Granuloma faciale treatment with clofazimine 1

The authors report the case of a 70-year-old Caucasian woman who, for the last seven years, has suffered outbreaks of facial macular and nodular lesions unresponsive to multiple medical and surgical therapies. Some of the biopsies done at different times involving different lesions evidenced findings suggestive of granuloma faciale. The laboratory and imagiologic findings were within normal limits. Therapy with clofazimine initially associated with oral and intralesional corticosteroids led to the regression of the facial nodules.     

Multiple verruciform xanthomas of the oral mucosa associated with graft versus host disease

BACKGROUND: Verruciform xanthoma is an uncommon lesion that occurs primarily on the mucous membranes and more rarely on the skin. A few authors have reported the extremely rare occurrence of multiple lesions. Triggering or enhancing factors have been occasionally described such as an underlying immunosuppression or associated inflammatory mucous or skin diseases. We report, to the best of our knowledge, the first case report of multiple verruciform xanthomas of the oral mucosa in a patient with graft-versus-host disease with specific oral lesions. CASE REPORT: A 57 year-old man presented with an 8-year history of chronic myeloid leukemia. He was considered in complete remission for leukemia after allogenic bone marrow transplantation. Nevertheless, he was still treated with immunosuppressive drugs for oral and cutaneous lesions of chronic graft-versus-host disease. In this context, the patient presented two symmetric lesions of the gingiva. These lesions had progressed over several months. The clinical presentation was similar, with a yellowish and verrucous aspect and a sessile base. Histologic and immunohistochemical analysis led to the diagnosis of multiple verruciform xanthomas. DISCUSSION: The occurrence of multiple lesions of this rare tumour in our patient was probably not fortuitous. Immunosuppression associated with oral chronic inflammatory lesions are certainly involved in the pathogenesis of these two verruciform xanthomas, for example following degeneration of epithelial cells after local chronic irritation and/or reduction of Langerhans cells. Systematic research of enhancing or triggering factors seems essential in verruciform xanthoma.     

Congenital Malalignment of the Great Toenails With Acute Paronychia

Congenital malalignment of the great toenails (CMGT) has been well documented. In the present case, it was complicated by acute paronychia. It is important for physicians to recognize and treat CMGT to prevent sequelae such as onychocryptosis, onychogryphosis, and recurrent paronychia.     

Relapsing bullous amyloidosis of the oral mucosa and acquired cutis laxa in a patient with multiple myeloma: a rare triple association

It is well known that primary systemic amyloidosis [light chain (AL) amyloidosis] is associated with hidden dyscrasia or multiple myeloma. Acquired cutis laxa (cutis laxa acquisita; CLA) has also been described in patients with plasma cell dyscrasias, including multiple myeloma. We report a case in which haemorrhagic oral bullae were the first sign of an undiagnosed primary systemic amyloidosis related to multiple myeloma IgG‐λ and previously diagnosed CLA. There is only one report in literature of this rare triple association; however, in that case the patient did not have oral mucosal involvement or bullous amyloidosis.     

Inguinal syndrome secondary to Prevotella bivia after accidental bite in orogenital sex

The authors report a case of an inguinal bubo in a young man caused by an anaerobe, Prevotella bivia, which was acquired during oral sexual intercourse. As far as the authors know, this is the first reported case of a sexually transmitted infection by Prevotella. Prevotella spp. inhabit the oral cavity and are highly prevalent in bacterial vaginosis, a polymicrobial syndrome resulting from replacement of the normal vaginal Lactobacillus spp. flora by high concentrations of anaerobic microorganisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis and other uncultivated anaerobes.     

Isolated oral erosions: an unusual manifestation of secondary syphilis

The oral cavity is the most common extragenital site of infection. We report a case of a 50-year-old female with isolated oral ulceration as the presenting manifestation of secondary syphilis. In contrast with the oral lesions of primary syphilis, which tend to be solitary, painless, indurated ulcers, oral lesions of secondary syphilis are typically painful, multiple, and accompanied by a concomitant cutaneous eruption.     

Oral melanoacanthoma with prominent spongiotic intraepithelial vesicles

Oral melanoacanthoma is a rarely-reported, benign pigmented lesion of oral mucosa. Spongiosis was only recently mentioned as a light-microscopical finding occasionally seen in oral melanoacanthoma, and the formation of spongiotic intraepithelial vesicles to our knowledge has never been reported. The authors discuss a case of a 34-year-old, black woman who acutely developed extensive hyperpigmented oral lesions which on the biopsy showed both intraepithelial dendritic melanocytes and severe spongiosis forming intraepithelial vesicles. These lesions resolved spontaneously in a few months which led the authors to believe that the term melanoacanthoma, implying that it is a tumor, is a misnomer. This report supports findings of other investigators who consider oral melanoacanthoma to be a mucositis with unusual proliferation of dendritic melanocytes in the epidermis.     

Erythema multiforme during cytomegalovirus infection and oral therapy with terbinafine: a virus–drug interaction

The authors report a case of erythema multiforme in a 32-year-old woman who was also taking oral terbinafine for an onychomycosis. The patient data analysis showed serological positivity for cytomegalovirus (IgM and IgG) and hepatitis C virus and serological titre of antinuclear antibody was elevated. After a brief review of the literature the authors propose the possibility of virus-drug interaction as a model of adverse drug reactions.     

Multiple xanthogranulomas in an adult

Xanthogranulomas develop in adults as well as in children; however, adult cases with multiple lesions are very rare. We report an adult who developed both multiple cutaneous lesions on the face and trunk and lesions on the conjunctiva, oral mucosa and genitalia. We believe that this is the first such case described.     

Juvenile gangrenous vasculitis of the scrotum: A rare cause of genital ulcer

Juvenile gangrenous vasculitis of the scrotum is a rare entity of unknown aetiology which should be considered in the differential diagnosis of genital ulcers, mainly with those caused by sexually transmitted infections. The authors report a case of a 23-year-old patient who presented a single painful scrotal ulcer developing shortly after an episode of pharyngotonsillitis. The ulcer was treated with oral corticosteroids with total healing and no relapse in over two years of follow-up.     

Case of Fusarium paronychia successfully treated with occlusive dressing of antifungal cream

We report a case of refractory Fusarium paronychia in a 42‐year‐old man with Behçet's disease receiving oral cyclosporin and corticosteroid. Symptoms resembling candidal paronychia of his little finger could not be cured by topical ketoconazole and oral terbinafine. The pathogen was identified as Fusarium solani species complex by gene analysis, and was multiple drug resistant. The case eventually resolved by occlusive dressing therapy with 0.5% amorolfine cream for 3 months.     

Multiple co-existing sexually transmitted diseases in a bisexual man

The authors report an interesting and instructive case of a bisexual man with four concurrent sexually transmissible infections: secondary syphilis, genital herpes, gonococcal proctitis, and asymptomatic chlamydial urethritis. The case illustrates the necessity for a systematic approach to the diagnosis and management of multiple co-existing sexually transmitted diseases, and it underscores the importance and difficulty of contact-tracing in this patient population.     

Pseudoporphyria induced by dialysis treated with oral N-acetylcysteine

Pseudoporphyria is a rare bullous dermatosis that clinically and histopathologically is similar to porphyria cutanea tarda. It mainly affects patients with chronic renal failure on peritoneal dialysis or hemodialysis. Medications can also be involved in the etiology. Diagnosis and management of this condition is a challenge for dermatologists. The authors report a case of pseudoporphyria related to dialysis with favorable outcome after the use of oral N-acetylcysteine.     

A Case of Atrophoderma of Pasini and Pierini Associated with Borrelia burgdorferi Infection Successfully Treated with Oral Doxycycline

Atrophoderma of Pasini and Pierini is a form of dermal atrophy that manifests as either single or multiple, sharply demarcated, hyperpigmented, non-indurated patches. These patches are marked by a slight depression of the skin, with an abrupt edge (i.e., the "cliff-drop" borders), usually located on the backs of adolescents or young adults. The pathophysiology of the disease is unknown, but some authors have suggested a role of Borrelia burgdorferi infection. A 35-year-old woman visited our department because of asymptomatic, hypopigmented, depressed patches on her chest and back lasting for three months. Laboratory evaluations were normal, except for positive serum antibodies to Borrelia burgdorferi. Histologic examination revealed a significantly decreased thickness of the dermis. The patient underwent treatment with oral doxycycline 200 mg/day for six weeks, after which the depth of depression was improved. Herein, we report a case of atrophoderma of Pasini and Pierini, associated with Borrelia burgdorferi infection, successfully treated with oral doxycycline.     

Chronic graft-versus-host disease: clinical presentation of multiple lesions of lichenoid and atrophic pattern

Graft-versus-host disease is observed mainly in recipients of hematopoietic cell transplantation and is expressed by cutaneous or systemic signals and symptoms. Graft-versus-host disease is clinically classified as acute or chronic. Chronic Graft-versus-host disease occurs in up to 70% of hematopoietic cell transplanted patients and its clinical manifestations have important impact on morbidity and quality of life. The authors report an expressive cutaneous, oral and adnexal involvement in a patient with chronic Graft-versus-host disease with multiple lesions of lichenoid and atrophic pattern.     

Eruptive vellus hair cyst in a patient with pachyonychia congenita.

Pachyonychia congenita is characterized by symmetrical nail dystrophy, palmoplantar keratoderma, oral leukokeratosis, and follicular hyperkeratosis. In addition to these features, multiple cutaneous cysts of various kinds have been described. We report a case of pachyonychia congenita associated with eruptive vellus hair cyst.     

Acne fulminans successfully treated with prednisone and dapsone

Acne fulminans is a rare condition and the most severe form of acne. It involves the sudden onset of febrile and multisystemic symptoms, with poor response to ordinary therapy in patients who previously had mild to moderate acne. It is characterized by hemorrhagic ulcerative crusting lesions on the face, chest and upper back. The authors report a case of acne fulminans that was successfully treated with oral prednisone and dapsone.     

Multiple basal cell carcinomas after long-term exposure to hydrazine: case report and review of the literature

Hydrazine (N(2)H(4)) is a clear, inorganic colourless liquid. It is known to be a skin sensitizer, a corrosive agent and it causes dermatitis on contact. Hydrazine is employed in chemical plants, used as a corrosion inhibitor for feed waters and may be added to rocket fuels. The authors report the case of a 68-year-old man with multiple basal cell carcinomas (BCCs) covering his arms and face. The patient worked in a steam power plant with extensive exposure to hydrazine for a period of over 10 years. The present case report strongly suggests that there may be a correlation between the long-term exposure to hydrazine and an increased risk for multiple BCCs.     

Generalized granuloma annulare after pneumococcal vaccination

Granuloma annulare may be caused by multiple triggers. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination.     

Eczematous-like drug eruption induced by synergistins

The authors report 4 cases of eczematous-1ike drug eruption after oral ingestion of pristinamycin (3 cases) and virginiamycin (1 case). The lesions occurred after contact sensitization with topical virginiamycin. The clinical symptoms appeared a few hours after ingestion: a generalized maculopapular eruption, sometimes with general symptoms of anaphylactic reaction. Eczema appeared again on initial areas of contact dermatitis. There is a common allergenic group between these 2 antibiotics, which is a macrocyclic lactone. Physiopathology of this drug eruption is not clear: allergic reaction of the delayed type or anaphylactic reaction. Patients allergic to virginianmycin should be strongly cautioned against oral pristinamycin.