Erythema multiforme-like cutaneous lesions in monomorphic epitheliotropic intestinal T-cell lymphoma: a rare case report.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), also known as Type II enteropathy-associated T-cell lymphoma (EATL), is an aggressive peripheral T-cell lymphoma. EATL generally presents in adults with gastrointestinal symptoms. Skin involvement is very rare, found only in approximately five percent of patients. The authors report a 67-year-old Asian male who presented with chronic diarrhea and developed erythema multiforme-like cutaneous lesions. A skin biopsy revealed extensive pagetoid spread of atypical lymphocytes in the epidermis. The results of an immunohistochemistry test led to a diagnosis of MEITL. This report points to the need for dermatologists and dermatopathologists to consider a possible diagnosis of MEITL when encountering similar cases.

A Study of Plasma Zinc Levels in Thais with Alopecia Areata.

Objective: To study the correlation between the plasma zinc levels of Thai participants with alopecia areata (AA) and compare to the levels of Thais who do not have AA. Material and Method: A cross-sectional study of thirty Thais with AA (case group) and thirty gender and age-matched healthy subjects (control group). All participants underwent blood tests measuring zinc and confounding factors. Results: Participants in both groups were the same gender, 20 (66.7%) women and 10 (33.3%) men. The median age was 37 in the study group and 38 in the control. In the study group, the median disease duration was three months (interquartile range 1-6). Patients who had AA for more than three months had a lower mean plasma zinc level than those who had AA for less than three months without statistical significance (58.33±8.59, 62.43±13.19 µg/dL (mean ± standard deviation or SD), respectively, p-value = 0.40). The correlation between plasma zinc levels and disease duration of AA (p-value = 0.31) and the plasma zinc levels and the Severity of Alopecia Tool (SALT) score (p-value = 0.16) were not statistically significant. The mean plasma zinc level in the study group was lower than in the control group with statistical significance (61.20±12.00, 67.17±10.04 µg/dL (mean ± SD), respectively, p-value = 0.04). Conclusion: The plasma zinc level in participants with AA is statistically significantly lower than in participants without AA. A more in depth study should be conducted to determine whether prescribing zinc supplement would be of benefit to AA patients.

Epidemiological, Clinical, and Histopathological Characteristics of Patients with Sporotrichoid Lymphocutaneous Infection in Southern Thailand: A 10-Year Retrospective Study.

Sporotrichoid lymphocutaneous infection is caused by a variety of pathogens. However, in most cases, the causative pathogen cannot be identified on the basis of clinical and histopathological features. We examined the clinical manifestations, histopathologic findings, causative pathogens, treatment, and prognostic factors of sporotrichoid lymphocutaneous infection, specifically in the context of Thailand. The electronic medical records of patients with sporotrichoid lymphocutaneous infection who visited Songklanagarind Hospital from January 2000 to December 2010 were reviewed. A total of 53 patients were included; 41 (77.4%) were female, 12 (22.6%) were male, and the mean (SD) age was 52.9 (± 15.9) years. Nodules, plaques, and papules were the most commonly observed morphologies. Upper extremities were the most commonly infected sites. Mammal-caused injuries were associated with fungal infection but not at a statistically significant level. The most common histopathologic finding was suppurative granuloma. The identified causative pathogens were mainly dematiaceous fungus and occasionally nontuberculous Mycobacterium. Itraconazole was the medication of choice for empiric and specific treatment of the patients with confirmed fungal infection. Dematiaceous fungi were the most common identified pathogens causing sporotrichoid lymphocutaneous infection in southern Thailand. Empirical itraconazole is useful, especially in patients who report contact injury caused by pets at the primary lesion site. Skin biopsy for tissue histopathology and culture is essential.

Clinical characteristics, mortality, and prognostic factors for bullous pemphigoid in a Thai population.

Bullous pemphigoid is an uncommon, autoimmune, blistering disease. Clinical features, associated conditions, and outcomes differ according to country. We aimed to determine the mortality rate and clinical characteristics of Thai patients and to evaluate the risk factors associated with survival.A retrospective analysis was conducted on 119 patients, over a ten-year period, at Songklanagarind Hospital, the largest tertiary university hospital in Southern Thailand.The median age of onset was 82 years [interquartile range 72, 90], and 60 (50.4%) patients were men. The underlying diseases were hypertension (53.8%), neurological disease (42.8%), and diabetes mellitus (31.9%). Fifty-eight patients (48.7%) experienced pruritus, and 61.3% of patients had mild cutaneous lesions (less than 10% of the body surface area) on the day of diagnosis. Nine percent of patients presented with mucosal involvement. Complete blood counts showed anemia (32.8%), neutrophilia (30.3%), and eosinophilia (42.9%). The 1-, 3- and 5-year overall mortality rates were 28.1% [95% confidence interval (CI), 7.8-36.6], 55.7% (95% CI, 44.4-64.7) and 71.9% (95% CI 59.9-80.2), respectively. On multivariate analysis, high neutrophil/lymphocyte ratio [odds ratio (OR) 5.55, P < .001] and anemia (OR 2.93, P = .025) were found to be independently associated with mortality rate, whereas disease remission (OR 0.25, P = .003) was demonstrated to be a good prognostic factor.This is the first study to analyze the mortality rate of Bullous pemphigoid in Thailand. Mortality was associated with high neutrophil/lymphocyte ratio and anemia.

Recurrent extragenital herpes simplex type 2 occurring in a distal location of the same dermatome.

Herpes simplex infection (HSV) is a common infectious disease, which the main clinical manifestations are mucocutaneous infection. Extragenital infections are reported in both type 1 and type 2 of herpes simplex virus. We report a case of a 33-year-old female with recurrent extragenital HSV type 2 infection on the right medial wrist. The patient had history of the previous infection site locating on the right posterior deltoid however both of two sites are the same dermatomal distribution. This report demonstrates the recurrent herpes simplex infection can develop in another area of the dermatomal distribution.

Clindamycin-induced acute generalized exanthematous pustulosis: A case report.

RATIONALE: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. Sterile, non-follicular pustules overlying the erythematous skin characterize this reaction. PATIENT CONCERNS: A 30-year-old Asian women presented with sterile, non-follicular lesions with pus-fluid levels on her back 2 days after taking clindamycin. Skin biopsy revealed a spongiotic change in the epidermis with a focal subcorneal pustule and perivascular eosinophil and lymphocyte infiltration. DIAGNOSIS: Clindamycin-induced AGEP. INTERVENTIONS: We discontinued clindamycin treatment and prescribed systemic corticosteroids. OUTCOMES: The pustule stopped spreading within 1 day and the rash improved within 2 days. LESSONS: AGEP is a pustular cutaneous adverse drug reaction that can appear with pus-fluid levels, clinically mimicking Sneddon-Wilkinson disease. The differentiation between both conditions is a history of drug use, characteristic skin lesions and histopathology.

A Case Report of Prurigo Nodularis-Like Lesions in a Patient with Lepromatous Leprosy.

Leprosy or Hansen's disease is a chronic granulomatous infection that primarily affects the peripheral nerves and, consequently, the skin. Clinical manifestations vary from hypopigmentation to erythematous plaques, and it can present with leonine facies. We report a case of a patient with an uncommon clinical presentation of prurigo nodularis-like lesions without loss of sensation, for which two biopsy specimens demonstrated different histological subtypes. The first was the classic histology of lepromatous leprosy, whereas the other specimen revealed an atypical histoid leprosy variant pattern. This case report describes a patient with an atypical presentation of leprosy.

Cutaneous Myiasis Caused by Chrysomya megacephala in an Infant with Psoriasis Vulgaris.

Cutaneous myiasis is an infestation of the skin by fly larvae, which usually occurs in adults. We present a case of cutaneous myiasis caused by Chrysomya megacephalain a 3-month-old infant with psoriasis vulgaris. In this case report, we highlight the clinical, histopathologic, taxonomic identification, and treatment of cutaneous myiasis occurring in psoriatic skin.

Burkitt lymphoma initially mimicking varicella zoster infection.

Burkitt lymphoma is an aggressive type of nodal non-Hodgkin lymphoma. This disease commonly involves the gastrointestinal tract, bone marrow, central nervous system, and in rare instances, the skin. We report the case of a 78-year-old Asian man who had experienced subacute fever and significant weight loss. He initially presented with a zosteriform skin rash on his right temporal area, which primary physicians diagnosed as varicella zoster infection and treated with antiviral drugs. The rash developed on the left forehead and chest. Dermatopathological studies on a skin lesion on the chest wall showed characteristics of Burkitt lymphoma. After a week of palliative chemotherapy, regression of all skin lesions was observed. This report aims to demonstrate an unusual zosteriform pattern of cutaneous involvement in Burkitt lymphoma.

Tinea nigra mimicking acral melanocytic nevi.

Tinea nigra is a superficial infection caused by dematiaceous fungi. The clinical skin lesion is characterized by well-circumscribed brown-black macule patches on the palms and soles. In Asia, such pigmentation on these areas can be suggestive of acral lentiginous melanoma, which cause morbidity and mortality. Here, we report a case of a young patient with solitary black macule on the left palm for a year. Potassium hydroxide test was positive for pigmented short hyphae. The lesion subsided following topical antifungal treatment without recurrence. This report aims to provide insights into diagnosis of patients with pigmentations on acral areas.

Verruca plana mimicking seborrheic keratosis in the elderly: A case report.

Verruca plana is a common viral infection in childhood and early adulthood caused by the human papillomavirus. The clinical presentation can mimic that of benign epithelial neoplasms, particularly seborrheic keratosis, which is common in the elderly. We report a case involving an Asian female patient in her eighties who presented with multiple skin papules resembling seborrheic keratosis on her forehead. Based on the dermatopathologic studies, verruca plana was diagnosed.

Poroma: A case report of pulsatile papule visualized on dermoscopy.

Poroma, a benign sweat tumor, commonly presents with a nontender papule on the extremities. It can appear with a blinking light appearance on dermoscopy in real time.

Calciphylaxis mimicking ecthyma gangrenosum.

Calciphylaxis is a rare cutaneous disease that may cause fatal complications in patients on long-term dialysis. Early diagnosis and proper management decrease complications. However, it can mimic cutaneous infections, especially ecthyma gangrenosum and cutaneous vasculitis. The authors report on a patient with chronic kidney disease (CKD) on dialysis for 10 years who developed painful skin necrosis on his right thigh. The tissue culture was positive for Enterobacter cloacae, Citrobacter freundii, and Pseudomonas aeruginosa, but the histopathology was compatible with calciphylaxis. This report aims to further the knowledge of physicians in order to help them recognize calciphylaxis in CKD patients with painful necrotic ulcers.

Bullous and pustular cutaneous larva migrans: two case reports and a literature review.

Cutaneous larva migrans (CLM) is a common skin infestation in tropical countries. The classic presentation is a serpiginous, migratory track on the feet. Local and systemic reactions, as well as secondary bacterial infections, are rarely reported. The authors report two cases of CLM with a blister and pustular response on uncommon body locations. The patients were treated with anthelmintic therapy, and a topical corticosteroid was used to relieve their severe reactions. This report aims to describe an infrequent presentation of a common disease and review treatment plans.

Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report.

RATIONALE: Thrombotic thrombocytopenic purpura (TTP) and hemophagocytic lymphohistiocytosis (HLH) are rare hematologic conditions and have high mortality. Both TTP and HLH result from deregulation of the immune system. There are no published reports of coexisting TTP and HLH in elderly patients. PATIENT CONCERNS: A 67-year-old Asian male presented with altered consciousness and fever for 2 days. Physical examination revealed markedly pale, mild icterus with petechiae and purpura. Initially, TTP was recognized in this patient. Bone marrow studies are suggested for evaluating elderly patients to assess specific causes, especially infection and neoplasm. DIAGNOSES: The TTP was diagnosed based on typical history-related symptoms and a specific laboratory result of very low ADAMTS13 level. The diagnosis of HLH was determined after detection of high levels of ferritin and lactase dehydrogenase, which were confirmed by the presence of hemophagocytosis in the bone marrow. INTERVENTIONS: Systemic corticosteroids and plasma exchange were initiated as specific treatment of the patient. OUTCOMES: The patient died in 3 weeks from ventilator-associated pneumonia. LESSONS: The HLH should be tested using bone marrow studies and specific laboratory tests in patients with TTP.

Tinea of vellus hair: a diagnostic and therapeutic challenge.

Tinea infection is a common superficial fungal infection of the skin, hair and nails. Tinea of vellus hair is a rare form of dermatophytosis that is difficult to diagnose and treat. Herein, the authors report the case of a patient who had an itchy rash on the cheek. Microscopic and mycological studies confirmed the diagnosis of tinea of vellus hair. The patient was treated with systemic antifungal therapy with clinical improvement. This report aims to describe an infrequent subtype of common disease and review clinical clues, tools for diagnosis as well as treatment plans.

Lobular panniculitis associated with chikungunya fever: A case report.

Chikungunya fever is a mosquito-borne viral disease classically characterized by an acute onset of fever, arthralgia, and skin rash. In this article, we report the acute febrile illness of an adult female with arthropathy and morbilliform eruptions. The patient developed panniculitis lesions on both shins. This report aims to describe an infrequent cutaneous presentation of chikungunya fever.

Zoster-like cutaneous metastatic adenocarcinoma of the lung: A case report.

The zosteriform pattern is an infrequent cutaneous finding in oncologic patients who have a skin metastasis from a different primary source. Herein we report a case of adenocarcinoma of the lung which presented with zoster-like lesions along the thoracic dermatome. The histopathology indicated a metastatic neoplasm with variable glandular formations. Immunohistochemistry results pointed to the diagnosis of metastasized lung cancer. We suggest physicians should consider this rare diagnosis when experiencing similar cases.

The use of topical minoxidil to accelerate nail growth: a pilot study.

Linear nail growth rate is affected by various conditions, one of which is the level of blood flow. Our supposition was that topical minoxidil, which has vasodilatory properties, can increase the rate of nail growth. The aim of this study was to determine the impact of topical minoxidil on nail growth. A 5% topical minoxidil solution was applied twice daily to the fingernails of 32 participants. Two groups of 16 participants were randomly chosen. In one group, the applications were made to the right index and left ring fingernails, and, in the other, the left index and right ring fingernails. During each visit (weekly during the first month and every 2 weeks during the second month), the nail length of six fingernails (index, middle, and ring of both hands) was measured using a digital caliper. Beginning in the first week, the mean nail length of the treated nails was greater than that of nails in the untreated group with statistical significance. There were no systemic or cutaneous side effects. During the first month, the mean growth of the treated nails was 4.27 mm/month compared with 3.91 mm/month in the untreated nails (P = 0.003). These findings suggest that a 5% concentration of topical minoxidil can stimulate nail growth with increased growth beginning in the first week of application. The results may have important implications for the treatment of nail disorders; however, a comparable study involving participants with nail disorders is highly recommended.