Mycobacterium chelonae Cutaneous Infection: An Important Differential Diagnosis in the Immunosuppressed Patient with Chronic Ulcers.

In 2018, a 38-year-old woman was referred to our hospital with some nodules and nonhealing ulcers on her left thigh that had been present for 18 months. Her medical history included rheumatoid arthritis (RA) being treated with 20-mg prednisone for the last 8 years. There was no history of trauma, surgery, or cosmetic procedure on the leg. Physical examination revealed multiple lesions on her left thigh, including nodules, surrounded by erythema, some of them being covered with a fine white-yellowish scale and hyperpigmented macules. Central atrophy was evident in some lesions. She also had one ulcer with purulent discharge (Figure 1). An infectious disease and vasculitis were considered in the differential diagnoses. Biopsy and culture were conducted from the lesion. A Ziehl-Neelsen stain was obtained from the ulcer's discharge with visible acid-fast bacilli (Figure 2). Light microscopy examination revealed a mixed granuloma with lymphocytes, neutrophils, and giant cells in the dermis (Figure 3). The culture was positive for M. chelonae sensitive to clarithromycin. Treatment with clarithromycin was initiated (500 mg, twice a day) for 8 weeks, with healing of some of the lesions. She was advised to continue antibiotic treatment for 4 more weeks and to report to our hospital after its completion, but she never returned and was lost on follow-up.

Periungual eccrine poroma.

BACKGROUND: Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands. OBJECTIVE: Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.

Periungual eccrine poroma.

BACKGROUND: Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands. OBJECTIVE: Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.

The molecular fingerprint of human papillomavirus infection and its effect on the Langerhans cell population in squamous cell carcinomas of the genital skin.

BACKGROUND: Information is scarce about the presence of molecular alterations related to human papillomavirus (HPV) infection in squamous cell carcinomas of the genital skin and about the effect of this infection in the number of Langerhans cells present in these tumors. AIMS: To determine the presence of HPV in genital skin squamous cell carcinomas and to see the relationship between HPV infection and changes in the expression of Ki-67 antigen (Ki-67), p53 protein (p53), retinoblastoma protein (pRb) and E-cadherin and to alterations in Langerhans cell density, if any. METHODS: A descriptive, comparative, retrospective and cross-sectional study was performed with all the cases diagnosed as squamous cell carcinomas of the genital skin at the Dermatopathology Service from 2001 to 2011. The diagnosis was verified by histopathological examination. The presence of HPV was examined using chromogenic in situ hybridization, and protein expression was studied via immunohistochemical analysis. RESULTS: The 34 cases studied were verified as squamous cell carcinomas and 44.1% were HPV positive. The degree of expression of pRb was 17.50% ±14.11% (mean ± SD) in HPV-positive cases and 29.74% ±20.38% in HPV-negative cases (P = 0.0236). The degree of expression of Ki-67 was 47.67% ±30.64% in HPV-positive cases and 29.87% ±15.95% in HPV-negative cases (P = 0.0273). CONCLUSION: HPV infection was related to lower pRb expression and higher Ki-67 expression in comparison with HPV negative samples. We could not find a relationship between HPV infection and the degree of expression of p53 and E-cadherin or with Langerhans cell density.

Comparación del examen directo, el cultivo y el blanco de calcoflúor para el diagnóstico de onicomicosis / Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis

Antecedentes. El diagnóstico micológico de onicomicosis puede establecerse mediante el examen microscópico directo (KOH) de una muestra clínica, el cultivo y la adición de blanco de calcoflúor. Objetivos. Comparar el porcentaje de positividad y el grado de correlación entre la adición de KOH, el cultivo y la tinción con blanco de calcoflúor en el diagnóstico de onicomicosis. Métodos. Estudio descriptivo, transversal y comparativo. Se utilizaron muestras de fragmentos ungueales de los pies para la adición de KOH, cultivo y adición de blanco de calcoflúor para examen bajo fluorescencia. Se calculó el porcentaje de positividad de las diferentes técnicas y se determinó el grado de correlación entre ellas (Programa Epi Info v 3.4.3©). Resultados. La adición de KOH dio un resultado positivo en el 66,67% de los casos, el cultivo en el 33,33% y la tinción con blanco de calcoflúor en el 57,58%. El KOH y el blanco de calcoflúor se asociaron a un mayor porcentaje de positividad que el cultivo (p < 0,01 y p < 0,05, respectivamente). El grado de correlación entre el KOH y el blanco de calcoflúor fue excelente (κ = 0,8085; p < 0,0001), mientras que fue débil entre el KOH y el cultivo y entre el blanco de calcoflúor y el cultivo. Conclusiones. No se recomienda el uso sistemático de blanco de calcoflúor en los laboratorios porque no parece conferir beneficios adicionales cuando se compara con el KOH. Esto reviste especial importancia cuando los recursos son limitados(AU)

Background. Mycological diagnosis of onychomycosis can be performed by direct microcopy (KOH), cultures and calcofluor white. Aims. To compare the percentage of positivity and the degree of correlation of KOH, cultures and calcofluor white for the diagnosis of onychomycosis. Methods. Descriptive, transversal and comparative study. Samples of toenails with onychomycosis were used for KOH, cultures and calcofluor white under fluorescence. The percentage of positivity of the different techniques was calculated and the degree of correlation between them was determined (Epi Info v 3.4.3©). Results. KOH was positive in 66.67% of the cases, cultures in 33.33% and calcofluor white in 57.58%. KOH and calcofluor white had a higher percentage of positivity than culture (p<0.01 and p<0.05 respectively). The degree of correlation between KOH and calcofluor white was excellent (κ=0.8085; p<0.0001); however, the degree of correlation between KOH and culture and between calcofluor white and culture was poor. Conclusions. The use of calcofluor white is not recommended in routine laboratories because it does not seem to bring any additional benefits when comparing with KOH. This is especially important when funding is a great problem(AU)

Evaluation of Demodex folliculorum as a Risk Factor for the Diagnosis of Rosacea In Skin Biopsies. Mexico's General Hospital (1975-2010).

CONTEXT: Rosacea significantly affects the quality of life and its pathophysiology is not well understood. It has been suggested that the presence of Demodex folliculorum in the affected skin could be related to the development of rosacea. AIMS: To study the risk for association between the presence of D. folliculorum in skin biopsies and the diagnosis of rosacea. SETTINGS AND DESIGN: Analytical, observational, retrospective, case-control study. MATERIALS AND METHODS: Skin biopsies of patients diagnosed clinically as rosacea and the same number of controls were studied. The controls were selected among the facial skin biopsies that were not diagnosed as rosacea. All the slides were analyzed for the presence of D. folliculorum and the density of the infestation was assessed. STATISTICAL ANALYSIS USED: Absolute/relative frequencies, mean, standard deviation, odds ratio (OR), Chi square and Independent Student t-test with Epi Info v. 3.4.3(®). RESULTS: D. folliculorum was present in 80% of the skin biopsies of rosacea patients and in 30% of the controls. The risk of suffering rosacea was increased among persons infested with the mite (OR = 9.33 [95% confidence interval: 2.85-30.60]; P = 0.0001). The mean infestation density among the cases was 1.908 for every 10 high-power fields while it was 0.718 among the controls (P < 0.005). There were no statistically significant differences among the groups with regard to sex and age. CONCLUSIONS: The presence of D. folliculorum in skin biopsies is associated with the diagnosis of rosacea. The infestation density was increased among the patients with rosacea.

Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis.

BACKGROUND: Mycological diagnosis of onychomycosis can be performed by direct microcopy (KOH), cultures and calcofluor white. AIMS: To compare the percentage of positivity and the degree of correlation of KOH, cultures and calcofluor white for the diagnosis of onychomycosis. METHODS: Descriptive, transversal and comparative study. Samples of toenails with onychomycosis were used for KOH, cultures and calcofluor white under fluorescence. The percentage of positivity of the different techniques was calculated and the degree of correlation between them was determined (Epi Info v 3.4.3(©)). RESULTS: KOH was positive in 66.67% of the cases, cultures in 33.33% and calcofluor white in 57.58%. KOH and calcofluor white had a higher percentage of positivity than culture (p<0.01 and p<0.05 respectively). The degree of correlation between KOH and calcofluor white was excellent (κ=0.8085; p<0.0001); however, the degree of correlation between KOH and culture and between calcofluor white and culture was poor. CONCLUSIONS: The use of calcofluor white is not recommended in routine laboratories because it does not seem to bring any additional benefits when comparing with KOH. This is especially important when funding is a great problem.

Skin biopsy: a pillar in the identification of cutaneous Mycobacterium tuberculosis infection.

INTRODUCTION: The present study aimed to establish the frequency and clinical characteristics of cutaneous tuberculosis among Mexican adult patients. METHODOLOGY: Ninety-five patients with clinically compatible lesions to cutaneous tuberculosis participated in the study. All patients were HIV negative and none of them had previous anti-TB treatment. A skin biopsy was taken from every patient suspected of having tuberculosis, and a histopathologic examination was performed as follows: Ziehl-Neelsen staining; culturing of mycobacteria by Löwenstein-Jensen (L-J) medium; Mycobacteria Growth Indicator Tube detection via BACTEC (MGIT-360); and polymerase chain reaction (PCR) with the sequence of insertion IS6110 for Mycobacterium tuberculosis complex. RESULTS: Tuberculosis was confirmed in 65 out of 95 cases (68.4%). Identified lesions were scrofuloderma (42 cases, 64.6%); lupus vulgaris (12 cases, 18.4%); warty tuberculosis (six cases, 9.2%); and papulonecrotic tuberculoid (five cases; 7.7%). The Ziehl-Neelsen staining was positive for acid fast bacilli in nine cases (13.8%) and 48 patients were positive for the PCR amplification (73.8%). All skin biopsies resulted positive for tuberculosis. A positive clinical response to the specific treatment was considered a confirmation for tuberculosis. The noninfectious etiology corresponded to 30 cases (31.6%). CONCLUSIONS: Tuberculosis in developing countries is still an important cause of skin lesions which must be studied via histopathological examination and culture due to their low bacillary load. A PCR test is necessary to obtain faster confirmation of the disease and to establish an early, specific and effective treatment.

Myxoid neurofibroma: an unusual presentation.

Myxoid neurofibroma (MN) is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical staining for S-100 protein. The most common locations of the MN are the face, shoulders, arms, periungual and in the feet. To our knowledge, this is the first time that a trunk location is reported. MN should be included in the differential diagnosis of tumors on this location.

Annular atrophic lichen planus.

A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.

Giant skin tags: report of two cases.

Skin tags are skin-colored, pedunculated tumors with a smooth surface. Histologically are composed by loose collagen fibers and dilated capillaries. Giant skin tags are reported rarely in the literature. We present the case of two giant skin tags on labium majus. To our knowledge, these are the largest skin tags reported.

Dermatofibroma. Análisis clínicopatológico de 10 años en el servicio de dermatopatología del Hospital General de México / Dermatofibroma. A ten year clinico-pathological analysis in the department of dermatopathology at the hospital general de méxico

El dermatofibroma es un tumor fibrohistiocítico común en la práctica de la dermatología, ocurre de predominio en mujeres jóvenes, con topografía preferencial en las extremidades inferiores; es de lento crecimiento y representa una mezcla de células fibroblásticas e histiocíticas con disposición característica. Siendo el Hospital General de México un pilar en el diagnóstico y tratamiento de pacientes con afecciones cutáneas, se realizó un estudio observacional, retrospectivo, longitudinal, descriptivo y abierto, incluyendo 187 especímenes de dermatofibromas para determinar sus características clinico-patológicas, en el periodo de enero de 1991 a diciembre de 2000. La frecuencia general fue de 1.23 por ciento en relación con los padecimientos cutáneos evaluados en el periodo. El predominio fue para el grupo de edad de 21-30 años, con un predominio mujer:hombre de 4:1. La topografía predominante fueron las extremidades inferiores, siendo las superiores el segundo lugar. En el análisis histopatológico, los dermatofibromas clásicos fueron 62.24 por ciento, atípicos el 18.7 por ciento, histiocitofibromas 14.43 por ciento e histiocitomas 1.6 por ciento. Dentro de los cambios epidérmicos destacó la acantosis simple, seguido por atrofia epidérmica; los cambios dérmicos revelaron presencia constante de patrón estoriforme, células epitelioides, nodos colagenosos, edema del estroma, hemosiderina, neovascularización periférica, xantomatización e incluso en pequeña proporción mitosis. Se encontró un caso de dermatofibroma atípico con metaplasia ósea y 2 con lesiones con aspecto intratumoral de colagenoma esclerótico. Se clasificaron 2 dermatofibromas como variante liquenoide y 3 como erosivos o ulcerados. Se concluye que hacen falta rutas diagnósticas específicas para el estudio de los dermatofibromas y neoplasias fibrohistiocíticas relacionadas, y que las variantes morfológicas distan mucho de modificar su evolución clínico-patológica (AU)

Siringoma de células claras: estudio clinicpatológico de un caso y revisión de la literatura / Clear cells syringoma. A clinicopathological study of a case and literature review

Se reporta el caso de un hombre de 59 años de edad, con un tumor pequeño, de aspecto papilar, en párpado inferior del ojo izquierdo, de 20 años de evolución. El tumor corresponde a un siringoma de células claras, con aumento en el número de células claras en las glándulas sudoríparas no tumorales y asociado a diabetes mellitus. La asociación de siringoma de células claras con diabetes mellitus quizás represente un dato morfológico en la piel relacionado con la endocrinopatía mencionada.

Pénfigo vegetante tipo hallopeau: presentación de un caso / Vegeutingpemphigus hallopeau type: presentation of a case

El pénfigo vegetante, variante rara de pénfigo vulgar, corresponde al 5 por ciento de los pacientes con pénfigo. Se divide en tipo Neumann y tipo Hallopeau, el primero caracterizado por ampollas fláccidas que al erosionarse forman vegetaciones o proliferaciones papilomatosas, especialmente en áreas intertriginosas. La variante Hallopeau se inicia con pústulas, es menos grave y remite más fácilmente con el tratamiento. Se describe un caso de pénfigo vegetante tipo Hallopeau, se trata de una mujer de 64 años con dermatosis a nivel de mucosa oral, pliegues submamario e inguinocrural y áreas perianal y vulvar, constituida por exulceraciones, neoformaciones vegetantes, ampollas fláccidas y pústulas. El estudio histológico y de inmunofluorescencia directa confirman el diagnóstico. Recibió tratamiento con prednisona a dosis de 1 mg/kg/día con remisión clínica completa.

Leucoplasia verrucosa proliferativa. Presentación de un caso y revisión bibliográfica / Verrucose proliferative leucoplasia. A clinical case an review of literature

Se describe el caso de un paciente femenino de 74 años que cursó con leucoplasia verrucosa proliferativa de 12 años de evolución. Inició con lesión leucoplásica con aumento de tamaño y número de afectó la totalidad de la cavidad bucal. Mejoró con tratamiento a base de criocirugía; pero posteriormente desarrolló carcinoma epidermoide en el fondo de saco anterosuperior bilateral, área donde asentaba una prótesis total. La leucoplasia verrucosa proliferativa es una forma de leucoplasia oral altamente agresiva de evolución lenta y progresiva, multifocal, persistente y resistente a todo tipo de tratamiento con un alto índice de recurrencia y malignización

Sensibilización a distancia: dermatofítides / Sensibilization at distance: dermatophytides

El mecanismo de producción de la hiposensibilización a distancia (ID o IDE), cualquiera que sea su origen, ha sido difícil de dilucidar, lo cual ha sido el motivo para realizar esta revisión. La mayor parte de los hongos poseen una estructura compleja compuesta por La N-acetil glucosamina, la cual es fundamental en la producción de IDES, debido a que: es el antígeno de superficie de los dermatofitos que va a producir la formación de dichas IDES, ya que es semejante a la colágena tipo I de la piel y los glucosamin-glicanos que se utilizan para su conservación. Cuando se monta una respuesta inmunitaria contra la glucosamina de los dermatofitos se hace una reacción cruzada contra la colágena tipo I de la piel

Mastocitosis cutánea difusa, presentación de un caso y revisión del tema / Difuse cutaneous mastocytosis: report of a case

Se presenta el caso de un paciente masculino de 5 meses de edad, diagnosticado clínica e histológicamente como mastocitosis cutánea difusa, se hace una revisión del tema