Perforating folliculitis in a patient with cystic fibrosis

We report a case of a young man with perforating folliculitis and cystic fibrosis with complications including chronic obstructive pulmonary disease, insulin dependent diabetes mellitus, and liver cirrhosis. We demonstrate increased TGF-β1 immunohistochemical staining in the perforating folliculitis lesions of our patient and discuss the possible associations between cystic fibrosis and perforating folliculitis.     

Perforating folliculitis in association with primary sclerosing cholangitis

Two patients with primary sclerosing cholangitis developed perforating lesions in the skin of the extremities. Clinically and histologically, the cutaneous condition showed the features of perforating folliculitis with superimposed lesions of prurigo nodularis. The course of the eruption paralleled the severity of the biliary disease. A theory of pathogenesis for the development of the perforating folliculitis in these patients is suggested. To the best of our knowledge, this is the first report of the coexistence of both conditions.     

Eosinophilic folliculitis in a Caucasian patient: association with toxocariasis?

Sterile eosinophilic folliculitis, a clinical entity first described by Ofuji in 1970, is a rather rare skin disorder, in particular in the non-Asian population. We report the first case of eosinophilic folliculitis associated with toxocariasis in a Caucasian patient. Topical and systemic anti-inflammatory and antiphlogistic therapy along with systemic antihelminthic treatment resulted in complete remission of the skin lesions. In addition, there was a marked decrease of antibodies to Toxocara antigens in the patient's serum following antihelminthic therapy. Given that (I) some cases of eosinophilic folliculitis have been reported which were associated with infestation with metazoan parasites; (2) infestations with the roundworm Toxocara canis are known to induce eosinophilic reactions in some tissues; and (3) therapy-induced remission of eosinophilic folliculitis was accompanied by a decrease of Toxocara-directed antibodies in the patient's serum, we propose that there is an aetiopathogenic link between toxocariasis and eosinophilic folliculitis in this patient.     

Disseminated paracoccidioidomycosis in a liver transplant patient

Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.     

Acinetobacter baumanii folliculitis in a patient with AIDS

Gram-negative folliculitis usually involves the face and develops in patients with acne or rosacea during long-term antibiotic therapy. Numerous pathogens have been found, but not, until now, Acinetobacter baumanii which has previously been recognized as an important cause of nosocomial infections and hospital outbreaks. We report here a case of A. baumanii folliculitis of the face, neck, arms and upper part of trunk in a patient with AIDS responding to intravenous treatment with ticarcillin-clavulanic acid. The bacterium was not found on healthy skin and the source of the infection remained unknown.     

Development of folliculitis and pyoderma gangrenosum in association with abdominal pain in a patient following treatment with isotretinoin

A 19-year-old man with severe acne developed extensive scalp folliculitis and later superficial pyoderma gangrenosum following treatment with isotretinoin. A cyclical neutropenia was noted and bone marrow findings suggested myelodysplasia. We believe that isotretinoin was implicated in the development of overt symptoms in this patient whose haematological condition was previously asymptomatic.     

Hairy leucoplakia in liver transplant patient

Oral hairy leucoplakia has been described only in patients infected with the human immunodeficiency virus (HIV) and is a significant predictor for the subsequent development of AIDS. The occurrence of hairy leucoplakia in a liver transplant patient suggests that the lesion is not restricted to HIV seropositive individuals, but can be found in other categories of immunosuppressed patients.     

Widespread Candida folliculitis in a nontoxic patient.

We present a case of widespread Candida folliculitis in a nontoxic, immunocompetent woman. Predisposing factors included obesity and use of systemic antibiotics and topical steroids. Diagnosis was made through potassium hydroxide and Gram's stain examination of the pustular contents. The patient was treated with oral ketoconazole and topical econazole, with resolution of the eruption in six weeks. We suggest that temperature played a role in the follicular location of the lesions.     

Demodex folliculitis on the trunk of a patient with mycosis fungoides

A 43-year-old man with tumour Stage mycosis fungoides developed multiple follicular pustules on the trunk during total-skin electron beam therapy. A potassium hydroxide preparation of (he contents of the pustules revealed the presence of Demodex mites. The patient was treated with 6% sulphur lotion with rapid improvement of the cutaneous lesions. We believe that this case represents a pustular folliculitis caused by Demodex mites, Immunosuppression associated with mycosis fungoides and its treatment may have resulted in the proliferation of this obligate parasite of the pilosebaceous follicle, and the development of the folliculitis.     

Mycobacterium chelonae/abscessus complex infection in a liver transplant patient

A 25‐year‐old woman presented in October 1999 with fever, nausea, vomiting, and a nodular eruption that had developed over the previous 7 days. Her past medical history was significant for chronic sclerosing cholangitis, which necessitated a liver transplantation in 1994 and a second one in 1998 due to graft rejection. Upon admission, she was taking the following medications: prednisone 20 mg q.d., cyclosporine 375 mg p.o. b.i.d., sirolimus 10 mg p.o. q.d., levofloxacin 500 mg p.o. q.d., and ganciclovir 1000 mg p.o. t.i.d. On skin examination, there were tender, nonfluctuant, erythematous, subcutaneous nodules, 0.3–1.0 cm in diameter, scattered on her arms and legs (see Fig. 1 ). While undergoing diagnostic evaluation, the patient was empirically treated with intravenous antimicrobials for presumed sepsis as well as increased dosages of glucocorticosteroids for the possibility of acute graft rejection. Her laboratory data were significant for elevated liver function tests, blood urea nitrogen, and creatinine. A punch biopsy of a nodule on her left forearm showed a neutrophilic and histiocytic lobular and septal panniculitis (see Fig. 2 ), and all special stains, including acid‐fast bacillus (AFB) stains, and tissue cultures were negative for infectious organisms.

Figure 1 Open in figure viewer PowerPoint Erythema nodosum‐like nodules on the leg