Primary mucocutaneous histoplasmosis presents as oral ulcer .

We are reporting a rare case of primary mucocutaneous histoplasmosis. A 47-year-old male with a part-time job of rearing pigeons presented with a non-healing oral ulcer with no associated systemic symptoms. Differential diagnosis of oral ulcerative lichen planus, squamous cell carcinoma and mucocutaneous leishmaniasis was considered. Histopathology showed multiple organisms with a peripheral halo, stained strongly with Gomori methenamine silver stain.

The "sign of groove", a new cutaneous sign of internal malignancy.

A 36-year-old young male with multiple heterosexual contacts presented with bilateral inguinal bubo and the classical "sign of groove". A diagnosis of lymphogranuloma venereum (LGV) was made and a three-week course of doxycycline was given. Lack of response prompted us to investigate further. A biopsy of the bubo was consistent with non-Hodgkin's lymphoma (NHL). Immunohistochemistry of the lymph node done at the Regional Cancer Center (RCC), Trivandrum, confirmed the diagnosis as NHL of diffuse large B-cell type. The second patient, a 32-year-old male with two unprotected heterosexual contacts presented with a left-sided inguinal bubo of six weeks duration. An empirical course of doxycycline was given even though investigations did not reveal any STI. Lack of response prompted us to do a lymph node biopsy, which was consistent with NHL, which later with immunohistochemistry was confirmed as NHL, diffuse large cell type. We are reporting here that the "sign of groove" is not specific for LGV as thought earlier, but can occur in NHL also.

Malignant acanthosis nigricans with liver secondaries from an occult primary adenocarcinoma of gastrointestinal tract.

A 38-year-old female presented with hyperpigmented velvety plaques on the nape and the sides of the neck with diffuse pigmentation of the face and flexures suggestive of acanthosis nigricans. The dorsa of both the hands showed increased rugosity, hyperpigmentation and hyperkeratosis of the palms, suggestive of tripe palms. Investigations revealed multiple secondaries in the liver. Histopathology showed the secondaries to be from adenocarcinoma of the gastrointestinal tract.

Chronic granulomatous disease.

A 2(1/2)-year-old child presented with multiple discrete granulomatous lesions on the face and flexural regions since the age of 2 months along with lymphadenopathy. The patient also had recurrent bouts of pyodermas and respiratory tract infections. Biopsy of the lesion showed necrosis of tissue with suppuration and histiocytes but no evidence of tuberculosis, fungal infections or atypical mycobacteria. Lymph node biopsy also showed necrosis with suppuration but no infective organism. Nitroblue tetrazolium test was negative indicating that the neutrophils failed to oxidize the dye. We are reporting here a rare case of chronic granulomatous disease.