by PCR. Because of increasing numbers of immunosuppressed and HIV‐positive patients, as well as an infection rate of 13 % for B. henselae in domestic cats in Germany, one must be alert to the presence of bacillary angiomatosis.     

Cutaneous Mycobacterium intracellulare infection presenting as multiple asymptomatic papulonodules in an immunocompetent adult: A case report and review of the literature

Disseminated cutaneous nontuberculous mycobacteria infection is rare in immunocompetent hosts. We report a case of Mycobacterium intracellulare infection in an immunocompetent patient presenting with simultaneously developing multiple asymptomatic cutaneous papulonodules. The possibility of lung lesions as the primary focus is suspected. We review the literature for other cases of multiple cutaneous M avium complex infections in immunocompetent hosts. There are differences in the virulence of M avium and M intracellulare, and hence in the underlying immune status of the hosts.     

Verrucous cyst.

Human papillomavirus has been detected in a variety of cutaneous premalignant and malignant conditions, as well as in benign cutaneous warts. Changes consistent with epidermis papilloma virus infection occurring in epidermal cysts have recently been reported in the dermatologic literature only in plantar epidermal cysts. We report five examples of a form of cutaneous cyst that is histologically distinctive and that has not been previously reported, to our knowledge. We describe five cases of epidermal cysts showing marked verrucous changes of their stratified squamous inner linings, some of which also show proliferative changes. Human papillomavirus genomes were detected via polymerase chain reaction. None of the DNA probes for Southern blot hybridization demonstrated homology with the human papillomavirus types usually associated with cutaneous warts or carcinoma. We believe this cyst to represent a newly described manifestation of human papillomavirus infection, and propose the name verrucous cyst for this entity. Further studies may reveal the specific human papillomavirus type(s) associated with the verrucous cyst.     

Parvovirus B19 infection presenting concurrently as papular–purpuric gloves‐and‐socks syndrome and bathing‐trunk eruption

Parvovirus B19 infection can cause a wide range of cutaneous manifestations, including papular–purpuric gloves‐and‐socks syndrome (PPGSS) and petechial bathing trunk eruption. We report a case of an immunocompetent woman with a primary parvovirus B19 infection presenting as concurrent PPGSS and petechial bathing trunk eruption. Parvovirus B19 seroconversion was confirmed several days after the onset of the clinical manifestations. The coexistence of these two cutaneous manifestations of primary parvovirus B19 infection has rarely been reported in the literature. It is important to recognize parvovirus B19 infection early, based on the cutaneous manifestations, to avoid potentially serious systemic complications in susceptible individuals.     

Cutaneous T-cell lymphoma in patients with human immunodeficiency virus infection

The development of cutaneous T-cell lymphoma is unusual in individuals with human immunodeficiency virus type 1 infection. We present four patients with cutaneous T-cell lymphoma and human immunodeficiency virus type 1 infection. Immunophenotyping of lymph node tissue in three of these patients revealed a predominance of T-suppressor cells. Possible causes for the development of cutaneous T-cell lymphoma in the presence of human immunodeficiency virus type 1 infection are discussed.     

Primary cutaneous nocardiosis in immunocompetent children

Primary cutaneous nocardiosis is an infrequent opportunistic infection that mainly affects immunodepressed hosts. We describe two immunocompetent patients who exhibited two clinical forms of cutaneous nocardiosis, a mycetoma from walking barefoot in contaminated water and in the case of the other patient a lymphocutaneous form on the basis of a stabbing-cutting injury. In both cases the tests performed ruled out any immunodeficiency, particularly chronic granulomatose disease, since nocardiosis is regarded as an infection that acts as a marker for that illness. Treatment with cotrimoxazole led to the total healing of the lesions in both patients.     

Reactivation of dormant cutaneous Leishmania infection in a kidney transplant patient

BACKGROUND: Leishmaniasis is an infection caused by a protozoan parasite belonging to genus Leishmania and transmitted by the Phlebotomus sandfly. Clinical presentations of infection include visceral, cutaneous, and mucocutaneous forms. Leishmaniasis is endemic in Africa, Asia, Europe, South America, and southern part of North America. This infection is extremely rare in the US and is mostly found among travelers coming from endemic areas. Cases of cutaneous and visceral leishmaniasis have been reported in organ transplant recipients in endemic areas. CASE REPORT: We describe a case of cutaneous leishmaniasis in a kidney transplant patient, originally from Bolivia, who resides in the area known to be non-endemic for leishmaniasis and who is known not to travel within or outside of the US after the transplantation. RESULTS: Histologic examination of cutaneous lesion revealed extensive subcutaneous lymphohistiocytic inflammation with clusters of amastigote within histiocytes. CONCLUSION: To our knowledge, this is the first case of cutaneous leishmaniasis in a kidney transplant patient residing in the US in an area known to be non-endemic for leishmaniasis, probably after reactivation of a previously dormant infection acquired outside of the US at least 9 months prior to developing clinical symptoms.     

Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and prevention

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection.     

Primary cutaneous cryptococcal cellulitis secondary to insect bite in an immunosupressed patient after liver transplantation

Cutaneous cryptococcosis is usually a manifestation of disseminated disease, especially in immunosuppressed patients. Primary cutaneous cryptococcosis has also been described in some patients without evidence of systemic disease. Distinguishing between primary and secondary cutaneous cryptococcosis may be difficult as patients can be asymptomatic or cutaneous lesions may precede systemic involvement by some months. Features supporting primary disease are a history of cutaneous inoculation, and solitary superficial lesions on uncovered parts of the body. We present a liver transplant patient with cutaneous cryptococcal cellulitis subsequent to an insect bite, without systemic involvement and with excellent response to treatment with amphotericin B for 15 days and surgical debridement plus oral fluconazole for 3 months. In immunosupressed patients with cellulitis a cryptococcal infection must be excluded. If cutaneous cryptococcosis is diagnosed, systemic evaluation and prompt lengthy treatment are required.