Non-scarring patchy alopecia: What else, apart from alopecia areata?

A 67-year-old woman presented with a 3-month history of patchy alopecia areata (AA)-like hair loss and multiple painful enlarged lymph nodes at cervical, nuchal, and left axillary site. The patient was on follow-up for IgM monoclonal gammopathy of undetermined significance, stable for many years. A punch biopsy from a patch of the temporal scalp revealed the presence of B-cell lymphoid infiltrates consistent with marginal zone B-cell lymphoma (MZL). Other staging examinations were conducted to make a definitive diagnosis of nodal MZL with secondary cutaneous involvement. The patient showed a complete remission of the alopecia, without evidence of scarring, after immunochemotherapy for lymphoma.

Mycetomatoid infection of the penis by Candida albicans.

BACKGROUND: Mycetoma is generally understood to be a chronic suppurative infection involving the skin and the underlying tissue. Mycetomas may be classified as those produced by true fungi (eumycetoma) versus those due to aerobic bacteria Actinomycetales (actinomycetoma). METHODS: We report the atypical case of a mycetomatoid infection of the penile shaft and glans in a 36-year-old man, originally from Senegal, affected by Takayasu's arteritis. RESULTS: Extensive investigations excluded any other causative pathogen other than Candida albicans, and the ailment accordingly healed after fluconazole monotherapy. CONCLUSION: The authors discuss the unusual site of the disease and the singular clinical features related to the fungal etiology and put forward considerations on the pathogenic role of common microorganisms.

A case of perianal Crohn disease misdiagnosed as condylomata acuminata.

We report a case of a 30-year-old woman with vegetative lesions in the perianal area to highlight the importance of considering perianal Crohn disease in the differential diagnosis of a resistant condylomata acuminata that does not improve after treatment.

Mesotherapy and cutaneous Mycobacterium fortuitum infection.

BACKGROUND: Cutaneous infections caused by Mycobacterium fortuitum usually are a complication of trauma or postsurgical wounds. CASE REPORT: A 41-year-old woman presented with numerous dusky red nodules, abscesses and sinuses on the right buttock and on the lateral surfaces of both thighs. The lesions developed at the injection sites of mesotherapy treatment. M. fortuitum was cultured from a biopsy specimen and purulent fluid drained from lesions. The lesions had cleared completely with ciprofloxacin 500 mg b.d. for 3 weeks, and then 250 mg b.d. for another 3 weeks. CONCLUSIONS: This case demonstrates the importance of suspecting mycobacterial etiology in patients with nodules and abscesses in the areas of mesotherapy treatment.

Papules arising after radiotherapy for rhabdomyosarcoma.

Radiation therapy, even at low doses, can induce a wide spectrum of vascular skin proliferations ranging from nonmalignant ones, such as benign lymphangiomatous papules (BLAP), to frankly malignant pathologies, such as angiosarcoma. We describe a 50-year-old Caucasian woman with a past history of uterine rhabdomyosarcoma, treated 22 years prior with surgical excision, chemotherapy, and radiotherapy. She presented with a few skin-colored papules and a clear discharge located in the previously irradiated area (right inguinal region). Histopathology showed a proliferation of irregular, interanastomosing vascular channels, thin walled and lined by prominent endothelial cells with focally hobnail features. Cytological atypia of endothelial cells, mitotic figures, hemorrhagic areas, and necrosis were not observed. The endothelial cells expressed D2-40 and CD31. A diagnosis of BLAP following radiotherapy for uterine rhabdomyosarcoma was made. The patient was treated with complete excision using electrodessication. At the 20-month follow-up visit the patient was still free of recurrence.