Two simultaneous mycetomas caused by Fusarium verticillioides and Madurella mycetomatis.

Mycetoma is a chronic granulomatous disease, classified into eumycetoma caused by fungi and actinomycetoma due to aerobic filamentous actinomycetes. Mycetoma can be found in geographic areas near the Tropic of Cancer. Mexico is one of the countries in which actinomycetoma is endemic. We report an extraordinary case of an adult male with double eumycetoma caused by Madurella mycetomatis and Fusarium verticillioides on both feet.

Actinic Prurigo Cheilitis: A Clinicopathologic Review of 75 Cases.

Actinic prurigo (AP) is a chronic idiopathic photodermatosis that primarily affects American Indians in the United States and Mestizos in Latin American countries. Clinically, the onset of the disease is usually in the first decade of life but may appear initially in adult life, and it is characterized by symmetric involvement of sun-exposed areas of the skin, particularly areas of the face, resulting in polymorphic erythematous papules, macules, and plaques in different stages of evolution. Lower lip involvement includes swelling, scaling, fissures, hyperpigmentation, and ulcerations of the vermilion border. and in some cases could represent the only manifestation of the disease. The histopathologic features of AP have been studied; however, there is a controversy regarding whether AP cheilitis has distinct histopathologic features that could allow accurate separation from other specific and nonspecific forms of cheilitis. The diagnosis can be challenging, mainly when lip lesions are the only manifestation of the disease. In this study, the authors investigate the clinicopathologic features of 75 cases of AP cheilitis to provide further criteria for its diagnosis and classification. All 75 patients presented with lip lesions. Thirty-three cases were diagnosed as AP cheilitis with cutaneous lesions and 42 cases were diagnosed as AP cheilitis without cutaneous lesions (only lip lesions). Histologically, of the 33 cases with AP cheilitis with cutaneous lesions, 17 (52%) cases showed follicular cheilitis, and of the 42 cases that had only lip lesions, 18 (43%) cases showed follicular cheilitis. Histologically, AP cheilitis can present as follicular cheilitis; thus, supporting the diagnosis. Also, our findings confirm that lip lesions can present as the only manifestation of the disease, showing typical histological and clinical features. This form of cheilitis has not being well described in the dermatologic and dermatopathologic literature.

Cutaneous blastomycosis. An imported case with good response to itraconazole / Blastomicosis cutánea. Caso clínico importado con buena respuesta al itraconazol

Background. Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus called Blastomyces dermatitidis, which generally produces a pulmonary form of the disease and, to a lesser extent, extra-pulmonary forms such as cutaneous, osteoarticular and genitourinary, among others. Cutaneous blastomycosis is the second clinical presentation in frequency. It is considered as primary when it begins by inoculation of the fungus due to traumas, and secondary when the lung fails to contain the infection. Case-report. We present the case of a 57 year-old male who had a 5 year-history of an irregularly shaped verrucous infiltrative plaque related to and insect bite and posterior trauma due to the manipulation of the lesion. B. dermatitidis was identified using direct examination, stains, isolation in culture media, histopathology, and molecular studies. An antifungal susceptibility test was performed using method M38-A2 (CLSI). Clinical and mycological cure was achieved with itraconazole. Conclusions. This cutaneous blastomycosis case acquired in the United States (Indianapolis) is rather interesting and looks quite similar to other mycoses such as coccidioidomycosis or sporotrichosis. The presented case shows one of the multiple issues concerning migration between neighboring countries (AU)

Antecedentes. La blastomicosis es una micosis profunda, subaguda o crónica, causada por el hongo dimorfo Blastomyces dermatitidis, que generalmente produce una enfermedad pulmonar y, en menor proporción, formas extrapulmonares (cutánea, osteoarticular y genitourinaria). La blastomicosis cutánea es la segunda forma clínica más observada; es de tipo primario cuando se presenta por la inoculación del hongo a través de traumatismos, y de tipo secundario cuando se disemina a partir de un foco pulmonar. Caso clínico. Se presenta el caso de un varón de 57 años con blastomicosis cutánea verrugosa de 5 años de evolución, relacionada con la picadura de un insecto, que empeora con la manipulación de la lesión. El caso fue confirmado por la identificación de B. dermatitidis en exámenes directos, tinciones, aislamiento en medios de cultivo habituales, análisis histopatológico y estudios moleculares. Se realizó una prueba de sensibilidad antifúngica por el método M38-A2 (CLSI). La curación clínica y micológica se logró con itraconazol oral. Conclusiones. Este caso de blastomicosis cutánea adquirida en Estados Unidos (Indianápolis) es de gran interés y resulta similar a los de otras micosis, como la coccidioidomicosis y la esporotricosis. Este caso refleja uno de los múltiples factores relacionados con la migración entre países cercanos (AU)

Cutaneous blastomycosis. An imported case with good response to itraconazole.

BACKGROUND: Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus called Blastomyces dermatitidis, which generally produces a pulmonary form of the disease and, to a lesser extent, extra-pulmonary forms such as cutaneous, osteoarticular and genitourinary, among others. Cutaneous blastomycosis is the second clinical presentation in frequency. It is considered as primary when it begins by inoculation of the fungus due to traumas, and secondary when the lung fails to contain the infection. CASE-REPORT: We present the case of a 57 year-old male who had a 5 year-history of an irregularly shaped verrucous infiltrative plaque related to and insect bite and posterior trauma due to the manipulation of the lesion. B. dermatitidis was identified using direct examination, stains, isolation in culture media, histopathology, and molecular studies. An antifungal susceptibility test was performed using method M38-A2 (CLSI). Clinical and mycological cure was achieved with itraconazole. CONCLUSIONS: This cutaneous blastomycosis case acquired in the United States (Indianapolis) is rather interesting and looks quite similar to other mycoses such as coccidioidomycosis or sporotrichosis. The presented case shows one of the multiple issues concerning migration between neighboring countries.

Post-burn hypertrophic scars are characterized by high levels of IL-1ß mRNA and protein and TNF-α type I receptors.

Post-burn hypertrophic scars are characterized by increased collagen synthesis and hyperplasia, and may be associated with erythema, pain, dysesthesia, pruritus, and skin border elevation. Although the etiopathogenesis of hypertrophic scarring remains unclear, proinflammatory and profibrogenic cytokines are known to play an important role in general skin dysfunction. This study assessed mRNA expression, proteins, and type I receptors of tumor necrosis factor-alpha (TNF-α) and interleukin 1-beta (IL-1ß) in normal skin, normotrophic and post-burn hypertrophic scars. Skin biopsies were obtained from 10 hypertrophic and 9 normotrophic scars, and 4 normal skin sites. Only post-burn scars covering more than 10% of the body were included. Ex vivo histopathological analysis evaluated scar maturity, in situ hybridization assessed mRNA expression, and cytokine protein and cytokine/cell colocalization were performed using single- and double-label immunohistochemistry, respectively. IL-1ß is overexpressed in hypertrophic scars at the post-transcriptional level, associated primarily with keratinocytes and CD1a(+) cells. Type I receptors for TNF-α are overexpressed in blood vessels of hypertrophic scars. The coordinated overexpression of IL-1ß and TNF-α type I receptor may maintain the fibrogenic phenotypes of hypertrophic scars, even those in "remission".

Eumycetoma caused by Cladophialophora bantiana successfully treated with itraconazole.

A 57-year-old male presented with dermatosis of the dorsum of the foot consisting of tumefaction, deformity and sinus tract formation. The direct examination of exudates as well as the biopsy tissue, demonstrated the presence of black granules. A dematiaceous fungus was isolated from the lesions and was identified by ribosomal DNA sequencing as Cladophialophora bantiana. This is the second report of this fungus as an etiologic agent of eumycetoma in humans. Clinical and mycologic cure was achieved after 20 months of treatment with itraconazole at a starting dose of 300 mg/day that was tapered during the course of therapy. The patient's isolate had an itraconazole MIC of 0.012 microg/ml.

Medallion-like dermal dendrocyte hamartoma: a new clinically and histopathologically distinct lesion.

Dermal dendrocyte hamartomas are extremely rare; only two examples have been described with clinical features different from our cases and with incomplete immunohistochemical characterization. We report three female patients presenting a medallion-shaped, well-defined, slightly atrophic and asymptomatic congenital lesion. All 3 patients showed a fusiform-cell proliferation. Immunohistochemistry was positive for CD34, factor XIIIa, and fascin. Electron microscopy showed typical features of dermal dendrocytes. We believe that the lesions described represent a new, clinically and histopathologically distinct lesion originating in dermal dendrocytes. We propose to name it medallion-like dermal dendrocyte hamartoma.

Síndrome de anticuerpos antifosfolípidos / Antiphospholipid antibody syndrome

La vasculitis necrosante es una de las manifestaciones cutáneas del síndrome de anticuerpos antifosfolípidos, ya que dos terceras partes de los pacientes, que desarrollan este síndrome, presentan úlceras necróticas que pueden confundirse con úlceras de cualquier otra etiología. La aparición de estas úlceras está asociada con más frecuencia a la presencia de anticuerpos anticardiolipina que a la de anticoagulante lúpico en sangre. Se presenta el caso de una paciente de 52 años de edad con vasculitis necrosante asociada al síndrome de anticuerpos antifosfolípidos (AU)

Lipoma y angiolipomas: estudio clínico patológico, comparativo y retrospectivo en 260 pacientes / Lipomas and angiolipomas. Clinical and pathological study in 260 cases

Estudio clínico-patológico, comparativo y retrospectivo en 260 pacientes con lipomas y angiolipomas, en un periodo de 18 años. El 52.6 por ciento de los casos correspondieron a lipomas y el 47.3 por ciento a angiolipomas. A diferencia de los lipomas, los angiolipomas mostraron una mayor tendencia a presentarse como tumores múltiples y dolorosos, ocurriendo en individuos relativamente más jovenes