Chromoblastomycosis Presenting with Sporotrichoid Distribution and Bony Destruction: A Rare Presentation.

Chromoblastomycosis (CBM) presenting with linear distribution and with underlying bony destruction is rare. Herein, we report such a presentation in a farmer who presented with ulcerated nodules over the right leg and swelling of the right foot. Potassium hydroxide (KOH) preparation and histopathological examination of biopsy from nodule revealed characteristic sclerotic bodies on Gomori methenamine silver and periodic acid Schiff stain (PAS), which confirmed the diagnosis of chromoblastomycosis. X-ray of right foot revealed osteolytic destruction of right third metatarsophalangeal joint. Work-up for systemic involvement did not reveal any involvement. He was placed on combination therapy of itraconazole and terbinafine and is under follow-up.

Updates on Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by IADVL SIG Leprosy.

The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.

Study of BCG Immunotherapy in the Management of Multiple, Extensive Non-Genital Cutaneous Common Warts.

BACKGROUND AND AIMS: Most of the available treatment therapeutic modalities for warts are aimed at destruction of virus. However, despite adequate treatment, the virus may persist in the surrounding tissues leading to recurrence. Owing to side effects such as pain, scarring, and risk of secondary infection, these modalities may not be suitable for multiple lesions, extensive involvement and for the treatment of warts in the paediatric age group. The aim of the study was to evaluate the efficacy and safety of intra lesional BCG vaccine in the management of patients with multiple extensive non-genital common warts. METHODS: Thirty patients with multiple, extensive non-genital cutaneous common warts, with age ranging from 6 to 60 years who were not on any treatment for warts and did not have any active infections (including HIV) or past history of tuberculosis attending the department of dermatology of our hospital in a 2-year period were included. Mantoux test was performed in all patients and positive responders were taken up for study. BCG vaccine was administered into the largest wart intradermally and the injection was repeated every 3 weeks for a maximum of five injections or till the complete clearance of warts, whichever was earlier . The efficacy was assessed every 3 weeks and a final assessment was done at the end of the 12th week. Patients were followed up for another 6 months. OBSERVATIONS: Majority of patients were in the age group of 5-14 years. Males (63.3%) were afflicted more than females. Most patients (63.3%) exhibited partial response at the site of injected wart at the end of one month and 70% patients showed complete clearance at the end of 3 months and 36.6% responded with 3 injections and 26.6% patients required 4 for response followed 23.3% requiring 5 injections. CONCLUSION: Intralesional immunotherapy using by BCG vaccine appears to be is a promising treatment modality for the treatment of warts, particularly the multiple and recalcitrant ones. The advantages include the resolution of both the injected and distant warts with negligible recurrence and with minimal side effects.

Zygomycosis of the Scalp Caused by Rhizopus oryzae Presenting as Kerion in an Immunocompetent Child.

Deep mycosis of the scalp caused by Rhizopus oryzae mimicking kerion is rare. Herein, we report a case of such infection in a 5-year-old immunocompetent boy who presented with multiple painful boggy swellings with discharging sinuses on the scalp of 4 months' duration. Purulent discharge from the swelling cultured on Sabouraud's dextrose agar yielded R. oryzae species which was confirmed by molecular analysis by polymerase chain reaction. The child was managed with parenteral liposomal amphotericin-B which helped in clearance of infection.

Erythema Gyratum Repens Associated With Diffuse B-cell Lymphoma-Report of A Rare Case.

Erythema gyratum repens (EGR) is a rare paraneoplastic dermatosis known to be associated with internal malignancy. Herein, we report a case of EGR with diffuse large B-cell lymphoma (DLBCL) in a young farmer who presented with generalized massive lymphadenopathy and wood-grain pattern dermatosis. Lymph node biopsy with immunohistochemistry established the diagnosis of DLBCL. He was managed by the oncologist with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen which alleviated his symptoms considerably after completion of three cycles and was under follow-up.

Malignant Syphilis in an Immunocompetent Adult Male.

The occurrence of malignant syphilis in an immunocompetent individual is rare. We present malignant syphilis in a 35-year-old immunocompetent male who presented with a 1-month history of noduloulcerative lesions on the torso. Examination revealed multiple pustules, nodules, and deep-seated ulcers distributed on the trunk, face, and upper and lower limbs. Characteristic morphology of lesions, positive serological tests for syphilis, characteristic histopathology, and resolution of lesions following institution of penicillin therapy confirmed the clinical diagnosis of malignant syphilis.

Desmoid Tumor of Rectus Abdominis Presenting with Grey-Turner's and Cullen's Sign: A Report of a Rare Case.

Desmoid tumor of rectus abdominis presenting with Grey-Turner's and Cullen's sign is rare. Herein, we report desmoid tumor of rectus abdominis in a 64-year-old multiparous female who presented with ecchymosis involving left flank and around the umbilicus. Histopathological examination of biopsy from the tumor confirmed the diagnosis of the desmoid tumor. She was referred to a surgeon for radical resection.

Borderline Tuberculoid Leprosy Associated with Histoid Leprosy.

Coexistence of two immunologically diverse forms of leprosy in an individual is very rare. Herein, we report a case of association of borderline tuberculoid (BT) leprosy with histoid leprosy (HL) in a young immune competent male. He was diagnosed as a case of BT leprosy 10 years ago and now presented with multiple papules and nodules. Histopathological examination of biopsy taken from patch and nodule showed features of BT and HL, respectively.

Painless Ulcers and Fissures of Toes: Hereditary Sensory Neuropathy, Not Leprosy.

Hereditary sensory neuropathies (HSN) are rare genetically determined neuropathies. They often manifest as painless injuries in children. We present HSN in a 5-year-old boy who presented with recurrent fissuring and ulceration involving both great toes.

Amelanotic Melanoma in the Vicinity of Acquired Melanocytic Nevi and not Arising from Agminated Melanocytic Nevi: Masquerading as Pyogenic Granuloma.

Amelanotic melanoma (AMM) presenting as pyogenic granuloma and occurring in the vicinity of acquired melanocytic nevi is rare. Herein, we report such a manifestation in a 68-year-old male who presented with the painful red nodule and multiple pigmented patches involving the left great toe. Histopathological examination of skin biopsy taken from the nodule with an immunohistochemical study using HMB45 and S-100 confirmed the diagnosis of AMM. Biopsy from the pigmented patch near the nodule showed features of melanocytic nevus. Investigative work up revealed metastatic deposits in the left inguinal lymph node with no evidence of systemic involvement, placing him in malignant melanoma Stage IIIC of American Joint Committee on Cancer (AJCC) tumor node metastasis system. The development of AMM in the vicinity of acquired melanocytic nevi and manifesting as granuloma pyogenicum is unique in this case.