North American blastomycosis in an immunocompromised patient.

Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus, Blastomyces dermatitidis, that generally produces a pulmonary form of the disease and, to a lesser extent, extrapulmonary forms, such as cutaneous, osteoarticular, and genitourinary. Both immunocompetent and immunocompromised individuals can be infected, but more severe disease occurs in the immunocompromised. Blastomycosis can be diagnosed by culture, direct visualization of the yeast in affected tissue, antigen testing, or a combination of these methods. Treatment course and duration depend on the severity of illness. For mild to moderate pulmonary disease, treatment is itraconazole. For severe blastomycosis, lipid-formulation amphotericin B is given, followed by itraconazole. We present an interesting case of cutaneous blastomycosis acquired in Atlanta, Georgia, that looks quite similar to other mycoses, such as coccidioidomycosis and sporotrichosis, and describe its distinguishing features.

Congenital self-healing reticulohistiocytosis: an underreported entity.

Langerhans cell histiocytosis (LCH), also known as histiocytosis X, is a group of rare disorders characterized by the continuous replication of a particular white blood cell called Langerhans cells. These cells are derived from the bone marrow and are found in the epidermis, playing a large role in immune surveillance and the elimination of foreign substances from the body. Additionally, Langerhans cells are capable of migrating from the skin to lymph nodes, and in LCH, these cells begin to congregate on the bone, particularly in the head and neck region, causing a multitude of problems. Langerhans cell histiocytosis is classified into 4 variants: congenital self-healing reticulohistiocytosis (CSHR)(also known as Hashimoto-Pritzker disease), Letterer-Siwe disease, Hand-Schüller-Christian disease, and eosinophilic granuloma. Despite various clinical presentations and severity, all subtypes are pathologically caused by the proliferation of the Langerhans cell.

Management of Periocular Granuloma Annulare Using Topical Dapsone.

Granuloma annulare is a disease characterized by granulomatous inflammation of the dermis. Localized granuloma annulare may resolve spontaneously, while generalized granuloma annulare may persist for decades. The authors present the case of a 41-year-old Hispanic man with a two-week history of periocular granuloma annulare. Due to previously reported success in the use of systemic dapsone for the treatment of granuloma annulare, and the periocular proximity of the patient's lesion, topical dapsone was used for treatment. Various additional therapies for the management of granuloma annulare have been reported, such as topical and systemic steroids, isotretinoin, pentoxifylline, cyclosporine, Interferon gamma, potassium iodide, nicotinamide, niacinamide, salicylic acid, fumaric acid ester, etanercept, infliximab, and hydroxychloroquine. Additional clinical trials are necessary to further evaluate the effectiveness of topical dapsone in the management of granuloma annulare.

Salivary gland choristoma (heterotopic salivary gland tissue) on the anterior chest wall of a newborn.

Salivary gland choristoma (heterotopic salivary gland tissue) is a rare condition typically seen in the newborn period. This developmental heterotopia is generally nonprogressive, with little risk of malignant transformation. We present the second known reported case of a salivary gland choristoma located on the anterior chest wall. Knowledge of this rare entity will allow for accurate diagnosis and management of this benign anatomic variant.