Blisters over burn scars in a child

We present the case of an 11-month-old baby with a burn that healed normally over a month, but subsequently developed successive crops of blisters over the scar. There were no changes in his general condition. Clinical, immunological, histological and ultrastructural studies provided a diagnosis of mechanical dermatitis produced by microtrauma. Electron microscopy studies revealed the sub-epidermal nature of the blisters and the presence of underlying fibrin deposits.     

Mees' lines in a patient following acute arsenic intoxication

A 62‐year‐old Turkish man developed nausea and vomiting 1 h following a dinner with friends and business associates. In the following few days, he developed dark urine, anemia, and thrombocytopenia. Five of his dinner companions developed similar symptoms of varying degrees, and one died. It is unknown how their food and beverage consumption differed during the meal. During the subsequent month, the patient developed gait ataxia, leg weakness, and burning pain and numbness in a glove‐and‐stocking distribution. Six weeks later, he traveled to the USA and was evaluated by our Department of Neurology. An electromyogram demonstrated generalized peripheral polyneuropathy, with motor and sensory axon loss. The patient was referred to the Department of Dermatology for evaluation of possible arsenic poisoning. Cutaneous examination revealed one transverse white band on several fingernails approximately 3–4 mm distal to the proximal nail fold, consistent with Mees’ lines ( Fig. 1 ). A plaque of confluent 3‐mm hypopigmented macules was evident on the extensor aspect of the left forearm ( Fig. 2 ). Hair, nail, and urine samples were obtained to rule out heavy metal poisoning; the arsenic levels obtained were 27.6 µg/g (normal, 0.03–3 µg/g), 2.98 µg/g (normal, 0.03–3 µg/g), and 82 µg/L (normal, < 81 µg/L), respectively.

Figure 1 Open in figure viewer PowerPoint Mees' lines present on the fingernails     

Calcinosis cutis following liver transplantation in a pediatric patient

We report the occurrence of calcinosis cutis in a 3-year-old girl after liver transplantation. The cutaneous lesions consisted of 5 mm white papules on an erythematous base in linear and rosette configurations that developed in the abdominal and lumbar areas 10 days after transplantation. The patient had received calcium chloride solution intravenously during surgery. We excluded other causes of ectopic calcification such as hyperparathyroidism, renal failure, and extravasation of calcium solution. We discuss the etiology of calcinosis cutis after liver transplantation. This sequence of events has not been previously described in pediatric patients.     

Transverse leukonychia following chemotherapy in a patient with Hodgkin's disease

Nail changes often represent diagnostic hallmarks for a variety of systemic diseases. The awareness of drug-induced nail injuries is important in order to avoid unnecessary diagnostic activities. We observed a 21-year-old female patient with Hodgkin's lymphoma, who developed transverse leukonychia of all fingernails associated with polychemotherapy.     

Unilateral subungual hyperkeratosis following a cerebrovascular incident in a patient with psoriasis

The prevalence of nail abnormalities in psoriasis is reported to be between 50 and 90% of affected adults. These include pitting, nail discoloration, onycholysis and subungual hyperkeratosis. Although nail changes may be associated with neurological disease, there are no previous reports of psoriatic nail changes following cerebrovascular events. We report the first case to our knowledge of unilateral subungual hyperkeratosis in a psoriatic patient which developed following a cerebrovascular event.     

Pemphigus herpetiformis following D-penicillamine in a patient with HLA B8

A 57-year-old patient with rheumatoid arthritis, who was being treated with D-penicillamine, developed a bullous eruption 2 months after the onset of treatment. On the basis of the clinical, histological and immunofluorescent findings, the diagnosis of herpetiform pemphigus was made. The eruptions disappeared within 2 weeks after the discontinuation of D-penicillamine treatment. During the 16-month follow-up period there was no recurrence. It is noteworthy that a patch test with potassium iodide was positive and that testing for HLA antigens revealed HLA B8, A1, A2, and BW39.     

Taking cell cultures to the patient in an attempt to improve chlamydial isolation.

McCoy cell cultures were inoculated with 121 urethral and cervical specimens taken from patients attending one of two sexually transmitted disease clinics. The mean number of Chlamydia trachomatis inclusions was greater when the cultures were inoculated with the specimens and centrifuged in the clinic than when the specimens were first stored in liquid nitrogen. Furthermore, 18 of the 29 chlamydia-positive specimens produced larger numbers of of inclusions when inoculated immediately. Despite this, the isolation rate from specimens inoculated directly (22%) was about the same as from specimens which had been frozen (21%). Of the 30 occasions on which the cell monolayers were disrupted, 29 followed immediate inoculation. This may possibly have been due to some toxic factor in some of the specimens.     

Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome

We describe three patients with trophic ulceration and blistering of the fingertips associated with carpal tunnel syndrome. One of the patients also had non-insulin-dependent diabetes mellitus. Autonomic neuropathy distal to the carpal tunnel was probably present in all subjects at the time of presentation; in the patient with recent symptoms the skin was warm, and sweating was virtually absent, whilst the other two patients described cold skin, consistent with prolonged autonomic neuropathy.     

Calcifying panniculitis following subcutaneous injections of nadroparin-calcium in a patient with osteomalacia

Calcifying panniculitis is a rare form of calcinosis cutis belonging to the spectrum of calciphylaxis that has almost invariably been described in patients with severe renal disturbances. We report a patient with osteomalacia without chronic renal failure, who developed calcifying panniculitis following subcutaneous administration of nadroparin-calcium. Light microscopy studies of biopsy specimens revealed multiple foci of microcalcification within the adipose lobules, in the interadipocyte spaces, in connective tissue septa and in the media of small arteries in the subcutis. The patient had an elevated level of intact parathyroid hormone, whereas the calcium-phosphorus product was normal. The lesions slowly resolved upon discontinuation of nadroparin. We conclude that calcifying panniculitis is a rare complication associated with the subcutaneous administration of nadroparin-calcium that may rarely also occur in the absence of renal disturbances. Low molecular weight calcium-containing heparins should probably be used with caution in the presence of hyperparathyroidism.     

Acquired reactive perforating collagenosis following diclofenac therapy in a patient with parapsoriasis

A case of acquired reactive perforating collagenosis in a 70-year old man with a long standing digitate parapsoriasis is reported. Multiple asymptomatic cutaneous hyperpigmented papules with a central adherent keratotic plug developed simultaneously with widespread purpuric eruption following a single i.m. diclofenac injection. Histologic examination of a keratotic lesion revealed an epidermal crater with centrally degenerated collagen and elastic fibre extrusion. This case is interesting for the lack of pruritus, the transepithelial elimination of both collagen and elastic fibres and the association with parapsoriasis. The etiologic role of diclofenac is discussed. The term acquired perforating dermatosis may be more suitable for this case.     

Subcutaneous granuloma annulare following influenza vaccination in a patient with diabetes mellitus

An influenza vaccination often causes local reactions, such as induration and erythema at the injection site, and occasionally systemic reactions. The association between these reactions and influenza vaccinations has not been fully recognized. By contrast, granuloma annulare (GA) is an idiopathic, palisaded, granulomatous condition, and has some clinical variants, including localized, generalized, perforating, and subcutaneous types. We report a 76-year-old woman, who was suffering from a tender subcutaneous nodule on her left upper arm. One month before, she had just received influenza vaccination on the same area. Histological analysis demonstrated that subcutaneous tissue contained numerous large areas of necrosis, surrounded by palisaded epithelioid histiocytes. We diagnosed our case as a subcutaneous type of GA following influenza vaccination. To our knowledge, this is the first report of GA associated with influenza vaccination.     

Graft-versus-host disease-like syndrome following blood transfusion in a patient with duodenal ulcer

Graft-versus-host disease (GVDH)-like syndrome occurred in a 45 year-old man with duodenal ulcer who had received a transfusion of 8 units of packed red blood cells. Clinical features included high fever, macropapular rash, hepatic dysfunction, pancytopenia and, finally, fatal septicemia. A skin biopsy obtained from the chest revealed satellite cell necrosis of epidermal cells, mononuclear cell infiltrate of the upper dermis and epidermis, and vacuolar degeneration of basal cells. Autopsy bone marrow was aplastic. The occurrence of GVHD in immunologically normal individuals following blood transfusion is extremely rare.     

Pyoderma gangrenosum following tattoo placement in a patient with acute myelogenous leukemia

A 37-year-old African American female with a diagnosis of acute myelogenous leukemia (AML) being treated with chemotherapy presented with a lesion on her lower back within the confines of a newly inked tattoo. Five days after tattoo placement, she developed an oozing, indurated, necrotic plaque at the site. Four days later, she developed chills, fever, and neutropenia. A skin biopsy was performed and was consistent with pyoderma gangrenosum (PG) or neutrophilic dermatoses. PG is an inflammatory skin disease associated with both cutaneous trauma and systemic disease, including hematologic malignancy. PG after tattoo placement, in both healthy patients and those with hematologic malignancies, has, to our knowledge, not yet been described in the literature. While further studies are necessary to investigate the link between PG and tattooing, oncologists may wish to counsel patients with leukemia to refrain from obtaining new tattoos.