Annular lichenoid dermatitis of youth: a separate entity or on the spectrum of mycosis fungoides? Case report and review of the literature.

Annular lichenoid dermatitis (ALDY) is a rare dermatosis that is most often seen in children and young adults and is characterized by annular patches with raised borders, most frequently on the trunk and the groin. A distinct lichenoid tissue reaction involving the base of the rete, resulting in squared-off rete ridges, helps to differentiate this from other lichenoid dermatoses and mycosis fungoides (MF). Herein, we report an additional case of this condition in a 7-year-boy, whose biopsy exhibited the typical quadrangular rete alteration and also contained distinct aggregates of CD8+ lymphocytes, Langerhans cells and colloid bodies within the involved rete. A literature review with emphasis on the clinical and histopathological differential diagnosis reveals additional clinical features of ALDY to potentially help differentiate this entity from annular presentations of mycosis fungoides.

Sexually transmitted diseases causing genital lesions in adolescents.

Evaluating the adolescent with a genital lesion requires a thorough knowledge of the common and less-common STDs that cause genital findings. A thoughtful history and complete physical examination are always in order, as is testing for a particular suspected STD and for coexisting STDs, especially HIV.

Functional characteristics of lymphocytes propagated from a human multivisceral allograft.

We investigated the characteristics of lymphocytes propagated from biopsies of the mesenteric lymph nodes, liver, and ileum of a human multivisceral allograft in order to provide functional evidence for the presence or absence of rejection and graft-versus-host disease (GVHD). The recipient was a 39-month-old girl with secretory diarrhea due to microvillus inclusion disease and end-stage liver disease secondary to prolonged parenteral nutrition. She developed a multifocal posttransplant lymphoproliferative disorder (PTLD) and died 37 days after transplantation. Four pairs of sequential mesenteric lymph node and liver biopsies (13, 17, 24, and 33 d posttransplant) and a single ileal biopsy (31 d posttransplant) were placed in culture with recombinant interleukin-2 (rIL-2) and phytohemagglutinin (PHA). T-cell phenotyping of cultured cells showed that CD8+ cells became dominant in all three tissues. The alloreactivity of biopsy-grown cells was determined using the primed lymphocyte test (PLT) and cell-mediated lympholysis test (CML). The proliferative and/or cytolytic responses of biopsy-grown cells to donor but not recipient or third party cells provided evidence for rejection and absence of GVHD. This donor-specific alloreactivity was detected before there was histologic evidence of rejection and during the period of active lymphoproliferation. This study suggests that the functional characterization of graft-infiltrating lymphocytes is useful in defining the immunologic events following multivisceral transplantation.