Cutaneous Crohn's disease treated with infliximab and 4 years of follow up.

Metastatic Crohn's disease (MCD) is a rare, non-contiguous cutaneous manifestation of Crohn's disease. To date, there have been only four reports in the literature of an effective treatment of this condition with infliximab and there are no long-term follow-up studies on adult MCD patients treated with infliximab. We present a case of MCD treated with infliximab with 4.5 years of follow up.

Disseminated zygomycosis due to Mycocladus corymbifera with cutaneous and cerebral involvement.

Fungal infections caused by zygomycetes are important and potentially life threatening infections. These opportunistic moulds have been increasingly implicated in human disease and are most frequently seen in immune compromised patients. We report a case of disseminated infection with Mycocladus corymbifera involving the brain, lungs, kidneys and skin in a 16-year-old patient with acute lymphoblastic leukaemia. The skin lesions played a significant role in the diagnosis of mucormycosis. These infections have an exceedingly high mortality rate and early recognition of cutaneous lesions is essential to successful management.

Ulcerative necrobiosis lipoidica responsive to colchicine.

Necrobiosis lipoidica is an uncommon granulomatous disease of unknown aetiology. Few treatments have emerged with consistent efficacy and the ulcerated form of necrobiosis lipoidica can be particularly difficult to treat. A 56-year-old non-diabetic woman with chronic ulcerative necrobiosis lipoidica unresponsive to other therapies was commenced on colchicine treatment. Complete resolution of the ulcers was observed after 2 months' therapy with colchicine 500 µg twice daily.

Dermatofibroma and halo dermatitis.

The occurrence of a halo of dermatitis surrounding acquired naevi was initially reported by Meyerson in 1971 with histological features of focal spongiosis, parakeratosis, irregular acanthosis and a lymphocytic infiltrate in the upper dermis. When the same inflammatory reaction occurs around other lesions it is referred to as the Meyerson phenomenon or halo dermatitis. We report a rare case of the Meyerson phenomenon occurring around a dermatofibroma in a 69-year-old woman. This case highlights that the phenomenon may occur in a broad range of clinical scenarios and is not limited to acquired naevi in young adults.

Radiotherapy for head and neck cancer in elderly patients.

BACKGROUND AND PURPOSE: Elderly patients with head and neck cancer may not be treated aggressively with radiotherapy, due to concerns regarding tolerance of treatment and toxicity. A retrospective study was undertaken of patients aged 80 years and over, treated by definitive radiotherapy for head and neck cancer. MATERIAL AND METHODS: 98 patients aged 80-92 received radiotherapy for carcinoma of the head and neck between 1991 and 1995. All patients received beam directed radiotherapy with radical intent using an immobilisation shell. RESULTS: Cancer specific survival was 59% and overall local control was 70% at 5 years. Both were significantly affected by T stage and site of disease. Cancer specific survival was comparable to that of patients aged below 80 years. Seven patients died within 6 months of the treatment. Three patients developed severe late toxicity. Metastatic disease occurred in eight patients. CONCLUSIONS: Radiotherapy is a beneficial and well tolerated treatment in elderly patients with carcinoma of the head and neck.