Carcinoma cuniculatum of the buttock. An unusual case with an inverted growth

A rare case of carcinoma cuniculatum involving the buttock in a 56-year-old male is presented. This case is uncommon in that the tumor was largely subcutaneous, while the usual carcinoma cuniculatum is an exophytic growth. Although carcinoma cuniculatum has a wide clinical and histological spectrum, to our knowledge there has been only 1 case with similar histological features, located in a pilonidal sinus, and another case located on the buttock.     

Three Cases of Organoid Nevus on the Trunk and Extremity

Organoid nevi are most commonly observed on the scalp. Although they are rarely found on the trunk and extremities, we were able to study 3 cases of organoid nevi involving distributions of this sort. These included a 39-year-old male with a 2 × 6 cm brown area on the left flank (case 1), an 8-year-old female with a 5 × 6 cm hypopigmented macule on the lower left leg (case 2), and a 45-year-old male with a 1.5 × 3 cm brown spot on the back (case 3). All these were histopathologically confirmed to be organoid nevi. The lesion in case 1 revealed basal cell epithelioma, that in case 2 exhibited hypohidrosis caused by poorly developed sweat glands, and the lesion in case 3 was typical, as was an additional one on the same patient's scalp.     

Cross‐linked hyaluronic acid filler hydrolysis with hyaluronidase: Different settings to reproduce different clinical scenarios

Skin necrosis is the most severe complication arising from hyaluronic acid (HA) injection. To avoid skin necrosis, hyaluronidase should be injected along the course of the involved artery, to allow blood flow restoration. We evaluated the ability of hyaluronidase to degrade a HA filler in two simulated clinical situations—a compression case and an embolization case—to identify differences in the hyaluronidase injection. In the compression case, a bolus of HA filler was directly soaked in hyaluronidase solution; in the embolization case, a vein harvested from a living patient was filled with the same HA filler and then soaked in hyaluronidase. We then evaluated the quantity of HA remaining after 2 hr. While we found hydrolysis of HA in both cases, in the compression case, we detected almost complete hydrolysis, whereas in the embolization case we observed a reduction of the 60%. Our results support the hypothesis that vessel compression can be resolved with only one injection of hyaluronidase, while in the case of vascular embolization, repeated perivascular injections should be performed owing to the reduction of hyaluronidase activity.     

Case study methodology in tissue viability. Part 1: Methodological considerations

Case studies are often presented in relation to tissue viability problems. Within hierarchies of evidence, case studies are sometimes seen to be on a par with expert opinion. This paper examines the case study as a research method and seeks to determine its value in tissue viability research. The term 'case study' denotes a general strategy for research where several methods of data collection are used to provide an in-depth analysis of an individual, group or institution. Three types of case study are used in research: intrinsic, instrumental and collective. All case studies utilize data triangulation within their design, that is, the use of a variety of sources of data within a study. It is one of the major strengths of the case study method. Data sources include documentary data sources, observation and interviews. As in any research, validity and reliability are important in case study methodology; in particular, construct validity, internal validity and external validity. Case studies are potentially vulnerable to observer error and observer bias. Examples are given of potential case studies in tissue viability and their strengths and weaknesses. If undertaken prospectively, with clearly defined multiple sources of data collection and a documented chain of evidence, case studies can add breadth to our knowledge and experience of caring for patients with tissue viability problems.     

Nevoid Basal Cell Carcinoma Syndrome and Hairy Skin Patches

We report a case of an increasing number of discrete patches of darkly pigmented terminal hair in a patient with nevoid basal cell carcinoma syndrome. This case adds to a small case series of three patients which have previously reported this observation. We report this case to highlight hairy patches as an important clinical feature associated with nevoid basal cell carcinoma syndrome.     

Amblyomma testudinarium tick bite: one case of engorged adult and a case of extraordinary number of larval tick infestation

This paper reports two recent cases of tick bite due to Amblyomma testudinarium. The first case was an 86-year-old farmer infested with a fully engorged adult tick attached on his inguinal region. The second case was a 57-year-old male infested with an extraordinarily large number of larval ticks (> 100 larvae). The ticks were identified as A. testudinarium based on morphological characteristics. To our knowledge, the latter case is the eleventh case of larval tick bites among all tick species and the fourth case with larval A. testudinarium in Japan.     

Oral isotretinoin and haemophilia A

The effects of oral isotretinoin on the coagulation system are still not well known: some case reports describe thrombocytopenia or thrombocytosis, others present different effects on fibrinolysis. We report a case of severe acne treated with oral isotretinoin in a patient affected with haemophilia A. In this case, which differs from the only other case reported in the literature, oral isotretinoin did not appear to influence the haemophilic patient's need of factor VIII.     

Cutaneous infarction. Manifestation of disseminated mucormycosis.

We describe the second reported case of cutaneous infarction as a manifestation of disseminated mucormycosis. The lesion, which closely resembled ecthyma gangrenosum, occurred in a leukemic patient who was on a regimen of broad-spectrum antibiotics. In this case as in the only other reported case, Mucor pusillus was the cause.     

广东省1991年～2000年麻风病例发现情况分析

目的:了解广东省近10年麻风病例发现情况,评价目前防治策略,并为今后制订防治策略提供参考。方法:利用全省的麻风疫情报表,进行回顾性分析,部分数据进行统计学处理。结果:1991年～2000年广东省麻风病年发现率及患病率均呈下降趋势,而发现率的年平均下降幅度明显小于患病率的下降;1991年～1995年麻风病年发病率与发现率比较无显著性差异(t=2.775,P>0.05),但后5年(1996年～2000年)两者比较则有显著性差异(t=6.668,P<0.01);病例的早期发现平均为74.02％,各年变化不大;在病例的发现途径方面,被动发现(门诊,线索)占94.17％,各年比例变化不大。结论:在麻风疫苗实际应用之前,病例发现仍然是控制麻风病的主要手段,今后病例发现仍然是以皮肤专科门诊为主。1991年～2000年的发现率年下降幅度小于患病率,说明要彻底消除麻风病,仍要一定的时间。必须通过加强皮肤专科及相关科医生对麻风病的诊断水平,大众的健康教育宣传等措施,提高麻风的早发现、早治疗来进一步控制及消除麻风。     

Psoriatic Erythroderma and Hypothalamus-Pituitary Axis Suppression Due to Misuse of Systemic Steroid: Two Challenging Cases

Adding corticosteroid in homeopathic pills, self medication of steroid in the backdrop permanent cure in cases of psoriasis is not very uncommon in clinical practice in Indian subcontinent. First case a 52 year man, a known case of psoriasis vulgaris with psoriatic arthropathy of 15 years duration received multiple modalities of therapies without any satisfactory response. He was on self medication of tab prednisolone 10 mg daily with Cushingoid features. Second case a 22 year old boy, a known case of psoriasis from last 06 years was on Homeopathic treatment with Cushinoid features. Tapering of systemic steroid in first case and discontinuation of homeopathic drug in second case resulted in erythroderma and features of adrenal insufficiiency. Investigation revealed low morning cortisol and low cortisol following ACTH stimulation suggestive of HPA axis suppression. Planned withdrawal of steroid under the cover of short acting systemic steroid for short duration along with combination of immunosuppressants and supportive care gave an excellent result in both the cases.     

Cases with a spontaneous regression of an infiltrating non‐crateriform keratoacanthoma and squamous cell carcinoma with a keratoacanthoma‐like component

We herein report the natural course of an early/proliferative stage keratoacanthoma (KA) with infiltrating islands of cytological malignancy (case 1) and a squamous cell carcinoma (SCC) with a KA‐like component (case 2), which were observed until their complete regression. The presented case 1 suggests that one of the histopathological forms of KA includes this unusual, infiltrating, non‐crateriform architecture, and also indicates the possibility of complete remission in the KA associated with infiltrating islands of cytological malignancy. In the presented case 2, the peripherally‐associated KA‐like focus was histopathologically considered to be either a remnant of KA focus or verrucous keratosis (hyperplasia). Therefore, the complete spontaneous regression of case 2 suggests that SCC arising in KA still has the potential of spontaneous regression, or that an extremely rare event, namely, the spontaneous regression of (traditional) SCC occurred in the present case.     

Letter: An adult case of severe hand-foot-mouth disease accompanying persistent fever and systemic arthritis

This paper reports a case of adult HFMD with vesicles scattered on the whole body and severe oral lesions. In addition, a long-lasting elevated level of C-reactive protein (CRP) was a feature of this case. Our case is unusual for HFMD with long-lasting joint pain and high fever.     

Plasmapheresis in solar urticaria

Three patients with solar urticaria were treated with plasmapheresis. By intradermal injection of in vitro irradiated serum the existence of a circulating photoallergen was demonstrated in cases 1 and 2 but not in case 3. Plasmapheresis induced complete remission of solar urticaria in case 1 and transient improvement in case 2. In case 3, however, no beneficial effect was observed. It is suggested that some patients with solar urticaria, probably those with a circulating photoallergen, may benefit from plasmapheresis.     

Secondary cutaneous candidiasis with eosinophilia

Cutaneous candidiasis is a common skin infection caused by the Candida species, especially in intertriginous areas, and neutrophils usually infiltrate histopathologically. We describe a case of secondary cutaneous candidiasis which spread extensively to the trunk and extremities and showed marked dermal eosinophilia. This case and a similar reported case suggest that Candida can sometimes cause cutaneous inflammation predominantly composed of eosinophils.     

Cocaine‐related retiform purpura: evidence to incriminate the adulterant,levamisole

The term ‘cocaine‐induced pseudovasculitis' was coined to encompass a constellation of clinical and laboratory findings which mimics a systemic vasculitis but lacks confirmatory evidence of vasculitis on biopsy. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase (HNE) have been reported to distinguish the cocaine‐related syndrome from a true autoimmune vasculitis. Published cases of retiform purpura related to cocaine use are rare and an etiologic role for levamisole, a common adulterant of cocaine, has been postulated. We describe two female patients aged 39 and 49 years with cocaine‐related retiform purpura, mainly affecting the legs. The initial clinical and serological profile in case 1 led to a suspicion of anti‐phospholipid syndrome and in case 2 to Wegener's granulomatosis with an unexplained associated neutropenia. Skin biopsies revealed a mixed pattern of leukocytoclastic vasculitis and microvascular thrombosis in case 1 and pure microvascular thrombosis in case 2. Identification of anti‐HNE antibodies in both patients linked their disease to cocaine. The mixed vasculopathic pattern in case 1 and the associated neutropenia in case 2, both known adverse effects of levamisole, point to this as the true etiologic agent. Urine toxicology shortly after a binge of cocaine use in each case was positive for levamisole. Walsh NMG, Green PJ, Burlingame RW, Pasternak S, Hanly JG. Cocaine‐related retiform purpura: evidence to incriminate the adulterant, levamisole.     

Pruritic urticarial papules and plaques of pregnancy (polymorphic eruption of pregnancy): two unusual cases

Summary We report two unusually florid cases of polymorphic eruption of pregnancy (PEP) or pruritic urticarial papules and plaques of pregnancy, the first occurring in a triplet pregnancy, and the second with some clinical features more suggestive of pemphigoid gestationis (PG). The first case responded to treatment with moderately potent topical steroids while the second case required a short course of systemic steroids. Our first case is the only reported case of PEP occurring during a triplet pregnancy. We discuss the effect of multiple pregnancy on PEP and some distinguishing factors between PEP and PG.     

Clear cell acanthoma presenting as polypoid papule combined with melanocytic nevus

We report on a case of clear cell acanthoma that developed above a preexisting melanocytic nevus. Although melanocytic nevi can be complicated by the presence of several different types of epithelial or appendageal tumors, there have been no reported case of clear cell acanthoma combined with a nevus. Interestingly, in this case the clear cell acanthoma had a polypoid configuration, an unusual finding.     

Trends in leprosy case detection worldwide since 1985

Trends in case detection and case detection rate (CDR) since 1985 are described at regional and national levels. Annual case detection by WHO Region was available for 1994-2000. Using different sources, complete time series for case detection were constructed for 1985-1998 for a group of 33 endemic countries cumulatively (top 33), and for 14 individual countries (top 14). Population statistics were used to derive CDRs. India contributed 79% to global case detection in 1998. Africa, the Americas and South-East Asia each contributed about 30% when India is excluded. During 1994-2000, case detection did not decrease in these three WHO Regions. The 33 countries contributed 99% and 98% to global case detection in 1994 and 1998, respectively. Cumulative case detection for the top 33 minus India gradually increased, overall almost doubling. The contribution of the top 14 to case detection of the top 33 hardly changed over time, equalling 96% in 1998 (81% when India is excluded). In terms of annual case detection, Brazil was always ranked second after India; it accounted for 27% of 1998 case detection in the top 33 except India. In 1998, seven of the top 14 countries--including India and Brazil--had CDRs above 2 per 10,000. The CDR did not exceed 1 per 10,000 for the other half. Decreasing tendencies in CDR, either for the whole period or in the 1990s, are observed for four of the top 14 countries (Guinea and three Western Pacific countries: China, Vietnam and the Philippines). In conclusion, there is no general decline in case detection to date, and several important countries still have high CDRs. Prevalence is an irrelevant indicator for monitoring epidemiological changes in leprosy. Trends in the transmission and incidence of leprosy are still completely unclear, necessitating further research. The target to eliminate leprosy as a public health problem, defined as a prevalence of less than 1 per 10,000, is therefore also an inadequate yardstick for decision making on leprosy control.     

The long-term effect of pulsed dye laser on Necrobiosis Lipoidica: A case study

A 57-year-old female was presented with an irrepressible case of Necrobiosis Lipoidica considering the possibility of a surgical skin graft. Instead, a pulsed dye laser treatment was used as an alternate treatment. Previous case studies have been found in the literature on the effect of pulsed dye laser on Necrobiosis Lipoidica. The use of a pulsed dye laser in this case resulted in rendering the lesions asymptomatic for pain and a reduction in volume. Prolonged control was exhibited. From this case, we conclude that pulsed dye laser therapy is effective when increasing the number of treatments of laser therapy, and can be used as a treatment for Necrobiosis Lipoidica.     

Demonstration of heterogeneity in xeroderma pigmentosum

Summary Two cases of xeroderma pigmentosum were studied at the cytogenetic and molecular level. DNA repair impairment was revealed in case 1 by a nucleoid sedimentation technique whereas a half diminished rate of DNA repair could be demonstrated in case 2. This may be a further case of a xeroderma pigmentosum variant.