ABSTRACT
Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.
Subject(s)
Aged , Female , Humans , Acitretin , Amyloid , Amyloidosis , Biopsy , Birefringence , Bowen's Disease , Carcinoma, Basal Cell , Congo Red , Dermis , Eosinophils , Extremities , Ficusin , Leg , Microscopy, Electron , Mycosis Fungoides , Phototherapy , Physical Examination , Plaque, Amyloid , Porokeratosis , PUVA Therapy , Skin , Ultraviolet TherapyABSTRACT
Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.
Subject(s)
Aged , Female , Humans , Acitretin , Amyloid , Amyloidosis , Biopsy , Birefringence , Bowen's Disease , Carcinoma, Basal Cell , Congo Red , Dermis , Eosinophils , Extremities , Ficusin , Leg , Microscopy, Electron , Mycosis Fungoides , Phototherapy , Physical Examination , Plaque, Amyloid , Porokeratosis , PUVA Therapy , Skin , Ultraviolet TherapyABSTRACT
Reconstruction of defects on the lower third of the nose is always a challenge, as dissection of tissues in this area is not simple due to both a lack of elasticity and the structural complexity of the mid-facial area. When the defect size is less than 1.5 cm on the nose, primary closure or a bilobed flap is widely-used, while a skin graft is required for reconstruction of larger defects. Here we present two cases of a nasalis myocutaneous island pedicle flap with bilevel undermining with a relatively large nasal dorsum defect (>2 cm). The nasalis myocutaneous island pedicle flap with bilevel undermining was performed in order to maximize the movement of skin flaps and minimize the secondary movement of flaps after surgery. The nasal tip showed a slight upward movement immediately after surgery that subsequently moved down to a normal level. This technique can be utilized for reconstruction of the lower part of the nose for defects 2 cm or larger in size by maximizing the movement of the flap within the nasal structure. A major advantage is a higher flap survival rate due to proper arterial supply and the procedure results in relatively reduced secondary motion of the flap after the surgery.
Subject(s)
Elasticity , Nose , Skin , Survival Rate , TransplantsABSTRACT
BACKGROUND: Low-fluence 1,064 nm Q-switched Nd:YAG laser has been widely used for the treatment of melasma. Although new Q-switched Nd:YAG lasers with photoacoustic twin pulse (PTP) mode have been recently developed for high-efficiency, there is limited information available for the new technique. OBJECTIVE: This study was designed to investigate the efficacy and adverse effects after few sessions of repeated low fluence 1,064 nm Q-switched Nd:YAG laser treatment with PTP mode in Asian women with melasma. METHODS: Twenty-two Korean women were treated with a total of five sessions of low-fluence PTP mode Nd:YAG laser treatment (Pastelle®) at 2 weeks interval. Responses to treatments were evaluated by using Melasma Area and Severity Index (MASI) scoring, colorimeter measurement, and the investigators' and patients' overall assessments. Adverse events were recorded at each visit. RESULTS: Investigators' and patients' overall assessment showed that 'significantly improved' was assessed by 13 (59.1%) and 19 of 22 patients (86.4%), respectively. MASI scores were significantly reduced by 20.4%. The lightness, measured by using a colorimeter, was significantly increased by 1.3 point. Notable adverse events were not observed. CONCLUSION: After 5 sessions of laser therapy alone, about 60% of the subjects showed significant improvement. Few sessions of repeated laser toning treatment using the PTP mode is a safe and effective way to treat facial melasma.
Subject(s)
Female , Humans , Asian People , Laser Therapy , Melanosis , TwinsABSTRACT
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main symptoms of scrub typhus are fever, eschar, generalized rash, and swelling of the lymph nodes. Complications include pneumonia, myocarditis, meningitis, hepatitis, acute renal failure, and hearing loss. We report a rare case of Tsutsugamushi disease with acute bilateral hearing loss in a 65-year-old woman. The antibodies against O. tsutsugamushi were detected which led to the diagnosis of scrub typhus. She was treated immediately with oral doxycycline for 9 days and had a rapid and complete recovery. Scrub typhus can be associated with hearing loss, which is present in approximately one-third of the cases, but it is rare in Korea, therefore it is easy to misdiagnose scrub typhus as any other otological abnormalities. When patients present with fever, rash, and sensorineural hearing loss, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.
Subject(s)
Aged , Female , Humans , Acute Kidney Injury , Antibodies , Diagnosis , Doxycycline , Exanthema , Fever , Hearing Loss , Hearing Loss, Bilateral , Hearing Loss, Sensorineural , Hepatitis , Korea , Lymph Nodes , Meningitis , Myocarditis , Orientia tsutsugamushi , Pneumonia , Scrub TyphusABSTRACT
Plexiform fibrohistiocytic tumor (PFHT) is a rare mesenchymal neoplasm of intermediate malignancy and possibly of myofibroblast origin. It is morphologically divided into 3 groups: cellular, fibrous, and mixed. A 4-year-old girl presented with an irregular shaped subcutaneous mass on her left popliteal fossa for 6 months. The biopsy specimen showed multinodular tumor islands extending from dermis to subcutaneous layer, composed of histiocytes and osteoclast-like multinucleated giant cells, and circumscribed by fibrous tissue. Immunohistochemical staining was positive for CD68 in giant cells and histiocyte-like cells within tumor islands and faintly positive for smooth muscle actin around nodules. A cellular variant of PFHT was eventually diagnosed. Although PFHT comprises morphologically normal cells, it has the biological potential for malignant change and distal metastasis. Therefore, PFHT is categorized as a neoplasm of intermediate malignancy, and wide total excision with close follow-up is crucial.
Subject(s)
Child, Preschool , Female , Humans , Actins , Biopsy , Dermis , Giant Cells , Histiocytes , Islands , Muscle, Smooth , Myofibroblasts , Neoplasm MetastasisABSTRACT
Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schonlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.
Subject(s)
Female , Humans , Middle Aged , Carbamazepine , Ceftriaxone , Celiac Disease , Drug Eruptions , Edema , Exanthema , Extremities , Glomerulonephritis , Glomerulonephritis, IGA , Immunoglobulin A , Kidney , Linear IgA Bullous Dermatosis , Liver Abscess , Metronidazole , IgA Vasculitis , Skin , Skin Diseases , VancomycinABSTRACT
To confirm the effect of 7-valent pneumococcal conjugate vaccine (PCV7), pneumococcal nasopharyngeal (NP) carriage was compared between vaccinated (3 + 1 doses PCV7) and non-vaccinated children. Vaccinated subjects were recruited from highly vaccinated regions (> or = 60%), Seoul and Incheon whereas control subjects were recruited from Jeju Island where vaccination rates are low (< 15%). NP swabs were obtained from 400 children aged 18-59 months. Serotype and antibiotic susceptibility was analyzed. Pneumococcal carriage rate was 18.0% (36/200) and 31.5% (63/200) for the vaccinated and control group, respectively. Among those vaccinated, 41.7% (15/36) of the serotypes were vaccine-related type (VRT: 6A, 6C, 19A) with the most common serotype 6C. The next common type was non-typable/non-capsule 30.6% (11/36) followed by non-vaccine type 16.7% (6/36) and vaccine type (VT) serotypes were found in only 11.1% (4/36). In contrast, 52.4% (33/63) of the isolates in the control group were VT. Resistance rates for penicillin and erythromycin were lower in the vaccine group (vaccine vs control; penicillin 45.2% vs 71.4%, erythromycin 74.2% vs 90.5%, P < 0.05). Multi-drug resistance was also lower in vaccinated subjects (vaccine vs control; 45.2% vs 69.8%, P < 0.05). PCV7 reduces carriage in VT which leads to replacement of pneumococci by antibiotic susceptible VRT or non-vaccine type strains.
Subject(s)
Adult , Child , Child, Preschool , Humans , Infant , Male , Carrier State/immunology , Child Day Care Centers , Immunization , Microbial Sensitivity Tests , Nasopharynx , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines/administration & dosage , Prospective Studies , Republic of Korea/epidemiology , Serotyping , Streptococcus pneumoniae/isolation & purificationABSTRACT
PURPOSE: We aimed to investigate the clinical and phylogenetic characteristics of Escherichia coli Urinary Tract Infections (E. coli UTI). METHODS: We enrolled patients with culture-proven E. coli UTI, who were admitted at the study hospital from September 2008 to August 2009. We investigated clinical data of patients with E. coli UTI and characteristics of isolated E. coli strains. The phylogenetic groups were classified using triplex polymerase chain reaction (PCR), and the distribution of nine virulent genes was determined by multiplex PCR. RESULTS: A total of 47 patients have participated in this study. Thirty (63.8%) were under 6 months; eight (17.0%) were between 6-12 months; and nine (19.1%) were over 12 months. We compared two age groups between under 6-month and over 6-month. In the age group under 6-month, higher proportion of male (P=0.002) and group B2 strains (P=0.020) were observed. In contrast, higher proportion of female and group non-B2 strains were observed in age group over 6-month. Frequencies of papC, papGII, papGIII, sfa/foc, hlyC, cnf1, fyuA, iroN and iucC were estimated as 68.1%, 57.4%, 42.6%, 46.8%, 46.8%, 31.9%, 87.2%, 48.9% and 63.8%, respectively. In the comparison of phylogenetic groups, group B2 showed higher distribution of virulent genes, while group D included more strains resistant to trimethoprim/sulfamethoxazole (TMP/SMZ) than other groups. CONCLUSION: We showed the age group-specific difference in the distribution of sex ratios and phylogenetic groups; more male and group B2 strains in age group under 6-month, while more female and group non-B2 in age group over 6-month. However, further evaluation including larger number of patients will be necessary to confirm above thesis in future molecular epidemiological studies.
Subject(s)
Female , Humans , Infant , Male , Epidemiologic Studies , Escherichia , Escherichia coli , Iron , Multiplex Polymerase Chain Reaction , Sex Ratio , Urinary Tract , Urinary Tract InfectionsABSTRACT
Listeria monocytogenes is a facultative anaerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria occurs predominantly in the elderly, immunocompromised patients, pregnant women and newborns. Infections by this microorganism are rare in healthy infants and children. L. monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in children. The course of meningoencephalitis by listeria is often severe and even fatal. Acute hydrocephalus can develop as a complication and the mortality associated with listeriosis is significantly high. We present a case of meningoencephalitis caused by L. monocytogenes in a previously healthy 7-year-old girl.
Subject(s)
Aged , Child , Female , Humans , Infant , Infant, Newborn , Animals, Domestic , Arthritis , Bacillus , Brain Abscess , Hydrocephalus , Immunocompromised Host , Listeria , Listeria monocytogenes , Listeriosis , Liver Abscess , Meningitis , Meningoencephalitis , Osteomyelitis , Pregnant Women , Soil , VegetablesABSTRACT
Advances for the treatment of childhood cancer in several decades have remarkably improved long-term survival. Anticancer therapy is capable of causing a variety of delayed toxicities including secondary malignant neoplasm. Therefore close follow-up for secondary malignant neoplasm is important for surviving patients from cancer. Renal cell carcinoma is a rare tumor in childhood and has been reported previously to occur after treatment of a few solid tumors, including neuroblastoma. This report represents the first documented case of renal cell carcinoma arising as a secondary malignant neoplasm in a pediatric patient who previously was treated for germ cell tumor.