An unusual presentation of lupus vulgaris in pediatric patient: A clinico-histopathological diagnosis.

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 12 years old boy who was diagnosed as lupus vulgaris clinically as well as histopathologically simultaneously. He had well demarcated, irregularly bordered, pink, infiltrated plaques on the nose showing apple-jelly appearance on diascopy with multiple lymphadenopathy on bilateral submandibular and cervical group of lymph nodes. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux test showed positive reaction (20 mm) and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed significant improvement on anti-tuberculosis treatment. The main purpose of this case report was to emphasize that histopathological examination has diagnostic value in clinical suspicion of LV on face, when direct analysis or culture is negative.

The correlation of clinical appearance and the variation of disc-facet angle in Hirayama disease / 中国脊柱脊髓杂志

Objectives: To reveal the possible role and mechanism of disc-facet angle in the occurrence and progress of Hirayama disease by analyzing the correlation of clinical appearance and the variation of disc-facet angle in Hirayama disease. Methods: 45 patients with Hirayama disease treated in the orthopedic de-partment of Peking University Third Hospital from October 2006 to January 2012 were reviewed. There were 44 males(97.8%) and 1 female(2.2%) with an average age of 19.33±3.89(range 13-37) years old. The onset age was 16.33±2.73 (range 10-27) years old and the duration of history was 35.64±23.24 (range 1 to 120) months. The disc-facet angle of C3-T1 was measured on PACS system. An extension line was made along the upper edge of objective vertebral body on the CT scan sagittal reconstruction image. An extension line was made along the joint surface of upper articular process of objective vertebra on the sagittal plane which crossed the midpoint of the facets. The blunt angle between two lines was the disc-facet angle. The cases were divided into unilateral affect and bilateral affected group according to history, spinal cord function and spinal cord lesion level. The correlation of above data and the variation of disc-facet angle were analyzed. Results: The duration of history in unilateral affected patients was significantly shorter than that of bilateral affected patients (P<0.05). The duration of history in sequential onset patients was significantly shorter than that of simultaneous onset in bilateral affected patients (P<0.05). The JOA score 17 and Chinese score 40 in unilateral affected patients were higher than those of bilateral affected patients. The C3-C7 disc-facet angle of affected side was bigger than that of normal side in unilateral affected patients, and C5, C6 had statistically significant difference (P<0.05). The spinal cord lesion level was mainly at C5 and C6 in unilateral affected group. The disc-facet angle had no difference on both sides in bilateral affected patients but the figures at C4 and C5 level were bigger than that of normal side in unilateral affected patients. The spinal cord lesion level was mainly at C4 and C5 in bilateral affected group. The stability of upper cervical spine segments was even worse in unilateral affected group and resulting in higher level of spinal cord lesion comparing with bi-lateral affected group. Conclusions: The disc-facet angle of C4, C5 is bigger in bilateral affected patients and may be correlated with higher level spinal cord lesion and more severe clinical symptoms. The C5, C6 disc-facet angle of affected side is significantly bigger than that of normal side in unilateral affected patients. This may be the key factor of spinal cord lesion mainly at C5 and C6 level on the same side.

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

Clinical Analysis of Ramsay Hunt Syndrome / 대한피부과학회지

BACKGROUND: Ramsay Hunt syndrome (herpes zoster oticus) is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. It is not such a common dermatological disease like herpes zoster. However, reactivation of the latent varicella zoster virus causes facial palsy and therapeutic onset is one of the prognostic factors in Ramsay Hunt syndrome. OBJECTIVE: The aim of this study was to elucidate the epidemiology, the clinical characteristics of Ramsay Hunt syndrome and prognosis according to therapeutic ways. METHODS: The 84 cases diagnosed as Ramsay Hunt syndrome from January 2000 to July 2007 were assessed in regard to age, sex, clinical characteristics, electromyography (EMG) results, onset of neurological recovery according to medication and onset of rehabilitation therapy by review of medical records. RESULTS: Ramsay Hunt syndrome consisted 4.7% (84 cases of 1787) of total herpes zoster patients. The ratio of male to female patients was 37:47. Frequency was slightly higher in female patients. The mean age was 62+/-14.7 and the age distribution was in the range of 26~87 years. The most common clinical appearance was vesicular eruptions and facical nerve palsy including change in nasolabial fold and location of the lip (73.8%), followed by vesicular eruptions and vestibulocochlear symptoms like tinnitus and vertigo (16.7%), facial nerve palsy and vestibulocochlear symptoms appearing together (9.5%). EMG showed abnormal results in 67.9%. More than one kind of abnormality was commonly observed. The most common abnormal EMG result was fibrillation potential (42.2%), followed by positive sharp wave (31.3%), polyphasia (10.8%), high frequency discharge (8.4%), increased insertional activity (4.8%) and fasciculation (2.5%). There was no significant difference in onset of neurological recovery between acyclovir injections and oral famciclovir or valaciclovir treatment. The patients who had received physical therapy a week after the symptoms had developed, had a faster onset of recovery (2.8 week Vs 4.1 week, p<0.05). CONCLUSION: This study suggests that antiviral agents of a different kind may not affect recovery onset and earlier rehabilitation therapy seems to be effective in neurological recovery in Ramsay Hunt syndrome.