Questions raised by a case of adult-onset linear nodular scleroderma

Morphea presenting clinically with nodular or keloidal skin changes is extremely rare. Nodular scleroderma or keloidal morphea presenting in a linear distribution is even more uncommon. We present an otherwise healthy young woman with unilateral, linear, nodular scleroderma and review the somewhat confounding earlier literature in this area. To date, this young woman's skin changes have proven refractory to oral hydroxychloroquine and ultraviolet A1 phototherapy. Several aspects of this case including the patient's family history of Raynaud disease, her nodular sclerodermatous skin lesions, and the presence of U1RNP autoantibodies raised concern about her management with respect to future risk of developing systemic sclerosis.

Darier disease, radiation therapy, and herpesvirus -- an unfortunate triad

Darier disease (DD) is a rare autosomal dominant keratinizing disorder often characterized by brown scaly pruritic papules over the face, neck, and trunk. Herein is reported a patient who developed secondary cutaneous herpes simplex virus (HSV) following exacerbation of his DD as a result of radiation therapy. In November 2020, a 78-year-old man presented to clinic for a pruritic rash on his back consistent with DD. He had developed the rash after the conclusion of chemoradiation therapy for recently diagnosed urothelial carcinoma of the bladder with squamous differentiation. However, he returned two weeks later complaining of a marked worsening of the rash associated with a pain and burning sensations. Histopathology was non-conclusive, but the lesions were found to be positive for HSV-1 by PCR. The patient recovered without complication over a period of two weeks following a course of valacyclovir. There is precedent in the literature for ionizing radiation inducing flares of DD lesions in overlying skin. In addition, DD has been shown to put a patient at increased risk for secondary infections such as HSV. This case report demonstrates that HSV could pose a significant risk to those with DD receiving radiation therapy and thus could warrant prophylactic treatment.

Eosinophils are surprisingly common in biopsy specimens of cutaneous herpes simplex virus and varicella zoster virus infections: Results of a comprehensive histopathologic and clinical appraisal

BACKGROUND

While usually straightforward, diagnostic features of cutaneous herpes simplex virus and varicella zoster virus infection (HSV/VZV) are not always present in biopsy specimens. Although intuitively the presence of eosinophils may lead the pathologist away from the diagnosis of cutaneous HSV/VZV infection, in our practice we have noted that eosinophils are often encountered in diagnostic specimens.

METHODS

To deduce the frequency with which the inflammatory response accompanying cutaneous HSV/VZV infection includes significant numbers of eosinophils, we performed a retrospective review. We included 159 specimens from our database, diagnosed between 2009 and 2017. We determined the number of eosinophils in 10 high-power fields and noted additional histologic factors including presence of follicular involvement, ulceration, and pseudolymphomatous change.

RESULTS

Of all included cases, 63% had 0-1 eosinophils, 24% had 2-10 eosinophils, and 13% had more than 10 eosinophils. Statistical analysis did not reveal a significant association between any demographic or histologic features examined and the presence of increased eosinophils.

CONCLUSIONS

In this study, more than one-third of biopsy specimens diagnostic of cutaneous HSV/VZV infection had a prominent number of eosinophils. The detection of eosinophils should not be unexpected and should not lessen diagnostic suspicion for cutaneous HSV/VZV infection.

The characterization of serpentine minerals by X-ray diffraction

X-ray diffraction data on serpentine minerals are discussed. There arc three structural varieties of chrysotile: ortho-chrysotile, clino-chrysotile, and para-chrysotile. Methods are described for the estimation of the proportions of the first two of these in mixed specimens, and their distribution in nature is reviewed. The variations observed in powder photographs of serpentine minerals are interpreted in accordance with this classification. The criteria proposed by Selfridge for distinguishing between chrysotile and antigorite are shown to be unreliable, but valid criteria are presented. The powder photographs also reveal the existence of a third serpentine mineral, distinct from chrysotile and antigorite, for which the name lizardite is proposed. Four samples of bastite are shown to consist of chrysotile or lizardite rather than antigorite. All the serpentine minerals examined consist either of antigorite or of one or more of the group comprising lizardite and the chrysotile varieties.

Investigation of the crystal structure of antigorite

Selfridge (1936) examined by chemical, optical, and X-ray powder methods a large number of specimens of serpentine minerals (ideal formula H4Mg3Si2O9), many of which were known as antigorite. He found that nearly all gave similar powder photographs, indicating a close structural relationship, but that there were noticeable differences on the basis of which the specimens could be separated into two groups, one giving a photograph similar to that of chrysotile asbestos, and the other containing the varieties called antigorite. Gruner (1937) came to similar conclusions, and in addition he indexed most of the reflections using the cell dimensions a 5.33, b 18.5, c 2 x 7.33 Å., β 93°, remarking in particular on the correspondence between 001 reflections in the two groups.

Relapsing polychondritis with meningoencephalitis

Relapsing polychondritis (RP) is a rare autoimmune disease of the cartilaginous structures of the body with many systemic manifestations including meningoencephalitis (ME). We present a case of a man with RP-associated ME that was responsive to steroid treatment. An updated literature review of 7 cases of RP-associated ME also is provided. Early diagnosis of this condition may be of benefit to this select population of patients, and further research regarding the prognosis, mechanisms, and treatment of RP may be necessary in the future.

Noninvasive in vivo imaging to evaluate immune responses and antimicrobial therapy against Staphylococcus aureus and USA300 MRSA skin infections

Staphylococcus aureus skin infections represent a significant public health threat because of the emergence of antibiotic-resistant strains such as methicillin-resistant S. aureus (MRSA). As greater understanding of protective immune responses and more effective antimicrobial therapies are needed, a S. aureus skin wound infection model was developed in which full-thickness scalpel cuts on the backs of mice were infected with a bioluminescent S. aureus (methicillin sensitive) or USA300 community-acquired MRSA strain and in vivo imaging was used to noninvasively monitor the bacterial burden. In addition, the infection-induced inflammatory response was quantified using in vivo fluorescence imaging of LysEGFP mice. Using this model, we found that both IL-1α and IL-1β contributed to host defense during a wound infection, whereas IL-1β was more critical during an intradermal S. aureus infection. Furthermore, treatment of a USA300 MRSA skin infection with retapamulin ointment resulted in up to 85-fold reduction in bacterial burden and a 53% decrease in infection-induced inflammation. In contrast, mupirocin ointment had minimal clinical activity against this USA300 strain, resulting in only a 2-fold reduction in bacterial burden. Taken together, this S. aureus wound infection model provides a valuable preclinical screening method to investigate cutaneous immune responses and the efficacy of topical antimicrobial therapies.

An unusual presentation of blastomycosislike pyoderma (pyoderma vegetans) and a review of the literature

We report a case of blastomycosislike pyoderma (BLP), also known as pyoderma vegetans, in a 75-year-old woman. The patient initially presented with multiple lesions, some classic and others with highly uncharacteristic morphology. The appearance of unusual purulent hornlike lesions on both cheeks delayed recognition of the disease. The diagnosis of BLP is contingent on the fulfillment of 6 diagnostic criteria and the disease is highly refractory to current treatment strategies. We review the present understanding of disease pathology and available therapeutic modalities.

Zoster vaccine live for the prevention of shingles in the elderly patient

Shingles, also known as herpes zoster, is a common disease in the elderly population that is caused by reactivation of latent varicella zoster virus. Its manifestations and complications can lead to significant short- and long-term morbidity. In 2006, the United States Food and Drug Administration approved Zoster Vaccine Live (Zostavax) for the prevention of herpes zoster in immunocompetent adults age 60 and over. The approval was based on the results ofa large, multi-center clinical trial, the Shingles Prevention Study. This study showed that vaccination significantly decreased shingles incidence, burden of illness due to disease, and the development of, and severity of postherpetic neuralgia. This review offers an overview of varicella zoster virus infection and complications, a summary of the Shingles Prevention Study, and a critical analysis designed to aid the practicing physician who has questions about vaccine administration.

Mineralogical and petrological investigations of lunar samples

Fragments of igneous rocks and breccias, and one coarse-grained rock with thin sections, have been studied. Minerals found include pyroxene, plagioclase, olivine, ilmenite, troilite, ulvöspinel, native iron, cristobalite, tridymite, alkali feldspar, apatite, and quartz. Textures are described and interpreted. Among features revealed by optical, microprobe, x-ray diffraction, and electron microscope methods are extreme zoning and unmixing in pyroxene grains, compositional variations in ilmenites, and effects of shock metamorphism. Some trace elements were determined by x-ray fluorescence analysis.