Generalized eruptive keratoacanthomas of Grzybowski (case report)

В статье представлен краткий обзор литературы о клинических проявлениях, современных методах диагностики и лечения чрезвычайно редкого заболевания – множественной эруптивной кератоакантомы типа Гржебовски. Заболевание характеризуется возникновением сотен или тысяч генерализованных зудящих узелков на коже лица, туловища, конечностей, половых органов, слизистой полости рта и гортани в течение короткого времени. Заболевание развивается в возрасте старше 40 лет, имеет рецидивирующее течение, возможна спонтанная инволюция отдельных элементов с формированием участков депигментации или атрофических рубцов. Авторы приводят случай собственного клинического наблюдения множественной эруптивной кератоакантомы типа Гржебовски у пациента 50 лет, который обратился на консультацию к дерматовенерологу в клинику Уральского НИИ дерматовенерологии и иммунопатологии. Длительность болезни на момент обращения составляла 2,5 года, ее возникновению предшествовало неоднократное посещение больным стран с избыточной инсоляцией, что может рассматриваться в качестве этиологического фактора развития заболевания. Диагноз впервые был заподозрен на консилиуме дерматовенерологов на основании клинической картины заболевания и в дальнейшем верифицирован данными патоморфологического исследования биоптата пораженной кожи. Показана эффективность применения ароматических ретиноидов в лечении множественной эруптивной кератоакантомы типа Гржебовски и приведены побочные эффекты, которые развились у больного при самостоятельном увеличении дозы ацитретина до 70 мг/сутки. В статье констатируется чрезвычайно редкая встречаемость данного заболевания, о чем свидетельствует приведенный клинический случай, диагностируемый впервые более чем за 90-летнюю историю существования института. Подчеркивается важность консолидации клинического опыта нескольких ведущих дерматовенерологов для диагностики множественной эруптивной кератоакантомы типа Гржебовски. The article presents a brief review of the literature about clinical manifestations, modern methods of diagnosticsand treatment of an extremely rare disease – generalized eruptive keratoacanthomas of Grzybowski. The disease is characterized by the appearance of hundreds or thousands of generalized itchy nodules on the skin of the face, trunk, limbs, genitals, oral mucosa and larynx within a short time. The disease develops at the age of over 40, has a recurrent course, spontaneous involution of individual elements with the formation of areas of depigmentation or atrophic scars is possible. The authors describe a case of their own clinical care of generalized eruptive keratoacanthomas of Grzybowski in a 50-year-old patient who consulted a dermatovenerologist at the clinic of the Ural Research Institute of Dermatovenerology and Immunopathology.The duration of the disease at the time of visit to a doctor was 2,5 years, its occurrence was preceded by repeated visits to countries with excessive insolation, which can be considered as an etiological factor in the development of the disease. The diagnosis was first suspected at a boarddermatovenerologists based on the clinical picture of the disease and subsequently verified by the data of a pathomorphological examination of the biopsy of the affected skin.The effectiveness of the use of aromatic retinoids in the treatment of generalized eruptive keratoacanthomas of Grzybowski is shown and the side effects that developed in the patient with an independent increase in the dose of acitretin to 70 mg/day are given. The article states the extremely rare occurrence of this disease, as evidenced by the above clinical case, diagnosed for the first time in more than 90 years of the institute's existence. The importance of consolidating the clinical experience of several leading dermatovenerologists for the diagnostics of generalized eruptive keratoacanthomas of Grzybowski is emphasized.

Сlinical and epidemiological analysis of cases of enterovirus infection in the oryol region in adults

Objectives – to identify the clinical and epidemiological features of enterovirus infection in the adult population in the Oryol region, to track the seasonality of the disease, distribution in different age groups, and to assess the main clinical forms, symptoms, and complications.Objects and methods of research. The object of investigation was 24 medical histories of patients who gave informed consent, with a confirmed diagnosis of “enterovirus infection”, the 2 nd infectious diseases Department of Department of Oryol region “City hospital. S.P. Botkin”.Results. For the period from 2009 to 2019 was gospitalizirovany 24 patients with laboratory-confirmed diagnosis “enterovirus infection”. The most patients with this diagnosis were in 2017 – 33,5 %, the least – in 2012 – 4,1 %. In 2013 and 2019, there were no patients. Women were sick more often than men – 55 % of the total number of subjects. After analyzing statistical data, it was found that young people (aged 20–29 years) were sick more often – 58,3 %. There is a summer-autumn seasonality: 45,8 % and 54,2 %, respectively. 37,5 % of the subjects were in contact with infectious SARS patients. 37,5 % also left the Oryol region the day before.Most often, enterovirus exanthema was observed in patients – 58,3 %.. The onset of the disease in 100 % of cases was acute. All patients had fever, most often subfebrile – 54,2 %. The studied patients complained of body aches – 100 %, headaches of various localization and intensity – 96 %, sore throat – 12,5 %, vesicular-papular rash on the skin of the trunk, limbs, and head – 58,3 %, and enanthema on the oropharyngeal mucosa – 12,5 %. In 100 % of cases, the diagnosis was confirmed by a positive polymerase chain reaction response to the presence of enterovirus RNA.Conclusion. The study revealed that over the past 10 years, enterovirus infection in the Oryol region has a consistently low level. It is more common in young people. The disease is characterized by summer and autumn seasonality. In this area, the more common form is enterovirus exanthema.

Lessons From the First Wave of the Pandemic: Skin Features of COVID-19 can be Divided Into Inflammatory and Vascular Patterns

This review examines the clinical, morphological, and systemic factors related to coronavirus disease 2019 (COVID-19) cutaneous manifestations. The EMBASE, Medline, and Pubmed Central databases were searched from February 1, 2020 until April 25, 2020, using the search words “(COVID-19 OR SARS-CoV-2 OR coronavirus-19) AND (skin OR cutaneous OR dermatologic)”. Cutaneous manifestations of COVID-19 were included. The cutaneous manifestations can be classified into 2 types. Patients with inflammatory reactions consisted of morbilliform, varicella-like, urticarial eruptions, and vesiculobullous manifestations. These manifestations were mainly found on the trunk, limbs, and faces of patients and had mainly positive COVID-19 polymerase chain reaction findings (97.7%). Furthermore, there were 516 patients with acral vascular lesions: chilblains, livedo lesions, cutaneous small-vessel vasculitis, and other noninflammatory purpura. These were often nonpruritic (88%) and not seen in severe disease (88.7%). The cutaneous lesions have potential for early diagnosis of COVID-19 and prevention of disease transmission. The implications of COVID-19 in the field of dermatology continue to evolve as more clinical data becomes available.

The skin in pregnancy

Dermatoses in pregnancy are common, they may be very itchy and may influence the life of a pregnant woman dramatically. There are four classical dermatoses of pregnancy, which this chapter will examine. It is particularly important to recognize these as they may have serious health implications for mother and child. Intrahepatic cholestasis of pregnancy occurs in 1/40 to 1/500 pregnancies and is the most serious cause of itch in pregnancy, with potentially substantial effects on mother and fetus. Meanwhile, atopic eruption of pregnancy affects 1/300 pregnancies, typically with an eczematous eruption over abdomen and limbs. Pemphigoid gestationis occurs in 1/50,000 pregnancies and is due to circulating antibodies against the skin basement membrane zone. The eruption often begins around the umbilicus and spreads to the whole trunk, limbs, hands, and feet. If potent topical steroids fail systemic steroids are required. Transplacental transmission to the fetus may also occur. Recurrence in future pregnancies is to be expected.

Hepatitis in patients with syphilis: an overlooked association

We present the case of a patient who sought treatment for fever and a maculopapular rash involving the trunk, limbs, palms and soles. The patient also presented with hepatomegaly and elevated levels of liver enzymes (with a higher increase of alkaline phosphatase). With the proposal of early syphilitic hepatitis, during the stage of secondary syphilis, a venereal disease research laboratory andTreponema pallidumhaemagglutination tests were requested, which confirmed the diagnosis. All altered parameters improved with antibiotic treatment for secondary syphilis. Syphilitic hepatitis is an often overlooked presentation of syphilis and should be considered as a differential diagnosis in patients with elevated levels of liver enzymes and risk factors for syphilis.

Insights Into the Etiology of Gummosis Syndrome of Deciduous Fruit Trees in Israel and its Impact on Tree Productivity

Fungal gummosis syndrome of deciduous fruit trees was reported from several countries, including Israel. Symptomatic 5–7 to 10–14-year-old trees exude large amounts of gum on the trunk, limbs, branches, and twigs, accompanied by sunken lesions on the bark. The necrotic area extends to the xylem to form black to brown staining of the tissue. The general conception is that “this is a nuisance that can be pruned out of trees during the dormant season with no economic significance.” In this study we attempted to: (i) identify the fungi associated in the gummosis syndrome of deciduous trees in Israel and (ii) quantify the significance of gummosis syndrome on tree and fruit development and on crop value. Branches from symptomatic and asymptomatic deciduous trees were collected during 2012 to 2015 from 29 orchards including peach (14 orchards), nectarine (six orchards), apricot (six orchards), plum, cherry, and almond (one orchard each). In all cases, fungi associated with the Botryosphaeriaceae family were isolated from tissues exhibiting the typical gummosis symptoms. The decay fungus Phellinus sp. was isolated from 53.3% of the samples. The dynamics of fruit growth in symptomatic and asymptomatic trees was recorded in 2014 and 2015 in an 11-year-old peach orchard. In trees exhibiting the gummosis syndrome, yield was lower by 11.5 to 22.5% and its value was reduced by 14.7 to 19.4%, compared with those of asymptomatic trees in 2014 and 2015, respectively. Although these are substantial losses, the grower of the orchard was not aware of the losses occurring in his orchard. The reason for this situation is explained and discussed. The outcome conclusion of the current study is that the gummosis syndrome of deciduous trees imposes significant, hence undistinguishable, losses in mature deciduous fruit trees.

A Pediatric Case of Disseminated Lichen Sclerosus – a Case Report

Lichen sclerosus (LS) is an uncommon chronic inflammatory skin disorder with a predilection for the anogenital area, characterized by porcelain white papules, plaques and atrophic patches. We report a prepubertal, 12-year-old girl who presented with chronic, disseminated pearly, flat-topped papules, plaques and atrophic patches located on the trunk, limbs and in the anogenital area, consistent with LS based on clinical and histologic findings. Potent and ultrapotent topical corticosteroids should be considered as first-line treatment. The ultraviolet A1 (UVA1) and calcipotriol for extragenital lesions, as well as calcineurin inhibitors for anogenital lesions, are other treatment options for pediatric LS.

Revision of the costata-group of Alona s. lato (Cladocera: Anomopoda: Chydoridae) confirms its generic status

By taking Flavalona gen. nov. out of Alona s.l. (Cladocera: Anomopoda: Chydoridae), the last major clade has now been removed from this polyphyletic assemblage. Flavalona gen. nov. is a monophylum defined by having three, rarely two connected head pores and slit-shaped, rarely rounded lateral head pores. Postabdomen rather long, distally narrowed, with robust marginal denticles and weakly developed lateral fascicles of setules. End-claw weakly curved and with short basal spine. Male postabdomen with gonopores opening at the end of a penis-like outgrowth. Trunk limbs: exopodite of P2 with seta; inner portion of P4 with flaming-torch shaped setae; P5 with filter plate of three setae; P6 a large simple lobe. The relationship of the new genus with other Aloninae remains to be determined. A key to the 11 species of the genus is provided and a discussion of their geographic distribution and habitat type is given.

Changes in segmentation and setation along the anterior/posterior axis of the homonomous trunk limbs of a remipede (Crustacea, Arthropoda)

This study describes the segmentation and setation at different developmental stages of the homonomous trunk limbs of the remipedeSpeleonectes tulumensisYager, 1987 collected in anchialine caves of the Yucatan Peninsula. Most homonomous trunk limbs originate ventrolaterally and are composed of two protopodal segments, three exopodal segments and four endopodal segments; contralateral limb pairs are united by a sternal bar. However, the last few posterior limbs originate ventrally, are smaller sized, and have regressively fewer segments, suggesting that limb development passes through several intermediate steps beginning with a limb bud. A terminal stage of development is proposed for specimens on which the posterior somite bears a simple bilobate limb bud, and the adjacent somite bears a limb with a protopod comprised of a coxapod and basipod, and with three exopodal and four endopodal segments. On each trunk limb there are 20 serially homologous groups of setae, and the numbers of setae on different limbs usually varies. These groups of setae are arranged linearly and are identified based on the morphology of the setae and their position on the segments. The number of setae in these groups increases gradually from the anterior homonomous limb to a maximum between limbs 8–12; the number then decreases sharply on the more posterior limbs. Changes in the number of setae, which reach a maximum between trunk limbs 8–12, differ from changes in segmentation which vary only over the last few posterior trunk limbs. Following a vector analysis that identified a spatial pattern for these 20 groups of setae among the different homonomous limbs, the hypothesis was confirmed that the number of setae in any given group and any given limb is correlated with the group, with the position of the somite along the body axis, and with the number of somites present on the specimens. This is the first vector analysis used to analyze a pattern of developmental changes in serially homologs of an arthropod. Development of remipede limbs are compared and contrasted with similar copepod limbs. Architecture, particularly the sternal bar uniting contralateral limb pairs, proposed as homologous, and development of trunk limb segmentation of the remipede is generally similar to that of copepods, but the remipede limb differs in several ways including an additional endopodal segment, the proximal, that appears simultaneously with the protopod during development.

Facial Localization of Malignant Chondroid Syringoma: A Rare Case Report

First described by Hirsch and Helwig in 1961, chondroid syringomas (CSs) are rare, benign tumors of the skin arising from the eccrine sweat glands with tumor differentiation in the epithelial and mesenchymal tissues. They most commonly occur in the head and neck, although they may be also found in the axilla, trunk, limbs, and genitalia. The incidence of CS is <0.01% of all primary skin tumors. Malingnant chondroid syringomas (MCS), which are also called malignant mixed tumors of the skin, are extremely uncommon. MCSs commonly involve the limbs and rarely head and neck. In this article, we present a case of malignant chondroid syringoma localized in the face at the left nasolabial region in the light of literature review.