Scytalidium dimidiatum in Australia

Six patients with Scytalidium dimidiatum (Hendersonula toruloidea) infections of their skin and nails are presented. Two of these patients originated in tropical areas where the fungus is endemic and four were Australian born. Three of the Australian-born patients had no history of travel to areas where the fungus is endemic. It appears that S. dimidiatum is present in Australia.     

Scytalidium hyalinum infection of skin and nails

Five cases of skin and nail infection associated with Scytalidium hyalinum are described. The lesions were confined to the hands, feet and toenails. All the patients were from the West Indies and were of Negroid descent. Scytalidium hyalinum was the only fungus isolated on repeated culture from three patients, while the remaining two patients had mixed infections, one with Trichophyton mentagrophytes var. interdigitale and the other with Hendersonula toruloidea.     

Two cases of tinea pedis caused by Scytalidium hyalinum

Two cases of tinea pedis due to Scytalidium hyalinum, the first to be described in Italy, are reported. The patients were a 41-year-old woman and a 35-year-old man who had spent periods in the Caribbean. The clinical manifestations were indistinguishable from those caused by dermatophytes. In the women they were striking with 'moccasin foot' type lesions, whereas in the man they were less evident, with minor plantar desquamation and interdigital maceration. Diagnosis was based on direct mycological microscopic examination and culture. Clinical and mycological remission were obtained with systemic itraconazole therapy. These cases are reported because infections caused by Scytalidium hyalinum are rare in Europe and their clinical and mycological diagnosis, as well as therapy, may be problematic.     

Nail disease due to Scytalidium in Martinique (French West Indies)

INTRODUCTION: Scytalidium is an endemic mold in tropical and subtropial areas. Our purpose was to study the prevalence and clinical and epidemiological features of onychomycoses due to Scytalidium in Martinique (French West Indies). PATIENTS AND METHODS: We performed a prospective study on 106 patients (46 men and 60 women) with clinical onychomycosis, in the dermatological department of the Centre Hospitalier Universitaire of Fort-de-France. All patients underwent mycological sampling and were divided into two groups depending on the presence or not of Scytalidium. Age, sex, localization, clinical aspects, time of duration and environmental factors (place of residence, garden, animals, bare foot walk, immunodepression) were compared between the two groups using chi2, Fisher and Student's t test. Ten control volonteers without clinical onycomycosis underwent mycological sampling. RESULTS: Onychomycosis due to scytalidium represented 42 p. 100 of patients (Scytalidium hyalinum in 91 p. 100 of cases) and 56 p. 100 after elimination of patients with negative results. Medium age was significantly higher in Scytalidium group (62 versus 54 years; p<0.02). Toe nail was involved in 95 p. 100 of patients (big toe nail in 77 p. 100). Sole involvement was more frequent in Scytalidium group (47 p. 100 versus 14 p. 100; p<0.001). Sampling of controls showed scytalidium in one case. DISCUSSION: Our study confirmed the endemicity of Scytalidium hyalinum in Martinique and the frequence of sole involvement. Presence of Scytalidium without clinical features in one control is of epidemiological interest, and may explain the frequence of the disease.     

Successful eradication of Scytalidium dimidiatum-induced ungual and cutaneous infection with voriconazole

We report the successful treatment of extensive cutaneous infection and onychomycosis caused by Scytalidium dimidiatum in a 30-year old Nigerian woman.     

Two unusual cases of dental (periapical) infection

Cutaneous sinus tracts of dental origin are often a diagnostic challenge. A delay in correct diagnosis can result in inappropriate treatments. We describe two unusual cases of periapical infection. The first patient presented with a fistulized tumoral mass under the chin present for 1 year. The patient had only one tooth, and that was anatomically unrelated to the tumor. Radiological examination showed a dormant tooth that was infected periapically. The second case was a man who complained of asymmetry and change in his left nasolabial fold of 4-5 week's duration. On examination, the nasolabial folds were asymmetric without any sign of facial palsy. On intraoral examination, there was a severely decayed tooth on the same side. Radiological survey confirmed periapical infection. A few weeks after proper treatment, the nasolabial folds became symmetric.     

Three cases of focal dermal hypoplasia (Goltz syndrome)

Focal dermal hypoplasia or Goltz syndrome is a rare genodermatosis, characterized by multiple abnormalities of ectodermal and mesodermal origin. It is found predominantly in females and is characterized by hypoplasia of skin and papillomas. Three cases of focal dermal hypoplasia in infancy with unusual inheritance patterns are reported. Cutaneous features were atrophic reticulated scars involving the trunk and extremities following the lines of Blaschko. Papillomas were present on the genitalia and in a periorificial distribution. Skeletal abnormalities included syndactyly, polydactyly and lobster claw deformities. Ophthalmological examination revealed strabismus and retinal colobomas.     

Eosinophilic pustular folliculitis (Ofuji's disease) in Singapore: a review of 23 adult cases

The case records of 23 patients with classic eosinophilic pustular folliculitis (EPF), or Ofuji's disease, seen at the National Skin Centre in Singapore, from 1990 to 2001 were reviewed. All patients had clinical and histopathological findings consistent with EPF. There were eight men and 15 women (ratio 1:1.6). The mean age at presentation was 35 years. There was a marked predilection for Chinese patients (87%), with a racial distribution of 20:2:1 of Chinese, Malay and Indian patients, respectively. The most frequent site of occurrence was the face, particularly over both cheeks. The majority of patients (90%) treated with oral indomethacin had a good response within 2-4 weeks. Relapses were frequent in 82.6% of patients and maintenance with indomethacin or ketoprofen was beneficial. Eosinophilic pustular folliculitis is a rare but important disease entity presenting with recurrent indurated erythematous papulopustules and plaques on the face. Increased awareness of this condition is important as it can mimic many other conditions presenting as red plaques on the face.     

Three cases of erythema nodosum associated with Yersinia enterocolitica infection

Three cases of erythema nodosum associated with Yersinia enterocolitica infection were reported. They were diagnosed as Yersinosis following isolation of Yersinia enterocolitica from the feces and from serological investigation. The diagnosis was supported by the fact that Yersinia enterocolitica could be separated from the feces at an early stage of infection and that the serum agglutination titer for Yersinia enterocolitica increased within a month of infection. Clinically, the erythema nodosum preceded by abdominal pain and/or diarrhea was a complication of Yersinosis.     

976例系统性红斑狼疮患者院内感染情况分析

目的：了解系统性红斑狼疮患者院内感染的情况。方法：按我国《医院内感染诊断标准》,分析某院2001—2005年系统性红斑狼疮住院病人院内感染情况。结果：共976例系统性红斑狼疮患者,院内感染率为12．19％（119／976）。结论：应加强对SLE患者院内感染的预防,以进一步减少院内感染的发生。     

Three cases of embolia cutis medicamentosa (Nicolau’s syndrome)

Embolia cutis medicamentosa, also known as Nicolau’s syndrome, is a rare complication due to i.m. injections. Its real incidence is actually underestimated. Many drugs have been associated with it, but at the time only a few studies showed a related pathogenetic mechanism. Symptoms consist of immediate local pain, edema and cutaneous, subcutaneous and even muscular necrosis occurring in the first 48 h. The type of treatment depends mostly on time of diagnosis. A medical resolution can be achieved through heparin and cortisone injections within the first 48 h. Surgical debridement has to be considered as the main treatment in case of late diagnosis. We present three cases of Nicolau’s syndrome presenting to us in a short period of time that we treated with surgical debridement.     

The Epidemiology of Malassezia (Pityrosporon) Folliculitis in Singapore

Seventy patients with a clinical diagnosis of Malassezia folliculitis were studied, of which 48 were confirmed on finding unipolar budding yeastlike organisms on gramstained microscopy or histology specimens. The epidemiologic and clinical features of these 48 cases (M = 44; F = 4) were analyzed. The typical Singaporean patient with Malassezia folliculitis is a young man of mean age 22.2 years with erythematous follicular papules or pustules on the upper back, shoulders, upper chest, and sides of the back. Aggravating factors include heat and sweating. Excessive sebum production may be an important underlying factor.     

254例皮下组织真菌感染回顾性分析（1990-2019年）

 目的:了解广东地区皮下真菌感染的临床流行病学特征及致病菌菌学动态变化。方法：回顾分析1990年1月-2019年12月近30年我院皮肤科254例皮下组织真菌感染患者的一般特征、皮损组织病理、诊断及菌种分析。结果：平均每年确诊8.47例,患者平均年龄为47.78岁,男女患病率为1.46 ∶1,最常见感染部位为上肢（31.10%）,31~60岁患者为主要感染人群（46.12%）。孢子丝菌病仍是最常见的皮下组织真菌感染（55.91%）,但近20年其病例数有下降趋势。着色芽生菌病病例数近10年发病较前20年明显升高（P<0.05）。球形孢子丝菌和Fonsecaea monophora分别为孢子丝菌病及着色芽生菌病主要致病菌。结论：孢子丝菌病为最常见皮下真菌感染,着色芽生菌病例有增多趋势。基于原发与继发免疫缺陷疾病发病率的增高,少见菌种引起的感染在近10年明显增多。分子鉴定可为发现新致病菌、疾病的流行病学调查提供可靠依据。     

Mycetoma in South India: retrospective analysis of 13 cases and description of two cases caused by unusual pathogens: Neoscytalidium dimidiatum and Aspergillus flavus

Background Mycetoma is a chronic suppurative and/or granulomatous inflammatory lesion of skin, subcutaneous tissue, fascia, and tendons caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. The disease is characterized by triad of tumefaction, discharging sinuses, and grains. Material and methods Thirteen new cases of biopsy proven mycetomas were analyzed, retrospectively, from January 2000 to October 2009. Clinical parameters, bone involvement, microbiological properties, and histopathological features were evaluated. Categorization into eumycotic or actinomycotic was based upon features on hematoxylin and eosin stained sections with special stains. Therapeutic outcome was presented wherever available. Results There were eight actinomycetomas and five eumycetoma cases including 11 men and two women. Foot and lower extremities were the most common site of involvement (9 of 13, 69%). Culture results were available in 8 of 13 cases (61.5%). Madurella mycetomatis, Neoscytalidium dimidiatum, and Aspergillus flavus were the isolates among eumycetomas whereas Acinomadura madurae, Actinomadura pelletieri, and Nocardia species were the isolates among actinomycetomas. Two cases had underlying bone involvement. On follow‐up, four of five eumycetoma cases showed partial improvement following surgery and antifungal therapy, one had amputation of the lower leg. Of the actinomycetomas, six of eight had dramatic improvement following sulfamethoxazole‐trimethoprim based therapy, one had complete cure, and one was lost to follow‐up. Conclusion Strong clinical suspicion, exact categorization of lesion into eumycotic or actinomycotic along with culture correlation, is essential for prognosis and effective therapy.     

Three cases of porocarcinoma

Three cases of long-standing eccrine poromata are described showing a range of histological changes progressing towards malignancy. The duration of the lesions was from 10 to 20 years, finally presenting as raised, non-pigmented, sessile and pedunculated lobulated tumour masses on the foot, scalp and thigh. Two tumours showed ulceration; none was associated with metastasis. These clinical features are similar to reported series of eccrine porocarcinomata (Shaw et al. , 1982). Two of the patients had prior internal malignancies.
The excised tumour tissue was firm and grey-white in colour. Histology of the tumours showed continuity with the epidermis; one initially presenting as an exclusively intra-epidermal lesion. Typical appearances of eccrine poromata were demonstrated: closely packed small squamous cells formed broad interlacing trabeculae, with occasional clefts and duct-like spaces. Cytological evidence of dysplasia was present in the intra-epidermal lesion at the outset; in the others focal Bowenoid dysplasia has arisen from previously bland and uniform tumour epithelium. The most recent biopsies show a range of appearances from focal Bowenoid dysplasia in an otherwise benign lesion, through to invasive squamous carcinoma. We postulate a spectrum of development of porocarcinomata originating from long-standing poromata.
Histochemistry confirms active glycogen metabolism within the invasive tumour (Sanderson & Ryan, 1963; Hashimoto & Lever, 1964). Immunoperoxidase studies demonstrated carcino- embryonic antigen in clefts and duct-like structures, but not in the main mass of tumour tissue (Penneys, Nadji & Morales, 1982). Electron microscopy was performed on two of the tumours.     

汗孔角化症三例

正临床资料例1,患者,男,65岁。臀部斑块10余年,进行性加重2个月,于2014年3月9日就诊。患者10余年前无明显诱因出现臀部斑块,伴剧烈瘙痒。曾外用多种药物治疗(具体不详),效果不佳,皮损逐渐加重。患者为体力劳动者,既往体健,无高血压、糖尿病等病史。家族中无类似疾病史。体格检查:一般情况好,心、肝、肾检查未见异常。皮肤科检查:双侧臀部见对称性地图样疣状角化斑块,表面粗糙,     

Three cases of eccrine porocarcinoma

We report three cases of eccrine poroma, present for many years, in which features were seen suggesting transformation from a benign to a malignant tumour. These changes ranged from in situ Bowenoid dysplasia to frankly invasive squamous carcinoma. The most helpful diagnostic feature in distinguishing the origin of the tumours was the presence of strong cytoplasmic staining for carcinoembryonic antigen (CEA) in cells surrounding, and giving rise to, neoplastic ducts and clefts. Dermatopathologists examining eccrine poromata should examine the lesions carefully for any evidence of malignant change.     

女阴汗管瘤3例

报告3例局限于女阴的汗管瘤。患者均为青年女性,皮疹均表现为外阴部散在粟米至绿豆大的肤色或淡褐色扁平丘诊,表面光滑,患者无明显自学症状。1例患者的皮诊受月经周期影响。3例患者均经过组织病理检查确诊。