Extensive orf infection in a toddler with associated id reaction

Orf is a zoonotic parapoxvirus typically transmitted to humans by a bite from goats or sheep. We present an unusual case of multiple orf lesions on the fingers of a 13‐month‐old child who was bitten by a goat and subsequently developed progressive swelling, blistering, and necrotic papulonodules of the hand followed by an additional diffuse, pruritic, papular rash. A primary diagnosis of orf infection was confirmed using real‐time polymerase chain reaction, and the diffuse eruption was clinically consistent with an id reaction. Extensive necrosis and papular id reaction associated with orf rarely have been described.     

Ecthyma gangrenosum as a very early herald of acute lymphoblastic leukaemia

Ecthyma gangrenosum is a manifestation of cutaneous infection by Pseudomonas aeruginosa. The lesion may be associated with immunocompromise, in particular neutropenia. We present a case of ecthyma gangrenosum in a previously healthy child who 3 months later developed acute lymphoblastic leukaemia; we use this to illustrate the lack of information on the growth rate of malignant and premalignant leukaemic cells in children.     

刘明内外合治臁疮经验

刘明辨治臁疮从湿热、血瘀、气虚三方面着手,概括为湿热下注型与气虚血瘀型,药用四妙勇安汤或八妙通脉汤加减以清热解毒、活血化瘀,丹参通脉汤或补阳还五汤加减以补气活血、化瘀生新。同时佐中药外治法,以四畔理论为指导,通过观察臁疮溃疡皮肤和健康皮肤之间的皮色、皮温、肿势、有无触痛及疼痛等不同表现,判断臁疮的阴阳、虚实,辨治分湿热下注型、瘀血阻络型、气血亏虚夹瘀型,药用公英解毒洗剂、复方黄柏液、全蝎膏及珍珠生肌散等。     

Community acquired fulminant Pseudomonas infection of the gastrointestinal tract in previously healthy infants

Three previously healthy infants presented with diarrhoea and pyrexia and deteriorated rapidly. Two patients had necrotizing bowel disease requiring aggressive surgical intervention. All survived. P. aeruginosa gastrointestinal infection in previously healthy children is an extremely rare condition with a high mortality. Ecthyma gangrenosum was present in over 60% of reported cases although often not recognized initially. A high index of clinical suspicion, including prompt recognition of ecthyma gangrenosum, is mandatory for an early diagnosis of P. aeruginosa gastrointestinal infection. Early diagnosis and treatment may improve the prognosis.     

Rapidly growing cutaneous tumour of the right temple: Orf

A typical lesion of orf developed on the temple of a 61-year-old man who apparently contracted the infection indirectly. In addition to the classical histological features of epidermal hyperplasia, necrosis, ballooning and vesical formation, the lesion also showed florid pseudoneoplastic vascular proliferation and a prominent component of eosinophils in the dermal inflammation.     

Acute myeloid leukaemia presenting with ecthyma gangrenosum as the first manifestation: A case report

RationaleEcthyma gangrenosum (EG) is an uncommon cutaneous infection usually associated with Pseudomonas aeruginosa bacteremia in immunocompromised patients, particularly those with underlying malignant diseases. Despite its rarity, especially in immunocompetent or nondiagnosed immunodeficiency patients, EG can present as the first manifestation of an underlying immunosuppression.Patient concernsA 42-year-old Japanese man was admitted to our hospital with a 3-day history of a painless red macule on his right forearm and fever.DiagnosesBlood culture on admission revealed the presence of Pseudomonas aeruginosa, whereas pus culture of the skin lesion showed Pseudomonas aeruginosa and methicillin-susceptible Staphylococcus aureus positivity.InterventionsAdditional bone marrow aspirate examination and immunophenotyping were performed to confirm the diagnosis of acute promyelocytic leukaemia with PML-retinoic acid alpha receptor.OutcomesThe patient was successfully treated with a 14-day course of antibiotics, and no evidence of relapse was noted. The patient achieved complete remission after treatment for acute promyelocytic leukaemia.LessonsIt should be kept in mind that EG is an important cutaneous infection that is typically associated with P aeruginosa bacteremia and the presence of underlying immunodeficiency, such as acute leukaemia.     

中药内外结合治疗臁疮56例

目的 观察中药内外结合治疗臁疮的临床疗效.方法 纳入56例符合标准的臁疮患者,采用中药口服和外用换药相结合的治疗方法,观察治疗8周后的愈合情况并对比治疗前后疮面细菌培养结果.结果 治疗8周总有效率89.3％,创面细菌培养转阴率85.7％.结论 中药内外结合治疗臁疮临床疗效显著,能明显提高创面细菌培养转阴率.     

中西医结合治疗湿热下注型臁疮的临床观察研究

目的：观察银黄洗剂溻渍复合地奥司明片口服对湿热下注型臁疮疮面的疗效。方法：将 50 例湿热下注型臁疮患者随机分为治疗组及对照组各 25 例。对照组予以常规治疗,治疗组在常规治疗的基础上予以银黄洗剂溻渍,疗程均为 30 天, 观察临床疗效,比较其临床症状及体征（疼痛程度、疮面的色泽、气味、渗出及大小）评分,炎症相关指标（白细胞计数、超敏 C 反应蛋白值）的变化情况。结果：治疗组临床治愈率和总有效率为 52%、96%,对照组分别为 24%、76%（P<0.05）。治疗组和对照组疮面明显缩小、颜色气味及渗出均较治疗前明显改善,疼痛明显减轻（P<0.05）。治疗组及对照组较治疗前白细胞计数及超敏 C 反应蛋白值明显降低（P<0.05）,且治疗组较对照组降低更为明显（P<0.05）。结论：银黄洗剂溻渍联合地奥司明片口服,对湿热下注型臁疮有明显疗效,可明显改善患者的临床症状及体征,明显降低白细胞计数及超敏C 反应蛋白值。