ABSTRACT
Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous skin disease mainly affecting the central area of the face. A variety of treatments are reportedly of some benefit; however, controlled studies to establish the best treatment are lacking. Here, we report the cases of a 33-year-old man who presented with multiple, various-sized, erythematous maculopapules on the face and a 19-year-old man who presented multiple, reddish papuloplaques distributed on the face. Histopathological examinations of the two cases revealed large clear-boundary epithelioid cell granulomas with central necrosis surrounded by lymphocytic infiltration. Based on the clinical and histological findings, diagnoses of LMDF were made. As oral tetracycline and antimalarials were not fully effective in our cases, oral mini-pulse steroid therapy (dexamethasone, 5 mg bid for 2 days per week) was initiated. After several months, the eruption significantly improved, and most lesions were resolved. Here, we report two cases of LMDF successfully treated with oral mini-pulse steroid therapy.
Subject(s)
Adult , Humans , Young Adult , Antimalarials , Diagnosis , Epithelioid Cells , Granuloma , Necrosis , Skin Diseases , TetracyclineABSTRACT
Intralymphatic histiocytosis (IH) is a rare disease with variable and nonspecific clinical features, but with characteristic histopathological findings. Histopathologically, dilated lymphatic vessels containing aggregates of mononuclear cells are observed near the reticular dermis. IH is often associated with other diseases, such as rheumatoid arthritis, osteoarthritis, joint metal implantation, and with breast cancer where it occurs over the mastectomy scar. Although the pathogenesis of IH is not defined, some authors have suggested that lymphatic vessel engorgement by histiocytes migrating from neighboring inflammatory reactions may play a key pathogenic role. We present a case of IH associated with breast cancer. A 50-year-old female developed multiple tender erythematous plaques on both breasts and the right shoulder 3 years after bilateral mastectomy. To our knowledge, this is the first case of IH in association with breast cancer in the Korean dermatologic literature.
Subject(s)
Female , Humans , Middle Aged , Arthritis, Rheumatoid , Breast Neoplasms , Breast , Cicatrix , Dermis , Histiocytes , Histiocytosis , Joints , Lymphatic Vessels , Mastectomy , Osteoarthritis , Rare Diseases , ShoulderABSTRACT
BACKGROUND: Many studies about herpes zoster are available in Korean dermatological literature. However, only a few of them reported herpes zoster meningoencephalitis. OBJECTIVE: The aim of this study was to determine the epidemiology and clinical features of herpes-zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. METHODS: We examined the medical records of 3,154 patients with herpes zoster, who had visited our hospital from January 2008 to March 2016. Among them, 159 patients underwent cerebrospinal fluid analysis. Fifty-one patients who were diagnosed with herpes zoster meningoencephalitis and the 3,103 patients who were without meningoencephalitis were subjected to examinations to assess the incidence rates, the age distribution, the ganglion distribution, severity of acute pain, postherpetic neuralgia, serum VZV IgM and IgG, the clinical aspects, the underlying diseases, and the presence of complications. RESULTS: The rate of herpes zoster meningoencephalitis was 1.61%, with a mean age of 53.95 years, and the female-to-male patient ratio was 1.68. The trigeminal nerve was the most frequently involved dermatome (53.7%), with the ophthalmic branch (V1) involved at a rate of 68.96% among them. The serum VZV IgM was significantly higher in herpes zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. Dizziness, mental change, palsy, and myalgia with nausea/vomiting showed high predictive values. All the patients were treated with acyclovir for 10~14 days, and 1 of them expired (1.96%). CONCLUSION: The results of this study demonstrated that herpes-zoster meningoencephalitis was associated with high serum levels of VZV IgM compared with herpes zoster without meningoencephalitis. When a patient with herpes zoster has symptoms of headache and nausea/vomiting with dizziness, mental status change, palsy, or myalgia, herpes-zoster meningoencephalitis should be considered.