Foliculitis por candida albicansen drogadicto intravenoso / Folliculitis due to candida albicans in an intravenous drug-abuser

La foliculitis candidiásica es casi exclusiva de los consumidores de heroína marrón por vía intravenosa. Es debida a una infección sistémica por Candidaalbicans.Describimos el caso de un varón de 42 años de edad, HIV negativo, adicto a drogas por vía parenteral, que consultó por la presencia de pápulas y pústulasfoliculares dolorosas localizadas en regiones pilosas, la barba, el cuero cabelludo, zona centrotorácica y genital, de 48 horas de evolución, junto afiebre, malestar general y artromialgias desde hacía una semana. En el estudio oftalmológico se demostró la existencia de retinitis bilateral candidiásicajunto a uveítis anterior aguda en el ojo izquierdo. En el estudio histopatológico de las lesiones cutáneas se demostró la presencia de microabcesosfoliculares, y un leve infiltrado inflamatorio perifolicular compuesto por linfocitos y polimorfonucleares. En el cultivo de las lesiones cutáneas enmedios Saboreaud, se aisló Candida albicans.En la década de los noventa la incidencia de la candidiasis sistémica, en drogadictos intravenosos disminuyó notablemente, siendo en la actualidaduna entidad excepcional que aún hoy, hay que tenerla presente (AU)

Candidiasic folliculitis is an almost exclusive disease of intravenous brown heroin abusers. This entity is due to a systemic infection by Cándida albicans.A 42 year- old man, HIV negative and intravenous drug abuser, who was referred with painful, follicular papules and pustules located on hairs regions,of the beard, scalp, thoracic and genital areas is reported. The patient had also fever, general discomfort and arthromialgias. The ophthalmologicexamination demostrated bilateral, candidiasic retinitis and left acute anterior uveitis. Histopathological study showed follicular microabcess andslight inflammatory infiltrate with perifollicular arrangement and composed of lymphocytes and neutrophils. Culture of the biopsy specimen isolatedCandida albicans.In the decade of the nineties the incidence of the systemic candidiasis, diminished notably, being at present an exceptional entity although still it is necessaryto be aware the process (AU)

[Trichilemmal horn: a new case and review of the literature]. / Cuerno tricolémico: presentación de un nuevo caso y revisión de la literatura.

Trichilemmal horn, or trichilemmal keratosis, is an uncommon benign neoplasm of follicular lineage with trichilemmal differentiation. The essential characteristics of this tumor are its clinical presentation in the form of a cutaneous horn with trichilemmal keratinization apparent in the histology study (with a hyperplastic epithelium giving rise to dense, orthokeratotic eosinophilic keratin). We present a new case of this type of tumor in an 82-year-old woman who developed a solitary lesion on her scalp after surgical removal of a trichilemmal cyst. On the basis of the pathology report, the tumor was diagnosed as trichilemmal horn. We review the 33 reports of this tumor in the literature to date.

Glomeruloid haemangioma is not always associated with POEMS syndrome.

Glomeruloid haemangioma is considered a specific marker of POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes) syndrome and it is usually but not always associated with multicentric Castleman's disease. We report a 78-year-old man who presented with a single, red-violet soft nodule with superficial telangiectases on the scalp. Histopathologically, the lesion consisted of lobules of coiled aggregated capillaries that involved the lumina of dilated vascular structures, mimicking renal glomeruli. A collagenous stroma separated the capillary lobules, and eosinophilic, periodic-acid-Schiff positive globules of varying sizes and shapes were seen within the cytoplasm of endothelial cells. Immunohistochemical studies with antibodies against IgA and IgG, and against the kappa and lambda light chains of immunoglobulins showed immunoreactivity within the eosinophilic globules. Results of complete blood count, liver, renal and thyroid function tests, fasting blood sugar measurement, serum levels of oestradiol, testosterone, prolactin and cortisol, serum protein electrophoresis, immunoelectrophoresis and immunofixation yielded normal or negative results. No Bence-Jones proteinuria was found in a sample from a 24-h urine collection. To our knowledge, only two cases of glomeruloid haemangioma have been previously reported in patients without POEMS syndrome. We describe the third case of glomeruloid haemangioma in a patient without features of POEMS syndrome.

[Superficial spreading capillary hemangioma: case report]. / Hemangioma capilar de extensión superficial: descripción de un caso.

Superficial spreading capillary hemangioma has been described for the first and sole time by Mihara and collaborators in 1986, as a proliferation of capillaries in the dermal papillae, separated by thin elongated rete ridges. Clinically it appeared as an asymptomatic, isolated, small and long-standing red plaque of slow growth located in the plantar surface of a 57-year-old Japanese woman. We report a 23-year-old Caucasian woman with an asymptomatic, long-standing, brownish plantar lesion of stable size. In the pathological study we observed a capillary proliferation in tangles with slack stroma located in the papillary dermis. We report, therefore, the second case of superficial spreading capillary hemangioma published in the literature.

Epithelioid angiosarcoma of the breast involving the skin: a highly aggressive neoplasm readily mistaken for mammary carcinoma.

BACKGROUND: Angiosarcomas are malignant neoplasms of endothelial cells. Angiosarcoma of the breast is a rare neoplasm that behaves in a highly malignant fashion. It must be differentiated from benign vascular proliferations and from mammary carcinoma. METHODS: We report on a 49-year-old-woman who presented with a large mass involving the left breast. RESULTS: The lesion had an erythematoviolaceous hue and livedoid pattern at the periphery. Histopathologic study showed an epithelioid malignant neoplasm, and immunohistochemical studies demonstrated that neoplastic cells expressed immunoreactivity for endothelial cell markers. CONCLUSIONS: A diagnosis of epithelioid angiosarcoma of the breast was established. The patient was treated with radical mastectomy, but she refused any other additional therapy.

Cutaneous metastases from Ewing's sarcoma: report of two cases.

Ewing's sarcoma is a malignant osseous neoplasm that affects mostly children and young adult males. Clinically, the neoplasm presents with oedema, swelling, and pain of the involved area. Histopathologically, Ewing's sarcoma consists of solid sheets of small round cells, with vesicular nuclei and scant cytoplasm, arranged in irregular masses separated by strands of fibrous tissue, with areas of necrosis en masse intermingled with intratumoural haemorrhage. Ewing's sarcoma is an extremely aggressive neoplasm and metastases to sites such as lung, pleura, other bones, central nervous system, liver, and regional lymph nodes frequently develop in early stages of the disease. Surprisingly, despite the highly aggressive biological behaviour of this neoplasm, cutaneous metastases from Ewing's sarcoma are very uncommon. We report two patients with Ewing's sarcoma of the bone who developed cutaneous metastases. As in other internal malignancies, the onset of cutaneous metastases in patients with Ewing's sarcoma indicates a poor prognosis.

Drug eruption secondary to aciclovir with recall phenomenon in a dermatome previously affected by herpes zoster.

Classically, recall dermatitis refers to chemotherapy-induced reactivation of skin damage caused by radiotherapy months, or even years, earlier. The concept of recall dermatitis has now been extended to include radiation recall dermatitis induced by other drugs, ultraviolet radiation, extravasation of drugs, and allergic contact dermatitis. We now describe recall dermatitis along the residual cutaneous lesions of a previous thoracic herpes zoster in a patient who developed a drug eruption after oral administration of aciclovir. The most striking feature consisted of confluent linear erythema along the dermatomes previously involved by the herpes zoster episode. Histopathologic study demonstrated small foci of spongiosis, vacuolar changes involving the basal layer of the epidermis and single necrotic keratinocytes scattered within the epidermis. The papillary dermis appeared oedematous and with dilated blood capillaries surrounded by a sparse inflammatory infiltrate composed mainly of lymphocytes. Serial sections failed to demonstrate cytologic changes of herpes varicella zoster infection. We interpreted this case as an example of recall dermatitis because the widespread cutaneous eruption secondary to aciclovir was more intense in skin previously compromised by herpes varicella zoster infection. To the best of our knowledge, recall dermatitis has not been described before at the site of previous involvement by herpes zoster.

Olmsted syndrome: report of a case with study of the cellular proliferation in keratoderma.

Olmsted syndrome is a rare disorder that consists of sharply marginated keratoderma of the palms and soles, constriction of digits and toes that may result in spontaneous amputation of the distal phalanges, hyperkeratotic plaques around the body orifices, onychodystrophy, and other less common cutaneous and extracutaneous anomalies. Although some patients had other affected family members, most cases of Olmsted syndrome seem to be of sporadic occurrence. We describe a patient with the characteristic features of Olmsted syndrome. The symptoms consisted of diffuse transgrediens palmoplantar keratoderma and keratotic plaques around the mouth and nose. Our patient also had the associated anomalies of hyperhidrosis of the palms and soles and congenital deaf-mutism. Histopathologic study of the keratoderma demonstrated epidermal hyperplasia with acanthosis, papillomatosis, and orthokeratotic hyperkeratosis. Immunohistochemical study showed more basal and suprabasal keratinocytes of the epidermis with immunoreactivity for Ki-67 marker when compared with the keratinocytes of the epidermis of the adjacent non-involved skin. These results support the notion that Olmsted syndrome is a hyperproliferative disorder of the epidermis.