Cutaneous protothecosis on the bilateral wrists of a food handler.

Cutaneous protothecosis is caused by the achlorophyllic algae Prototheca, typically presenting as a localized plaque in immunocompetent individuals. We report a patient with bilateral erythematous plaques and pustules on her forearms, which had initially been treated with steroids for presumed eczema. Histology showed spherical spore-like bodies with internal morula-like septation, which were positive for periodic-acid-Schiff (PAS) staining, consistent with cutaneous protothecosis. Definitive treatment with oral itraconazole resulted in resolution of the lesions.

Efficacy of iontophoresis with glycopyrronium bromide for treatment of primary palmar hyperhidrosis.

BACKGROUND: There is limited data on the efficacy of iontophoretic treatment of primary palmar hyperhidrosis using glycopyrronium bromide. The first line treatment for primary palmar hyperhidrosis is usually topical aluminium chloride, but clinical experience indicates that it is not effective for more severe disease. OBJECTIVE: To evaluate the efficacy of using glycopyrronium bromide iontophoresis in the treatment of primary palmar hyperhidrosis, and to evaluate if the benefit of treatment varies with the severity of disease. METHODS: This is an open-label study involving patients undergoing weekly treatment of iontophoresis with glycopyrronium bromide for 4 weeks. Gravimetric measurements of sweat production and subjective scores of palmar sweatiness were recorded prior to starting treatment and 1 week after the last treatment. Side-effects were monitored weekly. RESULTS: Twenty two of the 25 patients recruited completed the 4-week treatment. There was a significant mean improvement of 23.4 mg/min (P = 0.001) between baseline and post-treatment gravimetric measurements. Patients with a higher baseline sweat output demonstrated a trend towards a greater reduction in sweat production (Pearson's correlation correlation coefficient, r = 0.41). The patients experienced dryness of the palms for a mean duration of 5 days after iontophoresis. All patients reported an improvement in satisfaction scores and 81.8% reported an improvement in subjective severity scores. No serious side-effects were encountered during the study. CONCLUSIONS: Iontophoresis using glycopyrronium bromide is an effective and well-tolerated treatment for primary palmar hyperhidrosis. The possibility of its greater benefit in patients with more severe baseline disease requires verification.

Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature.

Hepatosplenic candidiasis (HSC) in patients with acute leukemia poses management challenges because the therapeutic limitations of the present antifungal armamentarium may adversely impact on treatment outcomes of the underlying leukemia. We report a patient with acute myeloid leukemia who developed HSC during post-remission consolidation chemotherapy and was treated with a prolonged course of caspofungin followed by fluconazole. The stabilization of infection permitted further chemotherapy and autologous hematopoietic cell transplant (HCT) without breakthrough fungemia and further dissemination of candidiasis. The favorable outcome provides further evidence that with optimal treatment, the presence of stable or non-progressive HSC is not an absolute contraindication for HCT. The use of caspofungin in the primary treatment of HSC appears to be a promising approach. The favorable outcome seen in this case is encouraging, although further study on its efficacy is warranted.

Nasal-type extranodal natural killer/T-cell lymphoma presenting with extensive leg ulcers.

Primary cutaneous T-cell lymphomas are rare and can be difficult to classify precisely. We present a case of extranodal natural killer (NK)/T-cell lymphoma in a previously healthy, immunocompetent man who presented with extensive necrotic leg ulcers and disseminated skin nodules. Immunohistochemical studies revealed that the tumour cells were positive for CD3, CD30, granzyme B and T-cell intracellular antigen-1, and negative for CD5 and CD56, with positive staining for Epstein-Barr virus (EBV) RNA on in situ hybridization. A diagnosis of extranodal NK/T-cell lymphoma was made, based on the presence of cytotoxic granules and positive EBV RNA staining. The patient was treated with a regimen of chemotherapy comprising corticosteroids, intravenous methotrexate, ifosphamide, L-asparaginase and etoposide with initial response.