Annular elastolytic giant cell granuloma causes an irreversible disappearance of the elastic fibres.

A 67-year-old man presented with grouped red papules with a smooth surface coalescing to relatively well-demarcated plaques on his left thigh, in the axillae and on the lateral parts of the trunk. The plaques were growing slowly, and the older ones had a frilled surface. A skin biopsy showed a zone of disappearance of the elastic fibres with a rim of giant multinuclear cells with fragments of the elastic fibres in their cytoplasm. This finding is typical of annular elastolytic giant cell granuloma (AEGCG). After corticosteroid therapy, the inflammation resolved, causing the frilled surface of the lesions due to the disappearance of the elastic fibres. Remission of the skin lesions lasted for 1.5 years. A second skin biopsy taken from the site of the previous lesion showed the absence of the elastic fibres, thus their phagocytosis was irreversible.

[Syphilis in the third millenium]. / Syfilis a tretí tisíciletí.

BACKGROUND: For several decades the clinical picture of all stages of syphilis has been assumed to be immutable. The aim of the study was to describe the real spectrum of cutaneous and mucosal manifestations and organ changes and to ascertain whether the incidence of the disease has an increasing trend. METHODS AND RESULTS: The studied group included 92 patients (44 males, 48 females, average was 31.3 years) diagnosed in years 1992 to 1998 at our clinics. The diagnose was confirmed by a microscopic and/or serologic examination. Number of patients with the primary syphilis increased more than twice (1992 versus 1997), incidence of newly registered manifestations of the secondary syphilis has also increased (1996 to 1998), number of hospitalised patients in the stadium of syphilis latens increased at least twice (1992 versus 1996). Higher was the number of proven cases in pregnant patients: number of dead births increased twice, inborn forms of syphilis were three times more frequent. Among the newly described clinical forms the specific gastritis and specific uveitis were diagnosed. In immunosuppressed patients forms of lues maligna and the blue toes syndrome were identified. However, those forms were not diagnosed among our group of studied patients. CONCLUSIONS: During the last 10 years a significant increase of incidence of syphilis was reported in the population of Czech Republic. Such dangerous and almost explosive rise of new cases has been accompanied with increased number of inborn forms and with the occurrence of new clinical manifestations, namely in immunosuppressed patients.