Severe myelodysplasia with monosomies 5 and 7 presenting with rapidly fatal Sweet's syndrome.

A 57 year-old Chinese man with anaemia and thrombocytopenia due to monosomies 5 and 7-associated myelodysplasia developed progressive Sweet's syndrome. Recurrent episodes of cutaneous manifestations responded dramatically to corticosteroid therapy. However, progressive pulmonary infiltrates unresponsive to antimicrobial therapy resulted in respiratory failure and death.

Community-acquired legionellosis in Singapore.

Patients admitted to hospital with chest infections were examined serologically to see if these were due to Legionella pneumophila. Each of the 219 samples of serum collected from 177 patients was examined by two standard tests. The tests, which generally agreed, identified three individuals (1.7% of the group) who had sufficient antibody to suggest that they were suffering from current legionellosis. Serological evidence of previous infection was discovered (with differing degrees of certainty) in 26 (14.7%) of the others. The study showed that legionellosis is endemic in Singapore, and so must be taken into account in the differential diagnosis of cases of pneumonia.

Non-infective skin associations of diabetes mellitus.

A study of non-infective skin associations of diabetes mellitus was conducted on 100 consecutive outpatient diabetics over a 3-month period. 10 were insulin-dependent diabetics (IDDM), 24 insulin-requiring and 66 non-insulin dependent diabetics (NIDDM). A total skin evaluation was done for each patient with skin biopsy whenever appropriate. Twenty-three patients had diabetic dermopathy; the frequency of retinopathy in this group (39.1%) is significantly higher than that without diabetic dermopathy (6.9%) (p less than 0.001). There were 20 instances of cutaneous complications of therapy; 10 had insulin lipodystrophy (29.4% of 34 insulin users). Twelve patients, 8 of whom were overweight, had acanthosis nigricans. There were 6 Indians among them and all the patients had NIDDM. Eight had xanthelasma. Vitiligo occurred in 3.3% of those with NIDDM. Classical scleredema diabeticorum and cheiroarthropathy occurred in 2% of patients. One patient had atypical granuloma annulare. There was a higher incidence of xanthelasma in our study compared with studies done previously. Insulin lipodystrophy and acanthosis nigricans in the absence of classically described syndromes of insulin resistance seem to be fairly common phenomena and merit further investigation locally.

Lichen planus: a study of 72 cases in Singapore.

Seventy-two patients attending this hospital with a diagnosis of lichen planus were examined. There was a striking predominance of Indians (69%) and a surprisingly low incidence of Chinese (24%) and Malays (4%) in the study population, compared to the racial composition of the general clinic population. The age distribution curve of the study population was bimodal with peaks at age groups 21-30 (22%) and 41-60 (33%) years. The most common morphologic variant was lichen planus vulgaris (common type) which we observed in 46 (64%) patients, followed by lichen planus hypertrophicus in 8 (11%) and lichen planus atrophicus in 2 (3%). Lichen planus confined to the skin was observed in 49 (68%) patients. Mucous membrane involvement was seen in 21 (29%)-17 (24%) had oral mucosa membrane involvement and 4 (6%) genital mucous membrane involvement. In 16 (22%) cases, mucous membranes were exclusively involved--12 (17%) had oral mucous membrane involvement and 4 (6%) genital mucous membrane involvement. Nail changes were only observed in 2 (3%) patients. Eight (11%) patients had associated diabetes mellitus. Overall, lichen planus appeared to pursue a protracted course with only 4 (6%) patients clearing completely after a disease duration of 5-12 months.