Necrolytic acral erythema: a rare entity

Necrolytic acral erythema [NAE] is a rare but distinct clinical entity. It is one of the necrolytic erythemas that presents with itchy well-defined, dusky, erythematous to violaceous papules and plaques on acral areas

We report a case of a 50-year-old woman with 8-year history of itchy hyperpigmented papules and plaques on dorsum of both feet. Later, she developed similar lesions on both hands along with hemorrhagic blisters and purpura

She was found to be a hepatitis C virus [HCV] positive case. Histopathological findings were consistent with necrolytic acral erythema. She was treated with topical tacrolimus, oral zinc and cetirizine, and referred to medical outpatient department for treatment of HCV infection i.e. interferon and ribavirin

Factors predicting the recurrence of spontaneous bacterial peritonitis in patients with cirrhosis

To evaluate the frequency of recurrence of spontaneous bacterial peritonitis [SBP] in patients with end stage liver disease and the factors responsible for it. Descriptive study. The Aga Khan University Hospital, Karachi, from November 2008 till November 2009. Patients with cirrhosis who were admitted at AKUH with diagnosis of SBP during the study period were included. Any episode of SBP after resolution of the first index case of SBP within one year was considered as recurrence. Out of 238 cirrhotic patients, 157 [66%] had single, while 81 [34%] had recurrent episodes of SBP. History of using proton pump inhibitors [PPI] and diuretics was found in 113 [47.5%] and 139 [58.4%] patients respectively. Only 58 [24.4%] patients were on prophylactic antibiotic therapy. Univariate analysis revealed that the female gender [52%], and presence of porto-systemic encephalopathy [PSE, 31%] were statistically significant [p=0.03] among those who had recurrent SBP. On multivariate analysis bilirubin level of > 1.0 mg [OR=7.03; 95%CI=1.55-32], protective factor of hepatitis B [OR 0.31; 95%CI=0.13-0.70] and presence of urinary tract infection [UTl] [OR=2.24; 95%CI=0.99-5.09] were significant in patients with recurrent SBP. Recurrent SBP was noticed in 34% patients. Serum bilirubin level of > 1.0 mg, protective factor of HBV and presence of UTl were significant factors present in patients with recurrent SBP

Frequency of Infectious skin lesions in kidney transplant recipients

This study was performed to evaluate the frequency of skin lesions in kidney transplant recipients. A total of 681 kidney transplant recipients were followed at Shaheed Labbafinejad transplant center in Tehran, Iran. Skin lesions were evaluated, and diagnoses were made clinically and confirmed by lesion smear, tissue biopsy, tissue culture, and serologic examinations, as indicated. Skin lesions were found in 54 patients [7.9%], and their frequencies were as follows: dermatomal herpes zoster [18 patients, 2.6%, 13 men and 5 women], herpes simplex infection of face and lips [15 patients, 2.2%, 5 men and 10 women], chickenpox [6 patients, 0.9%, 5 men and 1 woman], Kaposi's sarcoma [5 patients, 0.7%, 3 men and 2 women], warts [4 women, 2 of whom had genital warts], pyoderma gangrenosum [1 man, 0.14%], multiple fungal abscesses of the leg [1 man, 0.14%], mucormycosis [1 man, 0.14%], and molluscum contagiosum [1 man, 0.14%]. Moreover, 2 women [0.3%] had generalized herpes simplex lesions. Frequencies of herpes zoster [3.5%], herpes simplex [2.5%], and human papillomavirus [0.6%] infections in our kidney transplant recipients were low. We recommend that all kidney transplant candidates be evaluated and immunized for herpes zoster virus before transplantation, all herpetic-form lesions of these patients be reported to physicians [even mild lesions], and finally, that all human papillomavirus lesions be diagnosed and treated promptly to prevent more serious lesions such as malignancies