Hyalohyphomycosis (Fusariosis): Atypical Presentation in an Immunocompetent Individual Responding to Itraconazole.

Hyalohyphomycosis includes infections caused by various fungal species that produce hyaline, septate, branched hyphae. Fusarium is one such species which usually causes multiple papulo-nodules, ecthyma gangrenosum-like ulcers in immunocompromised individuals. Also, fusariosis is usually difficult to manage and responds favorably to amphotericin B, voriconazole, and posaconazole in disseminated cases. Here, we report an atypical case of cutaneous fusariosis in an immunocompetent individual who presented with multiple large cystic swellings, psoriasiform plaques, and palmoplantar keratoderma, and the patient responded completely to itraconazole.

Case Series to Depict the Outcomes of Commonly Available Laboratory Investigations in Molluscum-Like Skin Lesions among HIV Positive Patients.

Molluscum-like skin lesions in HIV patients can be the presenting feature of the vast array of diseases. Hence, laboratory investigations play a crucial role in making an accurate etiological diagnosis. The studies that discuss the outcomes of commonly performed laboratory tests in molluscum-like lesions in HIV patients are very sparse. Hence, we conducted a study to bridge this literature gap. This study was conducted among four patients with HIV who had molluscum-like skin lesions. Shave biopsy was performed on all the patients and the specimens were sent for potassium hydroxide (KOH) mount/gram stain, fungal culture and histopathological examination. The tissue samples from cases 1, 2, 3 and 4 are mentioned as samples A, B, C and D, respectively. KOH mount showed yeast-like rounded bodies around 6 µm in size in samples A and B. The KOH mount in samples C and D showed septate branching hyphae. KOH mount in sample C also showed large rounded bodies around 35 µm which were identified as molluscum bodies. The histopathology of samples A and B showed features suggestive of talaromycosis whereas the histopathology of samples C and D showed features of molluscum contagiosum. Culture in Sabouraud Dextrose Agar grew T. marneffei in samples A, B and C. The commonly available laboratory tests immensely help in establishing the diagnosis of molluscum-like skin lesions. However, certain nuances in laboratory tests need to be understood lucidly. Studies with larger sample sizes need to be conducted to determine the possible co-infection of poxvirus and T. marneffei, as witnessed in sample C.

Nevus Lipomatosus Cutaneous Superficialis: Clinicopathological Spectrum of Six Cases from an Indian Archipelago.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare cutaneous hamartomatous lesion, histopathologically characterized by the presence of ectopic dermal adipocytes. Herein, reported is the clinicopathological aspect of six cases of NLCS, consisting of three males and three females, with age at presentation ranging from 18 to 47 years and duration of lesion ranging from 2 to 18 years. Out of the six cases, five were of solitary NLCS, who presented with nodules or polypoidal masses of variable sizes and duration. The lone case of classical NLCS presented with multiple skin-coloured cerebriform nodules over the right lower back in zosteriform distribution. The commonest location was lower back and thigh. Histopathological examination revealed lobules of mature adipocytes in the papillary and/or reticular dermis in all cases, thereby establishing the diagnosis of NLCS. Additional microscopic features encountered were surface ulceration, focal myxoid degeneration, mild perivascular lymphocytic infiltrate and attenuation of adnexal structures.

Epidemiological Study of Skin Disorders in Andaman and Nicobar Islands.

BACKGROUND: The study pertaining to the prevalence of diseases plays a valuable tool in the planning and implementation of health care facilities. The prevalence of skin diseases in Andaman and Nicobar islands, which is rightly called "Little India" considering the heterogeneity of the people living here, will serve as an indispensable tool. METHODOLOGY: The data from the outpatient records of the Dermatology Department of 2 consecutive years were collected retrospectively, the study duration being January 2017 to December 2018. The diagnoses were classified as per the International Classification of Diseases (ICD 10). The quantitative variables are expressed as numbers and percentages. RESULTS: Cutaneous infections namely dermatophyte infection, tinea versicolor, impetigo, scabies, molluscum, and warts were the most commonly encountered disorders. Hansen's disease was witnessed in 42 patients. Among the tribals, scabies, dermatophytosis, and pyoderma were the commonly encountered cutaneous disorders. CONCLUSION: Thus, the data presented in the present study can be extrapolated on the mainland considering the diversity of the population in the Andaman and Nicobar (A and N) Islands.

Primary Chylous Lymphangiectasia of Female Genitalia.

We report a case of a 50-year-old female who presented with multiple thick-walled vesicles involving the labia majora and minora which started developing at the age of 10 year. The vesicles extruded milky white fluid when punctured. Biochemical analysis of the fluid was consistent with chyle. Lymphoscintigraphy showed reflux of the radioactive tracer into the genitalia, thus confirming the diagnosis of primary chylous lymphangiectasia. The patient was not willing to undergo definitive surgical treatment. We report the case considering the rarity and to depict the usage of biochemical analysis of the vesicular content and lymphoscintigraphy to detect this entity.

Imatinib-induced Extensive Hyperpigmentation in a Case of Chronic Myeloid Leukemia.

Imatinib, a tyrosine kinase inhibitor, is well known to cause hypopigmentation because of its inhibitory effect on melanocytes. Herewith we report a case of chronic myeloid leukemia who developed extensive hyperpigmentation following imatinib therapy.

A Rare Association of Childhood Alopecia Areata and Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome: Successfully Treated with Diphenylcyclopropenone.

The genetic background of alopecia areata has only recently begun to get unraveled. We report the association of a case of pediatric alopecia areata with a rare genetic syndrome-blepharophimosis-ptosis-epicanthus inversus syndrome (BPES), which responded well to topical immunotherapy with diphenylcyclopropenone. In the background of increasing evidence surfacing on the genetic basis of alopecia areata, this association may be of significance.

Lumbar lipomeningomyelocele associated with multiple café au lait spots: a case report.

We report on a child with several café au lait spots in association with a lumbar lipomeningomyelocele as an apparently new association. Cutaneous markers, the identification of which plays a crucial role in the early diagnosis and management of spinal malformations, can accompany occult spinal dysraphism. Herein we report a case of lumbar lipomeningomyelocele associated with an overlying café au lait spot that served as a marker of occult spinal dysraphism. The patient also had segmental café au lait spots on the face, making the association unique.

A retrospective audit of skin biopsies done in a tertiary care center in India.

BACKGROUND: Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome. OBJECTIVES: The aim of this study was to retrospectively assess the quality of data included in the pathology request forms and reports and to assess the level of clinicopathological correlation in the reported biopsy specimens. METHODS: We retrospectively analyzed 3006 histopathology request forms and reports of skin, mucosal, and nail biopsies to assess the quality of data included in them and assessed the level of clinicopathological correlation in these biopsies. Two hundred discordant histopathology slides were randomly reviewed by a pathologist in the presence of a dermatologist to analyze the causes for discordance. RESULTS: The pathological diagnosis was concordant with clinical diagnosis in 1798 (59.8%) biopsies, partially concordant in 228 (7.6%) biopsies, and discordant in 929 (30.9%) biopsies. In a clinicopathologically concordant category, the duration for reporting the biopsies was significantly shorter, and the definitive pathologist's diagnosis was frequently mentioned. Of the 200 discordant slides reviewed randomly by a pathologist in the presence of a dermatologist, 7.5% slides afterward turned out to be consistent and 15% partially consistent with the diseases in doubt. CONCLUSION: Several deficits were identified that need to be rectified to improve the diagnostic accuracy of skin biopsy. A portion of discordant slides showing features compatible with the disease when reviewed by a pathologist and dermatologist together emphasizes the importance of a joint review by both in doubtful cases.

Carrying angle in children: a normative study.

Information about the carrying angle and its variations are important in the management of paediatric elbow injuries. We measured the carrying angle using bony landmarks for 300 rural South Indian children aged 5-18 years. The study confirms that the clinical carrying angle correlates best with age up to 15 years, following which there was a slight decrease in the angles. The rate of increase of the carrying angle for boys and girls is 0.42 and 0.60 degrees per year respectively. Sex differences seem to gradually increase with a maximum being around puberty. The carrying angle is greater in girls than in boys by a mean of 1.31 degrees. The carrying angle did not correlate well with height, weight, humeral length or ulnar length. The reproducibility of measuring the carrying angle by the simple technique used in our study leads us to propose that this may be used in actual clinical practice.