Mitral valve prolapse in psoriatic arthritis.

Twenty-five patients with psoriatic arthritis were studied by echocardiography in view of the known association of related seronegative arthropathies with aortic-valve lesions. The study group included 15 men and ten women with a mean age of 46.5 +/- 14.6 years. Twenty-two patients suffered from peripheral disease whereas three also had axial involvement. No aortic-valve lesions were found; however, mitral-valve prolapse (MVP) was detected in 14 patients (56%), nine men and five women. The mean age, mean duration of psoriasis, and mean duration of arthritis were similar in patients with and without MVP. HLA tissue typing, which was done in nine patients with MVP, revealed only one patient with HLA-B27. There was no predominance of any of the typical antigens found in psoriasis (HLA-B13, HLA-Cw6). In a control group of 32 psoriatic patients without arthritis, only two (6.4%) suffered from MVP.

Case report: severe pyoderma associated with familial Mediterranean fever--favorable response to colchicine in three patients.

Familial Mediterranean fever (FMF) is an autosomal recessive disorder that occurs most frequently among Sephardic Jews and Armenians. It is characterized by recurrent episodes of fever, peritonitis, pleuritis, and arthritis. Skin lesions are seen in some patients. Diagnosis of FMF usually is made on clinical grounds only, typically when recurrent attacks of abdominal pain, fever, and arthritis are observed in a patient with an appropriate ethnic background and family history. To date, there are no specific diagnostic laboratory tests for FMF. Three patients with severe recurrent Pyoderma are covered in this report. In all three cases, the cutaneous lesions were associated with clinical manifestations of FMF and responded to colchicine therapy favorably. The importance of such an association and its therapeutic consequences are emphasized.

Angioimmunoblastic lymphadenopathy following Kaposi's sarcoma.

The close relationship of Kaposi's sarcoma (KS) with other lymphoproliferative disorders is a poorly understood, but well documented, phenomenon. A case is presented of a 68-year-old woman with the classical form of cutaneous KS in whom disappearance of the lesions after treatment was shortly followed by the development of angioimmunoblastic lymphadenopathy, pursuing a fulminant course to death. Postmortem examination revealed diffuse involvement of the marrow, spleen, liver, and lymph nodes by the immunoblastic proliferation. The close association of these two conditions may represent more than a chance occurrence. The appearance of a constellation of nonspecific symptoms suggestive of a lymphoproliferative disorder in debilitated patients with KS should alert the physician to the possibility of the development of this rare complication.

Immunofluorescent localization of cytokeratin intermediate filaments as a means of defining the presence of recurrent basal cell carcinoma.

Intermediate filament subunits are reliable markers of cytogenetic origin for both normal and neoplastic cells. Immunohistochemical localization of cytokeratin filaments offers a sensitive and specific means of identifying basal or reserve cells when studying histologic sections of skin biopsy specimens. We have applied this technique on eighteen cases in which unequivocal diagnosis or recurrent basal cell carcinoma could not be rendered by conventional histologic techniques. In three of the cases studied, microscopic islands of basal cell carcinoma could be demonstrated by positive staining with cytokeratin antibodies. In the remaining fifteen cases, the possibility of recurrent basal cell carcinoma could be conclusively eliminated on the basis of negative staining with this antibody. Immunolabeling with tissue specific cytokeratin antibodies by indirect immunofluorescent examination may thus constitute a reliable and relatively simple technique that may serve to establish a definitive diagnosis in equivocal cases of suspected recurrent basal cell carcinoma.

Bullous skin lesion in familial Mediterranean fever.

An unusual painful bullous skin lesion of the foot occurred in a 49-year-old woman as the only clinical manifestation of familial Mediterranean fever. The lesion preceded other symptoms of the disease by several years and responded only to treatment with colchicine. Recognition of this peculiar skin lesion may lead to an earlier diagnosis of the disease.

Prayer nodules in Moslem men.

Seven cases of Israeli Moslem men with hyperkeratotic nodular callosities of the legs and forehead are reported. These patients were randomly encountered over a two-year period in our dermatology clinic. The nodules were attributed to repeated trauma to the legs and forehead sustained during Moslem prayer. This article familiarizes the clinician with the morphologic characteristics of these lesions, which may occur in some Moslem men.

Extraskeletal Ewing's sarcoma of the scalp.

A 15-year-old boy had an extraskeletal Ewing's sarcoma arising in the soft tissues of the scalp. The tumor was rapidly growing, subcutaneous mass unattached to the underlying bony structures. Histologic examination revealed a proliferation of primitive-appearing, round to oval cells adopting a lobular configuration. Immunohistochemical studies confirmed the undifferentiated mesenchymal nature of the neoplasm.

Treatment of epidermal cysts with Solcoderm (a copper ion and acid solution).

The treatment of epidermal cysts has often posed a problem for dermatologists. Although surgical excision has been adopted as the method of choice for the removal of these lesions, complications of surgery and recurrences have warranted the search for alternate therapeutic modalities. Use of a recently introduced compound, Solcoderm, is reported in the treatment of 116 epidermal cysts in 85 patients over a 2-year period. The satisfactory cosmetic results observed, low incidence of recurrence, low cost and ease of administration, make this drug a viable alternative in the management of epidermal cysts, particularly in those cases where surgery should be avoided.

Mixed diquat/paraquat-induced burns.

BACKGROUND: Ducatalon is a bipyridylium herbicide containing a mixture of diquat and paraquat, and is used in agriculture. Adverse reactions due to contact of this compound with the skin have rarely been described. CASE REPORTS: Two men were seen for severe pain due to extensive chemical burns in the perineal and scrotal regions, caused by leaking of Ducatalon from defective equipment used for spraying the herbicide. The lesions responded well to treatment with topical silver sulfadiazine, combined with systemic antibiotics. The damaged skin healed without scarring within a few days. The lesions have not recurred after the faulty spraying apparatus was replaced. CONCLUSION: Direct contact of the skin with Ducatalon may lead to severe chemical burns. Proper precautions should be taken by the personnel handling this compound, with particular attention to the integrity of the equipment used for spraying the herbicide.

Paget's disease of the breast with underlying carcinoma arising in systemic scleroderma.

A case is presented of Paget's disease of the breast with underlying infiltrating carcinoma arising in a 35-year-old woman with systemic scleroderma. The tumor arose in an area of the skin affected by the systemic scleroderma 4 years after the onset of her systemic disease. The possibility of a causal relationship between these two processes is discussed and a brief review of the literature is presented.

Erysipelas. Changing faces.

A retrospective study of 526 adult patients admitted to the Sheba Medical Center for treatment of erysipelas during the period 1972-1982 showed a steady increase in the number of cases admitted as well as a striking change in its classical pattern of distribution, with 86% of the lesions occurring in the lower extremities opposed to 5.9% in the face. Local trauma and superficial abrasions were identified as the major predisposing factors, whereas upper respiratory tract infection was almost negligible among the patients. Peripheral vascular disease, diabetes, and prolonged treatment with corticoids, immunosuppressants, or radiation were less frequently associated with the development of the disease. New trends were also observed for the age groups and seasonal distribution of the population studied.

Trabecular carcinoma of the skin. A histopathological study of two cases.

The first two cases of trabecular carcinoma of the skin reported in Israel are presented. On light microscopy, the tumors demonstrated a distinctive trabecular pattern, with cords of tumor cells embedded in the connective tissue stroma in the dermis. Dense-core neurosecretory granules, in association with formed desmosomes, were demonstrated by electron microscopy. This tumor may be misdiagnosed as lymphoma or metastatic anaplastic carcinoma, and awareness of its distinctive morphological features is necessary in order to arrive at the correct diagnosis.

Verrucous pseudonevoid melanoma.

A case of an unusual variant of malignant melanoma resembling a papillomatous dermal nevus is presented here. The lesion was initially diagnosed as a Spitz nevus, and recurred locally five months after excision. The features which distinguish this lesion from the more common types of benign dermal nevi include the architectural atypia of the melanocytes, with a tendency for continuous proliferation of single cells along the dermoepidermal junction, as well as the presence of cytologic atypia with large hyperchromatic nuclei and mitoses. Despite its seemingly innocent appearance, distinction of this low-grade variant of melanoma from its benign counterparts is of importance in order to avert the possibility of recurrence and potential metastases.

Trabecular carcinoma of the skin simulating metastatic disease.

A case of trabecular carcinoma of the skin that resulted in prequarter amputation of the arm for local tumor aggressiveness is presented. The tumor was originally diagnosed as metastatic, most probably neuroblastoma, leading to inadequate local resection that resulted in recurrence with extensive regional nodal metastases. The importance of recognizing trabecular carcinoma as a primary tumor of the skin with a potential for recurrence and metastasis is underscored, primarily since initial total excision with adequate margins of resection has proven in most instances to be curative.

Induction of cutaneous plasma cell tumor as a complication of adjuvant immunotherapy with methanol extraction residue of bacillus Calmette-Guérin.

Methanol extraction residue (MER), a cell wall fraction of bacillus Calmette-Guérin, has been reported to exhibit immunomodulating properties which permit its successful use as an adjuvant of immunotherapy in cancer patients. Its beneficial immunostimulatory effects are generally thought to be due to nonspecific stimulation of cell-mediated immunity. Little attention has been focused on its humoral stimulating properties. A case is presented of a patient undergoing treatment with adjuvant immunotherapy with MER for malignant lymphoma who developed a cutaneous plasma cell tumor at the injection site of the drug. This complication may represent the result of enhanced humoral immunity induced by the MER treatment. The development of a cutaneous plasma cell tumor must be added to the list of known MER toxicities, and may constitute an indication for the discontinuation of treatment with this agent.