Cutaneous Histoplasmosis in HIV Seronegative Patients: A Clinicopathological Analysis

Background: Diagnosis of extrapulmonary histoplasmosis in HIV seronegative and immunocompetent patients is often challenging, so a high index of suspicion is required. Cutaneous manifestation of infection shows a wide spectrum of lesions including erythematous plaques; maculopapules; crusted, verrucous, or desquamative papules and nodules; abscesses; and mucocutaneous ulcers among others. Due to the variations in its clinical presentation, histopathology plays a very important role in the detection of spores and the confirmation of diagnosis. Objectives: The aim of our study was to analyze clinicopathological characteristics of cutaneous manifestations of biopsy-proven histoplasmosis in HIV seronegative individuals. We also examined the utility of Fite stain for the diagnosis of Histoplasma capsulatum on tissue biopsy sections. Methods: This was a retrospective, observational study on 7 patients who were HIV seronegative and clinically manifested with isolated cutaneous lesions or disseminated disease. Skin biopsy from the lesions was performed on all 7 patients. In addition to H&E staining and special stains for detecting fungus, Fite staining was performed on all of the cases to study its utility in detecting H. capsulatum spores. Results: The skin lesions were widely disseminated in all patients and the most common cutaneous lesions were papules, present in all 7 patients. On review of the H&E-stained slides, the most common pattern was histiocytic lobular panniculitis-like infiltrate observed in 4 cases. Fite stain highlighted the yeast as magenta-colored spores on a blue background in all cases, except for 1 with a granulomatous pattern. Conclusion: A primary cutaneous manifestation of H. capsulatum infection in non-HIV-infected individuals is extremely rare. Fite stain could aid in differentiating the spores of H. capsulatum from those of other fungi, Cryptococcus and Candida in particular.

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Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

SAGE Open Medical Case Reports ◽

10.1177/2050313x21997194 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199719

Author(s):

Juan Carlos Palomo-Pérez ◽

Maria Elisa Vega-Memije ◽

David Aguilar-Blancas ◽

Erik González-Martínez ◽

Lucia Rangel-Gamboa

Keyword(s):

Respiratory Symptoms ◽

Case Series ◽

Signs And Symptoms ◽

Skin Lesions ◽

World Health ◽

Medical Community ◽

Atypical Pneumonia ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

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Dermoscopy and Trichoscopy in Dermatomyositis—A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm11020375 ◽

2022 ◽

Vol 11 (2) ◽

pp. 375

Author(s):

Magdalena Żychowska ◽

Adam Reich

Keyword(s):

Diagnostic Technique ◽

Skin Lesions ◽

Cross Sectional Study ◽

Cutaneous Lesions ◽

Cross Sectional ◽

Cutaneous Manifestations ◽

Non Invasive ◽

Inflammatory Dermatoses ◽

Curved Vessels ◽

Established Role

Background: (Video)dermoscopy is a non-invasive diagnostic technique that has a well-established role in dermatooncology. In recent years, this method has also been increasingly used in the assessment of inflammatory dermatoses. So far, little is known about the (video)dermoscopic features of dermatomyositis (DM). Methods: Consecutive patients with DM were included in the study and videodermoscopic assessments of the nailfolds, scalp, and active skin lesions were performed. Results: Fifteen patients with DM (10 women and 5 men) were included. Capillaroscopy showed elongated capillaries (90.9%), avascular areas (81.8%), disorganized vessel architecture (81.8%), tortuous capillaries (72.7%), dilated capillaries (72.7%), and hemorrhages (72.7%). The trichoscopic findings included linear branched vessels (80.0%), linear vessels (60.0%), linear curved vessels (53.3%), perifollicular pigmentation (40.0%), perifollicular erythema (33.3%), scaling (20.0%), white (20.0%) or yellow (20%) interfollicular scales, and white (20.0%) or pinkish (13.3%) structureless areas. Polymorphic vessels of an unspecific distribution and white or pink structureless areas were frequently observed under dermoscopy in cutaneous manifestations of DM, including Gottron’s papules and Gottron’s sign. Conclusions: Dermoscopy of the nailfolds (capillaroscopy), scalp (tricoscopy), and active cutaneous lesions may be of value in the preliminary diagnosis of DM.

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Calciphylaxis in a Patient With Non-Hodgkin Lymphoma: Case Report and Literature Review

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418761867 ◽

2018 ◽

Vol 22 (5) ◽

pp. 524-526 ◽

Cited By ~ 1

Author(s):

Meggie Morand ◽

Myrna Chababi-Atallah ◽

Sara-Élizabeth Jean ◽

Carolina Fernandes

Keyword(s):

Systematic Review ◽

Hodgkin Lymphoma ◽

Rare Condition ◽

Skin Lesions ◽

Review Of The Literature ◽

End Stage Kidney Disease ◽

Cutaneous Lesions ◽

Non Hodgkin Lymphoma ◽

End Stage ◽

High Index Of Suspicion

Background: Calciphylaxis is a well-known entity in end-stage kidney disease and after renal transplant. Cases of nonuremic calciphylaxis (NUC) have also been reported, but data on this rare condition are mainly empirical. Objective: We discuss a case of NUC secondary to spontaneous tumour lysis syndrome in a patient who had chemotherapy for non-Hodgkin lymphoma and present a review of the literature to better characterize malignancy-associated NUC. Methods: We identified 12 published cases of malignancy-associated NUC. Results: This systematic review of malignancy-associated NUC did not show a relationship between the type of malignancy, the distribution of skin lesions, or mortality. However, distal more than proximal involvement seems to be more frequently associated with calcium phosphate imbalance. Conclusion: Clinicians must maintain a high index of suspicion for calciphylaxis when evaluating patients with cutaneous lesions developed in the setting of malignancy.

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Clinico-epidemiological study of iatrogenic cutaneous manifestations in neonates in intensive care unit in a tertiary care hospital

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20184710 ◽

2019 ◽

Vol 5 (1) ◽

pp. 17

Author(s):

E. S. Sushmitha ◽

D. Manoj ◽

K. Ravindra ◽

G. Guruprasad

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Skin Lesions ◽

Care Hospital ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Term Neonates ◽

Medical College ◽

Goltz Syndrome ◽

Needle Prick

Background: Neonatal dermatology, by definition, encompasses the spectrum of cutaneous disorders that arise during the first four weeks of life ranging from from physiological and transient to grossly pathological lesions in the skin of a neonate. The aim and objectives of the study were to determine the quantum of iatrogenic problems which can be minimized and prevented.Methods: A total of 1000 neonates admitted in the tertiary care NICU of JJM Medical College were examined and spectrums of pathological cutaneous lesions noted.Results: Among 1000 neonates examined, 101 had iatrogenic cutaneous conditions which were commonly seen in day one of life in 48 neonates and least in newborns between 15-21 days. Skin lesions were commonly seen in full term neonates (59), followed by preterm (39) and post term (3) neonates.Among the iatrogenic injuries needle prick injury (83), thermal burns (12) and bronze baby syndrome (11) were most commonly were noted in LBW and the normal for weight neonates. A variety of other conditions which could not be categorized into any of the above categories accounted for 5 cases. These included albinism, Waardenburg syndrome, TORCH complex and Down’s syndrome and Goltz syndrome.Conclusions: Iatrogenic cutaneous abnormalities among neonates are under reported, with no detailed studies on these variants. Genetic, neonatal, maternal, social and geographic factors seen to influence the patterns of neonatal dermatoses. Hence, it is important for a dermatologist and paediatrician to have a thorough knowledge and to distinguish various iatrogenic manifestations and to minimize the outcomes during their stay in NICU.

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A clinical study of various cutaneous manifestations in neonates

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20185513 ◽

2019 ◽

Vol 5 (1) ◽

pp. 8

Author(s):

Shams Zia Usmani ◽

Kshitij Saxena ◽

Venkatarao Koti ◽

Shrish Bhatnagar ◽

Gaurav Paliwal ◽

...

Keyword(s):

Neonatal Period ◽

Cutaneous Lesion ◽

Skin Lesions ◽

Good Prognosis ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Medical College ◽

Variable Nature ◽

Detailed Assessment ◽

Neonatal Skin

Background: Cutaneous manifestations are common in neonates. Transient and pathological neonatal dermatoses should be differentiated to avoid unnecessary treatment and thus considering the variable nature and severity of neonatal skin lesions, it is important to be aware of the transient skin lesions in newborn and to differentiate these from other serious conditions which will avoid unnecessary therapy to the neonates and the parents can be assured of good prognosis of these skin manifestations. The present study has been carried out to study the clinical pattern of cutaneous lesion in neonatal period.Methods: A total of 255 neonates from Department of Dermatology in collaboration of Department of Pediatrics, Era’s Lucknow Medical College and Hospital were evaluated for cutaneous manifestations. A detailed assessment regarding history, clinical examination and investigations were recorded and analyzed.Results: Out of 255 neonates, 138 (54.1%) were males and 117 (45.9%) were females. The sex ratio (M:F) was 1.18. The most common dermatoses were physiological desquamation (54.1%) and mongolian spots (37.6%) followed by milia (19.6%), miliaria (14%), epstein pearls (10.2%).Conclusions: The physiological and transient cutaneous lesions are common are in neonates. Physiological cutaneous manifestations were quite frequent apart from birthmarks/congenital cutaneous manifestations. An understanding of these manifestations helps in managing and deciding the appropriate manifestation.

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A Clinical Profile and Co-morbidities of Pemphigus Vulgaris Patients: A Study of 35 Cases

KYAMC Journal ◽

10.3329/kyamcj.v10i2.42789 ◽

2019 ◽

Vol 10 (2) ◽

pp. 106-109

Author(s):

Md Abdur Razzaque ◽

Zulfikar Ali ◽

Kazi Shihab Uddin ◽

Md Imtiajul Islam ◽

Sajib Kumar Nath

Keyword(s):

Pemphigus Vulgaris ◽

Skin Lesions ◽

Cutaneous Lesions ◽

Female Ratio ◽

Medical College ◽

Autoimmune Blistering Disease ◽

Blistering Disease ◽

High Index Of Suspicion ◽

Male To Female ◽

Sixth Decade

Background: Pemphigus vulgaris (PV), an autoimmune blistering disease involving the skin and mucosa. PV frequently begins with oral lesions and progresses to skin lesions. Autoimmune bullous skin disorders are associated with IgG or IgA auto- antibodies against distinct adhesion molecules of the epidermis and dermal epidermal basement membrane zone, respectively. These auto- antibodies lead to a loss of skin adhesion which shows up clinically as the formation of blisters or erosions. Objectives: To characterize the clinical parameters and co-morbidities of PV patients from a single tertiary medical centre in Bangladesh. Material and Methods: This observational study was done including 35 PV patients attending in the department of Dermatology and Venereology, Khwaja Yunus Ali Medical College Khawja Eunus Ali Medical College from 2010 to 2014. Thirty patients of pemphigus diagnosed clinically confirmed and treated over a 4-year period (2010-2014). Results: Majority of the patients 45.7% belongs to age group 41-50 years. Mean age 47.12±11.13. The male to female ratio in our study sample was 1:1.5. The youngest patient was 17 years old and the oldest 68. For both genders, the risk of onset peaked during the fifth and sixth decade of life. Out of 35 patients, 15(42.9%) was presented with mucosal lesions only, while 13 patients 37.1% had mucocutaneous lesions and 7 patients 20% had only cutaneous lesions. The most common comorbidies were hypertension 20.0%, osteoporosis 17.1%, and diabetes 8.6%, thyroid disease 8.6%, psoriasis 5.7%, rheumatoid arthritis 2.7%, rheumatic fever 2.9%, autoimmune hepatitis 2.9%, and myasthenia gravis 2.9%. Conclusion: The associated comorbidities of PV emphasize the need for dermatologists to keep a high index of suspicion and actively evaluate patients to determine their presence. KYAMC Journal Vol. 10, No.-2, July 2019, Page 106-109

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Skin Lesions Associated with Nutritional Management of Maple Syrup Urine Disease

Case Reports in Dermatological Medicine ◽

10.1155/2017/3905658 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Jaraspong Uaariyapanichkul ◽

Puthita Saengpanit ◽

Ponghatai Damrongphol ◽

Kanya Suphapeetiporn ◽

Sirinuch Chomtho

Keyword(s):

Zinc Deficiency ◽

Maple Syrup Urine Disease ◽

Clinical Status ◽

Extended Period ◽

Skin Lesions ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Maple Syrup ◽

Natural Protein ◽

Urine Disease

Introduction. Maple syrup urine disease (MSUD) is an inborn error of branched chain amino acids (BCAAs) metabolism. We report an infant with MSUD who developed 2 episodes of cutaneous lesions as a result of isoleucine deficiency and zinc deficiency, respectively. Case Presentation. A 12-day-old male infant was presented with poor milk intake and lethargy. The diagnosis of MSUD was made based on clinical and biochemical data. Management and Outcome. Specific dietary restriction of BCAAs was given. Subsequently, natural protein was stopped as the patient developed hospital-acquired infections which resulted in an elevation of BCAAs. Acrodermatitis dysmetabolica developed and was confirmed to be from isoleucine deficiency. At the age of 6 months, the patient developed severe lethargy and was on natural protein exclusion for an extended period. Despite enteral supplementation of zinc sulfate, cutaneous manifestations due to zinc deficiency occurred. Discussion. Skin lesions in MSUD patients could arise from multiple causes. Nutritional deficiency including isoleucine and zinc deficiencies can occur and could complicate the treatment course as a result of malabsorption, even while on enteral supplementation. Parenteral nutrition should be considered and initiated accordingly. Clinical status, as well as BCAA levels, should be closely monitored in MSUD patients.

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Cutaneous Manifestations of Cystic Fibrosis

Journal of Interdisciplinary Medicine ◽

10.2478/jim-2018-0005 ◽

2018 ◽

Vol 3 (1) ◽

pp. 39-44

Author(s):

Anca Chiriac ◽

Laura Trandafir ◽

Cristian Podoleanu ◽

Simona Stolnicu

Keyword(s):

Cystic Fibrosis ◽

Autosomal Recessive ◽

Skin Lesions ◽

Nutritional Deficiencies ◽

Transmembrane Conductance Regulator ◽

Transmembrane Conductance ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Cystic Fibrosis Transmembrane

Abstract Cystic fibrosis (CF) is an autosomal recessive affliction triggered by genetic mutations in the cystic fibrosis transmembrane conductance regulator. The lung and pancreas are the most frequently affected organs in cystic fibrosis, cutaneous involvement is undervalued and underdiag-nosed. Skin lesions observed in patients diagnosed with cystic fibrosis are not well known and can create confusions with other dermatological diseases. The diagnosis of cutaneous lesions as signs of cystic fibrosis by pediatricians or dermatologists, despite their overlapping with different nutritional deficiencies, would allow earlier diagnosis and proper treatment and could improve quality of life and outcomes.

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Bortezomid-Induced Sweet Syndrome.

Blood ◽

10.1182/blood.v108.11.5128.5128 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5128-5128

Author(s):

Aline A. Schmidt-Tanguy ◽

Martine M. Avenel-Audran ◽

Séverine S. Lissandre ◽

Mammoun M. Dib ◽

Anne A. Croue ◽

...

Keyword(s):

Histopathological Examination ◽

Skin Lesions ◽

Pulmonary Complications ◽

Neutrophilic Dermatosis ◽

High Dose ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Sweet Syndrome ◽

The Third ◽

Periorbital Oedema

Abstract Bortezomid (VELCADE®) is a potent proteasome inhibitor used in patients with relapsed and/or refractory multiple myeloma (MM). Numerous undesirable effects are known including thrombocytopenia, neuropathy, various gastrointestinal disorders, fatigue, or rare pulmonary complications. Cutaneous complications have also been described. We reported here a case of Bortezomid-induced Sweet syndrome. A 72-year-old man received Bortezomid for a second relapse of MM previously treated with VAD (vincristine, adriamycin, dexamethasone), double high dose melphalan and autologous transplant, and thalidomide. Bortezomid was given at the dose of 1.3 mg/m2 on days 1, 4, 8, and 11 every 21 days. Dexamethasone was associated with the first cycle at the dose of 20mg/d given on days 1, 2, 4, 5, 8, and 9. On day 11 of the third cycle, a partial response was observed. However, the patient presented a painful skin eruption without any fever. Centimetric erythematous, oedematous papulo-nodular plaques were observed on his back and a periorbital oedema. Spontaneous partial regression was noted on the first day of the following cycle but major analgesic drug were necessary. These cutaneous lesions on the back and the dorsal of fingers recurred on the fourth and fifth cycles with a maximum on day 11. Histopathological examination of a lesion showed oedeme of the dermis and a perivascular polymorphic dermal infiltrate of lymphocytes, neutrophils and eosinophils with some leukocytoclasia, but without parietal necrosis or vasculitis. This findings were consistent with neutrophilic dermatosis. During the sixth Bortezomid cycle, the administration of dexamethasone 20 mg/d on days 1, 2, 4, 5, 8, 9, 11, and 12 prevents the reoccurrence of the skin lesions but the periorbital oedema persists. A variety of cutaneous manifestations has been described in MM. Sweet syndrome has been described in two untreated MM or in some patients receiving granulocyte-colony stimulating factor. Bortezomid has been associated with rash, pruritus, erythema, periorbital oedema, urticaria, alopecia, skin nodules. Few cases of non-necrotising cutaneous vasculitis with perivascular lymphocytic infiltrates have also been reported. Bortezomid-induced Sweet syndrome has been reported in three other patients at the second and third injection of the second cycle for two of them while the eruption occurred after the first injection in the third case. The recurring skin lesions after each bortezomid cycle strongly suggests Bortezomid responsibility’s in the occurrence of Sweet syndrome. Unlike classic hypersensitivity type reactions, this vasculitis rash may not necessary prompt cessation of drug as the administration of dexamethasone prevents its recurrence.

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Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

Dermatopathology ◽

10.3390/dermatopathology7010002 ◽

2020 ◽

Vol 7 (1) ◽

pp. 3-16 ◽

Cited By ~ 9

Author(s):

Gürkan Kaya ◽

Aysin Kaya ◽

Jean-Hilaire Saurat

Keyword(s):

Clinical Symptoms ◽

Case Reports ◽

Clinical Manifestations ◽

Skin Lesions ◽

Vascular Lesions ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Histopathological Features ◽

Pubmed Database ◽

The Mean

In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

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