Vulvar lymphangiectasia secondary to gastrointestinal tuberculosis infection in a teenager

We report a rare presentation of vulvar lymphangiectasia that developed secondary to gastrointestinal tuberculosis in a teenager, and its spontaneous resolution after anti-tuberculous treatment was completed.     

Vulvar myiasis due to Wohlfahrtia magnifica

Myiasis is a condition resulting from the invasion of tissues or organs of man or animals by the larvae of dipterous flies. The distribution of myiasis is worldwide, with more cases being reported from tropical, subtropical, and warm temperate areas. The various forms of myiasis may be classified from an entomological or a clinical point of view. This report describes a rare case of vulvar myiasis due to Wohlfahrtia magnifica in an otherwise healthy 20-year-old Iranian female. To our knowledge, this is the first report of cutaneous myiasis of the vulva due to W. magnifica from Iran and the Middle East region.     

Pre-septal cellulitis and facial erysipelas due to Moraxella species

We describe a patient with an acute ulcerated pre-septal cellulitis with subsequent spread across the face, in whom conjunctival swabs demonstrated the presence of Moraxella species. Unusually, this organism was resistant to penicillin. Clinical improvement was only achieved when treatment with co-amoxiclav was commenced on the basis of the antibiotic sensitivities demonstrated by culture of this organism. Moraxella species are rare skin pathogens but may be underestimated as they usually respond to a wide range of antibiotics; they should be considered as a cause of facial cellulitis or erysipelas which responds poorly to conventional therapy.     

Vulvar contact dermatitis due to seminal allergy: 3 cases

BACKGROUND: Contact sensitivity deserves to be assessed in acute vulvitis as well as chronic vulvar dermatitis with a specific orientation toward semen allergy whenever the pathology is post-coital. OBSERVATIONS: Three observations of semen allergy are reported. Two women presented with post-coital vulvitis due to delayed hypersensitivity to semen proteins without associated specific IgE. The type 2 allergy was confirmed by positive patch-tests and disappearance of symptoms when using condoms. Another woman presented with oedematous vulvitis associated with asthma and malaise per and post-sexual intercourse. Positive prick-tests with husband's semen and blood tests for specific IgE led to the diagnosis of type 1 hypersensitivity to semen, with disappearance of both vulvar and systemic symptoms with the use of condoms. DISCUSSION: Immediate or delayed type hypersensitivity may be discovered using prick and patch tests respectively. The observation of vulvitis or vulvar discomfort should promote such investigations, whenever a post-coital chronology is suggested. The good clinical pertinence of positive skin tests must be emphasized. Although type I hypersensitivity to semen is documented in the literature, with easy detection of specific IgE, delayed type 2 allergy presents as an as yet under-diagnosed etiology of post-coital vulvitis. Patch tests may help to confirm that contact dermatitis may be due to seminal proteins.     

Omphalith-associated relapsing umbilical cellulitis: recurrent omphalitis secondary to a hair-containing belly button bezoar

We report an 18-year-old man with recurrent cellulitis of his umbilicus and surrounding skin. Thorough investigation revealed a foreign body as the source of his relapsing infection, a compact collection of terminal hair shafts. Spontaneously occurring stonelike foreign bodies resulting from the accumulation and concretion of keratinous and amorphous sebaceous material within the umbilicus are referred to as omphaliths. However, because the composition of our patient's foreign body is pilar in origin, we propose that the foreign body be designated as either an omphalotrich or trichomphalith. Alternatively, because the umbilicus and epithelium of the gastrointestinal tract are embryologically related, we suggest that our patient's hair-containing foreign body be referred to as a trichobezoar, which is used to describe exogenous foreign bodies composed of ingested hair in the gastrointestinal tract. The patient's cellulitis resolved without any subsequent episodes following the removal of his belly button bezoar.     

A case of varicella complicated by cellulitis and scarlet fever due to Streptococcus pyogenes

We report a 4-year-old boy with cellulitis and scarlet fever due to streptococcal infection following the onset of varicella. He developed a painful ulcer and subcutaneous induration on the left shoulder and a small, light-red-colored rash on the trunk at approximately the same time as the development of vesicles over the entire body. Streptococcus pyrogenes was isolated from samples from the posterior intranasal space and the ulcer on the shoulder. The clinical symptoms improved with the administration of antibiotics and intravenous drip infusion, but it took approximately one month from the first visit for the subcutaneous induration to disappear and the ulcer to heal with epithelialization. The complication of secondary streptococcal infection in varicella is relatively rare in Japan, but in Western countries there have been many reported cases of life-threatening necrotizing fasciitis and necrotizing pyomyositis due to secondary streptococcal infection following varicella. Close attention should be paid to streptococcal infection as a complication of varicella.     

A symmetrical pustular auricular eruption due to recurrent HSV infection

We report a patient with a symmetrical presentation of HSV infection on both pinna, recurrent since his childhood. Our patient used to play rugby as a student and we feel that the symmetrical and unusual distribution for his viral infection may be related to direct inoculation due to trauma sustained in contact sports and subsequent autoinoculation. To our knowledge, no similar symmetrical presentation of HSV infection has been reported in the literature.     

Vulval lymphangiectasia.

Three cases of lymphangiectasia of the vulva are reported. One case followed Wertheim's hysterectomy for carcinoma of the cervix; two other cases had Crohn's disease with perineal involvement. Lymphangiectasia is a secondary phenomenon resulting from obstruction of previously normal lymphatics. This is in contrast with lymphangioma which is an anatomical abnormality. A review of the literature suggests that the vulval skin may be particularly susceptible to the formation of lymphangiectasia, and our patients' experiences suggest that they are easily mis-diagnosed.     

Acquired cutaneous lymphangiectasia

Summary We report a case of acquired cutaneous lymphangiectasia associated with underlying malignancy, and following an arthrotomy. Clinical and histological features were identical with those of acquired lymphangioma. Lymphangiography showed signs of acquired lymphatic obstruction. Both the underlying tumour and the arthrotomy were thought to be contributory factors.