bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scrofuloderma
Authors: Özkan SÛebnem , Gürler Nalan , Fetil Emel , E Atabey Neş. , Günes Ali Tahsin 
Published: March 2003

A 60‐year‐old woman presented to the Dermatology Department of Dokuz Eylül University Faculty of Medicine with complaints of hardened reddenings and inflammatory drainage on her right armpit, groin, and hips. These lesions appeared 2 months after a cholecystectomy operation, which had been performed 4 years ago, and showed unilateral progression. The patient had been treated unnecessarily with prednisolone (5 mg every other day) for 7 years because of arthralgia.Dermatologic examination revealed erythematous induration, fistulas with central serous or purulent drainage, and conical‐shaped scars on the regio axillaris dextra, regio abdominalis lateralis dextra, and regio lumbalis dextra. A linear operative scar with observable fistula located distally on the regio abdominalis lateralis dextra and another scar in a lateral position were observed. There were also abscesses, fistulas, and scars on the regio inguinalis and regio glutealis dextra (Fig. 1). Systemic examination was normal.Clinical picture before treatmentimageA tuberculin test showed erythema (9 cm) and induration in 72 h. Bacterial, mycotic, and tuberculous cultures of the vacuum and smear samples from the lesions and urine showed no reproduction.A histopathologic examination of the biopsy material revealed nonspecific slight acanthosis, perivascular mononuclear cellular infiltration in the superficial dermis, and a dense mononuclear cellular infiltration in the subcutis.The deoxyribonucleic acid obtained from the pus liquid by the phenol–chloroform method for the detection of mycobacterium tuberculosis with polymerase chain reaction was amplified using primers specific to microorganisms in the mycobacterium tuberculosis complex and also specific to the IS 6110 region. At the end of the molecular analysis, a product of amplification of 123 bp specific to mycobacterium tuberculosis was found.The erythrocyte sedimentation rate was 92 mm/h. All other laboratory values were normal, including biochemical analysis, anti‐human immunodeficiency virus, venereal disease research laboratory test, and rheumatoid factor. X‐Ray and high‐resolution computerized tomography examination of the chest, rectosigmoidoscopy, esophagus, stomach, duodenum, and small intestine passage X‐ray examinations, and vaginal smear inspections, performed to investigate other organ tuberculosis, did not show any pathologic finding. The arthralgic complaints of the patient were assessed as degenerative arthrosis by considering the bone–joint X‐ray examinations.Isoniazid 300 mg/day and rifampicin 600 mg/day were given to the patient and, since the sixth week of administration, no drainage from fistulas was observed. At the end of 9 months of treatment, the lesions improved, with scar formation, and no new lesions were observed (Fig. 2). The improvement has continued in the 4 months following the completion of therapy.Clinical picture after treatmentimage
Atypical cutaneous lymphoproliferative disorder in patients with HIV infection
Authors: Friedler Suzanne , Parisi Mary T.. , Waldo Elaine , Wieczorek Rosemary , Sidhu Gurdip , Rico M. Joyce 
Published: March 2003

AbstractBackground An inflammatory pruritic eruption which is characterized histologically by CD8+, atypical lymphocytes has been described in human immunodeficiency virus (HIV)‐infected patients. This disorder has been described as “pseudo‐Sezary” or a “cutaneous T cell lymphoma (CTCL)‐simulant”, however, as these patients do not resemble CTCL clinically, and the relationship between this entity and CTCL is unclear, a more descriptive term is “atypical cutaneous lymphoproliferative disorder” (ACLD). The purpose of this study is to categorize the clinical, histologic, and immunophenotypic features of 16 HIV‐infected patients with this skin disorder seen at the New York Department of Veterans Affairs Medical Center.Methods A retrospective chart review was conducted on 16 HIV‐infected patients with a histologic diagnosis of an atypical cutaneous lymphoproliferative infiltrate on skin biopsy. Skin biopsies were reviewed, and histologic features noted. Immunophenotyping was performed on 14 out of 16 samples; electron microscopy was performed on samples from five patients. Clinical manifestations, disease course, medication history, and response to treatment were noted.Results The patients presented with a pruritic, persistent, generalized, papular eruption. Pigment changes, including hyperpigmentation and hypopigmentation were common. Histologically, lesional biopsies were characterized by a superficial and deep polymorphous infiltrate with atypical lymphocytes which were CD8+ predominant, Ki‐1 negative, and occasionally CD7 antigen depleted. Sezary‐like cells were present in the infiltrate in four out of five patients by electron microscopy. None of the patients has systemic manifestations of lymphoma; however, one of the 16 patients eventually developed frank CTCL.Conclusions HIV‐infected patients can present with a pruritic, widespread disorder, often with pigment changes characterized by an atypical cutaneous lymphocytic infiltrate. This clinicopathologic disorder is a rare, reactive inflammatory condition which generally occurs in late stage HIV infection and rarely progresses to frank lymphoma.
Detection of Mycobacterium tuberculosis DNA using polymerase chain reaction in cutaneous tuberculosis and tuberculids
Authors: Tan Suat Hoon , Med Int , DipR . , Tan Boon Huan , PhD . , Goh Chee Leok , Med Int , Tan Kong Chong , Mcrp . , Tan Meng Fong , Ng Wee Chit , PhD . , Tan Wan Cheng 
Published: March 2003

AbstractBackground The objective of this study was to explore the role of the polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis DNA as a diagnostic aid in cutaneous tuberculosis, using routinely processed skin biopsy specimens.Methods and results A wide range of clinical specimens representing different forms of cutaneous tuberculosis and so‐called tuberculids were studied. A sensitive and specific PCR assay targeting the sequence IS6110 of Mycobacterium tuberculosis complex was used. The specimens were categorized as follows.1 Acid‐fast bacilli (AFB) positive on biopsy (nine specimens from seven patients who were immunocompromised).PCR was positive in five specimens. Of these, one specimen was culture positive and three specimens were culture negative.2 AFB negative on biopsy:(a) tuberculosis verrucosa cutis (23 specimens);(b) lupus vulgaris (three specimens);(c) cutaneous tuberculosis clinically suspected (six specimens).PCR was negative in all specimens.3“Tuberculids.”(a) erythema induratum/nodular vasculitis (20 specimens);(b) papulonecrotic tuberculid (two specimens);(c) erythema nodosum (20 specimens).PCR was negative in all specimens.Conclusions The role of PCR in clinical dermatologic practice, at this stage, may be in differentiating between cutaneous tuberculosis and atypical mycobacterial infections in the context of an immunocompromised patient where AFB can be demonstrated on biopsy and cultures may be negative. In this clinical situation, PCR allows the prompt diagnosis and early institution of appropriate therapy. We have not found PCR to be a useful complement to the clinical and histologic diagnosis of “paucibacillary” forms of cutaneous tuberculosis.
Relevance of complement fixing antinuclear antibodies
Authors: Fang Yisheng V.. , PhD . , Cyran Stanley J.. , Albini Boris , Rostami Rezvan , Ms . , Binder Walter L.. , PhD . , Beutner Ernst H.. , PhD . 
Published: March 2003

AbstractBackground Connective tissue diseases (CTDs) are a heterogeneous group of disorders defined by the association of a variety of clinical manifestations with immunologic and other laboratory findings. Overlap of syndromes and aberrant findings appear rather frequently.Methods Sera of eight antinuclear antibody (ANA) negative, cases of subacute cutaneous lupus erythematosus (SCLE) with antibodies to Ro (SS‐A) and a ninth case with clinical and laboratory signs of Sjögren’s syndrome and systemic lupus erythematosus (SLE) were tested for complement (C′) fixing antinuclear antibodies (C‐ANAs). The ninth case was examined in depth by direct immunofluorescence (DIF) and a two‐step “C + DIF” test of biopsies for C′ fixation to in vivo bound ANAs, as well as serum tests for C‐ANA, ANA, and SCLE markers.Results Sera of five of the eight ANA negative, Ro(SS‐A) positive SCLE cases had C‐ANAs. The ninth case, a 50‐year‐old woman with clinical and laboratory signs of Sjögren’s syndrome and SLE, gave a strong positive C + DIF reaction in the skin biopsy for in vivo bound ANAs that fix C′, but negative ANAs and C‐ANAs in routine serum tests; they revealed antimitochondrial antibodies. Serum tests on normal skin, however, revealed weak ANA and strong C‐ANA reactions with in vitro fixed C′.Conclusions ANA negative cases of SCLE or Sjögren’s syndrome may have C‐ANAs. A case with Sjögren’s syndrome and signs of SLE had both in vivo and in vitro C′ fixing ANAs. C‐ANA tests can aid in the identification of such cases.
Human gnathostomiasis (nodular migratory eosonophilic panniculitis)
Authors: Ruiz‐Maldonado Ramón , Mosqueda‐Cabrera Miguel A. 
Published: March 2003

A 42‐year‐old woman was first seen in January 1996 with a 7‐cm diameter erythematous–edematous, pruritic plaque on her right shoulder. The lesion had first appeared 3 weeks previously on the right side of the thorax and migrated to the shoulder. The patient had eaten raw fish (sashimi) in Japanese restaurants two or three times a year during the past few years.The presence of a migrating, pruritic, erythematous, and edematous plaque was clinically suggestive of nodular migratory eosinophilic panniculitis, also known as deep larva migrans or gnathostomiasis. The suspicion was further strengthened by the presence of 12% eosonophilia in the blood cell count.The patient was given albendazole, 400 mg/day for 7 days. Seven days after treatment, the lesion disappeared. Three months later the patient returned with a new lesion that had evolved over 1 month, similar to the previous one, but on the left side of the thorax. This time there was no history of the ingestion of raw fish, and therefore a relapse of gnathostomiasis was suspected. The patient was given 200 μg of ivermectin orally for two consecutive days. Again, 1 week after treatment the lesion disappeared, only to relapse 2 months later. This time the lesion evolved over 12 h. When the patient was seen, a 2‐cm diameter excoriated, urticaria‐like, pruritic nodule was present in the left scapular area (Fig. 1A). In an attempt to remove the parasite, a deep, 8‐mm punch biopsy was performed in the center of the lesion. A sagittal cut of the complete parasite was present in one of the histopathologic slides (Fig. 1B). Based on the epidemiologic and morphologic characteristics, the parasite was classified as Gnathostoma spingerum. After removal of the parasite, the patient has remained free of symptoms for over 2 years.(A) Excoriated, pruritic, urticaria‐like nodule in the scapular area. (B) Sagittal cut of Gnathostoma spingerum in a skin biopsy surrounded by a heavy inflammatory cell infiltrate: (a) head bulb; (b) intestine (hematoxylin and eosin, 10×)image
The profile of atopic dermatitis in a tertiary dermatology outpatient clinic in Singapore
Authors: Tay Yong‐Kwang , Khoo Boo‐Peng , Goh Chee‐Leok 
Published: March 2003

Abstract Background Atopic dermatitis is a common, chronic, relapsing, pruritic, eczematous skin condition occurring in patients with a personal or family history of atopy. The aim of this study is to describe the profile of atopic dermatitis seen at a tertiary referral skin center in a tropical multiracial country. Methods A retrospective chart review was conducted of all the patients with atopic dermatitis seen during the first six months of 1994. Results There were 492 patients, age range from 1 month to 74 years, with an equal sex ratio. The prevalence was 2%. The onset of the disease occurred before the age of 10 years in 61.2% of patients. In 13.6% of patients, the onset was after the age of 21 years. Two hundred and fifty four patients (52%) had “pure” atopic dermatitis without concomitant respiratory allergies; 238 patients (48%) suffered from a “mixed” type, with 23% having allergic rhinitis, 12% having asthma, and 13% having both asthma and allergic rhinitis; 231 patients (47%) had at least one first‐degree family member with atopy: atopic dermatitis (17%), asthma (15%), and allergic rhinitis (15%). Most of the patients, 416 (84.5%), had subacute dermatitis at presentation. Ichthyosis vulgaris was present in 38 patients (8%) and pityriasis alba in 13 patients (3%). The most common infective complication was bacterial infection (impetiginized dermatitis, folliculitis, cellulitis) present in 95 patients (19%), followed by viral infections (dermatitis herpeticum, viral warts, and molluscum contagiosum) in 17 patients (3%). Allergies were noted in 43 patients (9%). The most common was drug allergy (penicillin and cotrimoxazole) in 28 patients, followed by food allergy in 11 patients. Common aggravating factors reported included heat, sweating, stress, thick clothing, and grass intolerance. Most patients could be controlled with a fairly simple regimen of moisturizers, topical steroids, and antibiotics for acute flares. Short courses of systemic steroids were used in 78 patients (16%). Three patients were treated with phototherapy: two on combined UVA and UVB (UVAB) and one on oral psoralen photochemotherapy (PUVA). Conclusions The pattern of atopic dermatitis in Singapore is similar to that reported in the Western literature, except for a lower prevalence and a significant proportion of adult‐onset atopic dermatitis.
Peeling skin syndrome
Authors: Taştan Halis B. , Akar Ahmet , Gür Ali Rıza , Deveci Salih 
Published: March 2003

A 26‐year‐old white man presented with migratory peeling patches that had been present since birth. He stated that his condition was continuous and asymptomatic. There was no marked seasonal variation. Parental consanguinity was present.His parents were first cousins, but were unaffected by peeling skin syndrome. He had four brothers and two sisters. The only affected brother, an 18‐year‐old man, had an identical history and clinical findings.Physical examination showed widespread discrete peeling skin patches of variable size and shape with underlying erythema ( Fig. 1). The palms and soles were also involved. Peeling of the skin was produced easily by rubbing or stroking of the skin. Sheets of superficial epidermis could easily be peeled without bleeding or pain. The oral mucousPeeling skin patches on left armimagemembrane, teeth, hair, and nails showed no abnormalities. He was in good general health.A complete blood count, urinalysis, and routine blood chemistry were within normal limits. Serum iron and copper levels were also normal. Plasma and urinary amino acids analyzed by paper chromatography did not show deviations. There was no eosinophilia.A skin biopsy specimen showed slight hyperkeratosis and thinning of the granular cell layer. Parakeratosis, acanthosis, and spongiosis were absent. The stratum corneum was separated from the underlying stratum granulosum. Hyperpigmentation was observed at the basal cell layer. A perivascular lymphocytic infiltrate and a few eosinophils were found in the upper dermis ( Fig. 2). Direct immunofluorescence studies did not reveal any immunoglobulin or complement deposition.Superficial perivascular lymphocytic infiltrate, and separation of the stratum corneum from the underlying stratum granulosum (hematoxylin and eosin, ×100)image
Lobomycosis in three Venezuelan patients
Authors: Brun Ana M. 
Published: March 2003

Case 1. A 52‐year‐old Brazilian man consulted us for a growth on his forehead (Fig. 1). He came from the Amazon region, had been a gold miner for many years, and had noticed a papule on his forehead that had grown slowly for 3 years. On inspection, a 3‐cm, smooth, shiny, elastic nodule was found, the same color as the skin. The clinical diagnosis was lobomycosis; a small sample was taken with a scalpel blade, placed in KOH 20%, and numerous round cells in small chains were seen. Biopsy confirmed the diagnosis. He was treated with surgical excision and was lost to follow‐up.Case 1: growth on the foreheadimageCase 2. An 83‐year‐old Venezuelan man was brought to us by his daughter for an ulcerated verrucous plaque, measuring 6 cm by 4 cm, on his right sole (Fig. 2). The lesion was firm, had started at the age of 63 years as a papule, and later became a plaque which had ulcerated recently. He had been a gold and diamond miner for most of his life, in the southeastern Venezuelan state of Bolívar. The clinical diagnosis was epithelioma cuniculatum. The histology showed pseudoepitheliomatous hyperplasia, numerous cells in giant cells, and histiocytes; Grocott stain showed chains of uniform round to oval cells (Fig. 3 and 4). Over the years, he was treated with ketoconazole and itraconazole to no avail; new nodules appeared on the dorsum of the foot and on his leg (Fig. 5). He is now 98 years old, and fit except for lobomycosis. He has no lymphadenopathy and no neoplastic degeneration of his lesions.Case 2: ulcerated verrucous plaque on the soleimageCase 2: histology (hematoxylin and eosin)imageCase 2: nodules on the footimageCase 3. A 64‐year‐old man from the gold mining region of El Callao, in Bolívar state, was hospitalized for severe heart failure; a mass of nodules was noticed on his right arm (Fig. 6) and we were asked for a consultation. He had worked for many years in the underground gold mines and the lesions had been present for more than 25 years. On inspection, a mass of smooth, shiny, firm, pedunculated, and sessile nodules was seen on the posterior lateral aspect of his right arm; some were hypopigmented, others hyperpigmented. The impression was of a bunch of plums, measuring 6 cm by 12 cm. The clinical diagnosis was plexiform neurofibromas vs angiofibromas. The biopsy showed atrophic epidermis, numerous round cells in giant cells, and no lymphocytic infiltrate; Grocott stain showed single budding with chain formation. The patient was treated with partial surgical excision, but was lost to follow‐up.Case 3: mass of nodules on right armimageDiscussion
An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection
Authors: Archer‐Dubon Carla , Icaza‐Chivez Maria Eugenia , Orozco‐Topete Rocio , Reyes Edgardo , Baez‐Martinez Rosa , De León Samuel Ponce 
Published: March 2003

Abstract Background
Malassezia is a lipophilic fungus commonly found in normal human skin. Infection of the hair follicle by Malassezia furfur occurs in patients with predisposing factors such as diabetes or immunosuppression, or who are undergoing antibiotic treatment. Malassezia furfur folliculitis is an infrequent nosocomial infection which may be associated with fomite transmission. Methods We reviewed the clinical files of three adult patients from an intensive care unit (ICU) who simultaneously developed folliculitis through Malassezia infection. We specifically analysed predisposing factors, possible transmission modes, characteristics of skin lesions, results of biopsies and cultures, treatment, and patient outcome. Results The three male patients were in neighboring beds and they all had factors that predisposed them to underlying immunosupression. Simultaneously, and within hours of each other, they developed erythematous follicular papules and pustules on the face and chest. The skin biopsies revealed an acute folliculitis with abundant round to oval yeasts of up to 5 μm in diameter. Stains for fungi (Schiff’s peryodic acid, Grocott and silver methenamine) revealed numerous unipolar budding yeasts without hyphae, consistent with M. furfur. Conventional cultures were negative. The diagnosis of folliculitis by M. furfur was established and antifinigal treatment initiated, with adequate outcome of the dermatosis. After this outbreak, the aseptic and hygienic measures of the health care personnel of the ICU were reviewed and corrected. Conclusions The simultaneous emergence of this superficial infection by M. furfur suggests fomite participation. This dermatomycosis is an infrequent nosocomial infection in adults, which to our knowledge has not been previously reported.
The microbiology of infected and noninfected leg ulcers
Authors: Bowler Philip G. , Davies Barry J. 
Published: March 2003

AbstractBackground A clinical study was undertaken to investigate and compare specifically the aerobic and anaerobic microbiology of infected and noninfected leg ulcers.Methods Leg ulcers, defined as being infected on the basis of clinical signs, were swab sampled and investigated for aerobic and anaerobic microorganisms using stringent isolation and identification techniques.Results Two hundred and twenty isolates were cultured from 44 infected leg ulcers, in comparison with 110 isolates from 30 noninfected leg ulcers. Statistical analysis indicated a significantly greater mean number of anaerobic bacteria per infected ulcer (particularly Peptostreptococcus spp. and Prevotella spp.) in comparison with the noninfected ulcer group (2.5 vs. 1.3, respectively) (P < 0.05). Also, anaerobes represented 49% of the total microbial composition in infected leg ulcers compared with 36% in noninfected leg ulcers. The mean numbers of aerobes per wound in the two ulcer groups were not statistically different (P > 0.05). The study failed to demonstrate a clear correlation between commonly implicated facultative pathogens and wound infection. The isolation rate of Pseudomonas aeruginosa was generally low and, although Staphylococcus aureus was a frequent isolate in both wound types, it was more prevalent in noninfected leg ulcers.Conclusions This study has demonstrated the complex aerobic–anaerobic microflora which exists in leg ulcers, the prevalence of anaerobes in infected wounds, and a poor correlation between the presence of specific aerobic pathogens and wound infection. In view of these findings, the role of microbial synergistic interactions in the pathogenesis of chronic wound infection may be of greater clinical importance than the isolated involvement of any specific potential pathogen.