Cutaneous phycomycosis. Report of three cases with identification of Rhizopus.

Three cases of pustular and ulcerative cutaneous phycomycosis developed postoperatively in orthopedic patients following exposure to a contaiminated surgical adhesive (Elastoplast). A review of the pertinent literature revealed no other similar series of reported cases. The epidemiologic investigation of these cases is discussed. This experience demonstrates that with appropriate exposure, normal saprophytes can invade the skin in immunocompetent patients, producing active and invasive lesions.     

Impairment of Th cell response in Card9 knockout mice with cutaneous mucormycosis caused by Rhizopus arrhizus

Card9 is a signalling adaptor protein in the downstream of many innate pattern recognition receptors (PRRs) and exerts a significant role in antifungal immunity. To date, Card9 deficiency has been reported to be related to increased susceptibility to many fungal infections. In this study, we established mucormycosis murine model of Rhizopus arrhizus (R. arrhizus) using wild‐type (WT) mice and Card9 knockout (Card9^?/?) mice to investigate the antifungal effect of Card9 against R. arrhizus infection. Card9^?/? mice were more susceptible to R. arrhizus infection than WT mice, which could be related to the impaired NF‐κB pathway activation, local cytokine production and Th cell responses in Card9^?/? mice.     

Cutaneous New World leishmaniasis-sporotrichosis coinfection: Report of 3 cases

Three cases of coinfection with Leishmania and Sporothrix spp in the same lesion are described. The patients had ulcers with erythematous borders and regional lymphadenopathy. The diagnosis of leishmaniasis was accomplished by direct visualization of the amastigotes or culture of the promastigotes, or both. The diagnosis of sporotrichosis was proved in two cases by culture of Sporothrix schenckii and by the histopathologic features in one case. All patients had a positive sporotrichin test. Two patients responded successfully to oral potassium iodide. One patient received oral itraconazole 100 mg/day because of intolerance to iodides and was cured. To our knowledge coinfection with Leishmania and Sporothrix spp has not been reported. The use of empirical treatments for leishmaniasis such as poultices or puncturing of the lesion with thorns or woods splinters might introduce Sporothrix and explain the coinfection. (J Am Acad Dermatol 1999;40:1002-4.)     

Cutaneous mucormycosis: a case report

Cutaneous mucormycosis is a rare opportunistic fungal infection. It usually is benign in immunocompetent patients, but it can lead to devastating consequences in immunocompromised patients. Immediate diagnosis and treatment are crucial in preventing fatality. We describe a case of cutaneous mucormycosis in a man with a history of non-Hodgkin lymphoma in an effort to raise diagnostic suspicion of this life-threatening infection and prevent a fatal outcome.     

Cutaneous mucormycosis secondary to acquired reactive perforating collagenosis

Acquired reactive perforating collagenosis (ARPC) is a rare perforating disease of the skin. It is characterized by hyperkeratotic papules with transepidermal elimination of degenerated material including collagen and elastic fibers. The disease presents clinically as umbilicated papules with a central adherent keratotic plug. Mucormycosis infection, caused by the molds of the class Zygomycetes and order Mucorales, generally occurs as an opportunistic infection. It presents most frequently in patients with diabetes mellitus, in patients with leukemia receiving chemotherapy, and in those on sustained immunosuppressive therapy. We describe a patient with type 2 diabetes mellitus and end-stage renal disease requiring hemodialysis in whom extensive cutaneous mucormycosis with secondary spread to the brain, lumbar spine, and breast developed in the setting of ARPC. To our knowledge, this is the first case report of a patient with ARPC who developed extensive cutaneous mucormycosis.     

Cutaneous myiasis due to Dermatobia hominis: a report of six cases

We report six cases of Dermatobia hominis myiasis imported into the U.K. from Belize. With increasing international travel, myiasis may be encountered more frequently in countries in which the parasites are not indigenous. The life-cycle of D. hominis is described, and scanning electron micrographs show the detailed appearance of the larva.     

Cutaneous B cell lymphomas: Report of two interesting cases

Cutaneous B cell lymphomas can arise primarily from the skin or may occur due to secondary spread from nodal lymphomas. Primary lymphomas are confined to the skin without systemic spread and they differ from secondary lymphomas in their clinical behavior, treatment and prognosis. Cutaneous lymphomas being relatively rare, lack of precise definition and understanding of their clinical behavior diseases leads to pitfalls in the diagnosis. We report two cases of cutaneous B cell lymphomas who presented with fever of unknown origin initially and later found to have skin lesions. Hence, skin can be a potential diagnostic clue in the evaluation of patients with fever of unknown origin. The distinctions between the primary and the secondary lymphomas become important in choosing the treatment and assessing the prognosis.     

不规则毛霉致皮肤型毛霉病一例

患者,女,65岁。反复左上肢结节、斑块、流脓伴疼痛7年,累及右上肢1年。2型糖尿病病史3年。左手背皮损组织病理示表皮棘层肥厚伴角化不全,真皮全层多灶肉芽肿形成伴淋巴细胞、浆细胞浸润,胶原纤维变性,并累及皮下脂肪;真菌培养示白色绒毛状菌落生长,镜下表现为粗大、无分隔菌丝,可见圆形孢子囊;宏基因组测序示不规则毛霉。诊断为不规则毛霉致皮肤型毛霉病。     

不规则毛霉致原发性皮肤毛霉病一例

患者女,39岁,右面部斑块、溃疡伴疼痛2个月。既往患急性髓系白血病1年,经治疗后缓解,半年前再次复发。皮肤科检查：右面颊5 cm × 5 cm紫红色斑块,中央糜烂溃疡,表面覆盖黄褐色痂皮,可见肉芽组织,剥去痂皮有黄色脓液溢出,皮损边界清晰,边缘稍隆起,触痛明显。实验室检查：白细胞28.75 × 109/L,中性粒细胞1.05 × 109/L,淋巴细胞27.17 × 109/L,红细胞2.20 × 1012/L,血红蛋白69 g/L,血小板84 × 109/L;肝肾功能、电解质及心电图检查未见异常。皮损组织病理HE及过碘酸希夫染色示真皮内大量淋巴细胞及组织细胞浸润,并见宽大无隔菌丝。真菌小培养见宽大透明无隔菌丝,并见假根、匍匐菌丝及球形孢子囊。分子生物学鉴定为不规则毛霉。诊断：①不规则毛霉致原发性皮肤毛霉病;②急性髓系白血病。给予口服羟基脲（0.5 g每日3次）、一次性静脉输注悬浮红细胞（4个单位）,静脉滴注两性霉素B（起始剂量5 mg/d,每天递增5 mg,最大增至25 mg/d,约0.5 mg·kg?1·d?1）,患者皮损逐渐变平、缩小。12 d后因故患者出院后失访。     

Cutaneous fibrolipomatous hamartoma: Report of 2 cases with retrocalcaneal location

Precalcaneal congenital fibrolipomatous hamartoma is an underreported benign entity that has been described in the literature under different names. We present two cases of unilateral fibrolipomatous hamartoma (FLH) appearing in a unique location: on the posterior aspect of the foot overlying the heel. We propose the term "FLH of the skin" as a more inclusive and less confusing term for this condition, thus allowing distinction with FLH arising from neural tissue. High‐frequency ultrasonography appears to be a useful diagnostic tool that may avoid unnecessary biopsies for this condition.     

Cutaneous infection due to acremonium

We report an immunocompromised patient who developed a cutaneous infection caused by acremonium which is a rare opportunistic fungi. With the increasing number of immunocompromised patients opportunistic fungal infection can cause serious diseases and early recognition is mandatory.     

原发性皮肤毛霉病一例

患者男,52岁。鼻背部红斑并皮下结节,软腭溃烂,偶有疼痛并伴鼻出血3年余,左眼眶下出现0.8 cm × 0.4 cm大小结节1月余。患者曾接受伊曲康唑、氟康唑等抗真菌药物治疗,无满意疗效。患者一般情况好,既往有肺结核病史,Ｔ淋巴细胞亚群示CD3减少。皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润,HE和PAS染色见粗大较短的无隔菌丝。经真菌培养及分子生物学鉴定为多变根毛霉。该临床分离株在体外对两性霉素B敏感,对伊曲康唑、酮康唑、氟康唑均耐药。经两性霉素B治疗6周后,患者皮损明显消退,两性霉素B总用量为821 mg。治疗结束后,手术活检取鼻背部及软腭组织做真菌培养和组织病理检查。组织病理中炎性细胞明显减少,未发现菌丝。26 ℃、32 ℃（± 3 ℃）中恒温培养3周均未见真菌生长。据此,该患者已达到临床、组织病理学和真菌学治愈。治疗期间自觉食欲差,有药物性肾功能异常、一过性低血钾。     

Photocontacs dermatitis due to dexketoprofen. Report of 2 cases

Dexketoprofen is the active isomer of ketoprofen and likewise belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs) derived from propionic acid. We have recently studied, using patch and photopatch tests, two women with a characteristic clinical picture of contact photodermatitis who had used topical dexketoprofen (Enangel) in the days before onset of the rash. In both cases we used the standard series of GEIDC, a series for NSAIDs, the product itself (Enalgel) and its excipients. On examination of the photopatches of both patients at 96 hours we found positive reactions to dexketoprofen and Enalgel. Furthermore, in one of the women we observed simultaneous photosensitivity to other NSAIDs and to several excipients of Enangel. Reviewing the literature we have found only three references on contact photodermatitis due to dexketoprofen. We describe two new cases, with multiple photosensitivities in one of them. We consider that such patients should be patch tested with dexketoprofen at 0.1-1 % petrolatum, concentrations that are notably inferior to those used in previous publications.     

Vulvar contact dermatitis due to seminal allergy: 3 cases

BACKGROUND: Contact sensitivity deserves to be assessed in acute vulvitis as well as chronic vulvar dermatitis with a specific orientation toward semen allergy whenever the pathology is post-coital. OBSERVATIONS: Three observations of semen allergy are reported. Two women presented with post-coital vulvitis due to delayed hypersensitivity to semen proteins without associated specific IgE. The type 2 allergy was confirmed by positive patch-tests and disappearance of symptoms when using condoms. Another woman presented with oedematous vulvitis associated with asthma and malaise per and post-sexual intercourse. Positive prick-tests with husband's semen and blood tests for specific IgE led to the diagnosis of type 1 hypersensitivity to semen, with disappearance of both vulvar and systemic symptoms with the use of condoms. DISCUSSION: Immediate or delayed type hypersensitivity may be discovered using prick and patch tests respectively. The observation of vulvitis or vulvar discomfort should promote such investigations, whenever a post-coital chronology is suggested. The good clinical pertinence of positive skin tests must be emphasized. Although type I hypersensitivity to semen is documented in the literature, with easy detection of specific IgE, delayed type 2 allergy presents as an as yet under-diagnosed etiology of post-coital vulvitis. Patch tests may help to confirm that contact dermatitis may be due to seminal proteins.