An unusual presentation of tuberculous epididymo-orchitis: case report.

An Asian man initially presented with a urethral discharge caused by lower urinary tract infection, which was followed by acute epididymo-orchitis. This responded well to antibiotics but was followed by a less acute form of epididymo-orchitis, which did not respond to antibiotics and which tissue biopsy showed to be tuberculous. The inflammatory injury of acute epididymo-orchitis may have activated a silent tuberculous focus in the epididymis, which led to the subsequent subacute tuberculous epididymo-orchitis.     

Prevalence of chlamydial infection in acute epididymo-orchitis.

The prevalence of sexually transmitted infection was studied in 40 men presenting with acute epididymo-orchitis in Leeds. Chlamydia trachomatis infection was identified in 13 of 29 men (45%) aged under 35 years. Neisseria gonorrhoeae was isolated from four of these 13 men with chlamydial urethritis. C trachomatis was isolated from the urethra of only one of 11 men (9%) aged over 35. Appreciable bacteriuria was found in six of these 11 men (55%). Noting details of sexual history and screening for sexually acquired pathogens is advocated in younger men with acute epidiymo-orchitis.     

Improvement in treatment of patients with gonorrheal epididymo-orchitis

Examinations of 46 patients with gonorrheal orchiepididymitis have revealed reduced IgA, IgG and IgM levels, a rise of circulating immune complexes level, and depressed lysozyme activity. Addition of proteolytic enzymes to combined therapy has improved the treatment efficacy and normalized the humoral immunity and nonspecific defense parameters.     

Tuberculous epididymo-orchitis and papulonecrotic tuberculids of the glans penis

A 25-year-old male presented with an asymptomatic papulo-pustular eruption over the glans penis. The clinical features and investigations were suggestive of papulonecrotic tuberculids of the glans penis. He had an underlying bilateral active tuberculous epididymo-orchitis and a healed focus of pulmonary tuberculosis.     

Tuberculous epididymo-orchitis presenting within the setting of a sexually transmitted disease clinic

BACKGROUND: Tuberculous epididymo-orchitis (TBEO) is uncommon in Western cities in the modern era. A case series of 3 patients with TBEO presenting to a sexually transmitted diseases (STD) clinic has never previously been reported. GOAL: The goal of this study was to report all known cases of TBEO attending a London STD clinic within the last 6 years. STUDY DESIGN: We conducted a case analyses. RESULTS: The 3 patients aged 30, 42, and 47 years were all HIV-negative and immigrants (2 black Africans, 1 Middle Eastern). The median duration of scrotal swelling was 3 months (range, 2-4 months). Mycobacterium tuberculosis was isolated from early-morning urine specimens in 2 of 3 cases. All had grade IV Heaf test (equivalent to greater than 15 mm Mantoux induration), unilateral TBEO without renal tract disease, and responded to antituberculous chemotherapy. CONCLUSION: The changing epidemiology of TB and demography of Western countries could lead to an increase in such patients presenting at STD clinics. The early diagnosis of TBEO, which is aided by clinical acumen and conventional diagnostic tools, can prevent complications.     

Comparison of metallothionein-overexpression with sentinel lymph node biopsy as prognostic factors in melanoma

BACKGROUND: Metallothioneins (MT) are ubiquitous, intracellular small proteins with high affinity for heavy metal ions. Immunohistochemical MT overexpression in paraffin-embedded tissues of patients with primary melanoma is associated with poor prognosis. While sentinel lymph node (SLN) biopsy is an established surgical technique for high-risk melanoma patients with predictive value for progression, the benefit of this procedure for the individual patient's overall survival remains unclear. AIM AND METHODS: We examined the role of MT overexpression in comparison with SLN biopsy in melanoma patients as a prognostic marker for progression and survival. One hundred and fifty-eight (158) patients underwent SLN biopsy due to high-risk melanoma. Primary melanoma specimens were investigated by using a monoclonal antibody against MT on routinely fixed, paraffin-embedded tissues. The patients were followed up (median 37 months); the data of disease free survival and overall survival were calculated with a broad panel of statistical analyses. RESULTS: Twenty-eight (18%) out of 158 recruited melanoma patients developed metastases, 17 (11%) patients died due to widespread disease. Kaplan-Meier curves gave significant disadvantages for the MT-positive as well as the SLN-positive group for progression and survival. In the Fisher's exact test and Pearson's chi(2)-test MT overexpression was highly significant for progression, whereas SLN biopsy failed significance. In univariate as well as multivariate Cox regression analysis MT overexpression proved an excellent marker for progression (P=0.007 and P=0.009), although the P-values for survival were not significant. In contrast, while in the univariate analysis SLN biopsy did not show significant results for progression it did for survival, and in the multivariate analysis reached a P-value < 0.05 for both measured endpoints. CONCLUSION: Results corroborate the validity of MT overexpression in primary melanoma as a useful prognostic marker in melanoma patients. Accuracy is comparable and to some degree supplementary to the results of SLN biopsy.     

Identification of Mycobacterium tuberculosis and non‐tuberculous mycobacteria from cutaneous sarcoidosis lesions by reverse blot hybridization assay

While the etiology of sarcoidosis remains uncertain, mycobacteria have been suggested as a causative infectious agent. To investigate the causal relationship between mycobacteria and sarcoidosis, we performed a reverse blot hybridization assay (REBA) to identify mycobacteria from the skin samples of nine patients with sarcoidosis. Six of the nine samples were shown to be positive for mycobacteria by REBA, including Mycobacterium tuberculosis and non‐tuberculous mycobacteria. This is the first study to identify mycobacteria from the skin samples of sarcoidosis patients using REBA, and our results could strengthen the etiologic association between mycobacteria and sarcoidosis.     

Chronic lupus erythematosus presenting as acneiform lesions

BACKGROUND: Cutaneous manifestations of lupus erythematosus are numerous but usually permit easy diagnosis. However, there are atypical lesions that can mimic benign dermatologic disorders. We report on a patient with lesions of acne leading to the diagnosis of chronic lupus erythematosus, and who subsequently developed systemic lupus erythematosus. CASE REPORT: A 30-year-old woman presented with inflammatory lesions and comedos on the face. The eruption started after her last pregnancy and was refractory to local and general treatment. She also complained of arthralgia, Raynaud's phenomenon and diffuse alopecia. Cutaneous biopsy was characteristic of chronic lupus erythematosus. Immunofluorescence microscopy of lesional skin showed a lupus band deposit. Antinuclear antibodies were highly positive. The patient was successfully treated with chloroquine. Three years later, the patient presented with photodistributed eruption. Antinuclear antibodies were still positive and in addition anticardiolipin antibodies were found. Final diagnosis was systemic lupus erythematosus. DISCUSSION: Acneiform lesions are rarely reported in lupus erythematosus. Only three similar cases were reported in literature. Atypical and treatment-resistant eruptions should attract attention. Furthermore, the occurrence of systemic lupus in chronic lupus erythematosus is not an unfrequent phenomenon and the oestrogen-dependance of chronic lupus lesions may predict this association.     

The rash that presents as target lesions

We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them to differentiate between those with serious systemic and life-threatening diseases from others with ordinary skin ailments.     

表现为发疹性瘙痒性丘疹的汗孔角化病

报告1例表现为发疹性瘙痒性丘疹的汗孔角化病.患者男,50岁.臀部丘疹伴剧烈瘙痒7年,逐渐融合成斑块,丘疹突然增多并累及双下肢1年.皮损组织病理检查符合汗孔角化病.给予角质剥脱剂外用及阿维A口服治疗4周,皮损暂无明显改善.     

Skin lesions as a sign of subacute pentachlorophenol intoxication

Pentachlorophenol (PCP) and its sodium salt are frequently used in wood preservatives. Little is known about the effects on man when being chronically exposed. Only vague skin symptoms, such as rashes, acne and cutaneous infections were described. We present two cases of pemphigus vulgaris with a known non-occupational chronic PCP exposure. The clinical course and the titer of pemphigus antibodies roughly correlate with the PCP levels in serum. In one case of chronic urticaria the exacerbations also run parallel to the PCP serum levels and increased anti-skin antibodies, without any manifestation of pemphigus vulgaris. The role of PCP as one of the causes provoking pemphigus vulgaris and chronic urticaria with raised anti-skin antibodies is discussed.