Chronic non-healing ulcers as presenting sign of acquired immunodefciency syndrome

@#A typical forms of herpes simplex virus (HSV) infections, which indicate severe impairment of cellular immunity can be challenging to diagnose. In this paper, we report the case of an atypical HSV infection presenting as chronic nonhealing wounds, which are the frst sign of HIV, in a 50-year-old female patient. Te lesions had emerged as two large, chronic, and painful ulcerations on the left buttock and labia major 8 months prior. Te skin biopsy revealed multinucleated keratinocytes with ground glass nuclei and intranuclear Cowdry type A viral inclusions. A serologic test for HIV-1 was positive. Her CD4+T-cell count was 42/mm3. Clinicians should be familiar with the dermatologic manifestations of HIV, as they are occasionally key to correctly suspecting an underlying HIV infection, allowing for early diagnosis and treatment.

Elevated serum nitric oxide and hydrogen peroxide levels as potential valuable predictors of herpes zoster

Objective:To evaluate the biomarkers of oxidative stress in herpes zoster patients compared with control subjects.Methods:This study compared the nitric oxide (NO), hydrogen peroxide (HResults:The significant differences were observed in the serum levels of NO, HConclusions:High levels of NO and H

Elevated serum nitric oxide and hydrogen peroxide levels as potential valuable predictors of herpes zoster

Objective: To evaluate the biomarkers of oxidative stress in herpes zoster patients compared with control subjects. Methods: This study compared the nitric oxide (NO), hydrogen peroxide (H

Evaluation of elastic fibers pattern with orcein staining in differential diagnosis of Lichen planopilaris and discoid Lupus erythematosus

Differential diagnosis of Lichen planopilaris and discoid lupus erythematosus especially in late stages is a problem for clinicians and pathologists. Our aim was to find discriminator histopathologic findings that help us to achieve definite diagnosis without using immunofluorescence study. The histopathologic findings in 77 cases of lichen planopilaris were compared with those of 26 cases of discoid lupus erythematosus with Hematoxylin and Eosin and especially staining [Alcian blue pH 2.5, Periodic Acid Shiff, Orcein]. Final histopathologic diagnosis was based on histologic findings, clinicopathological correlation, past medical history and immunofluorescence studies if were applied before. Then elastic fibers pattern in dermis and follicular sheath with orcein staining were described without having information about final diagnosis. New and subtle presentations of histologic changes were assessed. We compared all histopathologic finding for each staining method. Some histologic changes such as hypergranulosis, epidermal atrophy, mucin deposition, diffuse scar and some other patterns were not specific for any diagnosis. A setting of histopathologic findings and clinicopathological correlation were needed for accurate diagnosis. We had only one specimen for the vertical section, and we had no horizontal sections. Description of elastic fibers pattern in orcein staining may be helpful in achieving a specific diagnosis, but this is not completely reliable, and we had overlap features. Finally, immunofluorescence study may be recommended for suspicious cases

Cutaneous leishmaniasis with unusual clinical and histological presentation: report of four cases

Old world cutaneous leishmaniasis [OWCL] usually causes a single, self-healing and uncomplicated lesion mainly on the exposed area of body. This report presents four cases of OWCL from Iran that misdiagnosed with sarcoidosis, lymphoma, and acne agminata. Two out of four patients showed a history of purplish red plaques for at least 5 years who misdiagnosed as sarcoidosis because of histological and clinical characteristics. The other one presented with flesh-colored nodules disseminated all over his skin that was misdiagnosed as lymphoma for ten years. The last patient was misdiagnosed as acne agminata due to tuberculoid reactions in examination of the lesion biopsy. All the patients responded to the treatment with meglumine antimonate

Clinical and laboratory features of anticonvulsant cutaneous reactions

Cutaneous drug reaction is a common side effect of antiepileptic drugs [AEDs]. In recent years, a significant increase in cases of cutaneous drug reaction due to AEDs and some changes in its pattern in our department have been noticed. Therefore, we carried out this study to present clinical and paraclinical characteristics of these cases. All records of patients who were hospitalized at our hospital with a diagnosis of cutaneous drug reaction due to anticonvulsant therapy between March 2006 and September 2009 were reviewed. The most common offending drug was lamotrigine. The main indication of anticonvulsant therapy was for idiopathic seizures. The most frequent type of cutaneous reaction was maculopapular and/or erythrodermic rash. Eosinophilia was detected in 56.5% of the patients. Although serious reactions with AEDs are not common, they may be life threatening. So, timely and accurate diagnosis can prevent fatal reactions and affects subsequent anticonvulsant treatment options

Granuloma faciale with disseminated extrafacial lesions

Granuloma faciale [GF] is a rare cutaneous disorder categorized as a localized form of small-vessel vasculitis. Clinically, it manifests as single or multiple well-demarcated red-brown plaques, papules and nodules, nearly always confined to the face. Herein, we report a 39-year-old man with multiple red-brown infiltrated plaques on face and extrafacial lesions on back, shoulders and both arms. Skin biopsy revealed typical histopathological findings of GF. The patient failed to respond to pulsed dye laser but intralesional triamcinolone combined with cryotherapy led to an acceptable response

Does short-term low-dose methotrexate treatment affect homocysteine blood level in patients with psoriasis?

An elevated homocysteine level is an independent risk factor for cardiovascular disorders. Psoriatic patients have an increased risk of cardiovascular diseases; In addition, hyperhomocysteinemia is a complication of methotrexate treatment. We undertook a study to evaluate the plasma levels of homocysteine, vitamin B12 and folate in patients with psoriasis before and after short-term low-dose methotrexate treatment. Twenty six patients with psoriasis were recruited. The plasma levels of homocysteine, vitamin B12 and folate were evaluated before and 8 weeks after methotrexate therapy [in the peak of methotrexate effect]. No significant difference was found between the plasma profile of homocysteine, vitamin B12 and folate before and after methotrexate treatment. In the short-term treatment of psoriasis, methotrexate does not increase homocysteine level

Isotretinoin in treatment of acne: its efficacy, side effects, and recurrence rate of disease

Acne is a chronic inflammatory disease of pilosebaceous units. In addition to an unpleasant appearance, it may result in scarring in some cases. Despite the introduction of different treatments, oral isotretinoin is the most effective treatment and affects all the factors involved in the pathogenesis of this disease. This study was performed on patients with acne to examine the therapeutic effects, recurrence rate, and adverse effects of this drug. One hundred patients with acne, who were visited at the Bou-Ali Hospital during 2000 - 2001, and found eligible to take part in this study were selected. The severity of acne was graded at the beginning, during, and after a 6-month treatment course with oral isotretinoin. Necessary laboratory tests were done. The data of 83 of 100 patients who continued the treatment for 6 months were analyzed. The mean +/- SEM severity score of acne improved from 3.15 +/- 0.10 to 0.58 +/- 0.09 [P < 0.0001]. Complete cure was achieved in 65% of patients. The mean +/- SEM follow-up was 8.7 +/- 2.3 months and the acne severity score was 1.04 +/- 0.13 during the follow-up period. Overall, the recurrence rate was 19%; 4% of patients had to undergo retreatment. A rise in triglyceride level was the only significant laboratory alteration observed. Oral isotretinoin appears to have favorable results and the least adverse effects in treatment of carefully-selected patients with acne