A Novel Presentation of Cutaneous Angiosarcoma: A Case Report and Review.

We report a case of a 70-year-old male, with slowly widening induration, ulceration, and oozing for 3 months on the scalp and face. The diagnosis of aggressive cutaneous angiosarcoma was made on histopathology and immunochemistry from the biopsy material from the involved area of the skin.

Distinct clinico-immunological profile of patients infected with human papilloma virus genotypes 6 and 11.

Anogenital warts are primarily caused by Human Papillomavirus (HPV) type 6 and 11, which belong to the taxonomic family Papillomaviridae, genus alpha-papillomavirus and species 10. The presentation of the warts is varied and most of the patients have high recurrence rate of wart lesions. Studies had shown that an effective cellular immune response is required for the control of HPV infection. Here, we report distinct clinico-immunological profile of two patients presenting with venereal warts caused by HPV genotypes 6 and 11. The Case 1 manifested greater number of verrucous warts and case 2 had fewer subtle lesions. Further, evaluation of HPV antigen-specific cellular immune response revealed a robust T cell response against HPV6 peptide and a weak response against HPV11 in case 1. Interestingly, HPV genotyping revealed type 6 in case 1 with greater severity of infection and robust immune response against HPV6 peptide. In contrast, case 2 presented with milder infection and weak immune response and was positive for genotype 11. More extensive study with larger cohorts will strengthen our observation and could be relevant for designing immunotherapeutic adjunct strategies along with the standard treatment for rapid clearance of HPV infections in these patients. This communication reports immune status of two patients with venereal warts and their correlation with clinical presentation and the genotyping.

Linear adamantinoid basal cell carcinoma in the axilla.

We present a case of asymptomatic deeply pigmented linear plaque with rolled borders that we encountered in an elderly Indian male over a sun protected site, the left axilla. The diagnosis of linear adamantinoid basal cell carcinoma was confirmed on histopathological examination.

Study of Association of Atherosclerotic Risk Factors and Metabolic Syndrome in Patients of Psoriasis at a Tertiary Care Centre in North India: A Case Control Study.

OBJECTIVE: To study the association between psoriasis and atherosclerotic risk factors, including metabolic syndrome. METHODS: Fifty patients with psoriasis and 50 controls were included in the study. Atherosclerotic risk factors were evaluated as per National Cholesterol Education Project Adult Treatment Panel III (NCEP-ATPIII). Metabolic syndrome was diagnosed as per South Asian Modified -National Cholesterol Education Programme's Adult Treatment Panel III (ATP III). RESULTS: Psoriatic patients had a significantly higher prevalence of hypertriglyceridaemia (≥150 mg/dl) (p=0.013), low HDL (< 40mg/dl) (p=0.025), impaired fasting blood glucose (≥100 mg/dl) (p=0.026). Metabolic syndrome was present in significant number of psoriasis patients than in controls [42 (28%) versus 9 (6%)] (P=0.009). CONCLUSIONS: There is a significantly higher prevalence of metabolic syndrome and atherosclerotic risk factors in psoriasis patients as compared to controls.

Back pain, lower limb immobility and ulcers as indicators of abdominal aorta occlusion below the origin of renal arteries, Leriche syndrome.

A 33-year-old female, presented with fever, lower limb ulcers and severe backache. The present history evolved four weeks after the complaints of claudication of buttocks, thighs and calves. Lower limb arterial pulsations were not detectable. Colour Doppler and Computed Tomograph (CT) Angiography revealed blockage of abdominal aorta below the origin of renal arteries. The cause of the fever, lower limb ulcers and cruciate backache could be related to this occlusion. This obstruction which was first described by Leriche and is not known to endow with such perplex symptomatology and that too, to a dermatologist with acute febrile illness, severe backache and lower limb ulcers.

Acral, pure cutaneous, self-healing, late-onset, cellulitis-like Langerhans cell histiocytosis.

BACKGROUND: An unusual and not yet reported clinical presentation of pure cutaneous Langerhans cell histiocytosis (LCH) that was a diagnostic dilemma. OBJECTIVE: To bring to light the newer presentation of this disease. METHOD: The case was managed on clinical grounds initially as cellulitis. However, after the investigations and confirmation of the diagnosis, she was managed symptomatically. RESULTS: Pure cutaneous LCH may manifest in early adulthood with features of cellulitis, erythematous edematous vesicular plaques, and nodules distributed in the flexural acral areas. CONCLUSION: Pure cutaneous LCH may have an acute late onset with unusual morphology as cellulitis, inverse acral distribution, and self-healing.

Late-onset Rothmund-Thomson syndrome.

A 43-year-old woman presented with complaints of exfoliation of the skin and mottled pigmentation all over the body, intolerance to sunlight for the last 14 years, and swelling on the lower one-third of the neck for 15 years. She was apparently well until the age of 29 years when she noticed redness on her shins which later progressed to involve the upper limbs, chest, and face. Three months later, she observed multiple, small, brownish plaques over the erythematous areas, which gradually spread to the sun-exposed areas, namely the face, forearms, hands, and nape of the neck. The erythema disappeared within 5 months of onset. The patient experienced redness of the face, intolerance to the sun, and reduced sweating, particularly during the summer. There was no history of bullous eruption, difficulty during deglutition, tremors, or pedal edema. She suffered five miscarriages and, ultimately, was successful in delivering a normal boy who is now 16 years of age. She had menarche at the age of 14 years and her menstrual cycle was regular. There was no history of similar illness in the family. On cutaneous examination, the skin on the face, neck, trunk, buttocks, and limbs was found to be dry, lusterless, thin, and covered with fine scales. Mottled hyperpigmentation was observed all over the body. Atrophy and telangiectasia were seen over the neck (Fig. 1), face (Fig. 2), nape of the neck, upper and lower limbs, back, and chest. Mild erythema was observed over the face, nose, ears, and forearms. The hair on the scalp, eyebrows, axillae, and pubic area was sparse and thin. The teeth were loose and discolored due to caries, and a foul odor emanated from the mouth. The nails were lusterless and centrally depressed. The thyroid gland was enlarged, smooth, nontender, and moved with deglutition. No bruit was heard over it. No ocular abnormality was detected. The patient had a haemoglobin level of 7.6 g%, total serum iron binding capacity of 70 micromol/L (normal, 45-66 micromol/L), and serum ferritin level of 10 microg/L (normal, 15-200 microg/L). Peripheral blood smear showed hypochromic microcytic red blood cells. Total and differential leukocyte counts, erythrocyte sedimentation rate (ESR), blood glucose, serum electrolytes, total and differential serum proteins, liver function tests, blood urea, and microscopic examination of urine and stools were within normal limits. The thyroid profile and complement C3 and C4 levels were within normal limits. Rheumatoid factor, antinuclear factor and LE cells were absent. Abdominal ultrasonogram was normal. Fine needle aspiration cytology from the thyroid gland showed features suggestive of colloid goiter. Skin biopsy revealed thinning of the epidermis, flattening of the rete ridges, and hydropic degeneration of the basal cell layer. The dermis was edematous with dilated capillaries, melanophages, and a band-like mononuclear infiltrate. The sweat glands were reduced in number.

X-linked dominant inheritance in palmoplantar keratoderma with leukokeratosis: a study of the pedigree of two cases.

Keratoderma of the palms and soles is not of rare occurrence. Its association with leukokeratosis of the mouth is well recognized. We describe two siblings having callosities like keratoderma over the weight bearing areas of soles, pressure areas of palms and palmar creases with leukokeratosis of cheeks. On study of the pedigree of these probands we could trace the trait transmission by a rare X-linked dominant mechanism.

Eosinophilic leukemoid reaction in a case of bullous pemphigoid.

A 70-year-old woman was having bullous pemphigoid. The blood tests revealed leucocytosis and eosinophilic leukemoid picture, confirmed later on with bone marrow aspiration.