Acquired reactive perforating collagenosis associated with papillary thyroid carcinoma: a paraneoplastic phenomenon?

Acquired reactive perforating collagenosis (ARPC) is an uncommon dermatosis characterized by transepidermal elimination of altered collagen. It is commonly seen in patients with diabetes mellitus and/or chronic renal insufficiency. Rarely, it has been reported in association with malignancy and other conditions. We report a 30-year-old woman with insulin-dependent diabetes mellitus who presented with multiple, discrete, violaceous, hyperkeratotic papules on the extensor aspects of both legs, characteristic of ARPC. Four months later, metastatic papillary thyroid cancer was diagnosed. This case further supports the possibility that ARPC may represent a paraneoplastic phenomenon.

Aspergillus fumigatus Majocchi's granuloma in a patient with acquired immunodeficiency syndrome.

Majocchi's granuloma, also known as nodular granulomatous perifolliculitis, is an uncommon fungal infection of the skin and subcutaneous tissue. It can occur in healthy and immunocompromised patients. The most common cause of Majocchi's granuloma is Trichophyton rubrum. We report a case of a Majocchi's granuloma caused by Aspergillus fumigatus in a patient with acquired immunodeficiency syndrome.

Botryomycosis caused by Staphylococcus aureus and Pneumocystis carinii in a patient with acquired immunodeficiency disease.

Botryomycosis is an uncommon, chronic, granulomatous and/or suppurative, opportunistic infection affecting the skin and viscera, primarily caused by bacteria. The exact pathogenesis of this infection is not well understood. However, both the host's immune status and microbial infectivity have been implicated in the pathogenesis of this unusual clinical condition. To date, botryomycosis caused by a nonbacterial pathogen has not been reported in the literature. We report a case of cutaneous botryomycosis caused by combined Staphylococcus aureus and Pneumocystis carinii. Cutaneous P. carinii infection without pulmonary involvement is extremely rare.

Postinflammatory medial canal fibrosis.

OBJECTIVE: Our objective was to describe the diagnosis and treatment of postinflammatory medial canal fibrosis by reviewing a large series. STUDY DESIGN: This study was conducted via retrospective chart review. SETTING: This study was conducted at a tertiary otologic referral center. PATIENTS: The 24 patients had a clinical diagnosis of postinflammatory medial canal stenosis. Only one of the 16 females and eight males was under 18 years of age, and the mean age for the group was 50.5 years (range 5-78). fourteen patients had bilateral diseases. INTERVENTION: Surgical therapy was performed in 14 ears (11 patients), and medical therapy was performed in nine. RESULTS: For patients undergoing surgical treatment, mean pure-tone average hearing threshold improved from 37 dB preoperatively to 26 dB postoperatively. The air-bone gap improved from 24 dB to 15 dB. There were three recurrences of disease in the surgery group. CONCLUSION: Postinflammatory medial canal stenosis is a rare disorder resulting from chronic external otitis that required surgical intervention to correct the resulting conductive hearing loss.