Acute bacterial septic vasculopathy.

OBJECTIVES: The frequency and clinicopathologic characteristics of cutaneous lesions in sepsis are not well known. This study aimed to analyze cutaneous lesions in bacterial septic vasculopathy. METHODS: The study population comprised 32 patients with bacterial sepsis, cutaneous lesions, and skin biopsy-proven septic vasculopathy. The clinical and histologic characteristics of the lesions were analyzed. Findings in non-immunosuppressed patients (NISPs) and immunosuppressed patients (ISPs) were compared. RESULTS: Nine of 32 patients were immunosuppressed. The foci of sepsis were variable; in 17 patients, the focus was not identified. Although Neisseria meningitidis was the most common causal agent, several microorganisms were identified. Cutaneous manifestations were an early event in 90.6% of patients. The most common skin signs were purpuric lesions and petechiae. Overall mortality was 28.1%; 65.5% of patients survived without sequelae. Skin biopsies showed thrombi in 100% of cases. Other common findings were inflammatory infiltrate, blood extravasation, and epidermal involvement. Bacteria within the vascular wall were seen in 21.9% of cases and fibrinoid necrosis in 25%. A comparison of ISPs with NISPs disclosed that meningococcemia was more common in the latter group, and the presence of pustules was more common in the former. Histopathology testing revealed that fibrinoid necrosis and bacterial invasion of the vessel wall were more common in ISPs than in NISPs. Conclusions Several microorganisms can cause septic vasculopathy. Clinical presentation is variable and does not depend on the microorganism or the pathogenic mechanism. Histopathologically, septic vasculopathy is a thrombo-occlusive vasculopathy with variable morphology. Cutaneous lesions are an early event and allow for rapid diagnosis.

Cutaneous composite hemangioendothelioma with satellitosis and lymph node metastases.

The term hemangioendothelioma has been used in recent years to name a heterogeneous group of vascular neoplasms, intermediate in both biological behavior and histopathologic appearance between benign tumors (hemangiomas) and frankly malignant tumors (angiosarcomas). Thus, within the spectrum of hemangioendothelioma have been successively included epithelioid hemangioendothelioma, spindle cell hemangioendothelioma, retiform hemangioendothelioma, kaposiform hemangioendothelioma, polymorphous hemagioendothelioma of the lymph nodes, papillary intralymphatic angioendothelioma (PILA) and composite hemangioendothelioma. The latter is a vascular neoplasm showing varying combinations of benign, low-grade malignant and malignant vascular components. We herein report a case of composite hemangioendothelioma showing a combination of retiform hemangioendothelioma, epithelioid hemangioendothelioma, spindle cell hemangioma and PILA. The neoplasm showed a more aggressive behavior than other reported cases of composite hemangioendothelioma and it developed satellitosis and metastases to the inguinal lymph nodes. Neoplastic cells expressed immunoreactivity for Prox-1, supporting a lymphatic line of differentiation.

Eosinophilic folliculitis following allogeneic peripheral blood stem cell transplantation: case report and review.

Eosinophilic folliculitis is considered a heterogeneous group of disorders, with several clinical subsets, sharing a common histopathological appearance. Increasing numbers of cases, following bone marrow transplantation (BMT), have been reported in recent years. We herein present a case of eosinophilic folliculitis that appeared in a 26-year-old woman 5 months after allogeneic peripheral blood stem cell transplantation as treatment for eosinophilic acute leukemia. Our review of the published cases has shown that eosinophilic folliculitis in patients after BMT could be considered as a pattern of reaction related to immune dysregulation.

Migration of aluminum silicate from the oral cavity to the submandibular region, with foreign body granuloma formation: report of a case.

We present the first case of foreign body granuloma in the cervical (submandibular) region as a result of migration of noninjected aluminium silicate particles from the oral mucosa. This migration can be explained by macrophage phagocytosis and transport through the local lymphatic network and surgical disruption of fascial layers. The appearance of foreign body granulomas in distant sites may appear several weeks after the local event in a specific disposition according with the migration route. This entity must be born in mind in differential diagnosis of multiple nodules, pigmentation, or persistent swelling in the cervical-orofacial region.

Necrobiotic xanthogranuloma.

Necrobiotic xanthogranuloma (NXG) is an uncommon granulomatous disease involving the skin and extracutaneous tissues. In its typical clinical presentation, it consists of multiple indurate yellow-brownish plaques or nodules, usually located on the periorbital area. The lesions often are bilateral and symmetric and frequently show tendency to atrophy and ulceration. Most cases are asymptomatic, and oral mucosal erosions are sometimes present. Ophthalmologic complications are observed in many patients, and NXG may involve other extracutaneous sites. Paraproteinemia is closely associated with NXG, demonstrating a monoclonal gammapathy, and other hematologic or lymphoproliferative disorders also may appear in association with NXG. Large areas of degenerated collagen alternating with granulomatous inflammation, multinucleate giant cells, cholesterol clefts, and lymphoid follicles are the most outstanding histopathologic characteristics of NXG. The prognosis for NXG is good, but no curative treatment is available. Chemotherapy with alkylating agents is the most frequently administered treatment, but oral and intralesional corticosteroids, interferon alpha, plasmapheresis, surgical excision, and radiation therapy also have been used for treatment of this disorder, with variable results.

[Treatment of mycosis fungoides with PUVA and bexarotene]. / Tratamiento de micosis fungoide con PUVA más bexaroteno.

INTRODUCTION: The combined use of bexarotene and PUVA is a treatment that is currently being investigated. In this paper, six patients treated with this combination are presented. OBJECTIVES: To assess the efficacy and safety of treatment with PUVA + bexarotene in patients with mycosis fungoides (MF). Patients, material and methods. Six patients diagnosed with MF in different stages, who received three sessions of PUVA treatment a week (initially 2.35 J/cm 2, with progressive increases to a maximum of 23.5 J/cm 2) + bexarotene (initial dose 300 mg/m 2/day, decreasing to 200, 150 or 75 mg/m 2 if signs of toxicity appeared). All received atorvastatin. RESULTS: Stage at the start of treatment: two patients IIb, one patient Ib with B2 blood involvement, two patients Ib, one patient Ia. Five of the six patients responded to the treatment (three full remissions [FR], two partial remissions [PR]). One patient did not respond. In those in whom FR was achieved, the time required for the response was 10, 20 and 24 weeks. All presented with hypertriglyceridemia (maximum 1194 mg/ dL). It was necessary to administer thyroid hormone supplements to four of the patients. Two of them had alterations in the hepatic biochemistry values, and two others presented with alterations in the muscle profile analysis. CONCLUSION: The combination of PUVA and bexarotene is a safe and effective treatment for MF. It will be necessary to await the results of the clinical trials currently underway to see if their combined use is better than treatment with PUVA alone. The response rate (RR) was 86 % (three FR and two PR out of six patients).

[Post-radiotherapy telangiectasias. Treatment with pulsed-dye laser. Sequential histological studies]. / Telangiectasias posradioterapia. Tratamiento con láser de colorante pulsado. Estudios histológicos secuenciales.

Chronic radiodermatitis after radiotherapy is a frequent sequela that may be worrying for the patient. Few cases have been published in the literature in which pulsed-dye laser has been used in the treatment of telangiectasias that appeared after radiotherapy for breast cancer. We present a female patient with radiodermatitis on the neck after radiotherapy for nasopharyngeal carcinoma. The patient received five sessions of pulsed-dye laser treatment (3 ms pulse duration, 7 mm spot size, fluence between 7 and 12 J/cm 2). Sequential histological studies were performed. The response to treatment was very good, with the lesions almost completely disappearing. The patient was very satisfied with the result. Pulsed-dye laser is a safe and effective treatment for chronic radiodermatitis of the neck after radiotherapy.

A case of Grover's disease with syringoma-like features and leukemia cutis.

UNLABELLED: Leukemia cutis used to be a late manifestation of leukemia. On the other hand, Grover's disease has been described in the setting of cancer. CASE REPORT: A patient diagnosed as having a chronic myelomonocytic leukemia presented with lichenoid, slightly infiltrated plaques on the anterior aspect of his thorax and abdomen and papulovesicles on his back. A skin biopsy showed the co-existence of leukemia cutis, Grover's disease, and syringoma-like features. DISCUSSION: We discuss and comment upon this unusual association.

Tratamiento de micosis fungoide con PUVA más bexaroteno / Treatment of mycosis fungoides with PUVA and bexarotene

Introducción. La utilización conjunta de bexaroteno y psoraleno y radiación ultravioleta A (PUVA) en la actualidad es un tratamiento en investigación. En el presente trabajo se presentan 6 pacientes tratados con esta combinación. Objetivos. Valorar eficacia y seguridad del tratamiento con PUVA más bexaroteno en pacientes con micosis fungoide. Pacientes, material y métodos. Seis pacientes diagnosticados de micosis fungoide en distintos estadios que han recibido PUVA, tres sesiones semanales (inicio 2,35 J/cm 2, con aumentos progresivos hasta llegar a un máximo de 23,5 J/cm 2) más bexaroteno (dosis inicial, 300 mg/m 2/día, disminuyendo a 200, 150 o 75 mg/m 2 si aparecía toxicidad). Todos los pacientes recibieron atorvastatina. Resultados. Al inicio de tratamiento, 2 pacientes se encontraban en estadio IIb, un paciente en Ib con afectación hemática B2, 2 pacientes en Ib y un paciente en estadio Ia. Cinco de los 6 pacientes respondieron al tratamiento (tres remisiones completas [RC], dos remisiones parciales [RP]). Un paciente no respondió. De los que obtuvieron RC, el tiempo hasta la respuesta fue de 10, 20 y 24 semanas, respectivamente. Todos los pacientes presentaron hipertrigliceridemia (máximo de 1.194 mg/dl). En cuatro de los pacientes fue necesario administrar suplementos de hormona tiroidea. Dos de ellos tuvieron alteraciones de la bioquímica hepática y dos más presentaron alteraciones analíticas del perfil muscular. Conclusión. La combinación de PUVA y bexaroteno es un tratamiento eficaz y seguro para la micosis fungoide. Habrá que esperar a los resultados de los ensayos clínicos en curso para ver si es mejor su uso combinado que el tratamiento con PUVA sola. El índice de respuesta fue del 86 % (3 RC y 2 RP de 6 pacientes)

Introduction. The combined use of bexarotene and PUVA is a treatment that is currently being investigated. In this paper, six patients treated with this combination are presented. Objectives. To assess the efficacy and safety of treatment with PUVA + bexarotene in patients with mycosis fungoides (MF). Patients, material and methods. Six patients diagnosed with MF in different stages, who received three sessions of PUVA treatment a week (initially 2.35 J/cm 2, with progressive increases to a maximum of 23.5 J/cm 2) + bexarotene (initial dose 300 mg/m 2/day, decreasing to 200, 150 or 75 mg/m 2 if signs of toxicity appeared). All received atorvastatin. Results. Stage at the start of treatment: two patients IIb, one patient Ib with B2 blood involvement, two patients Ib, one patient Ia. Five of the six patients responded to the treatment (three full remissions [FR], two partial remissions [PR]). One patient did not respond. In those in whom FR was achieved, the time required for the response was 10, 20 and 24 weeks. All presented with hypertriglyceridemia (maximum 1194 mg/ dL). It was necessary to administer thyroid hormone supplements to four of the patients. Two of them had alterations in the hepatic biochemistry values, and two others presented with alterations in the muscle profile analysis. Conclusion. The combination of PUVA and bexarotene is a safe and effective treatment for MF. It will be necessary to await the results of the clinical trials currently underway to see if their combined use is better than treatment with PUVA alone. The response rate (RR) was 86 % (three FR and two PR out of six patients)

Telangiectasias posradioterapia. Tratamiento con láser de colorante pulsado. Estudios histológicos secuenciales / Post-radiotherapy telangiectasias. Treatment with pulsed-dye laser. Sequential histological studies

La radiodermitis crónica tras el tratamiento con radioterapia es una secuela frecuente que puede resultar preocupante para el paciente. En la literatura especializada se han publicado pocos casos en los que se han utilizado el láser de colorante pulsado en el tratamiento de telangiectasias aparecidas tras radioterapia por cáncer de mama. Presentamos una paciente con radiodermitis en el cuello tras radioterapia por carcinoma de cavum. La paciente recibió 5 sesiones de láser de colorante pulsado (pulso de 3 ms, diámetro de impacto de 7 mm y energía entre 7 y 12 J/cm 2). Se realizaron estudios histológicos secuenciales. La respuesta al tratamiento fue muy buena con una desaparición casi completa de las lesiones. La paciente quedó muy satisfecha del resultado. El láser de colorante pulsado es un tratamiento seguro y eficaz de la radiodermitis crónica del cuello tras radioterapia

Chronic radiodermatitis after radiotherapy is a frequent sequela that may be worrying for the patient. Few cases have been published in the literature in which pulsed-dye laser has been used in the treatment of telangiectasias that appeared after radiotherapy for breast cancer. We present a female patient with radiodermatitis on the neck after radiotherapy for nasopharyngeal carcinoma. The patient received five sessions of pulsed-dye laser treatment (3 ms pulse duration, 7 mm spot size, fluence between 7 and 12 J/cm 2). Sequential histological studies were performed. The response to treatment was very good, with the lesions almost completely disappearing. The patient was very satisfied with the result. Pulsed-dye laser is a safe and effective treatment for chronic radiodermatitis of the neck after radiotherapy

Pénfigo vulgar tratado con rituximab / Pemphigus vulgaris treated with rituximab

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[Mycosis fungoides-type eruptions induced by carbamazepine]. / Erupciones de tipo micosis fungoide inducidas por carbamazepina.

Cutaneous pseudolymphomas are inflammatory diseases of the skin that simulate malignant lymphomas in their clinical and/or histological form. Those induced by drugs are infrequent and are characterized by their clinical and histological polymorphism. There is no consensus regarding the definition of these dermatoses, and they can be seen in different forms of presentation. There are two main groups of drug-induced pseudolymphomas: those that clinically and histologically simulate cutaneous lymphomas, and those known as hypersensitivity syndromes. Pseudolymphomas cannot be differentiated from true lymphomas through clinical, pathological or molecular findings. The definitive test for diagnosis is the resolution of the lesions after the medication involved is suspended. We present three cases of carbamazepine-induced cases of pseudolymphomas that histologically simulate mycosis fungoides, with different clinical presentations.

La protección de datos en la práctica privada / Data protection in private practice

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Erupciones de tipo micosis fungoide inducidas por carbamazepina / Mycosis fungoides-type eruptions induced by carbamazepine

Los seudolinfomas cutáneos son enfermedades inflamatorias de la piel que simulan linfomas malignos en su forma clínica, histológica o en ambas. Los inducidos por fármacos son infrecuentes y se caracterizan por su polimorfismo clínico e histológico. Estas dermatosis no tienen una definición consensuada y pueden observarse bajo distintas formas de presentación. Existen dos grupos principales de seudolinfomas inducidos por fármacos: aquellos que clínica e histológicamente simulan linfomas cutáneos y los llamados síndromes de hipersensibilidad. Los hallazgos clinicopatológicos o moleculares no permiten diferenciar los seudolinfomas de los verdaderos linfomas. La prueba definitiva para el diagnóstico es la resolución de las lesiones después de suspender la medicación implicada. Presentamos 3 casos de seudolinfomas histológicamente de tipo micosis fungoide inducidos por carbamazepina con presentaciones clínicas diferentes

Cutaneous pseudolymphomas are inflammatory diseases of the skin that simulate malignant lymphomas in their clinical and/or histological form. Those induced by drugs are infrequent and are characterized by their clinical and histological polymorphism. There is no consensus regarding the definition of these dermatoses, and they can be seen in different forms of presentation. There are two main groups of drug-induced pseudolymphomas: those that clinically and histologically simulate cutaneous lymphomas, and those known as hypersensitivity syndromes. Pseudolymphomas cannot be differentiated from true lymphomas through clinical, pathological or molecular findings. The definitive test for diagnosis is the resolution of the lesions after the medication involved is suspended. We present three cases of carbamazepine-induced cases of pseudolymphomas that histologically simulate mycosis fungoides, with different clinical presentations