A Case of Chronic Arthritis Due to Mycobacterium intracellulare after Trauma / 결핵및호흡기질환

While nontuberculous mycobacterium (NTM) infections are recently on the rise, arthritis caused by NTM is hardly reported in Korea. NTM arthritis has no distinctive clinical characteristics from chronic arthritis. Tuberculosis of the joint specifically produces similar clinical and pathologic presentations to NTM arthritis, so it is not easy to distinguish between them. We report a case of Mycobacterium intracellulare in an arthritis patient after trauma and surgical repair of the injury. At the beginning, the patient was diagnosed as tuberculous tenosynovitis through pathology without microbiologic evidence. The final diagnosis was made after subsequent recurrences for several years. The misdiagnosis and delayed diagnosis led to irreversible joint destruction and functional impairment. NTM infection must be included in the differential diagnosis of chronic arthritis at the outset.

Complete Atrioventricular Block due to Infective Endocarditis of Bicuspid Aortic Valve

A 38-year-old man visited our emergency department presenting with a 6-day persistent fever. The man had undergone an orthodontic procedure 7 days prior to the visit. He had a fever with a temperature of 38.2degrees C and a diastolic murmur (grade III) was detected at the left sternal border. Reddish-brown lines beneath the nails were present, and raised lesions which were red and painful were detected on the soles of the patient's feet. Laboratory findings showed an elevated inflammatory marker. Transthoracic and transesophageal echocardiograms, showed a bicuspid aortic valve, and moderate aortic regurgitation and vegetation were noted. Treatment with antibiotics was given, but 4 days later, a 12 lead electrocardiogram revealed complete atrioventricular (AV) block. Immediately, a temporary pacemaker was inserted, and the following day an aortic valve replacement was performed. Intraoperative findings revealed a fistula around the AV node. He has suffered no subsequent cardiac events during the follow-up.

A Case Report of Carbon Monoxide Poisoning Induced Cardiomyopathy Complicated with Left Ventricular Thrombus

The heart and the brain, most oxygen-dependent organs, may be severely affected after carbon monoxide (CO) exposure. CO induced cardiotoxicity may occur as a consequence of moderate to severe CO poisoning, including angina attack, myocardial infarct, arrhythmias, and heart failure. We present a rare case of CO poisoning induced cardiomyopathy with left ventricular (LV) thrombus. It is thought that LV thrombus may have been caused severely decreased LV function with dyskinesis. After short-term anticoagulant therapy, echocardiography findings revealed complete recovery of LV dyskinesis and resolution of LV thrombus.

A Case of Chloroquine-Induced Cardiomyopathy That Presented as Sick Sinus Syndrome

A 52-year-old woman with rheumatoid arthritis who had been treated with prednisone and hydroxychloroquine for >12 years presented with chest discomfort and a seizure. She was diagnosed with restrictive cardiomyopathy combined with sick sinus syndrome. A myocardial muscle biopsy was performed to identify the underlying cardiomyopathy, which showed marked muscle fiber hypertrophy, fiber dropout, slightly increased interstitial fibrous connective tissue, and extensive cytoplasmic vacuolization of the myocytes under light microscopy. Electron microscopy of the myocytes demonstrated dense, myeloid, and curvilinear bodies. The diagnosis of hydroxychloroquine-induced cardiomyopathy was made based on the clinical, hemodynamic, and pathologic findings. This is the first case report describing chloroquine-induced cardiomyopathy involving the heart conduction system.

A Case of Adams-Oliver Syndrome

Adams-Oliver syndrome (AOS) is a congenital condition characterized by aplasia cutis congenita, transverse limb defects, and cutis marmorata telangiectatica. AOS can also be associated with extensive lethal anomalies of internal organs, including the central nervous, cardiopulmonary, gastrourointestinal, and genitourinary systems. Generally, the more severe these interrelated anomalies are, the poorer the prognosis becomes. In the relevant literature on this topic, it is somewhat unclear as to whether the prognosis of AOS without lethal anomalies alters the lifespan. We report a case of AOS with typical skin defects only, and no internal organ anomalies.

The Correlation between SCORAD Index and Instrumental Assessment in Evaluation of Atopic Dermatitis Severity / 대한피부과학회지

BACKGROUND: Atopic dermatitis is a chronic relapsing inflammatory skin disease characterized by dry skin, pruritus, and typical distribution of the lesions. Because an objective tool for the assessment of disease severity of atopic dermatitis has yet to be agreed upon, many dermatologists are dependent on subjective history and clinical scoring. Recently, instrumental measurements have been used for the assessment of skin barrier function. OBJECTIVE: The purpose of this study was to assess the correlation between SCORAD (scoring of atopic Dermatitis) index and the results of instrumental assessments of disease severity in atopic dermatitis. Additionally, we compared the values of instrumental measurements on normal and lesional skin. METHODS: From February to April 2007, 44 patients with atopic dermatitis were treated with topical steroids, topical calcineurine inhibitors, oral antihistamine agents and systemic steroids. At initial visit, and after 1, 2, 3, and 4 weeks of treatment, the SCORAD index was measured, and instrumental measurements of skin surface hydration (SSH), transepidermal water loss (TEWL), and pH were performed on the antecubital fossa (lesional skin) and flank (normal skin) of the patients by Corneometer(R), Tewameter(R), and skin-pH-meter(R). RESULTS: Significant correlation was found between SCORAD index and SSH (p<0.0001), TEWL (p<0.0001), and pH (p=0.1680). SSH and TEWL improved within 1 week of treatment but pH improved after 2 weeks of treatment. Instrumental assessments showed lesional skin had lower SSH, higher TEWL, and more alkaline pH than normal skin. CONCLUSION: Instrumental measurements showed correlation with SCORAD index. Therefore, we can use instrumental assessments as well as SCORAD index in the assessment of disease severity of AD.

Vitiligo Coexistent with Nevus Depigmentosus: This Was Treated with Narrow-Band UVB and These Lesions Were Followed Using the Mexameter(R), a Pigment-Measuring Device

Nevus depigmentosus (ND) is a congenital, non-progressive, hypopigmented lesion that is usually stable throughout an affected individual's lifetime. The clinical features of vitiligo are similar to those of ND, but the two diseases have different treatment responses and prognoses. We report here on a rare case of vitiligo that was coexistent with ND. Both conditions were treated with narrow-band UVB. An 11-year-old boy presented with two distinct types of hypopigmented lesions, one on the forehead and the other on his back. The first was a hypopigmented patch with leukotrichia, and it was incidentally discovered 3 months before the child was examined at our clinic and it had rapidly increased in size. The second hypopigmented patch was detected at birth and it had slowly been increasing in size. The hypopigmented lesion on the child's forehead was diagnosed as vitiligo, and the one on his back as ND. Once- or twice-weekly narrow-band UVB treatment was initiated. Improvements in the two lesions were assessed with clinical photography and using a Mexameter(R) (Courage-Khazaka Electronic, Germany), which is a pigment-measuring device.

A Case of Acquired Tufted Angioma That Mimicked Pyogenic Granuloma and It Was Precipitated by Trauma / 대한피부과학회지

Tufted angioma (TA) is a rare benign vascular tumor that is histologically characterized by circumscribed angiomatous vascular aggregates in the dermis and its "cannon-ball" pattern. The acquired type is known as angioblastoma of Nakagawa and it was first described in 1949. TA usually occurs on the trunk and neck in children, but TA sometimes occurs at birth or adulthood. The cutaneous manifestations include slowly spreading erythematous macules, papules and nodules that are generally without any other symptoms. We examined a 75-year old man with a bean sized solitary hemorrhagic crusted nodule on the tip of his 3rd finger, and the lesion was clinically similar to the pyogenic granuloma. The nodule developed at the site of a local injury that happened 6 months ago. The histopathological findings were consistent with tufted angioma. He was treated with surgical excision and it did not recur during the next 12 months. We report here on a case of tufted angioma that mimicked pyogenic granuloma, and this lesion occurred at an unusual location and it was precipitated by trauma.

Dermatofibrosarcoma Protuberans Arising froma Burn Scar

Malignant neoplasms arising in burn scars are well known. In previous literature, 25 cases of burn scar sarcomas were reported. However, dermatofibrosarcoma protuberans is very rare and only two cases have been reported. A 43-year-old Korean man presented with multiple erythematous clustered plaques and nodules and a skin-colored subcutaneous mass on the chest after a severe burn injury at the age of 8 years. A biopsy specimen revealed dermatofibrosarcoma protuberans. The tumor was excised widely to include the surrounding burn scar. Herein, we report this third case of dermatofibrosarcoma protuberans arising from a burn scar.

The Therapeutic Effect of Photodynamic Therapy with Aminolevulinic Acid Topical Solution and Blue Light for Actinic Keratosis / 대한피부과학회지

BACKGROUND: Actinic keratoses (AKs) are precancerous lesions that are treated with local liquid nitrogen cryotherapy, topical fluorouracil or topical chemotherapeutic agents. Photodynamic therapy (PDT) with various kinds of light sources has recently been tried for treating actinic keratoses. There have been no studies in the Korean literature about the effectiveness of aminolevulinic acid (ALA)-PDT combined with blue light for treating actinic keratoses. OBJECTIVE: We examined the safety and efficacy of PDT (using topical 20% ALA solution and blue light) for the treatment of actinic keratoses. METHODS: Twenty five AKs lesions of 17 patients were enrolled in the study. They were prepared with the application of topical 20% ALA solution for 2 hours and this was followed by exposure to 417+/-5 nm blue light at 10 J/cm2. The lesions were assessed at 48 hours and 2 and 4 weeks following PDT. Those target lesions remaining at week 4 were re-treated. Skin biopsies were done at 8 weeks to evaluate the response to ALA-PDT. RESULTS: Complete remissions were achieved for 64.0% of the AKs lesions after 2 treatment sessions. Only two patients suffered from a stinging sensation when exposed to the light therapy. CONCLUSION: Topical ALA-PDT with using a blue light source could be an effective treatment modality for actinic keratoses

A Case of Syphilitic Keratoderma Concurrent with Syphilitic Uveitis

Syphilitic keratoderma is a rare cutaneous manifestation of secondary syphilis, characterized by symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, no cases of syphilitic keratoderma and uveitis have been reported in the dermatologic literature. A 69-year-old woman presented with steroid-resistant hyperkeratotic patches on the palms and soles and uveitis for 4 months. As steroid-resistant uveitis must be evaluated for syphilis, viral infections, and autoimmune diseases, we ran several laboratory tests and the serologic test for VDRL was reactive (titer; 1:128). After treatment with penicillin G (4 MU, IV every 4 hours for 2 weeks), her skin lesions and visual disturbance were completely resolved. Therefore she was diagnosed as having syphilitic keratoderma and uveitis. Here, we report a rare case of syphilitic keratoderma concurrent with syphilitic uveitis and suggest that evaluation for syphilis may be required when skin lesions and ocular disturbance are resistant to long-term steroid therapy.

A Case of Blue Nevus Presented as Multiple Macules and Patches / 대한피부과학회지

A 32-year-old woman had multiple bluish macules and patches on her right back. They had gradually increased in number and size since they had first appeared at age 27 years. About 35 blue or blue-grey macules and patches measuring 1~40 mm in diameter were scattered on her back. Histologic examination showed hyperkeratosis and basal hypermelanosis in the epidermis and scattered spindle-shaped cells containing melanin granules in upper and middle dermis. Most of the dermal melanocytes were arranged parallel to the epidermis. We report a case of blue nevus on the back which presented as multiple scattered bluish macules and patches.

A Case of Myxoid Neurofibroma on the Hyponychium Following Repeated Laceration / 대한피부과학회지

We report a case of a 32-year-old woman with a myxoid neurofibroma occurring on the hyponychium of the 4th finger following repeated laceration. The tumor was histologically determined to be a myxoid neurofibroma. Myxoid neurofibroma may present as a sporadic lesion or in the context of neurofibromatosis 1. Although there is no predilection site of solitary lesion, occurrence on the hyponychium is rare. We report a case of solitary neurofibroma on the hyponychium of the 4th finger following repeated laceration.

A Case of Extensive Pityriasis Alba

Pityriasis alba (PA) is a common benign disease, characterized by hypopigmented macules or patches on the face, usually seen in children. However, two uncommon variants exist, a pigmenting type and an extensive type. Extensive PA is rare. The lesions tend to be less scaly, more persistent, more generalized, more symmetrical, and more frequently seen over the trunk and less so over the face. We report a child who had extensive PA lesions.

A Case of Intravascular Papillary Endothelial Hyperplasia after IPL Treatment / 대한피부과학회지

Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign vascular tumor characterized by the development of endothelial-lined papillary projections in the vascular lumen. Most authors believe that IPEH represents an unusual pattern of organizing thrombus, implying that a thrombus is the initial cause. A 13-year-old boy came to hospital because of a purpuric patch and violaceous plaque on his right forearm. Clinically, the lesions were thought to be a hemangioma or other vascular malformation. Therefore, we treated him with intense pulsed light (IPL) four times. After treatment, the initial skin lesions were erythematous and edematous and a new bluish mass and multiple scattered subcutaneous nodules appeared near the original skin lesions. Histologic examination of the new bluish mass showed an organic thrombus and endothelial-lined capillary projections in the dilated vascular lumen, compatible with IPEH. Here, we report an interesting case of IPEH after IPL treatment in a 13 year-old boy.