Subepidermal calcified nodule (nodular calcinosis of Winer)

Subepidermal calcified nodule (SCN) is a clinical form of idiopathic calcinosis cutis, which commonly affects children, and presents as yellowish-white lesions involving the face. It is often misdiagnosed for other disorders like warts and molluscum contagiosum and treated by ablative procedures. In such a scenario, lack of histopathological examination makes it difficult to reach the correct diagnosis. We here report a case of SCN which was diagnosed after an excisional biopsy. Further, histopathological finding of dermal calcium deposits must prompt the clinician to rule out other disorders leading to calcinosis cutis, before labelling the case as SCN.

A small molecule that targets the processivity factor of molluscum contagiosum virus has therapeutic potential

Molluscum contagiosum (MC) is an infectious disease that occurs only in humans with a tropism that is narrowly restricted to the outermost epidermal layer of the skin. Molluscum contagiosum virus (MCV) is the causative agent of MC which produces skin lesions that can persist for months to several years. MCV is efficiently transmitted by direct physical contact or by indirect contact with fomites. MC is most prevalent in children and immune compromised patients. The failure to develop a drug that targets MCV replication has been hampered for decades by the inability to propagate MCV in cell culture. To address this dilemma, we recently engineered a surrogate poxvirus expressing the MCV processivity factor (mD4) as the drug target. The mD4 protein is essential for viral replication by keeping the viral polymerase tethered to the DNA template. In this study we have designed and synthesized a lead compound (7269) that is able to prevent mD4 dependent processive DNA synthesis in vitro (IC50 = 6.8 μM) and effectively inhibit propagation of the mD4-VV surrogate virus in BSC-1 cells (EC50 = 13.2 μM) with negligible cytotoxicity. In human liver microsomes, 7269 was shown to be stable for almost 2 h. When tested for penetration into human cadaver skin in a formulated gel, the level of 7269 in the epidermal layer was nearly 100 times the concentration (EC50) needed to inhibit propagation of the mD4-VV surrogate virus in BSC-1 cells. The gel formulated 7269 was scored as a non-irritant on skin and shown to have a shelf-life that was completely stable after several months. In summary, 7269 is a potential Lead for becoming the first MCV anti-viral compound to treat MC and thereby, addresses this unmet medical need that has persisted for many decades.

[Young male patient with unusual space-occupying lesion of the lower eyelid]

BACKGROUND

A space-occupying lesion of the eyelid in young adults is often a sign of an inflammation, a trauma or a benign neoplasm. The aim of this case report is to demonstrate a rare basal cell carcinoma, which presumably already arose in adolescence without further high-risk factors.

METHODS

A 28-year-old male patient presented for a second opinion on a painless swelling of the right lower eyelid. According to the patient's history the swelling had been present since the age of 16 years and originally resembled a molluscum contagiosum. An ophthalmologist in private practice made the diagnosis of a suspected trichoepithelioma. The extended patient history revealed a blood coagulation disorder. The clinical ophthalmological examination revealed a nodular space-occupying lesion with a border wall and telangiectasia. The further ophthalmological examination was bilaterally inconspicuous. Due to the suspicion of a malignant process, an operation was promptly carried out using local anesthesia with complete tumor excision and pedicled flap plasty as well as a histopathological investigation to confirm the diagnosis.

RESULTS

The histopathological investigation revealed underlying infiltrates of a basaloid tumor with bale-shaped trabecular growth, sometimes with peripheral palisading of the cells. The cells were predominantly monomorphic with isolated pleomorphic nuclei and sometimes enclosed mitoses. Immunohistochemically the cells were strongly positive for BerEP4 and negative for epithelial membrane antigen (EMA). The diagnosis of a nodular basal cell carcinoma of the right lower eyelid was made. All incision margins were free of tumor cells (R0 resection). In the dermatological screening no further manifestations were detected.

CONCLUSION

Despite the occurrence of a space-occupying lesion of the eyelid in a young adult patient and also with no further risk factors, in addition to an inflammatory event and a benign tumor, a malignant disease, such as a basal cell carcinoma should also be taken into consideration. A tissue biopsy or complete excision with subsequent histological examination including an immunohistochemical analysis are essential for differentiation from other tumor entities.

[DISSEMINATED CRYPTOCOCCOSIS IN A LIVER TRANSPLANT RECIPIENT DIAGNOSED BY TZANCK SMEAR]

Cryptococcus neoformans is an opportunistic fungus which causes severe morbidity and mortality among immune-compromised patients. Cutaneous manifestations of systemic cryptococcosis are rare and may include a papulo-nodular rash, ulcers, cellulitis, molluscum contagiosum-like papules and more. The Tzanck smear is a well-known simple diagnostic test which can be performed bedside, in order to characterize cell cytology. Its classic use was in diagnosis of autoimmune blistering diseases or herpes virus infections. However, in recent years it has been used as an efficient diagnostic tool for other dermatologic conditions. We present a case of a 47-year old liver transplant recipient who presented with numerous cutaneous manifestations of disseminated cryptococcosis, initially diagnosed with bacterial cellulitis and non-melanoma skin cancer. With the aid of the Tzanck smear we rapidly established the correct diagnosis leading to swift treatment.

Eye signs that alert the clinician to a diagnosis of AIDS

One of the hallmarks of progressive immune deficiency is a steady decline in the absolute number of CD4+ T-lymphocytes. As the immune response thus becomes suppressed, opportunistic systemic infections such as protozoal (Pneumocystis carinii pneumonia, disseminated toxoplasmosis), viral (Cytomegalovirus pneumonitis and colitis and persistent invasive herpes simplex lesions), fungal (cryptococcossis and esophageal candidiasis) and bacterial infections (atypical mycobacterial and extrapulmonary tuberculosis) set in to claim their toll. Ocular complications occur in about 75% of AIDS patients and may be divided into four categories: Retinal microangiopathy, Opportunistic infections, Tumours, Neuro-ophthalmological lesions. Only the most frequently occurring manifestations will be highlighted.

An overview of poxviruses

The poxvirus family is a diverse and interesting group of viruses that affect both humans and animals. Poxviruses are epitheliotropic and therefore are of interest to the dermatologist. The genera of poxviruses known to affect humans are Orthopoxvirus, Parapoxvirus, Molluscipoxvirus, and Yatapoxvirus. The different poxviruses are reviewed, including their history, incidence, clinical presentation, and treatment.

The histogenesis of experimental molluscum sebaceum

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Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum

BACKGROUND

Viral folliculitis is an infrequently reported entity. The patients described herein were seen over a 12-year period of practice in a referral dermatologic setting. The cases involve a variety of viral infections limited to the hair follicle.

OBSERVATIONS

We describe 5 patients with a variety of viral folliculitides: 2 with herpetic sycosis caused by herpes simplex; 1 with herpex simplex folliculitis (this patient also had human immunodeficiency virus); 1 with herpes zoster without blisters; and 1 with molluscum contagiosum.

CONCLUSIONS

These 5 cases demonstrate that viral folliculitis has varied causes and presentations. Clinicians should consider viral agents in the differential diagnosis of superficial infectious folliculitis, especially in cases that are refractory to antibacterial or antifungal therapy.

Molluscum contagiosum of the eyelids in patients with acquired immune deficiency syndrome

BACKGROUND

Infection with molluscum contagiosum has been reported in patients with acquired immune deficiency syndrome (AIDS). Involvement of the eyelids by molluscum in patients with AIDS has rarely been mentioned.

METHODS

Two patients with AIDS presented with eyelid molluscum contagiosum. Detailed examination and follow-up was performed.

RESULTS

One patient had noted ocular irritation with epiphora for several weeks and showed a typical viral keratoconjunctivitis in both eyes. The other patient progressed to confluent masses involving the entire lower eyelid on one side. Removal of the lesions by surgery and cryotherapy was followed by recurrences in both patients within 6 to 7 weeks, the incubation period for this viral infection.

CONCLUSION

Molluscum contagiosum can form confluent lesions on the eyelids in patients with AIDS, which may cause a keratoconjunctivitis. Local removal of molluscum eyelid nodules appears to be of limited long-term value in patients with T-cell immunodeficiency.

The office approach to the sexually transmitted diseases: Part II

All physicians share a responsibility for educating the public in the expanding risks of sexually transmitted diseases, and in the vital importance of safe sexual practices. Both the public health implications of undiagnosed STDs and the adverse social consequences of an incorrect diagnosis emphasize the need to comprehensively and precisely diagnose these diseases, despite the problems encountered in obtaining material for culture. Current interest in AIDS should not obscure the facts that genital herpes continues to increase in prevalence, and that syphilis no longer is declining. The many extragenital syndromes associated with STDs, such as perihepatitis, polyarthritis, and acute septic states make it necessary to evaluate all sexual contacts.

Ocular viral infections

The ocular manifestations of viral infection vary greatly. Involvement of the anterior segment is generally mild and self-limited, except in cases of congenital infection which are often associated with significant alteration of ocular structures or in cases of childhood infection with herpes simplex virus or varicella-zoster virus, in which prolonged inflammation may lead to corneal thinning or perforation, glaucoma and cataract formation. Involvement of the posterior structures is potentially sight-threatening. Retinal or optic nerve involvement should be suspected in any patient who complains of acute onset of blurred vision in the absence of anterior segment inflammation or opacities in the ocular media. Fortunately retinal viral infection is rare in immunocompetent hosts. Optic neuropathy may occur as an isolated sign but is more often associated with more generalized involvement of the central nervous system. While specific therapy is not always available, early diagnosis of ocular viral disease should aid in the amelioration of acute symptoms and prevention of long term complications.