Subject(s)
Drug Eruptions , Immunoglobulin A/metabolism , Skin Diseases, Vesiculobullous , Vancomycin/adverse effects , Adult , Drug Eruptions/metabolism , Drug Eruptions/pathology , Female , Humans , Skin Diseases, Vesiculobullous/chemically induced , Skin Diseases, Vesiculobullous/metabolism , Skin Diseases, Vesiculobullous/pathology , Vancomycin/administration & dosageABSTRACT
Staphylococcal scalded skin syndrome (SSSS) in premature infants is a rare condition. We present SSSS in an extremely low-birth-weight (ELBW) infant with recurrent and confirmed bacterial sepsis. We present it to emphasize the importance for clinicians to not only recognize the clinical manifestations of SSSS, but also the need to closely monitor infants, especially very low-birth-weight (VLBW) and ELBW infants with SSSS for recurrence and bacterial sepsis. SSSS in preterm infants is a potentially lethal condition and early recognition and appropriate supportive care could be life-saving.
ABSTRACT
The International Society for Peritoneal Dialysis recommends the regular application of topical antibiotic-containing preparations in addition to a routine exit site care to reduce the risk of exit site infection (ESI). Among these prophylactic antimicrobial preparations, topical gentamicin is one of the widely used and effective antibiotics for prevention of ESI and peritonitis in peritoneal dialysis (PD) patients. Overall, topical gentamicin is well tolerated; however, its use can be associated with the development of allergic contact dermatitis (ACD). We describe a first reported case of PD catheter exit site contact ACD due to topical gentamicin mimicking ESI. The patient in this report developed worsening violaceous in color and pruritic rash surrounding the PD catheter exit site that appeared 3 weeks after the initiation of gentamicin cream. The association between development of rash and initiation of topical gentamicin led to a suspicion of local reaction to gentamicin rather than ESI. Skin biopsy confirmed ACD. Discontinuation of the provoking agent and subsequent treatment with topical hydrocortisone application led to a resolution of the exit site rash. Any rash at a PD catheter exit site should be considered infectious until proven otherwise. However, it is important to be aware of noninfectious etiologies of exit site rashes as the treatment of these 2 conditions differs.
ABSTRACT
BACKGROUND: The scalp has been proposed as an anatomic site that harbors melanocytic nevi with distinctive histologic attributes, so-called "special-site" nevi, similar to nevi on the breast and genitalia. However, detailed studies are lacking. OBJECTIVE: We sought to better delineate the features of scalp melanocytic nevi, particularly lesions that may qualify as special-site nevi. METHODS: The histologic features of 365 total melanocytic nevi of the scalp were studied from 322 patients over a consecutive period of 18 months from July 2007 through January 2009. RESULTS: A total of 56 nevi with characteristic features were identified. The most common features were: (1) random melanocytes containing large nuclei (92.9%) and abundant pale cytoplasm with dusty melanin granules (96.4%); (2) large nests (76.8%) situated along the sides of rete and between rete ridges (85.7%); (3) nests of poorly cohesive melanocytes (82.1%); (4) overlap features with Clark nevi (75.0%); and (5) overlap features with superficial congenital nevi (50.0%). Pagetoid spread (14.3%), asymmetry (23.2%), and poor lateral demarcation (16.1%) were less common. These 56 lesions predominated in the first 2 decades of life and were not observed after age 35 years. LIMITATIONS: Lack of long-term clinical follow-up of patients is a limitation; however, no recurrences or malignancies from these patients' scalps were submitted in the time period (≥ 3 years) since the initial biopsies. CONCLUSION: A special site scalp nevus is recognizable amongst scalp melanocytic nevi, and this lesion is more common in younger patients. Familiarization of its features should assist in the diagnosis and management of scalp melanocytic lesions.
Subject(s)
Melanocytes/pathology , Nevus, Pigmented/pathology , Scalp/pathology , Adolescent , Adult , Child , Child, Preschool , HumansABSTRACT
Blastomycosis is an infection caused by the dimorphic fungus Blastomyces dermatitidis. Infection can disseminate to skin, where characteristic ulcerative and verrucous plaques, sometimes studded with pustules, are typically seen. Herein we report 3 patients, two children and one adult, with pustular blastomycosis. Their cutaneous lesions exhibited a pustular morphology at the onset and throughout the course of their illness, without evolution to more typical verrucous or ulcerative plaques. These patients all resided in Memphis, TN, the site of previous case reports of pustular blastomycosis.
Subject(s)
Blastomyces/isolation & purification , Blastomycosis/diagnosis , Blastomycosis/drug therapy , Acute Disease , Adolescent , Aged , Amphotericin B/therapeutic use , Biopsy, Needle , Blastomycosis/mortality , Blastomycosis/pathology , Female , Follow-Up Studies , Humans , Immunohistochemistry , Infusions, Intravenous , Itraconazole/therapeutic use , Male , Risk Assessment , Sampling Studies , Severity of Illness Index , Survival RateABSTRACT
We present a 40-year-old man with occupation-induced pemphigus vulgaris (PV). He developed PV within days of a one-time heavy exposure to fumes of burning glyphosate, a broad-spectrum nonselective pesticide. This exposure suggests acute cutaneous contact as a stimulus in the development of his pemphigus. While the patient initially required mycophenolate mofetil and prednisone therapy, he has since eliminated contact with pesticides and has been successfully tapered off systemic medication. We discuss the case and review concepts of inducible PV by pesticides and physical cutaneous injury.
