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.

Evaluation of Hair Follicle Counts of Occipital Scalp Biopsies from Male Hair Transplant Patients in Thailand

Objective: To evaluate the average hair follicle count from the occipital scalp of Thai males with AGA who were candidates for hair transplantation. Materials & Methods: A cross-sectional study of 47 male with AGA undergoing hair transplantation surgery was conducted.  The 4-mm punch biopsies from the occipital scalp were evaluated for hair count parameters. The results were compared to prior studies. Results: The average counts of total hair follicles and the density of hair follicle per square millimeter were 18.6±1.2, and 1.5±0.1, respectively. The terminal-to-vellus ratio was 11.1, and the percent ratio of anagen-to-telogen ratio was 91.9:8.1. The hair count number is significantly lower than other ethnicities including Thais in general population (P < 0.001), but greater than the Thai males with AGA in the previous study. (P < 0.001). Conclusion: Our study showed a lower average hair density as compared to the other normal Asian population.  The total hair count in the occipital area from this study is less when compared to the previous studies conducted in Thai normal controls but higher than those with more advanced AGA. This result supported the evidence of hormonal effect involving the occipital scalp of male AGA.  

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.

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.

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.

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.

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.

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.

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.

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.

Elephantiasic Pretibial Myxedema: A Rare Manifestation in Graves’ Disease

Elephantiasic pretibial myxedema is an extremely rare condition, affecting patients with thyroid disease. The clinical manifestation is difficult to diagnosis, and the treatment is challenging. Herein, the authors report on a case of a patient with Graves’ disease, who had a long-standing enlargement of bilateral legs, and histopathologic studies confirmed the diagnosis as; pretibial myxedema. The patient was treated with an antithyroid drug, iodine-131 (131I) irradiation, a potent topical corticosteroid, with occlusion, and compression therapy, however, the patient’s skin condition remained unchanged. This report aims to demonstrate a rare form of pretibial myxedema, to review the clinical presentations, differential diagnosis as well as therapeutic options.

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.

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.

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.

Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis

A 60-year-old female was diagnosed with progressive systemic sclerosis and interstitial lung disease of two months' duration. The patient was treated for Raynaud phenomenon with aspirin, nifedipine, colchicine, and naproxen. Two weeks after treatment, she developed widespread erythematous patches with blistering eruptions on the face, torso, and extremities, and also had erosion on the oral mucosa. Skin biopsy for histopathology and direct immunofluorescent studies were suggestive of lupus erythematosus. To the best of our knowledge, this is the first case of toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis.

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.

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.

Risk Factors for Invasive Fungal Infection among Thai Oncologic Patients with Febrile Neutropenia and Cutaneous Presentation: A 5-Year Retrospective Study in Southern Thailand

Background:

Febrile neutropenia (FNP) is a condition defined by fever and neutropenia. There are current only limited data on related cutaneous manifestations. This study aimed to assess cutaneous lesions and their etiologies in a Thai group of FNP patients.

Methods:

A retrospective analysis was conducted on 43 non-transplant febrile neutropenic patients with concurrent cutaneous lesions, as determined by dermatopathologic studies at Songklanagarind Hospital in Thailand over a five-year period.

Results:

The mean age was 39 years (SD: 18.8). Approximately 60% were male. The most common underlying disease was a hematologic neoplasm. Twenty-one of the participants had developed FNP within 7.5±8.7 days after presenting with skin lesions. Twenty-two participants had skin lesions 9.0±11.1 days after FNP diagnosis. Cutaneous manifestations were mostly in the form of multiple lesions (67.4%), of which the most common were nodular skin lesions (37.2%) presenting on the lower extremities of the body (58.1%). The dermatopathologic diagnoses included infections which were almost all fungal and leukemia cutis. The development of skin lesions after FNP proved to be a statistically significant risk factor for fungal infection (OR 8.13, P = 0.009), whereas age (over 40 years) proved to be a statistically significant protective factor (OR 0.20, P = 0.04).

Conclusions:

There are a variety of cutaneous manifestations in FNP, of which the most common were cutaneous nodular skin lesions in the lower extremities. The most frequent infection was fungal in patients under 40 who had developed skin lesions after FNP.

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.

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.

Ultrasensitive hydrogen sensor based on Pt-decorated WO₃ nanorods prepared by glancing-angle dc magnetron sputtering

In this work, we report an ultrasensitive hydrogen (H2) sensor based on tungsten trioxide (WO3) nanorods decorated with platinum (Pt) nanoparticles. WO3 nanorods were fabricated by dc magnetron sputtering with a glancing angle deposition (GLAD) technique, and decorations of Pt nanoparticles were performed by normal dc sputtering on WO3 nanorods with varying deposition time from 2.5 to 15 s. Crystal structures, morphologies, and chemical information on Pt-decorated WO3 nanorods were characterized by grazing-incident X-ray diffraction, field-emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, and photoelectron spectroscopy, respectively. The effect of the Pt nanoparticles on the H2-sensing performance of WO3 nanorods was investigated over a low concentration range of 150-3000 ppm of H2 at 150-350 °C working temperatures. The results showed that the H2 response greatly increased with increasing Pt-deposition time up to 10 s but then substantially deteriorated as the deposition time increased further. The optimally decorated Pt-WO3 nanorod sensor exhibited an ultrahigh H2 response from 1530 and 214,000 to 150 and 3000 ppm of H2, respectively, at 200 °C. The outstanding gas-sensing properties may be attributed to the excellent dispersion of fine Pt nanoparticles on WO3 nanorods having a very large effective surface area, leading to highly effective spillover of molecular hydrogen through Pt nanoparticles onto the WO3 nanorod surface.

No Prognostic Impact of p53 and P-Glycoprotein Expression in Patients with Diffuse Large B-Cell Lymphoma

The aim of this study was to determine the clinical significances of p53 and p-glycoprotein (P-gp) expression on outcome predictors for patients with DLBC. We assessed the immunohistochemical expression of p53 and P-gp using formalin-fixed, paraffin-embedded specimens in 108 patients diagnosed with de novo DLBC. A high expression of p53 was found in 53.7% of the patients. No expression of P-gp was demonstrated in any of the specimens. There were no significant differences in the complete remission (CR) rate (P = 0.79), overall survival (OS) (P = 0.73), or disease-free survival (DFS) (P = 31) between the p53-positive and p53-negative groups. The final model from multivariate analysis that revealed poor performance status was significantly associated with CR (P < 0.001) and OS (P < 0.001). Moreover, the advanced stage was a significant predictor of DFS (P = 0.03). This study demonstrated no impact of the expression of p53 on either response or survival rates.