A Case of Herpetic Folliculitis / 대한피부과학회지

Although herpetic skin infections are very common, herpetic folliculitis is not often reported in the literature. It has varied presentations, some of which are clinically atypical requiring histopathological confirmation of follicular involvement. We report a case of herpetic folliculitis which developed on the left shoulder of a 36-year-old man with painful erythematous grouped papules, but without vesicles. On histopathologic examination of a papular lesion, viral cytopathologic changes such as ballooning degeneration and giant cell formation, were observed within the follicular epithelium, thus we could diagnose this case as a viral folliculitis. The patient was treated with an antiviral agent, and the lesions subsided within several days.

A Case of Palisaded Encapsulated Neuroma of the Eyelid / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a rare intraneural neuroma. It usually occurs as a solitary asymptomatic skin-colored papule, and commonly affects the butterfly area of the face of middle-aged adults. We report a case of PEN which developed on the right upper eyelid of a 30-year-old man. It was a 3 mm-sized skin colored papule, and histologically, there was a well- defined encapsulated nodule in the dermis, composed of spindle cells with basophilic and plump nuclei in a palisading pattern. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 protein, while the capsule of the nodule was positive for epithelial membrane antigen.

Antinuclear Antibodies in Patients with Behcet's Disease / 대한피부과학회지

BACKGROUND: Behcet's disease has features consistent with an immunopathogenic mechanism, but the autoreactivity in pathogenesis is unclear. OBJECTIVE: This study was to investigate the association of antinuclear antibodies (ANA) with Behcet's disease. METHODS: The patients in this study were diagnosed at Severance Hospital Behcet's Disease Specialty Clinic from May, 1998 to May, 2002. We evaluated the frequency, titers and immunofluorescence patterns of ANA in patients with Behcet's disease, and compared the frequency with a healthy control group. According to the positivity of ANA, we compared the frequency of minor symptoms to investigate the association of the severity of disease with ANA. RESULTS: 1. Of the 554 cases of Behcet's disease, 46 cases (8.3%) were ANA positive, however, of the 271 cases of healthy control group, only 5 cases (1.8%) were ANA positive. (p=0.0003) 2. In ANA titers 38 cases (82.6%) showed low titer (1: 40+, 1: 160-), 5 cases (10.9%) intermediate titer (1: 160+, 1: 640-), and 3 cases high titer (>1: 640+). There was no significant difference in intermediate and high titers between complete (17.9%) and incomplete type (14.3%). 3. In immunofluorescence patterns of ANA, 17 cases (37%) were speckled pattern, 5 cases (10.9%) homogeneous pattern, 3 cases (6.5%) centromere pattern, 2 cases (4.3%) nucleolar pattern and 19 cases (41.3%) unknown pattern. 4. Of 508 cases with negative ANA patients, 272 cases (53.5%) had minor symptoms, however, of 46 cases with positive ANA patients, 14 cases (30.4%) had minor symptoms (p=0.0027). CONCLUSION: From this study ANA was more prevalent in Behcet's disease. However, it was not related to severity of disease and most of them were low titer. ANA, herein, might play a minor role in pathogenesis of Behcet's disease.

Kaposi's Sarcoma: A Clinico-Pathological Study of 21 Patients / 대한피부과학회지

BACKGROUND: Kaposi's sarcoma (KS) is a mesenchymal tumor involving blood and lymphatic vessels. Viral oncogenesis by human herpesvirus 8 (HHV8) and cytokine-induced growth together with some state of immunocompromise represent important conditions for this tumor to develop. OBJECTIVE: The purpose of this study was to document the clinical and histopathological features of KS in Korea. METHODS: The medical records and histopathologic slides of patients with KS diagnosed at Yonsei University Medical Center from January, 1992 to March, 2003 were reviewed. We used immunohistochemical stains for HHV8 to determine whether HHV8 is present in KS. RESULTS: Among the 21 patients, classic KS was found in 7, acquired immunodeficiency syndrome (AIDS)-associated KS in 3, and iatrogenic, immunosuppressive KS in 11. Classic and iatrogenic KS most often have a preference for the lower extremities, while the upper body in AIDS-KS. Mucosal involvement and systemic organ involvement could be detected in AIDS-KS. Immunohistochemical stains for HHV8 were positive in 100% with classic KS and AIDS?KS, and 90.9% with immunosuppressive KS. Classic KS responded well to local therapy and showed indolent course. Iatrogenic, immunosuppressive KS generally regressed after reduction or cessation of immunosuppressive drug therapy, but some of them showed resistance to therapy. For AIDS-KS, no systemic treatments have been shown to prolong survival. CONCLUSION: Because classic KS and iatrogenic, immunosuppressive KS generally have a benign course, cautions are taken not to overtreat them. However, some cases of organ transplantation associated KS have an aggressive course, prompting us to consider active treatments to save transplanted organ.

A Case of Majocchi's Granuloma in a Renal Transplant Recipient / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophyton rubrum, however, other dermatophytes may be the causative agent. We presented a 29-year-old female, who underwent kidney transplantation for end stage renal disease 3 years earlier, had an erythematous nodule on her left lower leg for 6 months. Histology showed suppurative granulomatous inflammatory cellular infiltrates in the dermis. Many septate hyphae were noted within the granulomatous tissue stained with PAS. A fungal culture from biopsy specimen revealed T. rubrum. The cutaneous lesion treated with terbinafine 250 mg daily and 10 weeks later, there was a marked improvement in the lesion.

Kaposi's Sarcoma after Renal Transplantation / 대한이식학회지

PURPOSE: Although renal transplantation is the most effective treatment for end stage renal disease (ESRD), the incidence of malignant tumors due to long-term immunosuppression has been increasing. We experienced 9 cases of Kaposi's sarcoma (KS) after renal transplantation in our institution out of 2250 renal transplant recipients. KS is a rare mesenchymal tumor involving blood and lymphatic vessels. The oncogenesis by human herpesvirus 8 (HHV8) represent important condition for this tumor to develop. METHODS: Clinicopathologic features, treatment results, and prognosis of the 9 patients diagnosed with KS after renal transplantation were analyzed retrospectively. RESULTS: There were 6 male and 3 female patients. The mean age was 41.1 years. The average period until diagnosis of KS after renal transplantation was 60 months (range: 6 months~8 years). Clinical features were variable, but mostly presenting several red- purple papular and nodular tumors. Lesions were found in the lower extremities in 6 patients. Three patients presented with palpable lymph nodes in the neck and inguinal area without any skin lesions. Computed tomography showed diffusely enlarged showed an aggressive course. lymphnodes. Systemic involvement was found in 2 patients. Diagnosis was confirmed by histopathologic studies. Immunohistochemical stains for HHV8 were positive in all patients. Five patients showed regression of lesions after drastic reduction of immunosuppression, local resection and/or radiotherapy. But other 4 patients resistant to therapy. CONCLUSION: KS is a rare tumor and appears to be caused primarily by HHV8 in Korea as well. Reduction or cessation of immunosuppression potentially improves symptoms, but it also increases the risk of chronic graft rejection or graft failure. A large-scale study, accumulating data from transplantation cases in Korea, to understand the relationship between the various types of immunosuppression and KS, and to set guidelines for treatment appears to be necessary in the future.

Primary Cutaneous CD30-negative Large T-cell Lymphoma / 대한피부과학회지

Primary cutaneous CD30-negative large T-cell lymphoma without prior or concurrent mycosis fungoides represents a distinct group of cutaneous T-cell lymphoma with an aggressive clinical behavior. Primary cutaneous CD30-negative large T-cell lymphoma is a rare disorder which represents only about 5% of primary cutaneous T-cell lymphoma. A 51-year-old woman presented with a rapid growing, ulcerative plaque on the right lower leg of 2 years duration. Histologically, it showed diffuse infiltrates with a predominance of medium-sized to large pleomorphic lymphocytes in the dermis and subcutaneous fat layers, which stained positively with CD3 and negatively with CD20, CD30, CD56 on immunohistochemical staining. There was no evidence of extracutaneous metastsis.

Extensive Mongolian Spots Associated with Hunter Syndrome / 대한피부과학회지

We report a case of Hunter syndrome with extensive Mongolian spots. A 4-year-old male baby presented with asymptomatic, firm, raised, ivory-colored papules and nodules which coalesced to form ridges in a reticular pattern (pebbling of the skin) and were arranged bilaterally and symmetrically over the scapulae, and lateral aspects of the thighs. Large Mongolian spots were present over the back. He has low intelligence, short stature, a protuberant abdomen with hepatosplenomegaly, and broad hands with clawlike contractures of the distal interphalangeal joints. The result of qualitative analysis of mucopolysaccharride was positive for the dermatan sulfate and heparan sulfate in the urine. Massive mucinous materials which stained positively with alcian blue were observed from collagen fibers throughout the dermis of skin biopsy specimen. Metachromatic granules within fibroblasts stained with toluidine blue were also seen. This case is reported for its rarity and the typical skin lesions, the recognition of which may be helpful in diagnosis and genetic counselling.

A Case of Acantholytic Acanthoma / 대한피부과학회지

Acantholytic acanthoma is typically an asymptomatic, keratotic papule or nodule. In 1988, Brownstein described a previously unrecognized benign acanthoma, the acantholytic acanthoma. The term acantholytic is used because acantholysis is the outstanding histologic feature in this neoplasm; acanthoma is chosen because the growths are benign tumors of epidermal keratinocytes. On histopathology, these tumors may mimic pemphigus vulgaris, pemphigus vegetans, superficial pemphigus, or Hailey-Hailey disease, but had no evidence of any of these disorders. We report a case of acantholytic acanthoma seen on the inguinal area of a 79-year-old man who had a keratotic nodule on the left inguinal area.