Sporotrichosis in Manipur: report of two cases

Two cases of lymphocutaneous sporotrichosis are reported from Imphal. Sporothrix schenekii was isolated from pus from the lesion and identity was confirmed by mycelial to yeast conversion at 37 degrees C and mice pathogenicity test. One patient gave history of injury with bone of fermented fish (Ngari). Both the patients were treated successfully with oral administration of potassium iodide. These two cases are the first authentic cases of sporotrichosis from Manipur.     

多发结节表现的孢子丝菌病1例

患者男，31岁。3个月前因外伤后左膝部出现许多小结节，表面呈疣状。皮损真菌镜检（-），37℃温箱真菌培养（-），25℃温箱培养有菌落生长，经鉴定为申克氏孢子丝菌。予碘化钾，伊曲康唑治疗，3周后皮疹好转。     

Urticarial vasculitis: a report of nine cases and review of the literature

Urticaria may be the only cutaneous manifestation of a leukocytoclastic vasculitis. We have studied nine patients with urticarial vasculitis. The spectrum ranged from limited cutaneous disease (six cases) to severe systemic disease with renal failure (one case). The individual urticarial lesions were of long duration (over 4 h) in all patients and in seven cases an ecchymotic stain was left when the urticaria resolved. All patients complained of moderate to severe pruritus. Associated findings included arthralgia (two cases), fever (one case) and glomerulonephritis (one case), but none had neurological disease, abdominal pain or arthritis. Therapy was difficult in seven patients, and these cases were controlled only with systemic corticosteroids. This disorder falls within the larger group of vasculitides. It is distinguished only by its skin lesions, which cannot always be distinguished clinically from common urticaria.     

Tinea barbae (tinea sycosis): experience with nine cases

Tinea barbae is a rare dermatophytosis that affects the hair and hair follicles of the beard and mustache. This paper presents 9 cases of tinea barbae observed over an 18-year period of time and classified as follows: 1 was superficial and 8 were deep (6 folliculitis-like and 2 kerion-like). Most of the cases (4) were associated with topical steroid therapy, others with pet contact (3 cases) and one with diabetes. The causal agents isolated were: Trichophyton rubrum in 3; Microsporum canis in 3; Trichophyton mentagrophytes in 2; and Trichophyton tonsurans in one. The involvement of the hair was observed and classified in all cases. The trichophytin skin reaction was positive in all 9 patients. All the patients were treated with systemic antimycotics, 3 cases with griseofulvin, 1 with ketoconazole, 3 with itraconazole, and 2 with terbinafine. Clinical and mycologic cures were achieved at 6 to 8 weeks of treatment at the usual doses.     

Sporotrichosis masquerading as pyoderma gangrenosum: case report and review of 19 cases of sporotrichosis

We present the case of a 59-year-old woman who had large ulcerations on her right leg that were diagnosed initially as pyoderma gangrenosum and treated with three immunosuppressive agents (cyclosporin, prednisone and azathioprine) for 6 months. Results of a biopsy at 6 months showed numerous cigar-shaped bodies consistent with Sporothrix schenckii; identification was confirmed by tissue culture. A retrospective review was performed for all cases diagnosed as sporotrichosis from tissue culture or biopsy specimens at the Mayo Clinic. Nineteen cases were identified. The present case was the only one in which fungal organisms were visible on histological examination. The present case emphasizes the importance of making a definitive histological diagnosis in unusual ulcer cases or in suspected cases of pyoderma gangrenosum before the initiation of immunosuppressive therapy. The large number of cigar-shaped bodies in the tissue is a rare finding in sporothrix infection and has been reported in only two cases previously.     

孢子丝菌性下疳误诊为蜂窝织炎1例

报道１例误诊为蜂窝织炎的孢子丝菌性下疳。其早期皮损表现为左前臂２ｃｍ×８ｃｍ×１２ｃｍ潮红浸润性斑块,中心凹陷,上覆黑褐色厚痂,挤压后有脓汁溢出。曾在当地３次误诊为蜂窝织炎,并切开引流。其后,左上下肢又出现十几个红色结节,遂转来我院。经活检及真菌培养后确诊为孢子丝菌病。给予抗真菌治疗１月,皮损明显好转。     

Inoculation (tattoo) leprosy: a report of 31 cases

Thirty-one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty-five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.     

Profile of Vitiligo in Kumaun Region of Uttarakhand,India

Background:

Vitiligo is a common, acquired, pigmentary disorder characterized by loss of melanocytes resulting in white spots. This disease carries a lot of social stigma in India.

Objective:

To study the clinico-epidemiological profile of vitiligo patients in Kumaun region of Uttarakhand state in India.

Materials and Methods:

The clinical presentation of vitiligo was examined and analyzed in 762 vitiligo patients attending the Dermatology outdoor of Government Medical College, Haldwani, which is a referral centre for Kumaun region of Uttarakhand state in India.

Results:

Male and female patients were found to be affected almost equally. It was observed that onset of vitiligo was most common in 0-10 years age group, as evidenced by 336 cases out of 762 cases. Acrofacial type of vitiligo (339 cases out of 762) was most commonly observed, followed by vitiligo vulgaris, focal, segmental, mucosal, mixed, and universal vitiligo. The most common site of onset was the lower limbs followed by head and neck, upper limbs, trunk, genitalia, and mucasae. Leucotrichia was observed in 33.5%, Koebner''s phenomenon in 26.3%, and a positive family history in 19% of the vitiligo patients. The other common conditions associated were thyroid disorders (8.9%), diabetes (5.3%), and atopic dermatitis (4.9%).

Conclusion:

The study indicates that acrofacial vitiligo is the most common clinical type observed in Kumaun region of Uttarakhand in India. Onset of vitiligo is most common in first decade of life.     

鼻部孢子丝菌病36例临床分析

孢子丝菌病为东北地区常见的皮下组织真菌病.我科从2007年1月至2009年6月共确诊孢子丝菌病患者501例,其中初发皮损在鼻部者36例,现将这组鼻部孢子丝菌病临床资料总结如下.     

Sporotrichosis in Queensland: a review of 37 cases at the Royal Brisbane Hospital.

Thirty-seven cases of sporotrichosis, seen at the Royal Brisbane Hospital from 1965 to 1977, were reviewed. Twenty-eight of the patients were male. The Youngest was 11 and the oldest 80 years. Only four patients has the cutaneous lymphatic variety of sporotrichosis—the others had the localised cutaneous type. There were not cases of systemic sporotrichosis. The lesions in most patients were on the upper limb—mainly the forearm and hand. There was a variety of clinical appearances of the lesions. The most common being ulcerated lesions and verrucous plaques. Confirmation of diagnosis was by positive culture from scrapings or biopsy specimen and/or typical histology. Twenty-four patients were treated with potassium iodide mixture and 11 had the lesions removed surgically. Of the 18 patients followed up, 17 were considered cured.     

Cellular blue nevus with atypia (atypical cellular blue nevus): a clinicopathologic study of nine cases

Atypical cellular blue nevus (ACBN) has clinicopathologic features intermediate between typical cellular blue nevus (CBN) and the rare malignant blue nevus (MBN)/malignant melanoma (MM) arising in a CBN. Herein we report 9 cases of ACBN. The patients were caucasian (6 females and 3 males) with a mean and median age of 47/51 years. Two patients complained of recent changes and about half of these tumors were located on the buttocks or scalp, averaging 1.5 cm in diameter. Histologically, they were characterized by architectural atypia (infiltrative margin and/or asymmetry) and/or cytologic atypia (hypercellularity, nuclear pleomorphism, hyperchromasia, mitotic figures, and/or necrosis). Assessment of the expression of 3 tissue markers demonstrated rare solitary cell staining with oncogene product bcl-2, and a proliferative index of 23±19 and 39±30 cells/10 high power field with antibodies to PCNA and Mib-1, respectively. No significant differences were detected comparing the above levels of expression to a control group of 15 CBN; however, ACBNs tended to show a higher proliferative index by PCNA and Mib-1 as well as a significantly higher mitotic rate (1/10 HPF vs. 0; p=0.001). Analysis of DNA content showed DNA anetiploidy in both groups. Follow-up data on 9 of 9 patients showed 1 patient dead without disease and 8 alive without disease (mean/median follow-up 42/32 months, range 15-96 months). No patient during this follow-up time has experienced either a local recurrence or lymph node or visceral metastasis. These findings highlight the close resemblance of ACBN to the natural history of CBN. Nevertheless, many of the distinguishing histologic features of ACBN are also those of MBN. Because of these intermediate clinicopathologic features, ACBN warrant close scrutiny and long-term follow-up.     

Adenosquamous carcinoma: a report of nine cases with p63 and cytokeratin 5/6 staining

Adenosquamous carcinoma, a rare tumor of the skin with few reported cases in the literature, has not been studied with p63, cytokeratin 5/6 and cytokeratin 7. We stained nine such tumors with these markers. Histologically, the tumors showed superficial, atypical islands of keratinocytes in close association with islands displaying glandular differentiation. Clinically, lesions favored the head and trunk, and a subset of cases showed aggressive behavior. All tumors marked with p63 and cytokeratin 5/6, substantiating that diffuse positivity with these stains is supportive of a primary cutaneous origin. Six tumors stained focally in luminal areas with cytokeratin 7. Recognition of adenosquamous carcinoma is important for appropriate therapy, and stains for p63 and cytokeratin 5/6 may be helpful in ruling out metastatic adenocarcinoma.     

Cutis marmorata telangiectatica congenita: report of nine cases and review of the literature

The major clinical features of nine patients (seven women and two men) with cutis marmorata telangiectatica congenita (CMTC) were persistent cutis marmorata, spider nevus-like telangiectasia, and phlebectasia. Three of the patients had persistent ulcers and atrophy. In two patients, atrophie blanche-like lesions developed on the legs with ulcers. No patient had a family history of a similar disorder. Skin lesions were present at birth in seven cases, at the age of eight months in one case, and at eighteen months in one case. Three patients had clinical improvement of the skin lesions with age. Eight of the nine patients had associated physical anomalies. Biopsy specimens showed an increase in the number and size of the blood vessels in the upper dermis. Alkaline phosphatase staining gave negative results in the dilated blood vessels of the single case in which this histochemical study was done.