Is Kikuchi-Fujimoto disease a manifestation of systemic lupus erythematosus?

A 32-year-old woman presented with fever and swelling in the axillae of 2 months' duration, and erythema of the face, fluid-filled lesions on the trunk, oral ulcers, crusting of the lips, and redness and watering of the eyes for 3 days. The patient was initially diagnosed with tuberculous lymphadenitis and was given antituberculous treatment. One month later, she developed the present complaints (see below). The patient was photosensitive. There was no joint pain or Raynaud's phenomenon. She had experienced three intrauterine deaths in the past with no live births. On examination, the patient was pale. Bilateral axillary lymphadenopathy was present. The lymph nodes were mobile, non-tender, and not matted. Mucocutaneous examination revealed a malar eruption, flaccid bullae on the back (Fig. 1), crusting of the lips (Fig. 2), oral ulcers, and redness and discharge from the eyes. On investigation, immunoglobulin G (IgG), IgM, and IgA for tuberculosis were negative. There was anemia and leukopenia, the erythrocyte sedimentation rate (ESR) was raised, albumin in urine was positive, enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative, and venereal disease research laboratory (VDRL) test was nonreactive. Antinuclear antibody (ANA), dsDNA, and antiphospholipid antibody were positive. Fine needle aspiration cytology (FNAC) of the axillary lymph node showed loss of nodal architecture. The extensive infiltrate consisted of lymphocytes, histiocytes, immunoblasts, and necrosis of cortical and paracortical areas. There was histiocytic necrotizing lymphadenitis without granulocytic infiltration. These features were suggestive of Kikuchi-Fujimoto's disease (Fig. 3). Skin biopsy showed epidermal atrophy, basal cell vacuolation, focal hyperkeratosis, pilosebaceous atrophy, and follicular plugging. The dermis showed edema and a lymphocytic infiltrate in the upper dermis and around the blood vessels. These features were suggestive of systemic lupus erythematosus (SLE). Direct immunofluorescence of lesional skin showed a strong continuous basement membrane zone (BMZ) band of C3 and fibrinogen and a strong discontinuous granular BMZ band of IgG. IgA was negative. Covered skin showed moderate and strong positivity for IgM and IgG, respectively. C3, IgA, and fibrinogen were negative. These findings were suggestive of SLE (Fig. 4). Based on the clinical findings and investigations, a diagnosis of Kikuchi-Fujimoto's disease with SLE was made.

Occupational dermatoses in beedi rollers.

A total of 91 beedi workers were analyzed for the pattern of cutaneous lesions. Period of rolling beedi ranged from 2 months to 40 years. Dermatological findings included; callosities seen in 51 (56.04%) of workers on fingers and feet, nail changes in 22 (24.18%) like pigmentation, paronychia, dystrophy which were more prominent on the right index finger, fungal infections in 15 and eczemas in 29. Callosities and localised nail changes can be considered to be occupational marks in beedi rollers correlated to use of scissors for cutting leaves and use of gum and artificial metallic nails for rolling beedis.

Clinico-epidermiological studies on tinea versicolor.

One hundred and twenty patients with tinea versicolor who attended the outpatient department of Dermatology, K.M.C Hospital, Mangalore were studied with reference to their clinical features, age and sex distribution, relation to climate and personal habits. The disease was commonest among the age group of 21-30 years (30%). It was found to be distributed predominantly over the neck (71.6%), chest (58.3%) and back (70%). Inmost of the patients, lesions were observed first and also aggravated during summer months. One fourth of the patients either had systemic diseases or were on immuno-suppressant drugs. The disease was continuous in spite of taking treatment in 21.6% of patients. 38.3% of patients gave a positive family history. Even though the disease is resistant to treatment, avoiding the predisposing factors like increased sweating, sharing the towels and clothes, malnutrition, synthetic clothings will help to control the disease.

Congenital cerebriform melanocytic naevus with cutis verticis gyrata.

Congenital melanocytic naevus is hamartomatous or non-neoplastic proliferation of abnormal mixture of tissue's or non-neoplastic proliferation of abnormal mixture of tissue's normal components. Cutis verticis gyrata is hypertrophy with parallel or gyrate folds of skin of scalp. We report a young man who presented to us with hair loss on the back of the head and increased growth of hair over the upper back since birth. A biopsy proved the diagnosis of congenital melanocytic naevus.