bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pemphigus vegetans in association with human immunodeficiency virus
Authors: Lateef Aslam , Packles Michelle R. , White Soren M. , Don Philip C. , Weinberg Jeffrey M. 
Published: March 2003

A 23‐year‐old black man presented with a 2‐year history of blistering eruptions involving the skin and mucous membranes. Risk factors for human immunodeficiency virus (HIV) infection included sexual encounters with prostitutes. He had no additional past medical history and denied any family history of autoimmune blistering disorders. Over the last 2 years the patient had undergone multiple admissions at various medical centers with a diagnosis of pemphigus vegetans (PV). He was treated with a variety of topical and systemic medications, including steroids and antimicrobials, but he always relapsed within a few months. The patient presented to the Metropolitan Hospital Center with malaise, blisters, and vegetative lesions of several days’ duration.On physical examination, erosions, pustules, nodules, and verrucous, vegetating papules were noted in the axillae, groin ( Fig. 1), scrotal, and anal areas. There were erosions and crusts on the lower lips. The tongue showed mild desquamation and had a cerebriform appearance
(
Fig. 2). Paronychial crust and scale were noted on the hands and feet and an intact vesicle was noted on one finger. Inguinal, submandibular, cervical, and axillary lymphadenopathy was present. Hyperpigmented macules and patches were noted on the trunk and extremities.Erosions, crust, and verrucous papules in the groinimageCerebriform appearance of the tongue in association with crusts and erosions on the lipsimageA biopsy specimen of a verrucous papule from the left axilla showed marked spongiosis, intraepidermal acantholysis, and numerous eosinophils within the acantholytic vesicle ( Fig. 3). In addition, there was a marked superficial dermal infiltrate with eosinophils, plasma cells, and lymphocytes. A biopsy specimen of a pustule in the left axilla showed marked spongiosis, intraepidermal vesicle formation, superficial dermal edema, perivascular infiltration with lymphocytes and plasma cells, and exocytosis of neutrophils and eosinophils in the dermis and epidermis.Histopathology of vegetating lesion showing acantholysis and a dense eosinophilic infiltrate (hematoxylin and eosin, ×100)imageDirect immunofluorescence showed immunoglobulin G (IgG) and weak C3 on the intercellular junctions in the epidermis. Indirect immunofluorescence showed a high titer (>1 : 1280) of circulating antibodies with an intercellular pattern. Viral culture from the mouth and skin was negative for herpes simplex virus. Bacterial culture from the skin of the groin was positive for Proteus mirabilis. Blood cultures were negative. Laboratory tests on admission showed a normocytic anemia, and the CD4 count was 372 cells/mm3 (normal, 537–1571 cells/mm3 ). The urine on admission was positive for opiates and cocaine. The results of HIV‐1 testing by enzyme‐linked immunoabsorbent assay and immunoblotting were positive.
Erythroderma: a comparison between HIV positive and negative patients
Authors: Morar Nilesh , Dlova Ncoza , Gupta Aditya K. , Naidoo Dayalan K. , Aboobaker Jamila , Ramdial Pratistadevi K. 
Published: March 2003

Abstract Background Erythroderma has protean underlying causes. There have been isolated case reports suggesting an association between erythroderma and the human immunodeficiency virus (HIV). Objective To describe and characterize further the prevalence, etiology, and metabolic sequelae of erythroderma in HIV positive and negative patients. In a subset of patients, clinicopathologic correlation was performed. Method One hundred and thirty‐eight consecutive patients were prospectively recruited over a one and a half year period at the skin clinic of King Edward VIII Hospital. Demographic, clinical, biochemical, and histologic data were recorded. Results Seventy‐five per cent of the patients were black, 22.5% Indian, and 2.5% white. The men to women ratio was 1.9 : 1. The mean age was 34.7 years (range, 1 month to 85 years). Forty‐three per cent of patients were HIV positive, of whom 90% were black. The commonest causes of erythroderma in the total sample were atopic dermatitis (23.9%), psoriasis (23.9%), and drug reactions (22.5%). The commonest cause in the HIV positive group was drug reactions (40.6%), the commonest being ethambutol (30.8%). HIV positive patients had a significantly lower (P <  0.05) white cell count (7.6 vs. 10.5 ×  109/L), hemoglobin (11.1 vs. 12.6 g/dL), platelets (278.3 vs. 378.0 ×  109/L), and albumin (25.4 vs. 28.7 g/L) and significantly higher serum urates (0.6 vs. 0.4 m
m/L) than HIV negative patients. HIV positive patients did not have a significant increase in the number of episodes of erythroderma. Clinicopathologic correlation was greatest with psoriasis in the HIV negative group and with psoriasis and drug reactions in the HIV positive group. Conclusions A large proportion of erythrodermic patients in this study were HIV positive. Inflammatory dermatoses were the commonest cause of erythroderma in all the patients studied. Drug reactions were the commonest cause in HIV positive patients. In the young black patient, erythroderma may be a marker for HIV infection.
Cytokines in the pruritic papular eruption of HIV
Authors: Aires Juliana Machado , Rosatelli Jacy Berti , De Castro Figueiredo José Fernando , Roselino Ana Maria F. 
Published: March 2003

Abstract Background  The immunopathogenic mechanism of the pruritic papular eruption (PPE) of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is poorly understood, and the objective of the present study was to determine the concentration of the serum cytokines interleukin‐2 (IL‐2), IL‐4, IL‐5, IL‐10, IL‐12, and γ‐interferon (γ‐IFN) in an attempt to recognize the pattern of CD4+/CD8+ lymphocytes occurring in this dermatosis.Materials and methods  The study was conducted on 11 HIV‐positive PPE patients, matched for sex and age with eight HIV‐infected patients with no dermatosis and 10 healthy HIV‐negative individuals. Cytokines were quantified by enzyme‐linked immunoabsorbent assay (ELISA) using monoclonal antibodies (R & D Systems) and the data were analyzed by the Mann–Whitney, Kruskall–Wallis, and Spearman correlation tests.Results  An increased concentration of IL‐2 was observed in both the HIV‐positive (77.65 pg/mL, P < 0.001) and PPE (20.42 pg/mL, P < 0.05) groups when compared with the HIV‐negative group (9.50 pg/mL). The IL‐2 concentration was significantly higher (P < 0.05) in the HIV‐positive group than in the PPE group. Similarly, the γ‐IFN concentration was higher in the HIV‐positive (14.97 pg/mL) and PPE (12.67 pg/mL) groups when compared with the HIV‐negative group (8.58 pg/mL). The IL‐12 concentration was similar in the PPE and HIV‐positive groups (1.82 and 1.68 pg/mL, respectively), but higher than in the HIV‐negative group (1.17 pg/mL). The same occurred with IL‐5 (17.78, 17.79, and 15.74 pg/mL, respectively). There was no significant difference in IL‐4 concentration among the PPE, HIV‐positive, and HIV‐negative groups (10.95, 7.88, and 10.16 pg/mL, respectively), and the same was observed for IL‐10 (22.41, 21.13, and 20.92, respectively). There was a negative correlation between serum γ‐IFN concentration and peripheral CD4+ lymphocyte number (r = − 0.6256) in the PPE group (P < 0.05).Conclusions  The lower levels of IL‐2 and γ‐IFN and the negative correlation between γ‐IFN and peripheral CD4+ lymphocytes may indicate an early phase of immunosuppression in PPE.
Management of endemic outbreaks of scabies with allethrin, permethrin, and ivermectin
Authors: Paasch Uwe ,   md, Haustein Uwe‐Frithjof ,   md
Published: March 2003

Abstract Background At three residences for the elderly, recurrent scabies infestations became outof control. Due to the failure of repeated, nonsynchronized therapeutic efforts withconventional external anti‐scabies treatments, an eradication program had to be developed. We describe a protocol for the management of outbreaks of scabies. Methods According to the clinical examination and microscopically identified mites, all individuals of the population (IOP: patients, staff, and family members) were divided into two groups: (a) healthy and infested IOP; and (b) cases with crusted scabies. The first group was treated simultaneously once with external scabicides (allethrin or permethrin). All others were hospitalized and treated either with systemic ivermectin or with the latter in combination with permethrin. Results In 252 IOP living in three residences for the elderly, clinical signs of scabies were reported in 91.5%, 78.5%, and 15.4% of the patients (age 55–97 years; mean, 80.5 years), 54.1%, 32.9%, and 16.6% of staff members, and in 7%, 3%, and 0% of family members. The infested IOP showed crusted scabies (index cases) in 5.3%, 5.0%, and 1.7%, common scabies in 43.1%, 36.7%, and 7.1%, and postscabiotic dermatitis in 10.3%, 7.6%, and 3.5%. In 99.2% of the synchronously treated IOP in group (a) (n = 240), the conventional treatment with permethrin cream 5% or allethrin spray was effective. Group (b) (n = 12) received ivermectin (12 mg) once (n = 5) or twice (n = 7) after an interval of 8 days. One index case received permethrin three times. Conclusions Outbreaks of scabies in populations of elderly people require special management for disease control. Synchronous treatment with external permethrin cream 5% or allethrin spray, including all IOP once, and close control offers a time‐saving, cheap, and reliable method. Crusted scabies should be treated by oral administration of ivermectin once or twice after an interval of 8 days. Additional applications of permethrin and mechanical clearing of hyperkeratotic subungual areas shorten the course.
Overexpression of transforming growth factor‐β3 immunohistochemical staining in extramammary Paget's disease, but downregulated expression in Bowen's disease
Authors: Kawakami Tamihiro , Soma Yoshinao , Mizoguchi Masaho , Saito Ryuzo 
Published: March 2003

AbstractBackground  The role of transforming growth factor‐β (TGF‐β) in carcinogenesis is complex, with some reports indicating a tumor inhibition role and others indicating a tumor promotion role. In particular, TGF‐β3 is thought to play a key role in controlling epithelial homeostasis. Immunopositive p53 has been demonstrated in a variety of human malignant tumors and its role in oncogenesis and tumor progression is thought to be important. Extramammary Paget's disease (EPD) and Bowen's disease are skin cancers of unknown histogenesis.Objective  To clarify the role of TGF‐β3 and p53 in EPD and Bowen's disease and to better understand the origin of these disorders.Methods  Specimens were obtained from 12 patients with EPD and 12 patients with Bowen's disease seen at our clinic between 1993 and 2000. TGF‐β3 and p53 immunohistochemical staining was performed.Results  In three of the 12 EPD patients and five of the 12 Bowen's disease patients, positive p53 staining was detected. In contrast, TGF‐β3 overexpression was detected in all EPD patients, whereas downregulated TGF‐β3 expression was detected in all Bowen's disease patients.Conclusions  The present data suggest different roles for TGF‐β3 in abnormal epidermal cells in EPD and Bowen's disease. Thus, TGF‐β3 expression may be modulated differently via a p53‐dependent or ‐independent pathway in the pathogenesis of EPD and Bowen's disease. Moreover, high TGF‐β expression appears to be a useful indicator of tumor activity in EPD.
Dermatomyositis and mucinosis
Authors: Del Pozo Jesús , Almagro Manuel , Martínez Walter , Yebra‐Pimentel Mariá Teresa , García‐Silva Jesús , Peña‐Penabad Carmen , Fonseca Edwardo 
Published: March 2003

AbstractBackground  Mucin deposition is a common feature in autoimmune collagen diseases including dermatomyositis. Nevertheless, clinical manifestations of mucinosis are uncommon in patients with dermatomyositis. Two cases of mucinosis associated with dermatomyositis are reported.Patients  A 53‐year‐old woman presented with symmetrical plaques on the upper limbs formed by the coalescence of small, violaceous papules. In addition, she showed the typical cutaneous and muscle features of dermatomyositis. A 44‐year‐old woman with dermatomyositis of 5 years' evolution developed linear, flesh‐colored papules across the flexural creases of her palms and fingers.Results  Skin biopsy of the upper limb lesions in the first patient showed epidermal changes compatible with dermatomyositis and dermal mucin deposition. Histopathologic examination of the palmar lesions of the second patient showed less intense epidermal changes of dermatomyositis and dermal mucin deposition.Conclusions  Mucin deposition in patients with dermatomyositis may have an unusual clinical presentation, and it should be considered in the differential diagnosis of atypical cutaneous lesions in these patients.
Association of juvenile xanthogranuloma with café‐au‐lait macules
Authors: Thami Gurvinder P. , Kaur Sukhjot , Kanwar Amrinder J. 
Published: March 2003

A 2‐year‐old boy was referred to the dermatology services for the evaluation of yellowish‐brown raised lesions over the face of 3 months' duration. In addition, he had multiple asymptomatic hyperpigmented spots over the trunk, which his parents had noticed at the time of birth. His physical and mental milestones of development were normal. Apart from the cutaneous lesions, the child was otherwise well and there was no history of seizures. He was the only child born to nonconsanguineous parents. No family history of similar lesions was available.The boy weighed 14 kg, had a height of 88 cm, and a head circumference of 48 cm. General physical and systemic examination was normal. Cutaneous examination revealed multiple, yellowish‐brown papules over the forehead, sides of the face, and shoulders. The papules measured 0.5–0.8 cm in diameter, were discrete, well defined, oval and flat topped without any surface changes (Fig. 1). Multiple café‐au‐lait macules varying from 0.5 to 3.0 cm in diameter were present over the trunk (Fig. 2). There was no freckling in the axillary or the inguinal regions and no neurofibromas were present. A diagnosis of juvenile xanthogranuloma was considered.Papular lesions of juvenile xanthogranuloma on the left side of the faceimageMultiple café‐au‐lait macules over the backimageComplete blood counts, urine analysis, hepatic and renal function tests, and serum lipid levels were normal. A skin biopsy from a papule over the shoulder revealed a dense infiltrate in the dermis underlying a normal epidermis. The infiltrate was well demarcated and comprised lymphocytes, eosinophils, and foamy histiocytes along with Touton giant cells and proliferating fibroblasts. This confirmed the diagnosis of juvenile xanthogranuloma. The parents were informed about the benign and self‐limiting nature of the disorder and were advised to bring the child for regular follow‐up.
Multiple lesions of granuloma annulare following BCG vaccination: case report and review of the literature
Authors: Kakurai Maki , Kiyosawa Tomoharu , Ohtsuki Mamitaro , Nakagawa Hidemi 
Published: March 2003

A 12‐year‐old Japanese boy presented with asymptomatic, multiple annular, erythematous, infiltrated lesions on his left upper arm and right knee as well as the lateral side of the right ankle joint. He had noted these erythematous lesions five days after bacille Calmette‐Guerin (BCG) vaccination. The lesions gradually enlarged and increased in number. Topical corticosteroid therapy for several weeks failed to improve the lesions. There was no familial history of pulmonary tuberculosis.Physical examination revealed extensively disseminated, round, erythematous plaques and papules. Some plaques showed an annular configuration, varying in diameter from 5 to 45 mm, on his left upper arm, right knee and the lateral side of the right ankle joint (Fig. 1). One month after BCG vaccination, reddish‐brown, infiltrated erythema with crusts was observed at the BCG vaccination site (Fig. 2). Tuberculin test showed an erythema with induration measuring 2.5 cm in diameter at 48 h. Routine laboratory tests including complete blood cell count, erythrocyte sedimentation rate and biochemical analysis were within normal limits. Serum glucose level and GhbA1c were also normal.Annular erythematous lesion on left lateral malleolusimageMultiple, grouped, erythematous papules with crust, exactly corresponding to previous multipuncture BCG siteimageHistopathologically, a biopsy specimen obtained from an annular erythematous plaque on the lateral side of his right ankle joint revealed marked pale staining, well‐circumscribed degenerated collagen bundles surrounded by palisading histiocytes and lymphocytes in the dermis (Fig. 3). Alcian blue stain was positive among degenerated collagen fibers. An immunofluorescence study revealed IgG and C3 deposits in dermal vessels. These histologic features were consistent with granuloma annulare.Area of degenerated collagen surrounded by palisaded histiocytesimageTwo months later, the margins of the erythematous lesions had spontaneously faded and, within 7 months, had completely resolved. Reddish‐brown erythema at the BCG vaccination site had not disappeared.
Acne in Becker's nevus
Authors: Agrawal Sudha , Garg Vijay Kumar , Sah Shatrughan Prasad , Agarwalla Arun 
Published: March 2003

An 18‐year‐old man presented with a progressively enlarging, asymptomatic, well‐demarcated, irregular, hyperpigmented patch, 13 cm × 11 cm, on the anterior aspect of the chest below the left clavicular region, with a few small macules at the periphery, of 2 years duration. After 18 months, multiple, discrete, erythematous papules and comedones developed over the patch (Fig. 1). A few melanocytic nevi were present in and around the patch. A clinical diagnosis of Becker's nevus with acne vulgaris was made. A skin biopsy from the patch showed acanthosis, elongated rete ridges, increased pigmentation in the basal layer, and a mild perivascular lymphocytic infiltrate in the upper and lower dermis with few melanophages in the dermis. Histopathology of the comedone revealed slight acanthosis, irregular elongation of the rete ridges, and hyperpigmentation of the basal layer of the epidermis. Multiple melanophages were seen in the upper dermis. In the mid‐dermis, a ruptured closed comedone was seen. The follicular lumen contained a plug of loosely arranged keratinized cells, sebaceous material, and bacterial colonies. Aggregates of neutrophils were found at the site of rupture of the follicular wall. There was a mild perivascular lymphocytic infiltrate in the upper and lower dermis (Fig. 2). These features confirmed the diagnosis of Becker's nevus with acne vulgaris. The acne was treated with 0.05% tretinoin and 2% erythromycin creams. After 2 months of treatment, all the acne lesions subsided. On further follow‐up, the patient had relapse of the acne lesions over the patch with the discontinuation of treatment. A few new lesions also appeared on the face. The treatment was restarted, but the patient was lost to follow‐up.Multiple, discrete, erythematous papules and comedones over Becker's nevus with a few melanocytic nevi in and around the lesionimageSlight acanthosis, irregular elongation of the rete ridges, and hyperpigmentation of the basal layer of the epidermis, multiple melanophages in the upper dermis, and a ruptured closed comedone in the mid‐dermis (hematoxylin and eosin, × 40)image
Temporary henna tattoo reactions in children
Authors: Önder Meltem , Atahan Çiğdem Asena , Öztaş Pinar , Öztaş Murat Orhan 
Published: March 2003

Case 1 A 9‐year‐old girl applied a temporary henna tattoo to her right arm and 1 week later repeated the same process. In the following 2 days, erythema and papulovesicular eruptions developed at the application site (Fig. 1). Patch tests were performed with the European Standard Series, specific hairdressing agents, and commercial and natural henna. The patient showed a 3+ reaction to both natural henna and ‘‘para‐phenylenediamine (PPD)’' 1% and a 3+ reaction to nickel sulfate 5% at 48, 72, and 96 h (Fig. 2). She was treated with topical steroid cream (beclomethasone dipropionate), applied twice daily. A slight postinflammatory hypopigmentation was observed at the time of the patch test. The hypopigmentation has gradually decreased in severity over time (Fig. 3).Case 1: temporary henna tattoo reaction with papulovesicular eruptionsimageCase 1: patch test results. (A) 3+ reaction to nickel sulfate 5%; (B) 3+ reaction to para‐phenylenediamine (PPD) 1%; (C) 3+ reaction to natural hennaimageCase 1: postinflammatory hypopigmentationimage Case 2 An 11‐year‐old boy was admitted to our outpatient clinic with itchy, erythematous, papulovesicular eruptions on the left arm. These lesions appeared after application of a temporary henna tattoo with a ‘‘do‐it‐yourself’' kit to the left arm. Patch tests were performed with the European Standard Series and commercial tattoo products. The patient showed only a 1+ reaction to commercial henna. He was treated with topical steroid cream (beclomethasone dipropionate), and 2 weeks later his lesions had totally disappeared. Case 3 A 12‐year‐old girl applied a temporary henna tattoo to her left arm. Several hours later, erythema, edema, and itching developed. Patch tests were performed as for Case 2. The patient showed a 2+ reaction to commercial henna. Topical steroid cream (beclomethasone dipropionate) was effective, and 3 weeks later the lesions had healed with slight hypopigmentation. The postinflammatory hypopigmentation traced the tattoo design exactly, which was in the form of a fish (Fig. 4). On follow‐up, the hypopigmentation was not permanent.Case 3: fish‐shaped postinflammatory hypopigmentationimage
Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha‐Habermann's disease
Authors: Tsai Kau‐Sung , Hsieh Hsu‐Jung , Chow Kuan‐Chih , Lin Tze‐Yi , Chiang Shu‐Fen , Huang Hsuan‐Hua 
Published: March 2003

AbstractBackground  Febrile ulceronecrotic Mucha‐Habermann's disease (FUMHD) is a severe and very rare variant of pityriasis lichenoides et varilioformis acuta, which is characterized by large coalescing, and ulceronecrotic maculopapules or plaques. Morphological changes of the skin accompanied by persistent high fever and several constitutional symptoms have suggested virus infection in patients with FUMHD. However, the available information of viral origin is limited. In this study we investigated the relationship of cytomegalovirus (CMV), Epstein‐Barr virus (EBV), human herpesvirus 8 (HHV8), type I human T‐cell lymphotropic virus (HTLV‐I), and parvovirus B19 (PVB19) with FUMHD in a Taiwanese patient.Methods  The existence of CMV, EBV, HHV8, HTLV‐I, and PVB19 was determined by polymerase chain reaction (PCR). The presence of CMV in the endothelial cells was characterized by in situ hybridization (ISH) and immunohistochemistry (IHC).Results  Serologic immunoglobulin to CMV and IHC identification of CMV late gene in the biopsy specimen indicated that the patient was infected with CMV. Detection of CMV was confirmed by PCR and ISH.Conclusions  These results indicate that FUMHD is associated with dermal CMV manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection has yet to be determined.
Pancreatic panniculitis in a kidney transplant recipient
Authors: Echeverría Cristina M. , Fortunato Lucrecia P. , Stengel Fernando M. , Laurini Javier , Díaz Carlos 
Published: March 2003

AbstractBackground  Pancreatic panniculitis is a rare complication of pancreatic disease. Histopathologic findings are pathognomonic and may be helpful for early diagnosis.Methods  We present a female kidney transplant recipient, with systemic lupus erythematosus on immunossuppresive therapy, who developed panniculitis.Results  Histological features strongly suggested pancreatic panniculitis and this was confirmed by clinical, laboratory and image findings.Conclusion  The characteristic histologic features of pancreatic panniculitis may help to uncover undiagnosed pancreatic disease. Early therapy may avoid ensuing serious complications.