Imported African tick bite fever: a case report.

We describe a patient with African tick-bite fever who acquired his infection while visiting rural areas of South Africa and then became sick after returning to the United States. The dominant clinical feature of his illness was the presence of multiple, ulcerated lesions (tache noires). Physicians in the United States and other non-African countries who see travelers returning from southern parts of Africa who give a history of recent tick bite and/or present with multiple, crusted or vesicular skin lesions should be alert to this diagnosis and institute treatment with doxycycline.

Primary lymphocutaneous Nocardia brasiliensis infection.

We report a rare case of primary lymphocutaneous Nocardia brasiliensis infection occurring in an elderly diabetic man maintained on long-term therapy with prednisone. The mode of inoculation was that of a puncture wound caused by a contaminated needle that occurred one month prior to the development of the clinically apparent infection. The course of this patient's infection was protracted and required two surgical procedures and several months of antibiotic therapy. A review of 15 previously reported cases is presented as well as a discussion of appropriate medical therapy.

Necrotizing sialometaplasia: a sheep in wolf's clothing. Healing as a diagnostic test.

Necrotizing sialometaplasia is a benign self-limited intraoral lesion that is easily confused both clinically and histologically with squamous cell carcinoma. It presents as a painless ulceration, frequently on the hard palate, that histologically shows necrosis, inflammation, squamous metaplasia, and granulation tissue. It is thought to be due to infarction of minor salivary glands and heals spontaneously in six to 12 weeks. A brief period of observation for evidence of healing can be an important diagnostic clue in distinguishing this entity from cancer, thus saving the patient unnecessary surgery or radiation therapy.

Venous ulcers.

Successful therapy of venous ulcers combines local wound treatment modalities and ambulatory hemodynamic support to control the underlying disease. Compression bandaging reduces or eliminates edema, and a moist wound environment not only debrides necrotic tissue but also aids development of granulation tissue, a prerequisite for epidermal repair. We have occluded chronic wounds, known to be heavily colonized, with a hydrocolloid dressing for up to 7 days and found that soft-tissue infections occurred in only 1% of all dressing changes in our clinic, compared with 6.5% generally reported in the literature. In venous ulcers, resident bacteria may be beneficial in that their proteolytic activity assists with autolysis of fibrinopurulent wound exudate. The importance of lysing fibrin and reducing the number of existing fibrin "cuffs," thereby improving local tissue oxygenation and nutrient/waste exchange, is not completely understood; however, this phenomenon, in part, may explain the excellent clinical results obtained with one type of hydrocolloid dressing (DuoDERM), which has been shown to lyse fibrin more effectively than other types of moisture-retentive and hydrocolloid dressings.

Management of chronic and problem lower extremity wounds.

With simple, inexpensive therapy, virtually all venous ulcers heal without the need for hospitalization, skin grafting, growth factors, hyperbaric oxygen, or debilitating bed rest. Although the future promises to yield a greater understanding about the nature of these wounds and ways to treat them, one can benefit the vast majority of patients with available technology. Few therapeutic experiences are as gratifying as healing a patient's debilitating chronic wound.

Treatment of leg ulcers.

Leg ulcers represent the most common chronic wound in our population. This devastating problem often cripples patients, many of whom are in the prime of their working years. The resulting morbidity and financial cost are extraordinary. Fortunately, with the right approach, the vast majority heal with simple ambulatory outpatient therapy. The essential requirements for treating leg ulcers include a thorough understanding of lower extremity anatomy, vascular hemodynamics, and the management of trophic and inflammatory skin changes.

Treatment of lymphangioma circumscriptum with tunable dye laser.

We present the case of a patient with lymphangioma circumscriptum that was successfully treated with a flashlamp pulsed dye laser. Dermatologists are aware of the use of the pulsed dye laser for the treatment of port-wine stains and other vascular lesions. This case report illustrates the usefulness of the pulsed dye laser for the treatment of another common dermatologic condition.

Merkel cell tumor.

A case of a rapidly growing Merkel cell tumor occurring on the lower extremity in an 83-year-old woman is reported. A brief review of the clinical characteristics of this tumor as well as its immunohistochemical and ultrastructural features are presented.

Letterer-Siwe disease in an adult.

Letterer-Siwe disease, a proliferative disorder of Langerhans' cells, usually affects children during the first year of life. A 67-year-old woman is described here whose initial manifestation was a characteristic skin eruption. The clinical, pathologic, and ultrastructural features of Letterer-Siwe disease are reviewed and their role in diagnosis discussed.