EPIDERMODYSPLASIA VERRUCIFORMIS ASSOCIATED WITH MULTIPLE SQUAMOUS CELL CARCINOMAS

In this report a 48 year old patient with non-familial epidermodysplasia verruciformis is described. The disease had persisted for 36 years and had been incorrectly diagnosed as psoriasis on a number of occasions. From 1980 the patient developed numerous skin tumours, including five squamous cell carcinomas (SCCs) and a basal cell carcinoma, on the sun-exposed areas of his body. In June 1986 a poorly-differented SCC, presumed to be a secondary deposit from one of the previously resected skin cancers, was excised from his left parotid gland. A recurrence of this invasive SCC was resected two months later. Despite several courses of radiotherapy and treatment with transfer factor the tumour continued to enlarge, and the patient died from local effects in December 1987. The clinical, virological and immunological criteria used to establish the diagnosis are presented.     

MULTIPLE SUBCUTANEOUS LIPOGRANULOMAS ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS-LIKE SYMPTOMS

A case of a 45 year old woman with multiple subcutaneous nodules and systemic lupus erythematosus-like symptoms is reported. Histologically the nodules were identical to sclerosing lipogranuloma. The oily substance within the nodules was suspected to be due to depot penicillin injected ten years before. The patient was treated with corticosteroids and finally died of pulmonary fibrosis. This case may be included in the entity of adjuvant diseases of man.     

MULTIPLE BOWEN'S DISEASE OF THE FINGERS ASSOCIATED WITH HUMAN PAPILLOMA VIRUS TYPE 16

Background. The occurrence of multiple Bowen's disease (bd ) in skin away from the anogenital area is rare. In contrast, multiple lesions of bd involving the anogenital skin (bowenoid papulosis) are not so rare and have been found to associated with human papilloma virus (hpv ) usually type 16. We encountered a patient with multiple BD of the fingers and endeavored to detect hpv in his lesions. Methods. Separate bd lesions from 3 fingers of the patient were investigated for the presence of hpv by means of the polymerase chain reaction, followed by dot blot hybridization. Other cases of bd with coexistent HPV infection excluding the anogenital area were collected from the literature for comparative study. Results hpv type 16 was detected in each of the three finger lesions of bd . Twenty cases of hpv related bd involving sites other than the anogenital area were found in the literature. Three of these cases had multiple lesions. Conclusions. Review of the 4 cases with multiple hpv related nonanogenital bd and the 17 others with solitary lesions reveals predilection for the hands and feet (90%) and affinity for type 16 infection (81%). The lesions usually present as verrucous plaques.     

A CASE OF MULTIPLE MYELOMA PRESENTING AS A BULLOUS DERMATOSIS

Multiple myeloma is a malignant plasma cell proliferative disorder that produces a monoclonal immunoglobulin protein. The skin involvement and the development of bullous disease are rarely seen features in multiple myeloma. We present a 55-year-old man with a longstanding, large, tense bullous eruption and hypertrophic scars over his body accompanied recently with weight loss and fatique. He had no response to the previous treatments, which included oral glucocorticoids and dapsone. Histologic examination of the lesions revealed subepidermal bullae, while no immunoflourescence staining was observed. In a further detailed labarotory examination, multiple myeloma was detected. After the treatment of multiple myeloma with chemotherapy, the lesions regressed. Patients with longstanding, recurrent, unusual bullous eruption should be investigated for the development of multiple myeloma.     

POLYMORPHIC TYPE OF XANTHOMATOSIS IN ASSOCIATION WITH IgA MYELOMA

Clinical and immunochemical findings were reported from a 36-year-old woman with multiple xanthomas of various clinical types (plane xanthoma, tubero-tendinous, papulo-eruptive and follicular xanthomas), multiple myeloma (IgA, type L), and hyperlipemia with markedly elevated levels of plasma cholesterol and triglycerides. A bone marrow specimen showed foam cells and atypical plasma cell proliferation. Lipoprotein-IgA complexes were thought to exist in the serum of this patient on gel filtration and micro-ouchterlony test. Cutaneous xanthomas associated with multiple myeloma are plane xanthomas in most of the reported cases. Combination of several different types of xanthomas has been reported in only three cases, all of which were associated with IgA myeloma.     

HERPES GESTATIONIS WITH MULTIPLE RECURRENCES

A case of herpes gestationis with multiple attacks is reported. These attacks occurred over five years during and after three successful pregnancies, during and after three pregnancies which resulted in miscarriages, and during menstruation. The three living children did not have any skin problems. The diagnosis was substantiated, histologically and immunohistochemically. The patient was HLA DR3 positive. She was Rhesus?ve (Rh?ve) and the two first children were Rh+ve while the third one was Rh?ve. The investigative data are discussed in relation to the possible pathogenetic factors for the diseases.