SUBCUTANEOUS CHROMAOBLASTOMYCOSIS OCCURRING IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

A case of subcutaneous chromoblastomycosis occurring in a patient with systemic lupus erythematosus is presented. Because of the probable association with immunosuppression and the varity of the condition we feel this case should be reported.     

TUBERCULOSIS VERRUCOSA CUTIS ASSOCIATED WITH LUPUS VULGARIS

A 68-year-old peasant had an 8-year history of tuberculosis verrucosa cutis. After an injury the patient developed a pustule, which extended slowly and formed a plaque. New lesions appeared and increased in number and size. He was treated with various antibiotics without any significant effect. Three months previously a dull-red plaque developed on the chin without any complaints from the patient. The patient denied any history of tuberculous infection. The examination of the left foot revealed a verrucous plaque over the medial surface. There were firm, raised, and verru-cous papules, which exuded yellow pus. Similar lesions were present on the edge of the sole. The plaque was re-stricted by a margin of crusted papules. The affected nails were thick, keratotic, and damaged (Fig. 1). On the skin of the chin a single lesion was present, 1 × 2 cm in size, flat, irregular, dull-red in color and firm, without any secretion or accompanying symptoms (Fig. 2). Histology from the lesion of the foot revealed: necrosis in the superficial stratum corneum with numerous spongio-form pustules around and beneath the necrotic areas; marked acanthosis reaching pseudocarcinomatous hyperplasia and papillomatosis; and pronounced mononuclear infiltrate without tuberculid structures. Ziehl-Neelsen staining for mycobacteria was negative (Fig. 3). Histology from the lesion of the skin revealed: crusted parakeratosis and acanthosis and pronounced band-like infiltrate in the upper and middermis with well-formed tuberculoid structures and numerous giant cells. In the deep dermis the infiltrate was predominantly perivascular and periadnexial with tuberculoid structures in some areas. The collagen bundles were hyalinized (Fig. 4). The fluorescent staining with auramine revealed mycobacteria. (Fig. 5). The routine laboratory findings were within the normal limits except for a mild elevated ESR of 45 mm. Mantoux-test with 10 Ul of PPD showed induration with purple red surface (Fig. 6). The patient was x-rayed, but another tuberculous focus could not be detected. Treatment with isoniazid and rifampin was applied with rapid results (Fig. 7).     

PROGRESSIVE SYSTEMIC SCLEROSIS ASSOCIATED WITH CUTANEOUS AMYLOIDOSIS

A 43-year-old woman presented with a 3-year history of Raynaud's phenomenon and a six-month history of numbness in both arms. Sclerosis was noted on the entire body surface. The skin of the face was smooth and the lips were constricted (Fig. 1). The fingers and hands were atrophic and sclerotic, and full extension of the fingers and metacarpal joints was impossible (Fig. 2). There was pigmentation on the dorsal aspect of the hands. From the nape to the upper back, pruritic wavy, rippled or reticular pigmented macules in addition to sclerosis were noted (Fig. 3). Other parts of her skin did not show such a wavy pigmentation. Physical examination revealed no specific findings in the lung, heart, and abdomen. Neurologic examination was unremarkable. Motor function including muscle tonus was normal.
Laboratory studies disclosed that the complete blood count and tests of hepatic and renal function were within normal limits. Antinuclear antibody was I:80 and showed a speckled pattern, antitopoisomerase 1 antibody, anticen-tromere antibody, anti-Sm antibody and anti-RNP antibody were all negative, and the CH50 was 31.5 units/ml; C3 was 59.4 mg/dL; and C4, 17 mg/dL. Radiologically the chest and esophagus were normal.
Pulmonary function and electro-cardiogram were also normal. Histologic examination of a skin biopsy obtained from the upper back revealed that the collagen bundles throughout the dermis were thickened, homogenous, and closely packed. In the upper dermis, a small number of inflammatory cells around blood vessels was observed. Eosinophilic homogeneous masses were seen in the papillary dermis and upper dermis (Fig. 4). These homogeneous masses were positive to Dylan' (Fig. 5), Congo red, and thioflavin T staining. Therefore, the diagnosis of cutaneous macular amyloidosis was made.     

SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS DIAGNOSED WITH TREATMENT-RESISTANT ACNE

Background. Systemic lupus erythematosus (SLE) may involve any number of organ systems and varies greatly in the severity and type of involvement. Cutaneous manifestations of SLE are equally numerous and varied throughout the course of the disease within an individual, as well as varying between patients. Cutaneous manifestations of SLE are frequently the presenting symptoms, typically noted in the classic malar “butterfly” rash; however, other cutaneous patterns are frequently observed. Methods. We present here two patients who presented with what was thought to be acne refractory to treatment. Results. These patients actually were found to have a facial eruption associated with SLE as confirmed by skin biopsy. Conclusions. The importance of investigating atypical or treatment-resistant eruptions, especially in patients experiencing other symptoms, is emphasized.     

SYSTEMIC SCLEROSIS ASSOCIATED WITH CARCINOMA OF THE LUNG

SUMMARY.— A case of systemic sclerosis associated with squamous cell carcinoma of the lung is presented. The relationship between malignant disease and systemic sclerosis is briefly discussed. Haemoptysis occurilng in a patient with systemic sclerosis may not be caused by the disease but be due to neoplastic change in the lung, and therefore merits full investigation.     

EPIDERMODYSPLASIA VERRUCIFORMIS ASSOCIATED WITH MULTIPLE SQUAMOUS CELL CARCINOMAS

In this report a 48 year old patient with non-familial epidermodysplasia verruciformis is described. The disease had persisted for 36 years and had been incorrectly diagnosed as psoriasis on a number of occasions. From 1980 the patient developed numerous skin tumours, including five squamous cell carcinomas (SCCs) and a basal cell carcinoma, on the sun-exposed areas of his body. In June 1986 a poorly-differented SCC, presumed to be a secondary deposit from one of the previously resected skin cancers, was excised from his left parotid gland. A recurrence of this invasive SCC was resected two months later. Despite several courses of radiotherapy and treatment with transfer factor the tumour continued to enlarge, and the patient died from local effects in December 1987. The clinical, virological and immunological criteria used to establish the diagnosis are presented.     

系统性红斑狼疮患者的表皮细胞核斑点型IgG沉积

本文报道71例SLE患者检查表皮核斑点型IgG沉积的结果,探讨它与SLE临床表现、实验室异常尤其是免免学异常的关系,讨论其临床意义及发生机制。     

BLISTER FLUID IN BULLOUS SYSTEMIC LUPUS ERYTHEMATOSUS

SUMMARY.— A case of primary bullous systemic lupus erythematosus is presented. Serum was positive for LE cell factor and antinuclear factor (ANF). Blister fluid and synovial fluid showed ANF, but no LE cell factor; Tzanck preparations were consistently negative for LE cells.