Etiology of erythema nodosum.

One hundred patients with biopsy-proven erythema nodosum were studied at Ramathibodi Hospital from 1982 to 1992 to find out the etiology of this disease. Eighty-eight were females while twelve were males, with an age range from 6 to 72 years old (mean, 31 years old). Abnormal laboratory findings in these patients included elevation of erythrocyte sedimentation rate (76.9%), increase anti-streptolysin-O titer (10.7%), abnormal chest roentgenogram (16.7%), positive tuberculin test (50%). The cause of erythema nodosum is still unknown in a large group of patients, and it was found only in twenty-eight patients (28%). Twelve patients had tuberculosis, seven had history of antibiotic administration, six probably had streptococcal infection and the other three had Behcet's disease.

Clinical and histopathological features of secondary syphilis.

Fifty-four patients with secondary syphilis were studied in regard to the clinical manifestations, response to treatment and histopathology of the skin lesions. The correlation between the skin lesions and histopathology, between the duration of skin lesions and VDRL titer, between type of skin lesions and VDRL titer were also determined. The clinical manifestations varied from macular, maculopapular, papular, papulosquamous and urticarial lesions. The hair loss usually occurred on the scalp, but the eyebrows or even total body hair loss could occur. The response to treatment was good, only one patient relapsed. The histopathology was related to the clinical manifestations, there was sparse inflammatory cell infiltration in the dermis in macular lesions, but more dense infiltration as well as more epidermal change in papular and papulosquamous lesions. There were significant correlation between the duration of skin lesions and VDRL titer, but no correlation between types of skin lesions and VDRL titer.

Wells' syndrome with lock jaw: report of a case in Thai patient.

A case of Wells' syndrome with lock jaw in a 26-year-old Thai female is presented. The clinical features, the course of disease, the histological findings of tissue eosinophilia and flame figures and also significant peripheral blood eosinophilia support the diagnosis of Wells' syndrome in this patient. To the best of our knowledge this is the first case reported in Thailand. The association of lock jaw and Wells' syndrome has never been published in the literature.

Cutaneous leukocytoclastic vasculitis: clinical and laboratory features of 45 patients seen in Ramathibodi Hospital.

Forty-five patients with histologically proved cutaneous leukocytoclastic vasculitis were studied with regard to the clinical features, laboratory findings and etiology. There were 12 males and 33 females, with an age range of 13 to 64 years. The most common skin lesions were palpable purpura which appeared mostly on the lower part of the legs. Renal involvement was the most common systemic manifestation, which occurred in 45 per cent of the patients. Abdominal pain occurred in 42 per cent of the male patients while none of the female patients had this symptom. Arthralgia occurred in 20 per cent of the patients. The most common laboratory abnormalities were elevation of ESR, which was significantly more common in females than in males (P = 0.047). The possible etiology of leukocytoclastic vasculitis was identified in 5 patients, these included streptococcal infection in 2 patients, in the other patients the possible causes were penicillin hypersensitivity, systemic lupus erythematosus and livedoid vasculitis, respectively.

Prevalence of chlamydial infection in patients with gonococcal urethritis.

Using a fluorescein labelled monoclonal antibody ("Microtrak") to identify Chalmydia elementary bodies in urethral smears, we detected Chlamydia trachomatis in 32 (26.67%) of 120 male patients after treatment of their gonococcal urethritis. Sixteen of these 32 patients (50%) had normal urethral smear. Only 16 (50%) of the patients yielding chlamydia would have received treatment in the absence of diagnostic service for chlamydial infection.

Prospective study of cutaneous drug reactions.

One hundred and seventy-five patients with cutaneous drug reactions were studied with regard to age, sex, possible causative drugs and clinical course of the reactions. The age of the patients ranged from 3 to 78 years old, with the common occurrence between the age of 20 to 30 years. Females outnumbered males at a proportion of 1.8:1. The maculopapular rash was the most common reaction, which accounted for 42.9 per cent of the patients. Fixed drug eruption and Stevens-Johnson syndrome were the second and third common occurrences. The eruptions were attributed to 45 drugs, the three most common causative drugs were ampicillin, penicillin and trimethoprim-sulphamethoxazole. Ampicillin was the most common drug that caused maculopapular rash whereas tetracycline and trimethoprim-sulphamethoxazole were responsible for fixed drug eruption and Stevens-Johnson syndrome respectively. The drug eruption occurred within a few minutes to 3 weeks of beginning therapy. The eruptions lasted from 3 to 30 days depending on the type of reactions.

Short-course multi-drug therapy for leprosy patients.

Short-course multi-drug therapy for leprosy patients was evaluated in terms of effectiveness, recurrence rate and side effects. Of the 108 patients studied, 48.1 per cent defaulted. This MDT appeared to be quite effective in controlling leprosy. The medication could be stopped at 6 months in 83 per cent of the paucibacillary patients. The medication was continued further in 17 per cent of paucibacillary patients because of persistent skin lesions clinically and histopathologically. Recurrence occurred in 2.3 per cent of the paucibacillary patients. The effect of this regimen for multibacillary patient is difficult to evaluate because of the small number of patients studied. Side effects of this regimen occurred in 5.4 per cent of the patients. Leprosy reaction occurred in two patients with borderline lepromatous leprosy.