Nodular granulomatous phlebitis: a phlebitic tuberculid

A 22-year-old woman presented with recurrent non-ulcerating skin nodules overlying the great saphenous vein on the anteromedial lower legs. Histology showed a granulomatous phlebitis, and polymerase chain reaction performed on lesional skin detected DNA specific for Mycobacterium tuberculosis. The lesions resolved with anti-tuberculous therapy. This case may be a further example of nodular granulomatous phlebitis, a phlebitic tuberculid.     

前臂结节性筋膜炎一例

患者,男,31岁.右前臂皮下结节5天,伴轻度压痛不适.高频超声检查示:表皮连续微隆起,真皮深层及皮下组织可见一类椭圆形低回声结节,边界清楚,体积约6.30 mm×6.23 mm×3.20 mm.皮损组织病理示:真皮及皮下组织大量梭形细胞呈束状排列,胶原纤维增生,间质黏液样变,伴少量淋巴细胞浸润及红细胞渗出.诊断:结节性...     

结节性硬皮病一例

结节性硬皮病属于局限性硬皮病的罕见特殊类型,临床上多数结节性硬皮病患者并发系统性硬皮病且治疗效果较差。本病例患者仅表现为结节样皮损,无系统性硬皮病表现,且经过治疗后取得一定临床疗效。     

Disseminated lupus vulgaris and papulonecrotic tuberculid: case report

The incidence of tuberculosis and extrapulmonary forms of this disease is increasing all over the world. Lupus vulgaris is the most prevalent form of cutaneous tuberculosis in Europe and the Middle East. Papulonecrotic tuberculid, the most common form of hyperergic response to mycobacteria or their fragments, is uncommon in children. We report lupus vulgaris with papulonecrotic tuberculid in a 12-year-old girl who had a 3-year history of slowly growing plaques on her trunk, extremities, and the tip of her nose and papuloulcerative lesions over her entire body. A skin biopsy specimen showed minimally caseating granulomatous inflammation. Staining for acid-fast bacilli was negative in both plaques and papules. Polymerase chain reaction identified Mycobacterium tuberculosis DNA in the patient's sputum, gastric fluid, and plaques and was negative in the papules. She was started on antituberculous therapy with four drugs and her lesions responded rapidly.     

结节性二期梅毒1例

梅毒的结节性皮肤损害主要见于三期梅毒，在二期梅毒尤其是二期早发梅毒中极少见。报告1例表现为双上肢屈侧皮肤渗出性结节的二期早发梅毒，初诊被误诊为孢子丝菌病，治疗3个月后快速血浆反应素环状卡片试验(RPR)试验转阴，9个月后随访梅毒无复发，但局部瘢痕及色素沉着仍然存在。     

结节性恶性黑素瘤一例

结节性黑素瘤是一种处于垂直生长期的恶性黑素瘤亚型,占所有黑素瘤的10%～15%。皮损可为隆起的丘疹或斑块,偶尔呈息肉样,可发生于身体的任何部位。本患者,女,30岁。左上臂伸侧暗红色结节5年余,加重1年。皮损组织病理:真皮层见大量肿瘤细胞弥漫性浸润,细胞核大、异形,可见大量核分裂像。免疫组化:MelanA、SOX-10、Ki-67、P53、S-100均为阳性,Clark分级,IV级。诊断:结节性恶性黑素瘤。     

结节性皮肤淀粉样变一例

患者,男,46岁。左侧鼻唇沟、鼻翼及下颌结节1年。皮肤组织病理：真皮内可见大量嗜酸性、无定形物质沉积,甲紫染色和刚果红染色均阳性。诊断：结节性皮肤淀粉样变。给予复方倍他米松局封后结节缩小。     

结节性筋膜炎2例

报告2例结节性筋膜炎.患者均为年轻男性,表现为四肢突然出现的单发皮下结节,组织病理和免疫组化检查结果符合结节性筋膜炎改变.该病较少见,临床表现无明显特征,组织病理形态较复杂,误诊率高,该文结合文献复习了结节性筋膜炎的临床、组织病理学和免疫表型改变,总结了鉴别诊断的要点.     

Nodular scleroderma: a report of 2 cases

Nodular scleroderma, also known as keloidal scleroderma, is a rare form of scleroderma that may occur with either systemic sclerosis or localized scleroderma. Clinically, this disorder is characterized by keloidal nodules that form in sclerodermatous areas. These nodules may histologically show the presence of keloidal collagen. Because of the rarity of this condition, clinicians may not be familiar with the clinical and histologic features relevant to this scleroderma variant. In this report, we describe 2 cases of nodular scleroderma.     

Genital tuberculid in a female child: a new entity (childhood vulval tuberculid)

Abstract:  Localized tuberculid has been infrequently reported in the literature. Most of these reports are of papulonecrotic tuberculids localized to the penis, an entity designated as "penis tuberculid." In females, such a localized genital tuberculid has not been documented till date. We report an 11-year-old girl with lichen scrofulosorum confined to the vulva, associated with cervical and inguinal tubercular lymphandenitis.     

结节性皮肤狼疮性黏蛋白病

报告1例结节性皮肤狼疮性黏蛋白病。患者女,42岁。患有系统性红斑狼疮,在其病程中双上肢伸侧和背部出现许多肤色或暗紫红色丘疹和结节,伴瘙痒半年就诊。皮损组织病理学检查示真皮胶原纤维束间有大量黏蛋白沉积;电镜检查示真皮成纤维细胞周围有大量无定形物质沉积。     

结节性皮肤狼疮黏蛋白病1例

报告1例结节性皮肤狼疮黏蛋白病同时合并、桥本甲状腺炎。患者女，68岁，胸背部可见正常肤色或红色不规则结节及斑块性皮损，口腔及下唇黏膜溃疡。血白细胞、C3降低，抗核抗体（ANA）阳性，促甲状腺激素增高，抗甲状腺球蛋白抗体阳性，抗甲状腺微粒体抗体阳性。皮损组织病理可见真皮血管周围淋巴细胞浸润及黏蛋白沉积，直接免疫荧光示表、真皮交界处C3呈线状或颗粒状沉积。结合该患者病情，对结节性皮肤狼疮黏蛋白病临床特点及发病机制进行文献复习。     

(9) Phlebitic tuberculid, a new tuberculid?

Currently recognized tuberculids are papulonecrotic tuberculid, erythema induratum and lichen scrofulosorum. We describe two cases of what appears to be a hitherto undescribed tuberculid.
Two fit young Oriental women presented with relapsing small nodules on the shins which cleared spontaneously without scarring. The Mantoux test was strongly positive. Histology showed a granulomatous phlebitis with Langhans giant cells but without panniculitis or necrosis. No tubercle bacilli were grown from the skin lesions but there was culture-proven tuberculosis elsewhere (in the lung and cervical nodes, respectively). The eruption ceased with anti-tuberculous chemotherapy.
These two cases therefore fall within the definition of a tuberculid, yet resemble neither clinically nor histologically any of the three currently recognized forms. In the second case, direct immunofluorescence of the skin lesions showed dermal perivascular deposits of IgM, C₃ and fibrin, thus suggesting an immune complex-mediated vasculitis, although no immune complexes were detected in the serum, and complement levels were normal.
We would, therefore, suggest that these two cases represent a phlebitic tuberculid, possibly with an immune complex-mediated aetiology.     

结节性(假肉瘤性)筋膜炎1例

报告1例结节性(假肉瘤性)筋膜炎,患者男,80岁,左小腿皮下结节3个月,无明显自觉症状,增长迅速,组织病理检查示真皮及皮下组织大量梭形细胞增生,并可见红细胞外渗,予以手术切除后1个月皮损复发,后结节内流向曲安奈德2次后结节消失,观察半年未复发.     

结节性类天疱疮一例

患者,女,83岁。躯干、四肢反复出现丘疹、结节伴瘙痒2年。皮肤科查体：躯干、四肢见暗红色丘疹、结节,散在抓痕,局部结痂,未见水疱。组织病理示：表皮角化过度、角化不全,棘层增厚,真皮浅层血管少量淋巴细胞、嗜酸性粒细胞浸润。直接免疫荧光和间接免疫荧光均阴性。IIF:循环抗体IgG表皮侧阳性沉积。血清学检查示：抗BP230抗体：147.9 U/mL;抗BP180抗体>200 U/mL。诊断为结节性类天疱疮。给予泼尼松、盐酸多西环素、烟酰胺治疗,目前随访中。     

Papulonecrotic tuberculid with inflammatory nodular lesions of the lower leg: a report of two cases

Two cases of papulonecrotic tuberculid (PNT) with inflammatory nodules of the lower leg are reported. One is a 43-year-old woman with lymphadenitis tuberculosa, and the other is a 54-year-old man with penis tuberculid and epididymitis of possible tuberculous etiology. In both cases, PPD skin test was strongly positive, and antituberculous therapy was markedly effective. Although the theory of the etiology of PNT is changing due to the recent decrease in active tuberculosis, we think that one cause of so-called PNT is still tuberculosis, at least in Japan.     

Trigeminal neurotrophic ulceration–a report of four patients

We describe four elderly patients who developed neurotrophic ulceration in the trigeminal area of the face. In three patients, ulceration followed alcohol injection of the Gasserian ganglion for the treatment of intractable trigeminal neuralgia. In the fourth patient, ulceration in anaesthetic skin followed destruction of the sensory root of the trigeminal nerve in an area of brain stem infarction caused by occlusion of the posterior inferior cerebellar artery.     

Papulonecrotic tuberculid: a rare form of cutaneous tuberculosis

We describe a case of papulonecrotic tuberculid, a rare form of cutaneous tuberculosis, in a 25-year-old Philippino woman who had immigrated to Canada 8 years previously. The patient presented with a 3-week history of tender left cervical adenopathy; 1 week later, she developed multiple ulcerated erythematous nodules and emboluslike lesions scattered over her fingers. Results of a biopsy performed on the lymph node revealed granulomatous lymphadenitis, and Mycobacterium tuberculosis grew from the lymph node. Histopathologic analysis of an ulcerative finger lesion demonstrated nonnecrotizing granulomas with dense lymphocytic inflammation of the superficial dermis; however, results of acid-fast staining, mycobacterial culture, and polymerase chain reaction for M tuberculosis complex were all negative. Different conditions can mimic papulonecrotic tuberculid. Therefore, the diagnosis can be difficult unless M tuberculosis is isolated from a site other than the skin, because stain and culture results from skin biopsy specimens are typically negative and the polymerase chain reaction is positive in only 50% of cases. We review the epidemiology, clinicopathologic features, and differential diagnosis of papulonecrotic tuberculid. Awareness of this entity is important to distinguish it from other conditions and to institute appropriate therapy in a timely fashion.     

梅毒性脱发4例

报告4例以脱发为主诉症状的二期梅毒,脱发表现为虫蚀状,弥漫性小片状,脱发区毛囊周围充血发红,梅毒血清学试验及梅毒螺旋体检查阳性,对4例患者采用苄呈青霉素治疗后毛发再生,未留瘢痕.     

Necrobiotic xanthogranuloma: a report of four cases

Four patients are described who demonstrate the range of clinical and pathological features seen in necrobiotic xanthogranuloma with paraproteinaemia (NXG). Each patient had the typical periorbital yellow plaques with numerous well demarcated yellow indurated plaques on the trunk. All four patients had evidence of paraproteinaemia. The histopathology showed diagnostic features of intense necrobiosis with xanthomatization, including touton giant cells and the bizarre angulated giant cells of NXG. Previously, the patients had been diagnosed as atypical necrobiosis lipoidica, and the distinction between NXG and other necrobiotic conditions is discussed.