Clinical profile of molluscum contagiosum in children versus adults

Molluscum contagiosum mainly affects children, but in adults the advent of HIV has modified its clinical spectrum. Our study is designed to ascertain the clinical profile of molluscum contagiosum in children and adults and to discover the effects of underlying HIV infection. During the study period of September 2000 to June 2002, 150 cases of molluscum contagiosum are screened and recruited at the Department of Dermatology and STD, JIPMER, Pondicherry. These include 137 children (85 male, 52 female) and 13 adults (10 male, 3 female). In children molluscum contagiosum is most commonly seen in the 5-10-year age group (58 cases), followed by the 1-5-year age group (53 cases), the 10-14-year age group (23 cases), and the younger-than-1-year age group (3 cases). In adults molluscum contagiosum is most commonly seen in the 14-20-year age group, followed by 2 cases each in the age groups 20-26 years, 26-34 years, and 34-40 years. The male-to-female sex ratio was 1.6:1 in children and 3.3:1 in adults. In both children and adults the most common sites affected are the head and neck, followed by trunk, upper extremity, genitalia, and lower extremity. It appears that the distribution of molluscum in our patients is significantly affected by the high proportion of HIV-positive adults in our sample. Seropositivity for HIV by ELISA is found in 1 of 137 children and 8 of 13 adults. In these HIV-positive patients, 2 cases of giant molluscum and one furuncle-like presentation are seen.     

Lipoid proteinosis in two siblings: a report from south India

A 6-year-old girl and her 9-year-old brother, born of nonconsanguineous parents, had hoarseness and multiple, asymptomatic, raised skin lesions present since childhood. On examination, both siblings had hoarseness and numerous skin-colored, waxy papules distributed over the forehead, face, neck, axilla, groin, and extremities. Acneiform (pocklike) scars were present on the face, trunk, and extremities. Eyelid beading (moniliform blepharosis) was present over bilateral upper and lower eyelids. The tongue, lips, and frenulum were thickened and infiltrated, and the patients were unable to protrude the tongue out of the mouth. The scalp had patchy alopecia. Histological examination of representative skin specimens (from both siblings) showed deposition of pink, amorphous material in the papillary dermis, around blood vessels, and around appendages. These deposits stained positive with Periodic Acid-Schiff stain, were diastase resistant, and were negative for Congo red, confirming our clinical diagnosis of lipoid proteinosis. Over 250 cases of this rare disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is rare.     

Localized lepromatous leprosy presenting as a painful nodule in a muscle

Lepromatous leprosy is a generalized disease usually presenting with numerous macules, papules, nodules or plaques involving wide areas of the skin. It is generally believed that in India lepromatous leprosy often originates from the borderline spectrum (Jha et al, 1991). Localized lepromatous or borderline lepromatous disease is a rare variant of multibacillary leprosy (Yoder et al, 1985; Jha et al, 1991; Pfaltzgraff & Ramu, 1994; Vijaikumar et al, 2001). This variant usually presents as a single nodule or a localized area of nodules and papules, while most of the body surface appears normal (Pfaltzgraff & Ramu, 1994; Vijaikumar et al, 2001). Its occurrence in our case as a single painful nodule in the bicep muscle of left forearm was indeed intriguing, such presentation being rarely reported in the literature.     

Hepatobiliary scintigraphy. An effective tool in the management of bile leak following laparoscopic cholecystectomy

Bile leaks and bile duct injury has been the major postoperative complications described after laparoscopic cholecystectomy. In this study, we evaluated the role of hepatobiliary scintigraphy (HBS) in patients who underwent laparoscopic cholecystectomy, and there was a clinical suspicion of bile leak in postoperative period. METHOD: Twenty-five patients (M/F=11:14, mean age 39+/-8 years; range 24-58 years) with suspected bile leak postlaparoscopic cholecystectomy underwent sequential HBS. RESULTS: Thirteen patients had normal hepatobiliary scintigraphic studies. Five patients had small bile leak in gall bladder fossa with primary route of bile flow into the gut. All these 18 patients improved on conservative management alone. Significant bile leak from the cystic stump region was demonstrated in four patients. All of them were subjected to endoscopic cholangiography (ERCP), which confirmed the site of leak. All patients had stenting and sphincterotomy. One patient showed bile leak and obstruction at the lower end of common bile duct, he improved spontaneously. Another patient showed poor hepatocytes function and no excretion of radiotracer and underwent ERCP followed by hepaticojejunostomy for common hepatic duct ligation. One patient had frank bile leak in the right paracolic gutter and had to undergo hepaticojejunostomy. CONCLUSIONS: HBS is a valuable noninvasive method of investigating possible bile leaks or other biliary disruptions in postlaparoscopic cholecystectomy patients. Negative study for significant bile leak can assure the surgeon to manage the patient conservatively. However, it cannot be relied on absolutely when determining the need for reoperation for a significant bile leak in early postoperative period.     

Epidermolysis bullosa pruriginosa showing good response to low‐dose thalidomide – a report of two cases

Epidermolysis bullosa pruriginosa is a rare distinctive variant of dystrophic epidermolysis bullosa characterized by intense pruritus, lichenified plaques in linear distribution, and anonychia. It is a difficult condition to treat and causes a great deal of distress. The present authors report two cases showing good response to low‐dose thalidomide, with clinical and symptomatic improvement. The exact mechanism of action is not yet clear.     

Acquired Zinc Deficiency in an Adult Female

Acrodermatitis enteropathica is an autosomal recessive inherited disorder of zinc absorption. Acquired cases are reported occasionally in patients with eating disorders or Crohn''s disease. We report a 24-year-old housewife with acquired isolated severe zinc deficiency with no other comorbidities to highlight the rare occurrence of isolated nutritional zinc deficiency in an otherwise normal patient.     

Effect of pesticides on the growth of aquatic hyphomycetes

The effect of two herbicides (paraquat and 2,4-dichlorophenoxybutyric acid) and two fungicides (mancozeb and captafol) was studied on the growth of Flagellospora penicillioides, Lunulospora curvula and Phalangispora constricta using the poisoned-food technique. The pesticides did not produce any inhibition of growth at concentrations up to 5 mg/l. The required concentration to bring about total inhibition of growth varied among the chemicals and the cultures. The herbicides produced a slight enhancement of culture growth at concentrations ranging from 1 to 25 mg/l.