Varicella gangrenosa: A rare chickenpox complication.

Varicella gangrenosa is a rare but life-threatening dermatological complication of infection with varicella-zoster virus. A healthy 37-year-old male who had been diagnosed with varicella 20 days back was admitted to our hospital with complaints of fever and painful necrotic skin lesions. Physical examination revealed multiple round to oval ulcers covered with eschar predominantly over arms, lower limbs, back of trunk and flanks. Streptococcus pyogenes and Staphylococcus aureus grew in wound culture. Biopsy revealed ulceration and necrosis of epidermis, and edema, hemorrhage and granulation tissue formation involving the dermis and subcutaneous tissue. The patient was treated with acyclovir - parenteral followed by oral, antibiotics and supportive measures. The lesions healed and he was discharged after 20 days. We report this case to draw attention to the fact that varicella gangrenosum, even though a rare complication, may occur in the lesions of chicken pox and that the survival of patient depends on early diagnosis and aggressive treatment.

Spectrum of purpura fulminans: report of three classical prototypes and review of management strategies.

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin that is rapidly progressive and is accompanied by vascular collapse and disseminated intravascular coagulation. It usually occurs in children, but this syndrome has also been noted in adults. The three forms of this disease are classified by the triggering mechanisms. We describe three classical cases of purpura fulminans of the three classical prototypes treated at our center and their varied clinical outcomes. We also describe a case of acute infectious purpura fulminans secondary to systemic leptospirosis which to our best knowledge is the first reported case in world literature. The various treatment options for purpura fulminans have also been reviewed.

Fetal varicella syndrome.

Fetal varicella syndrome is a rare condition of the newborn, presenting with cutaneous scars, limb defects and ocular and central nervous system abnormalities. It is due to varicella or zoster developing in the fetus following maternal varicella infection during early pregnancy. We are reporting one such patient who presented with a linear, depressed, erythematous scar over the left forearm and axillary fold, with a history of maternal chicken pox during the first trimester of pregnancy.

Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology.

BACKGROUND: Infections of the skin by herpes viruses do not always present themselves in typical fashion. Early diagnosis, however, is crucial for appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and differential diagnosis of herpes virus infections, but the method is not yet available in large parts of the world, where diagnosis is made based on morphology alone. AIM: To refine criteria for the diagnosis of herpes virus infections of the skin by way of correlation of clinical and histopathologic findings with results of PCR studies. METHODS: We studied 75 clinically diagnosed patients of "zoster," "varicella," and "herpes simplex", to correlate clinical and histopathological findings with results of PCR studies on paraffin embedded biopsy specimens. RESULTS: Clinical suspicion of infection by herpes viruses was confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the cases. Zoster was frequently misdiagnosed as infection with herpes simplex viruses (30%). When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation with results of PCR studies, initial lesions of herpes virus infections could be identified to have a distinctive histopathological pattern. Herpetic folliculitis appeared to be a rather common finding in zoster, it occurring in 28% of the cases. CONCLUSION: We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically.

Anetodermia secundaria a una lepra tuberculoide polar / Secondary anetodermia due to Polar Tuberculoid Leprosy

Una mujer de 45 años tratada por una lepra tuberculoide polar hace 7 años en Paraguay, presentó en cara anterior de brazo izquierdo una típica lesión de anetodermia de 7 x 5 cm con hipoestesia residual. La coloración para fibras elásticas mostró disminución o ausencia de las mismas. La asociación de anetodermia es muy frecuente en casos residuales de lepra lepromatosa polar o subpolar, siendo extremadamente infrecuente en los de lepra tuberculoide. No hemos hallado ésta concomitancia en la bibliografía consultada

Anetodermia secundaria a una lepra tuberculoide polar / Secondary anetodermia due to Polar Tuberculoid Leprosy

Una mujer de 45 años tratada por una lepra tuberculoide polar hace 7 años en Paraguay, presentó en cara anterior de brazo izquierdo una típica lesión de anetodermia de 7 x 5 cm con hipoestesia residual. La coloración para fibras elásticas mostró disminución o ausencia de las mismas. La asociación de anetodermia es muy frecuente en casos residuales de lepra lepromatosa polar o subpolar, siendo extremadamente infrecuente en los de lepra tuberculoide. No hemos hallado ésta concomitancia en la bibliografía consultada (AU)

Análise do grau de concordância entre o relato de história pregressa de varicela e o resultado da sorologia dos profissionais de saúde do Instituto de Infectologia Emilio Ribas

Esse estudo foi realizado entre os profissionais de saúde do Instituto de Infectologia Emílio Ribas, que prestam atendimento direto a pacietes imunodeprimidos. Comparamos o relato de história pregressa de varicela com o resultado da sorologia, com o intuito de avaliar se o questionário é um bom instrumento na identificação dos susceptíveis. Como metodologia aplicamos um questionário para conhecer a susceptibilidade à varicela destes profissionais. A primeira dose da vacina contra varicela foi oferecida aos profissionais que relataram ser susceptíveis e a segunda dose, apenas foi oferecida para aqueles profissionais que apresentaram negativa.