Sporotrichoid pattern of nerve abscesses in borderline tuberculoid leprosy: A Case Report (sporotrichoid like abscesses in leprosy).

Linear distribution of multiple subcutaneous nodules or ulcers along the course of lymphatics, classically seen in lymphocutaneous sporotrichosis, has been observed in a number of other infections like localized cutaneous leishmaniasis, cutaneous tuberculous and non tuberculous mycobacterial infections, Pasteurella tularensis, Scopulariopsis blochi, Nocardia brasiliensis, yaws and syphilis. A case of borderline tuberculoid leprosy with multiple cutaneous nodules corresponding to resolving nerve abscesses in a sporotrichoid pattern is being reported.

Nocardia nova mycetoma over forehead in a lepromatous leprosy patient.

We present a case of a 31-year-old male, a known patient with lepromatous leprosy with a type 2 lepra reaction, who presented with a slowly growing asymptomatic swelling with multiple discharging sinuses over the forehead that developed over 6 months. Smears of the serosanguinous discharge on Gram staining showed Gram-positive branching filamentous bacilli, which on culture on blood agar showed chalky-white colonies. Histology of the lesion showed suppurative granulomas with polymorphs surrounding characteristic grains. The isolate was identified as Nocardia nova by gene sequencing and the patient was started on combined antibiotic therapy that resulted in complete resolution of the infection in six months. To the best of our knowledge, this is the first report of mycetoma related to Nocardia nova in association with leprosy.

Clinico-pathological spectrum of cutaneous sarcoidosis: an experience from a government institute in North India.

BACKGROUND AND AIMS: Sarcoidosis is a multisystem granulomatous disease of unknown etiology and cutaneous involvement is the second most frequent manifestation in systemic sarcoidosis.The aim of the present study is to evaluate the clinical and pathological spectrum of cutaneous sarcoidosis and compare the same with literature available. METHODS: The present retrospective study was conducted from January 2010-March 2015 and fifteen cases diagnosed as cutaneous sarcoidosis on biopsy were reviewed. The histological spectrum of cutaneous sarcoidosis was evaluated. RESULTS: The mean age at diagnosis was 46 years. Nine (60%) cases out of 15 were females. Most common cutaneous lesions were nodules (46.6%) followed by papules (40%). Classically, lymphocyte-poor, non-caseating epithelioid cell granulomas, was the most common histologic finding. Inclusion bodies were seen in 20% cases with occasional presence of fibrinoid necrosis (13.3%). Peri-adnexal granuloma, seen in one case, raised the possibility of tuberculoid leprosy. Foreign body was seen in one case supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. Epidermal changes including atrophy, loss of rete pegs, acanthosis, papillomatosis, hyperkeratosis, parakeratosis and basal cell vacuolation were seen in 46.6% cases. Reticulin was positive in all the cases while special stains for acid fast bacilli and fungi were negative. CONCLUSION: The clinical presentation of cutaneous sarcoidosis may be variable. Presence of naked, reticulin-rich granulomas is the most characteristic histopathological finding. Correlation of clinical history with histologic examination is essential to exclude other granulomatous diseases including leprosy, syphilis, other infectious granulomatous diseases and foreign body reaction.

Langerhans cell histiocytosis of skin: a clinicopathologic analysis of five cases.

BACKGROUND AND AIMS: Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of histiocytes characterized by a proliferation of abnormal and clonal Langerhans cells. We retrospectively studied clinicopathologic features of this disorder in five cases. METHODS: Clinical and histopathological findings of five cases of cutaneous LCH were reviewed based on the hospital records. RESULTS: The age of patients ranged from 28 days to 5 years and M: F ratio was 1:1.5. Clinically, the diagnoses suggested were histiocytosis, varicella, transient neonatal pustular melanosis, keloid, sarcoidosis, seborrheic keratosis and LCH. The most common type of skin lesion was a generalized papular lesion. Histologically, all cases showed aggregates of large mononuclear histiocytes (Langerhans cells) with reniform, irregular, cleaved nuclei and abundant eosinophilic cytoplasm. There was multi-systemic involvement in two patients and single-system involvement in three patients. CONCLUSION: Cutaneous lesions may be the sole presenting feature of LCH. Diagnosis is based on demonstration of S-100 positive histiocytes.

Isolation of Enterococcus faecalis from a case of nonpuerperal breast abscess.

Nonpuerperal breast abscess (NPBA) has different etiology as compared to the mastitis occurring in post partum women. The condition presents either as acute suppurative infection or chronic type. Organisms usually implicated are Staphylococcus aureus, coagulase negative staphylococci, and anaerobes. Mostly the infection is polymicrobial in nature. Herein, we report the isolation of Enterococcus faecalis from a case of acute suppurative NPBA.

Syphilitic panuveitis and asymptomatic neurosyphilis: a marker of HIV infection.

Co-existing human immunodeficiency virus (HIV) infection can alter the course and presentation of syphilis. Severe ocular manifestations and accelerated natural course of syphilis along with neurosyphilis may be associated with HIV infection. A 30-year-old man is described in whom syphilitic panuveitis and asymptomatic neurosyphilis served as a marker for HIV infection.

Laugier-Hunziker syndrome.

Laugier-Hunziker syndrome is a benign pigmentary disorder which manifests as macular hyperpigmentation of the lips and buccal mucosa. Some patients have longitudinal pigmented bands of nails. The syndrome has no systemic associations. Two patients of this rare syndrome are reported. Disorders producing similar pigmentary changes which must be differentiated are discussed.

Nasal myiasis in leprosy leading to unusual tissue destruction.

Nasal mucosal involvement is a constant feature in lepromatous leprosy (1). Granulomatous infiltration of nasal mucosa and consequent sensory loss may result in atrophic rhinitis and or painless ulceration, which is usually asymptomatic except for later complications of epistaxis, septal perforation, inflammation, and/or myiasis in long neglected patients. An unusual destruction of nasal architecture mimicking cancrum oris caused by myiasis in lepromatous leprosy is described for its rarity.

Heterophil negative infectious mononucleosis like syndrome due to hepatitis B virus.

A case of acute viral hepatitis B with features suggestive of infectious mononucleosis in a 20 year girl is described. A differential diagnosis of heterophil negative infectious mononucleosis like syndrome due to varied aetiology based on serology is emphasised.

Pilomatricoma--a reprospective analysis of 18 cases.

Pilomatricoma (calcifying epithelioma of Malherebe) is an uncommon skin tumour that occurs predominantly in young people. No studies are available from the Indian subcontinent on pilomatricoma. We analyzed records of 18 cases of pilomatricoma seen during 5 years period (1995-99). There were 16 females and 2 males and their age ranged from 5 to 60 years. All patients had solitary lesions in 10 out of 18 cases (55.5%), the tumour was located in head and neck region including 5 cases (27%) where it involved orbital margin and eye-brow. In only 2 out of 18 cases, a clinical diagnosis of pilomatricoma was suggested. In addition to the secondary changes described in previous studies, we observed additional changes like myxoid change, oedema fluid and necrosis with karyorrhectic debris in few of these tumours. Making a clinical diagnosis of pilomatricoma can be difficult. The final confirmation is by histopathological examination only.

Fluconazole and itraconazole in pityriasis versicolor.

Pityriasis versicolor is a common superficial fungal infection caused by Malassezia species. It has a high incidence and prevalence in tropical climates. Although it responds well to treatment, relapses and recurrences are frequent. In the present study the therapeutic response of single dose fluconazole (400 mg) with itraconazole (100mg twice daily ? 7 days) was compared in sixty patients of pityriasis versicolor. No significant statistical difference (p>0.05%) was observed between efficacy of two drugs. Therapy with fluconazole is preferable in view of single dose administration and lesser cost as compared to itraconazole.

IgG subclasses in pemphigus vulgaris.

Direct immunofluorescence in perilesional skin of 13 pemphigus patients is studied for IgG subclasses. IgG1 and lgG4 were predominant subclasses deposited. No correlation of subclasses of IgG with clinical parameters were found.

Vulval elephantiasis : A sequel to tubercular lymphadenitis.

Two cases of vulval elephantiasis arising as a sequel to complete destruction of regional lymph nodes of tubercular aetiology are described for its rarity.

Sarcoidosis.

Two cases of cutaneous sarcoidosis with itchy lesions are reported. Both patients had systemic involvement and were successfully treated with glucocorticoids.