Cutaneous manifestations of disseminated gonococcemia.

BACKGROUND: Sexually transmitted infections, includingurogenital gonorrheal infection, are a growing healthconcern in the United States. Nearly 50% of cervicalinfections are asymptomatic. If left undiagnosedand untreated, there is a risk of disseminatedinfection. PURPOSE: To describe an 18-year-old womanpresenting with disseminated gonococcal infectionconfirmed by blood cultures, skin biopsy, and urinegonococcal probe. We also describe the presentation,diagnosis, and treatment of disseminated gonococcalinfection, including discussion of the variousmorphologies of cutaneous lesions that have beenreported in the literature. MATERIALS AND METHODS: Thefeatures of a woman with disseminated gonococcalinfection are presented. Using PubMed, the termscutaneous, disseminated, gonococcal, gonorrhea,infection, lesions, manifestations, pustules, skin, andsystemic were searched. Relevant citations wereutilized and discussed. RESULTS: Hemorrhagic pustules,petechiae, and purpuric lesions developed in a youngwoman with fever and joint pain. Blood cultures grewbeta lactamase negative Neisseria gonorrhoeae andthe Neisseria gonorrhoeae/Chlamydia trachomatisprobe was positive for both N. gonorrhoeae and C.trachomatis. Biopsy revealed bulla with neutrophils,extravasated erythrocytes, fibrin deposits in the vesselwalls, and leukocytoclasia. CONCLUSION: Cutaneouslesions of disseminated gonococcal infection caninclude abscesses, cellulitis, petechiae, purpuricmacules, necrotizing fasciitis, and vasculitis. It isimportant for the clinician to recognize the clinicalsigns and symptoms of disseminated gonococcalinfection, particularly the various cutaneousmanifestations.

Bullous pilomatricoma: a rarely reported variant of pilomatricoma.

Pilomatricomas are cutaneous adnexal tumors with matrical differentiation. We report and describe a rare variant called bullous pilomatricoma.

Case report: cutaneous nontuberculous mycobacterial abscesses associated with insulin injections.

Nontuberculous mycobacterial (NTM) infections are on the rise and often cause skin diseases that are misdiagnosed. The authors present three cases of atypical mycobacterial infections in insulin-dependent diabetics occurring in sites of subcutaneous insulin injections. One of the patients was vitamin D deficient at the time of infection with NTM. The history and clinical presentation of the cases are presented; pathogenesis and treatment are discussed in conjunction with the correlation of mycobacterial disease susceptibility with vitamin D deficiency.

Transitional cell neoplasm of the nasolacrimal duct associated with human papillomavirus type 11.

BACKGROUND: Tumors of the lacrimal sac are rare but noteworthy because of their significant potential to become malignant or life-threatening if treatment is delayed. Dermatologists may be the first to encounter such neoplasms. OBSERVATIONS: We report a case of a 53-year-old Caucasian woman who presented with a seven-year history of an asymptomatic, subcutaneous nodule near her right medial canthus. Histology of the lesion revealed transitional epithelium in a papillary growth pattern with numerous goblet cells, scattered mitoses and focal full-thickness atypia. The patient was diagnosed with transitional cell neoplasm (inverted papilloma-type) of the nasolacrimal duct. PCR evaluation identified HPV type 11 in the lesion. CONCLUSION: Our report is one of a growing number of case reports and series detecting HPV DNA in these tumors which further supports HPV as an etiologic agent in epithelial lacrimal sac tumors. We believe that dermatopathologists need to be aware of this entity, as dermatologists may be the first to encounter these neoplasms. LIMITATIONS: The association of HPV with this tumor does not prove causality.

Acute localized exanthematous pustulosis: a cutaneous drug reaction in a dental setting.

BACKGROUND: Acute generalized exanthematous pustulosis is a severe cutaneous eruption caused most commonly by antibiotics. Rarely, a localized variant of this pustular reaction called "acute localized exanthematous pustulosis" has been described. CASE DESCRIPTION: A 29-year-old woman sought treatment at the authors' dermatology clinic for an outbreak of numerous superficial, nonfollicular pustules with an underlying erythematous base that was accompanied by subjective fever. The lesions appeared two days after the patient began taking amoxicillin prescribed for endocarditis prophylaxis before she underwent a dental cleaning. Cultures were negative for bacteria, and the eruption resolved within four days after the patient discontinued the drug therapy. CLINICAL IMPLICATIONS: Newly revised guidelines for antibiotic prophylaxis for endocarditis indicate that adverse reactions far outweigh the benefits in most cases. It is important that general dentists and oral surgeons recognize this rare pustular eruption, because antibiotics, particularly amoxicillin, are the primary inciting agents. In addition, health professionals should make clinical choices based on evidence, weigh the risks of any treatment plan against its benefits and practice caution when prescribing any drug.