Cutaneous Acanthamoeba in a patient with AIDS: a case study with a review of new therapy; quiz 386.

GOAL: To describe the presenting signs of an Acanthamoeba infection. OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical presentation of Acanthamoeba infection. 2. Describe the conditions that make a patient susceptible to Acanthamoeba. 3. Outline treatment options for Acanthamoeba infection. CME: This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. REVIEW DATE: April 2001. This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Albert Einstein College of Medicine and Quadrant HealthCom, Inc. The Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with ACCME Essentials.

An approach to clinical dermatologic diagnosis based on morphologic reaction patterns.

How do dermatologists examine a patient and instantly generate a differential diagnosis? Of course, as in any other field, experience plays a large role. After a condition with a distinctive appearance is seen hundreds of times, recognition becomes automatic. Nevertheless, dermatologists need to employ a disciplined mental process to generate a differential diagnosis from clinical findings. From the perspective of clinical diagnosis, all dermatology falls into 2 separate categories--inflammatory and neoplastic. The reaction pattern technique discussed in this article relates only to inflammatory conditions such as psoriasis, eczema, and urticaria. This article describes an approach to differential dermatologic diagnosis based on clinical reaction patterns.

Indinavir-associated maculopapular eruption.

Indinavir-associated adverse dermatologic reactions are rare but do occur. A 39-year-old man who was positive for the human immunodeficiency virus and had no known allergy, developed an erythematous, maculopapular eruption several hours after switching to a new triple-drug regimen consisting of stavudine, didanosine, and indinavir. The eruption completely resolved 2 weeks after he discontinued the antiretroviral combination. To preserve future treatment options, the patient was sequentially rechallenged with each agent and confirmed indinavir as the cause. The patient tolerated and responded to a new combination of stavudine, didanosine, and nelfinavir. The rapid onset of the adverse reaction suggested that it might have been immunoglobulin-E mediated. No cross-sensitivity between indinavir and nelfinavir was apparent.

Diagnostic ultrasound in dermatology: current uses and future potential.

Although ultrasound has been used for many years for a variety of medical diagnostic purposes, only recently have systems been designed that allow for its application to skin. High-resolution ultrasound systems now permit accurate, quantitative, noninvasive assessment of skin and cutaneous diseases. This technique will assist in the management of both inflammatory and neoplastic processes. Scans of skin obtained with a prototype high-resolution ultrasound system are presented. The computer-assisted creation of three-dimensional images from sequential B-mode scans is described.