Orolabial Lymphogranuloma Venereum, Michigan, USA.

Orolabial lymphogranuloma venereum was diagnosed for a man in Michigan, USA, who had sex with men, some infected with HIV. High index of suspicion for lymphogranuloma venereum led to accurate diagnosis, successful therapy, and description of an L2b variant with a unique genetic mutation.

Successful medical treatment of an Aspergillus terreus mycetoma of the nostril/lip in a 16-year-old Fjord pony gelding with pituitary pars intermedia dysfunction.

BACKGROUND: Mycetoma is a chronic, proliferative lesion of cutaneous/subcutaneous tissue characterized by draining tracts and granules in the discharge caused by actinomycetes (actinomycetoma) or filamentous fungi (eumycotic mycetoma). OBJECTIVES: This case report describes the unusual finding of a cutaneous mycetoma of the lateral wing of the right nostril in a gelding. ANIMAL: A 16-year-old Fjord gelding with suspected pituitary pars intermedia dysfunction (PPID) was presented for evaluation of a nonpainful, firm and raised mass involving the lateral wing of the right nostril and the lip. METHODS AND RESULTS: Cytological examination of the mass showed marked pyogranulomatous inflammation and histopathological examination revealed a fungal mycetoma. Fungal culture identified the causative organism as Aspergillus terreus, which is not known for its propensity to cause either dermal granulomas or mycetoma in domestic animals. Further investigation, including a TRH stimulation test, led to a diagnosis of PPID (Cushing's disease), which may have led to immunosuppression of the animal and increased susceptibility to infection. CONCLUSIONS AND CLINICAL IMPORTANCE: The horse was treated medically with pergolide for the PPID and oral potassium iodide for the fungal infection, with good therapeutic response and no relapse after five months. Surgical debridement or excision was not performed. To the best of the authors' knowledge, this is the first case report of a cutaneous mycetoma caused by A. terreus in a horse.

An extraordinary case of syphilis presenting with a labial ulcer.

In the differential diagnosis of patients with ulcers on the lips characteristics like the duration of the ulcer, number, size, depth, shape, base, margins, and distribution are considered. Such ulcers arise from many diseases particularly, viral and bacterial infections, malignancies can also be responsible. Classic syphilitic chancres are painless erosions settled on hard papule; these are evident in the genital area in more than 90% of patients. This study describes a case of a 38-year-old female patient presenting with a painful ulcer covering 3 quarters of the upper lip showing settlement on erythematous, edematous, and indurated plaque covered with hemorrhagic crusts. The aim of this study was to consider differences between the classic syphilitic chancre typically found in the genital region from extragenital chancres and to raise awareness of the possibility of primary syphilis when patients present with painful ulcers on the lip.

Syphilitic Chancre of the Lips Transmitted by Kissing: A Case Report and Review of the Literature.

Primary syphilic chancre most often involved genitalia, with 12% to 14% extragenital lesions. This article describes a rare case of a female patient with labial ulcer and diagnosed as oral syphilis (OS), an uncommon presentation of primary syphilis. OS is transmitted through orogenital contact.This study is case report and literature review.We report a 27-year-old woman with painless, ulcerative, and indurated lesion on her lower lip and a 7-day history of symmetrically distributed nonpruritic macules. OS was diagnosed based on clinical presentations and serologic test and patient's oral ulcer was cured with intramuscular penicillin G benzathine. However, both the patient and her husband denied any orogenital sexual history before. In addition, her husband was also diagnosed as syphilis later in our clinic. He reported having orogenital contact with other people.Therefore, this is a rare case of OS transmitted through kissing.

Panton-Valentine leukocidin positive Staphylococcal aureus infections of the head and neck: case series and brief review of literature.

Panton-valentine leukocidin (PVL) is a pore-forming cytotoxin produced by some clones of Staphylococcus aureus that is associated with infections ranging from uncomplicated skin and soft tissue infections to life-threatening necrotizing pneumonia. PVL S aureus-associated maxillofacial infections are rarely reported; therefore, a high degree of clinical suspicion is warranted and close liaison with microbiologists and appropriate samples are required for optimal management. This report discusses the management and learning points from 3 such cases managed by the Greater Glasgow and Clyde National Health Service maxillofacial surgical teams.

Anthrax of the lower lip.

Anthrax of the oral cavity and oropharynx is well known, whereas anthrax of the lips is very rare. We present a case of anthrax of the lower lip in a 57-year-old man. The infection was characterized by a wide, black eschar, surrounded by vesicles, crusts, and erythematous-edematous halo, with submandibular and laterocervical lymphadenopathy. The oral cavity, oropharynx, and tonsils were normal. Laboratory examinations revealed leukocytosis and increased inflammatory markers. Otolaryngologic, gastrointestinal, lung, and neurologic examinations were negative. The patient was successfully treated with oral ciprofloxacin. Although rare, anthrax should be considered in the differential clinical diagnosis in patients returning from areas where this disease is endemic.

[Nodular granuloma of the lip. An unusual manifestation of secondary syphilis]. / Epitheloidzellige granulomatöse Entzündungsreaktion an der Lippe. Ungewöhnliche Manifestation im Stadium II bei Frühsyphilis.

Syphilis is a sexually transmitted disease caused by Treponema pallidum which evolves through three overlapping stages. A 50-year-old woman presented with an expanding painless granulomatous nodule on her lower lip in combination with a maculo-papular exanthem. Both serologic studies and microscopic examination indicated an infection with Treponema pallidum. This case shows an unusual granulomatous nodular presentation of syphilis on the lower lip, emphasizing the variable clinical and histological manifestations syphilis, which shows an increasing number of new infections worldwide in recent years.

Lip abscess associated with isotretinoin treatment of acne vulgaris.

IMPORTANCE: Isotretinoin is frequently prescribed for the treatment of acne vulgaris. Among the numerous documented adverse effects, most common are xerostomia and cheilitis. Lip abscesses as a consequence of cheilitis present dramatically and may pose a diagnostic challenge. OBSERVATIONS: We present a case of a 15-year-old boy with a severe lip abscess requiring incision and drainage and hospital admission for intravenous antibiotic treatment of methicillin-resistant Staphylococcus aureus. We discuss the pathophysiologic characteristics of isotretinoin therapy and the likely causative role that the medication played in the development of the lip abscess. CONCLUSIONS AND RELEVANCE: Although rare, lip abscesses related to isotretinoin therapy present with substantial morbidity and should be promptly recognized. Misdiagnosis of mucositis and angioedema may delay appropriate therapy.

Reconstructive procedure of lower lip defect due to ecthyma gangrenosum--a rare complication of acute lymphoblastic leukemia.

Ecthyma gangrenosum is a rare invasive cutaneous infection mostly caused by Pseudomonas aeruginosa in immunosuppressed patients, especially during neutropenic states. Embolic lesions usually accompanying with septicemia of P. aeruginosa are typically painless, round, and centrally necrotic with a surrounding erythematous halo. Facial involvement occurred only in 6% of the patients, which may result to complicated defects for reconstruction. In this article, we aimed to present a case with relapse of acute lymphoblastic leukemia presented to our clinic with 50% defect of the lower lip due to ecthyma gangrenosum and its late-term reconstruction.

Pediatric cervicofacial necrotizing fasciitis: a case report and review of a 10-year national pediatric database.

OBJECTIVE: To present a case of a pediatric cervicofacial necrotizing fasciitis (NF), a rapidly progressive infection, and a review of a 10-year pediatric inpatient database. DESIGN: Case report and review. SETTING: Pediatric intensive care unit. PATIENTS: A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code 728.86 (NF), was the inclusion criteria for the Kids' Inpatient Database (KID) in 1997 and 2006. RESULTS: A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from 1997 and 2006, the relative risk of being discharged with NF in 2006 vs 1997 was 1.4 (95% CI, 9.95-2.28). Age at diagnosis of NF was older in 2006 compared with 1997 (11.5 years vs 8.05 years; P < .001). Deaths with a diagnosis of NF increased from 1997 compared with 2006: from 3.9% to 5.4%. In 2006, the odds of death were 15.1 times higher in pediatric discharges with a diagnosis of NF compared with discharges without a diagnosis of NF (P < .001; 95% CI, 9.3-23.1). CONCLUSIONS: Even with the advent of new treatments and antibiotics, the incidence and death rates of NF have changed little over the past 10 years. While it is still a rare diagnosis, knowledge and awareness of necrotizing fasciitis with aggressive medical and surgical treatment are still the foundation in disease survival.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis.

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

A blastomicose sul americana, paracoccidiodomicose (Pb micose) ou doença de Lutz é uma infecção fúngica endêmica na América Latina. É causada pelo fungo dimórfico Paracoccidiodes brasiliensis, e pode causar lesões na mucosa oral. Nós avaliamos a incidência de lesões orais de Pb micose nos pacientes atendidos em um Centro Especializado em Diagnóstico Oral com foco principal nas diferentes formas clinicas das lesões, suas localidades, ocupação dos pacientes, hábitos deletérios e diagnóstico e metodologia, e foram detectados 31 casos (18 pacientes). Os resultados mostraram que 88,8% dos pacientes eram do sexo masculino com idade média de 50 anos de idade, e 39% trabalham, ou trabalhavam, com atividades relacionadas à agricultura. Observou-se que 88,9% eram fumantes e 72,2% ingeriam álcool. Citologia esfoliativa foi feita em 66,6%. Mucosa jugal foi acometida em 30%, gengiva, e lábios 16% (cada um) foram os locais mais comuns de lesões orais da Pb micose. Comparando o diagnóstico inicial com o definitivo feito pelos profissionais, a acurácia foi de 33%; o diagnóstico dos estudantes foi mais preciso demonstrando 72,5% do diagnóstico inicial correto com diferença estatística significante (p=0,25) através do teste ANOVA do SPSS WIN com nível de significância de 5%. Biópsia incisonal e citologia esfoliativa são eficientes para um diagnóstico precoce desta doença na boca; o treinamento dos estudantes em diagnóstico para reconhecer as patologias orais é urgente para melhorar a saúde pública.

Jorge Lobo's disease with restricted labial presentation.

Jorge Lobo's Disease (JLD) is a chronic granulomatous cutaneous mycosis caused by Lacazia loboi. The most typical lesions are keloid-like growths preferentially located on limbs and ears. To the best of the authors' knowledge, only one labial case has previously been reported. We describe the case of a man who presented with a left-sided papulonodular lesion of 10 years' duration on the vermillion border of the upper lip. A successful surgical resection of the lesion was performed and there was no recurrence in eight years of follow-up.