scholarly journals Primary Cutaneous Cryptococcosis of Nasal Ala with Extensive Tissue Destruction

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S49-S50
Author(s):  
Y Nishiyama-Fujita ◽  
Y Xu ◽  
D S Kondapi ◽  
G R Parkerson
Keyword(s):  
Correct Diagnosis ◽  
Immunocompromised Host ◽  
Skin Lesions ◽  
Body Region ◽  
Tissue Destruction ◽  
Silver Stain ◽  
Nasal Tissue ◽  
Nasal Ala ◽  
History Of ◽  
Cutaneous Cryptococcosis

Abstract Introduction/Objective Primary cutaneous cryptococcosis (PCC) is rare and shows skin lesion(s) confined to a circumscribed body region mostly in immunocompromised host, with no sign of simultaneous dissemination condition. PCC usually presents as non-specific skin lesions such as cellulitis, nodules, and ulcers, and can be misdiagnosed in biopsy. We present a case of PCC with extensive tissue destruction. Methods/Case Report A 43-year-old male, with a history of human immunodeficiency virus infection 17 years ago, presented with complaint of his nose slowly “being eaten away” over the past 5 years after a bike accident. Physical examination showed most of the left nasal ala was completely destroyed, with visualizable septum. The biopsy of the left nasal ala showed the dermis has numerous yeasts with marked variation in size and shape, in foamy stroma with little inflammation. The capsules of the yeasts were highlighted by Mucicarmine stain. Grocott methenamine silver stain showed budding yeasts. The diagnosis of cutaneous cryptococcosis, gelatinous type, was rendered. Primary cutaneous cryptococcosis was considered based on no disseminated disease found, positive serum cryptococcus antigen with low titer (1:20), the culture of the nasal lesion positive for Crptococcus Neoformans, and the history of skin injury. The patient received appropriate treatment for PCC subsequently. Results (if a Case Study enter NA) NA Conclusion We have demonstrated a very rare case of undiagnosed/untreated PCC causing extensive destruction of skin and underlying nasal tissue. Identification of the histological features of cutaneous cryptococcosis, shown in this case, is the key for making the correct diagnosis.

A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

2019 ◽  
pp. 33
Author(s):  
K Thuraikumar ◽  
V Naveen ◽  
Mustaqim A ◽  
Arieff AA ◽  
K Shri ◽  
...  
Keyword(s):  
Back Pain ◽  
Soft Tissue ◽  
Histopathological Examination ◽  
Posterior Instrumentation ◽  
Spinal Tuberculosis ◽  
Previous History ◽  
Skin Lesions ◽  
Titanium Implants ◽  
Paravertebral Abscess ◽  
History Of

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

scholarly journals Factors Associated with Clinician Adherence to USPSTF Diabetes Screening Recommendations

2021 ◽  
Vol 12 ◽  
pp. 215013272110165
Author(s):  
Elaine Seaton Banerjee ◽  
Kyle Shaak ◽  
Nicole Burgess ◽  
Melanie Johnson ◽  
Beth Careyva
Keyword(s):  
Gestational Diabetes ◽  
Adult Population ◽  
Correct Diagnosis ◽  
Retrospective Chart Review ◽  
Diabetes Screening ◽  
Factors Associated ◽  
The Us ◽  
History Of ◽  
Missed Diagnosis ◽  
Significant Health

Introduction/Objectives: Diabetes and prediabetes impact nearly half of the US adult population and are associated with significant health risks but may be underdiagnosed. Effective screening may improve diagnosis and give patients opportunity to manage their disease. The purpose of this study was to determine screening rates, identify characteristics predictive of screening, and evaluate correct diagnosis of diabetes and prediabetes. Methods: Retrospective chart review of 71 433 patients eligible for diabetes screening, defined by completing A1c test within the 3-year study period. Results: A total of 31.3% of eligible patients received diabetes screening. Factors associated with screening include older age, female sex, non-white race, Hispanic ethnicity, Medicare or Medicaid insurance, higher BMI, and having a medical comorbidity. History of prediabetes or gestational diabetes were the strongest predictors for diabetes screening, but history of gestational diabetes was under-documented. Of those screened, 10.4% had a result consistent with diabetes and 51.8% had a result consistent with prediabetes. However, 52.9% of these patients had a missed diagnosis. Conclusions: Findings of this study indicate the need for uniform coverage for diabetes screening for all insurances, increased documentation of gestational diabetes to improve screening for patients with this history, and improving accurate diagnosis after screening is completed.

scholarly journals Complicated cutaneous leishmaniasis caused by an imported case of Leishmania tropica in Japan: a case report

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Hiroyuki Kitano ◽  
Chizu Sanjoba ◽  
Yasuyuki Goto ◽  
Kazumasa Iwamoto ◽  
Hiroki Kitagawa ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Skin Lesions ◽  
Leishmania Tropica ◽  
Case Presentation ◽  
Imported Case ◽  
Imported Cases ◽  
History Of ◽  
Hematoxylin And Eosin ◽  
Polymerase Chain ◽  
Positive Results

Abstract Background Leishmaniasis is not endemic in Japan, and imported cases are rare. However, there are increasing concerns regarding imported cases of cutaneous leishmaniasis from endemic countries to Japan. This report describes a case of imported cutaneous leishmaniasis that was diagnosed and treated in Japan. Case presentation A 53-year-old Pakistani man presented with skin lesions on both malleoli of his right ankle and the dorsum of the left foot. The skin lesions manifested as erythematous nodules surrounding an ulcer in the center of the lesion. The lesions of the malleoli of his right ankle each measured 3 × 3 cm, and the lesion on the top of his left foot measured 5 × 4 cm. He had been living and working in Japan but had a history of a visit to Pakistan for about 2 months in 2018. The skin lesions were biopsied. Giemsa and hematoxylin and eosin staining of biopsy samples showed amastigotes of Leishmania in macrophages, and the presence of Leishmania was confirmed by skin tissue culture. Polymerase chain reaction using biopsy specimens identified Leishmania parasites, and DNA sequence analysis revealed that the species was Leishmania tropica. The patient was treated with intravenous liposomal amphotericin B for 6 days. The erythema disappeared, and the erythematous nodules resolved within 3 weeks. Conclusion This is the first report of imported cutaneous leishmaniasis caused by L. tropica from Pakistan, and it is interesting that all three testing modalities showed positive results in this case.

scholarly journals Tuberculosis presenting as dacryoadenitis in the USA

2019 ◽  
Vol 12 (11) ◽  
pp. e231694 ◽  
Author(s):  
Harry Ross Powers ◽  
Mark Anthony Diaz ◽  
Julio C Mendez
Keyword(s):  
Correct Diagnosis ◽  
Developed Countries ◽  
Histopathological Analysis ◽  
Orbital Mass ◽  
Antituberculosis Therapy ◽  
The Usa ◽  
History Of ◽  
Patient’S History ◽  
High Degree ◽  
Filipino Woman

A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis. She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient’s history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

scholarly journals A case of diquat poisoning in pigs

2019 ◽  
Vol 64 (No. 11) ◽  
pp. 505-511
Author(s):  
Z Siroka ◽  
M Svoboda ◽  
Z Svobodova ◽  
I Nagl
Keyword(s):  
Toxic Substance ◽  
Large Body ◽  
Skin Lesions ◽  
Acute Poisoning ◽  
Pathological Examination ◽  
Tissue Destruction ◽  
Large White ◽  
Surface Areas ◽  
Stomach Fundus ◽  
White Foam

Diquat is a bipyridyl compound which belongs to the group of herbicides. Its activity is based on the liberation of the superoxide anion radical and, subsequently, hydrogen peroxide, leading to tissue destruction by oxidative stress. Acute poisoning is associated with high mortality within several hours to a few days. The reported case of poisoning occurred on a commercial farm. The fattening pigs of the Landrace and Large White breeds were affected. The pigs were kept on a deep litter. Reglone (active ingredient diquat dibromide, 200 g/l) was used on the farm fields to desiccate the clover crop. The dry clover straw was harvested and stored for approximately a month and then used as a litter. In total, 50 pigs were affected. The onset of the poisoning was very fast. Within eight hours after the litter administration, 20 animals died. The only clinical sign seen was severe haemorrhagic dermatitis. The pathological examination revealed acute superficial haemorrhagic dermatitis on the belly, the snout and the ears of the affected pigs. Hyperaemia of the tonsils, pharynx and oesophagus was diagnosed, as well as a pronounced hyperaemia of the stomach fundus. In the distal part of the trachea, there was a dense, white foam. The lungs were congested, with focal emphysema. The liver was slightly hyperaemic. The histological examination revealed a massive haemostasis in liver and diffuse acute polymorphonuclear hepatitis. The other organs were without changes. The examination revealed acute poisoning caused by the large body surface areas contacting with a toxic substance. The pigs that survived were immediately removed to a non-contaminated area. The changes on their skin were not so extensive compared to the dead ones. Within 5–7 days after the exposure to diquat, the skin lesions healed.

scholarly journals On Using a Mobile Application to Support Teledermatology: A Case Study in an Underprivileged Area in Colombia

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Juan Pablo Sáenz ◽  
Mónica Paola Novoa ◽  
Darío Correal ◽  
Bell Raj Eapen
Keyword(s):  
Rural Areas ◽  
Mobile Applications ◽  
Mobile Application ◽  
Correct Diagnosis ◽  
Skin Lesions ◽  
Healthcare Personnel ◽  
Combined Use ◽  
Forest Regions ◽  
The Face

Background. The use of mobile applications in dermatology to support remote diagnosis is gaining acceptance, particularly in rural areas, where dermatology services are commonly managed by healthcare personnel with no specialty training. Moreover, ontologies—sets of concepts that represent knowledge in a given domain—are increasingly being used to support medical diagnosis. A specific case is ONTODerm: an ontology to aid dermatological diagnosis. However, there is little information on the combined use of mobile applications and ontologies as support solutions in dermatology. Objective. Assessing the reliability of ONTODerm as a tool to support remote dermatological diagnosis when used together with a mobile dermatological application in underprivileged areas. Methods. A mobile application that allows characterization of skin lesions was developed, and the information about the lesions was sent to ONTODerm. An exploratory study was conducted in a remote area without access to a dermatologist. A total of 64 dermatological queries were recorded in the application and consulted with ONTODerm. Later, an experienced dermatologist evaluated the characterization and diagnosis of each query to determine the accuracy of the system. Results. The results showed that the probability of obtaining a correct diagnosis was between 64.4% and 85.6% with a confidence interval of 95%. A higher accuracy rate was obtained when the skin lesion occurred on the face or when its border was categorized as poorly demarcated. Conclusions. This study demonstrates the implementation of a teledermatology strategy based on mobile applications and domain ontology-driven knowledge base to provide timely assistance to healthcare professionals. This approach was found to be pertinent in the Colombian rural context, particularly in forest regions, where dermatology specialists are not available. The results of this article do not represent a final validation of the proposed approach; they suggest how the ontology can be improved to effectively support medical staff in marginalized regions.

Fatal Intracranial Hemorrhage in a Normal Infant Secondary to Vitamin K Deficiency

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 562-564
Author(s):  
PETER A. LANE ◽  
WILLIAM E. HATHAWAY ◽  
JOHN H. GITHENS ◽  
RICHARD D. KRUGMAN ◽  
DONNA A. ROSENBERG
Keyword(s):  
Vitamin K ◽  
Correct Diagnosis ◽  
Fatal Case ◽  
Male Infant ◽  
Hemorrhagic Disease ◽  
Normal Infant ◽  
Vitamin K Deficiency ◽  
Hospital Emergency Room ◽  
History Of ◽  
K Deficiency

Since the initiation of routine vitamin K prophylaxis in newborns, the incidence of hemorrhagic disease of the newborn has been dramatically decreased. Recently there have been suggestions in the literature that prophylaxis may be unnecessary.1-4 We report here a fatal case of vitamin K deficiency in an otherwise healthy 1-month-old who did not receive prophylaxis. This case is illustrative because the child was initially thought to have suffered nonaccidental trauma. In addition, the correct diagnosis was confirmed, retrospectively, after vitamin K administration, with new assays for vitamin K-deficient prothrombin. CASE REPORT This 4-week-old male infant was seen at a community hospital emergency room with a one-day history of irritability, poor feeding, and decreased responsiveness without fever.

Invasive cutaneous cryptococcosis of the nasal planum in a cat – case report

2018 ◽  
Vol XXIII (133) ◽  
pp. 56-62
Author(s):  
Ana Cláudia Balda ◽  
Juliana Cristina Gonçalves ◽  
Renata Cristina Menezes ◽  
Ana Cristina Fascetti de Souza ◽  
Guilherme Durante Cruz
Keyword(s):  
Private Practice ◽  
Infectious Agent ◽  
Skin Lesions ◽  
The Body ◽  
Small Animals ◽  
Cutaneous Lesions ◽  
Mixed Breed ◽  
Deep Mycosis ◽  
The City ◽  
Cutaneous Cryptococcosis

Crytococcosis is the most common deep mycosis in cats, despite its rarity in the medical practice of small animals. The infectious agent of the disease is Cryptococcus sp, an opportunistic fungus that can spread throughout the body. An approximately two-year-old mixed breed cat, weighting 3 kg was presented to a private practice in the city of São Paulo, Brazil. Physical examination relealed pyogranulomatous skin lesions, mainly on the nasal planum and the second digit of the left thoracic lim. The animal presented no neurological or respiratory signs. The response to antifulgal on cutaneous lesions was favorable, but the animal did not resist a second sedation and died within twenty-eight days after starting treatment. This report shows an atypical case of cryptococcosis due to the lack of immunodeficiency.

scholarly journals Primary Cutaneous Cryptococcosis in an Immunocompetent 6-Year-Old Female

2018 ◽  
Vol 2 (4) ◽  
pp. 240-242
Author(s):  
Mitchell Hobbs ◽  
Joy King ◽  
Rana El Feghaly ◽  
Robert Brodell
Keyword(s):  
Cryptococcus Neoformans ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Oral Fluconazole ◽  
Healthy Female ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Cutaneous Cryptococcosis ◽  
Superficial Culture

A 6-year-old otherwise healthy female presented to the ED with a right eyebrow lesion for one month.  Previous I&D attempts and empiric antibiotic treatment had failed to improve the lesion.  Following dermatology referral, superficial culture resulted with growth of Cryptococcus neoformans after which completion of oral fluconazole treatment resolved the lesion.  Though Cryptococcus neoformans infections commonly plague immunocompromised patients, primary cutaneous cryptococcosis in the immunocompetent patient is a rare but documented infection with a paucity of reported pediatric cases, and frontline physicians should be aware of such a diagnosis in the setting of persistent skin lesions without response to more commonly utilized therapies.

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