Unresolved chronic ulcerated nodules: Disseminated Cutaneous Sporotrichosis

We present a case of disseminated cutaneous sporotrichosis in a 72-year-old male patient who has multiple ulcerated painless nodules over the left side of his chest and on his upper and lower left limbs for three years. He was initially diagnosed to have nodular vasculitis based on early repeated biopsies. Despite the patient’s good compliance with his prednisolone medication, no significant clinical improvement was observed. Another biopsy, which was arranged after two years of treatment for nodular vasculitis, supported the diagnosis of sporotrichosis. Itraconazole was initiated, and all the lesions showed a remarkable response toward the treatment. The delay in finding the correct diagnosis unnecessarily exposed the patient to the side effects of steroid and caused the disease to worsen. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 191-195

Clinicopathological Study on Cutaneous Vasculitis

Introduction: Cutaneous vasculitis is an inflammatory process directed primarily at vessels which results in the destruction of the vessel walls leading to hemorrhage, ischemia, and/or infarction. Cutaneous involvement in cutaneous vasculitis may be primary or reflector of a systemic disease. Aim: To find out the aetiology and clinicopathologic features of cutaneous vasculitis in Chattogram costal area. Methods: A total of 50 patients diagnosed clinically and confirmed histologically as cutaneous vasculitis were selected for this descriptive cross-sectional study from March 2016 to August 2017. Detailed history, clinical examination and the baseline investigations along with special tests such as Antinuclear antibodies (ANA) profile, Antineutrophil Cytoplasmic Antibodies (ANCA) and Antistreptolysin O (ASO) titer were conducted in all patients. Results: Out of 50 cases, 20% of the patients had (Henoch-Schonlein purpura) HSP and 10% had Urticarial vasculitis (UV), collagen vascular disease associated vasculitis were present in 2%, Cutaneous polyarteritisnodosa (C-PAN), eosinophilic vasculitis and nodular vasculitis were present in 4% of the patients each. Rests of the patients (54%) were designated as idiopathic cutaneous small vessels vasculitis (SVV). The commonest lesion was palpable purpura. Infection was the commonest cause of cutaneous vasculitis for about 22%, followed by drugs (20%), malignancy (2%) and connective tissue disease (2%). Two patients with HSP had positive ANCA, 3 without any overt manifestations and 1 with systemic sclerosis. Histologically Leukocytoclastic vasculitis (LCV) was the commonnest pattern (72%), lymphocytic in 20%, granulomatous in 4% and eosinophilic vasculitis in 4% of patients. Conclusion: Cutaneous SVV is the commonest form of vasculitis. The heterogenecity of this group of disorders is well represented in this study. To reach an etiological diagnosis of vasculitis, clinical and pathological features need to be correlated and supplemented by laboratory investigations. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 61-64

Nodular vasculitis or erythema induratum without cutaneous tuberculosis: An unusual presentation in an uncommon site

Erythema induratum (EI) is a rare chronic disease, which occurs with cutaneous tuberculosis (TB). Nodular vasculitis, much rarer than erythema induratum, describes the same condition but without cutaneous TB, with lesions usually in the lower legs and rarely on the breasts. We report the case of a 46-year-old female with a history of crusted skin and necrotic lesions two years before, which, once self-limited, multiplied one month before and transferred to uncommon sites of the body, such as the breast. There was no evidence of other clinical presentations, and a chest X-ray gave no pathological findings. A biopsy was taken from the lesions, and the patient was diagnosed with erythema induratum without cutaneous tuberculosis, that is, nodular vasculitis. After treatment with calcineurin-inhibiting tacrolimus ointment, topical corticosteroids, and immunosuppressive oral azathioprine, the lesions improved.

Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study

Objectives: Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients. Methods: The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study. Results: KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1–26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases. Conclusions: Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) were observed.

Cutaneous Polyarteritis Nodosa: Uncommon and Rare Form of Cutaneous Vasculitis

Cutaneous polyarteritis nodosa (CPAN) is a variant of polyarteritis nodosa that is limited primarily to the skin. It is a chronic recurrent disorder characterized by the presence of nodular lesions with or without ulceration on the distal third of the lower limbs. Nodular vasculitis and thrombophlebitis can be clinically or pathologically mistaken for CPAN. We present a case of a 51-year-old woman with painful nodules on the lower limbs. Some of the nodules were ulcerated. Histopathological examination of a nodule on deep incisional biopsy revealed fibrinoid necrosis of a medium-sized artery in the subcutis along with perivascular mixed infiltrate. The patient did not have any symptoms or signs of internal organ involvement. The possible etiological factor has not been detected. The patient was treated with oral prednisone 0.5 mg/kg/day and dapson 150 mg/day. Over the one-year follow-up the lesions showed regression, with one minimal relapse which resolved after the short course of oral prednisone.