Subject(s)
Melanoma , Skin Neoplasms , Humans , Melanoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , UltrasonographyABSTRACT
Microsporidia are a group of obligate intracellular parasites that naturally infect domestic and wild animals. Human microsporidiosis is an increasingly recognized multisystem opportunistic infection. The clinical manifestations are diverse with diarrhea being the most common presenting symptom. We present a 52-year-old woman with a history of amyopathic dermatomyositis complicated by interstitial lung disease managed with mycophenolate mofetil and hydroxychloroquine who presented with a 7-month history of recurrent subcutaneous nodules as well as intermittent diarrhea and chronic sinusitis. A punch biopsy showed superficial and deep lymphocytic and granulomatous dermatitis with focal necrosis. Tissue stains for microorganisms revealed oval 1 to 3 µm spores within the necrotic areas in multiple tissue stains. Additional studies at the Centers for Disease Control and Prevention confirmed cutaneous microsporidiosis. This case is one of very few confirmed examples of cutaneous microsporidiosis reported in the literature.
Subject(s)
Dermatomycoses/immunology , Immunocompromised Host , Microsporidiosis/immunology , Dermatomyositis/complications , Dermatomyositis/drug therapy , Enzyme Inhibitors/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Lung Diseases, Interstitial/etiology , Middle Aged , Mycophenolic Acid/therapeutic useABSTRACT
Use of an automated reminder for an order to continue or to discontinue a urinary catheter resulted in a significant increase in the percentage of urinary catheters justified by an order and the percentage of urinary catheter discontinuation orders increased. This is an essential first step toward reducing inappropriate urinary catheter use.
