Exanthematous lichen planus in a child and Mycoplasma pneumoniae: a case report and literature review.

Lichen planus (LP) is a chronic inflammatory disease of the skin and mucous membranes. The disease usually affects adults and is only rarely encountered in children. Typically, skin lesions include violaceous, polygonal, flat papules and plaques, affecting predilection sites such as the wrists, ankles, and lower back. However, clinical presentation can be heterogeneous and is often atypical in children. Various precipitating factors are known to play an important role in the pathogenesis of lichen planus, some of which may also be coincidental. LP occurring after an infection with Mycoplasma pneumoniae is a rare occurrence. We present the case of a 13-year-old boy with pruritic papular skin lesions on the extremities and trunk. In view of the clinical and histopathological findings, LP exanthematicus was diagnosed. To the best of our knowledge, our case is the first of pediatric exanthematous LP after M. pneumoniae infection that has been reported so far.

Mucocutaneous pyoderma gangrenosum: a case report and literature review.

Pyoderma gangrenosum is an uncommon neutrophilic dermatosis that usually presents with rapidly growing, painful, undermined, and purulent ulcers that are more likely to develop at areas of trauma. It is associated with underlying systemic diseases in more than half of cases, most commonly with inflammatory bowel disease. Pyoderma gangrenosum has no specific clinical, histologic, or laboratory findings, and so the diagnosis is based on exclusion of all other diagnostic possibilities, especially infectious causes. Misdiagnoses are frequent, with systemic vasculitides representing one of the main imitators. Treatment of pyoderma gangrenosum usually requires a multidisciplinary approach, with infliximab emerging as the best treatment option for cases associated with inflammatory bowel disease. The prognosis of pyoderma gangrenosum remains unpredictable, and recurrences are common. Here, we report a case of mucocutaneous pyoderma gangrenosum as a preceding sign of ulcerative colitis that responded to treatment with methylprednisolone and infliximab.

Case Report: Necrotizing Stomatitis as a Manifestation of COVID-19-Associated Vasculopathy.

Necrotizing stomatitis is a rare, acute-onset disease that is usually associated with severely malnourished children or diminished systemic resistance. We describe a 1-year-old girl who developed necrotizing stomatitis, vasculitic rash, skin desquamation on the fingers and toes, and persistent hypertension after serologically confirmed SARS-CoV-2 infection. Her laboratory investigations revealed positive IgG anticardiolipin and IgG anti-ß2 glycoprotein antibodies, and biopsy of the mucosa of the lower jaw showed necrosis and endothelial damage with mural thrombi. Swollen endothelial cells of small veins in the upper dermis were confirmed also by electron microscopy. As illustrated by our case, necrotizing stomatitis may develop as a rare complication associated with SARS-CoV-2 infection and can be considered as a part of the clinical spectrum of COVID-19 vasculopathy. The pathogenic mechanism could involve a consequence of inflammatory events with vasculopathy, hypercoagulability, and damage of endothelial cells as a response to SARS-CoV-2 infection.

A retrospective analysis of clinical characteristics and management of perianal streptococcal dermatitis in children and adults.

INTRODUCTION: Due to the paucity of recent literature on perianal streptococcal disease (PSD), we performed a comprehensive analysis of clinical characteristics of PSD and its management. METHODS: We conducted a retrospective search in the laboratory information system of the Institute of Microbiology and Immunology, Ljubljana, Slovenia, between January 2006 and December 2016 and identified patients with suspected PSD. We reviewed patients' medical records and obtained data on patient age and sex, concomitant illnesses, duration of complaints, signs and symptoms of PSD, epidemiological history, date of diagnosis, microbiological characteristics of beta-hemolytic streptococcal isolates, additional laboratory findings, duration and type of systemic and/or topical therapy, and recurrence of PSD. RESULTS: We identified 64 pediatric and eight adult PSD cases in total. The most common signs and symptoms were perianal erythema (67/72; 93.1%), anal fissures (28/72; 38.8%), itching (22/72; 30.6%), and blood-streaked stools (19/72; 26.4%). The duration of symptoms varied from < 1 week to > 1 year, with 58.3% of patients experiencing symptoms between 1 week and 6 months. The majority of patients received systemic (63/72; 87.5%) and topical (56/72; 77.8%) treatment. CONCLUSIONS: Although the signs and symptoms of PSD are non-specific, clinicians should be highly suspicious of the disease in adults and especially in preschool children with perianal complaints. Despite being a common disease, there is still considerable delay in correct diagnosis and treatment, prolonging the discomfort of PSD patients.

Atypical hand, foot, and mouth disease in an adult patient: a case report and literature review.

Hand, foot, and mouth disease is a highly contagious disease that predominantly affects children under the age of five. The illness is much less common in adults and often presents with atypical skin lesions. Here we describe the case of a 19-year-old healthy, immunocompetent male patient with atypical clinical presentation, with a macular rash on the scalp, palms, soles, and shins, and with minimal lesions in the oral cavity. The diagnosis of hand, foot, and mouth disease was confirmed by isolation of coxsackievirus A6 from a vesicle smearobtained on the right sole. The skin lesions resolved spontaneously in 1 week. This case emphasizes the underestimated fact that hand, foot, and mouth disease can also occur in adults, in either typical or frequently atypical form, and it highlights the role of coxsackievirus A6. Together with the case presentation, a review of the literature describing the disease in adults is presented.

Microbiological characteristics of perianal streptococcal dermatitis: a retrospective study of 105 patients in a 10-year period.

Beta-hemolytic streptococci (BHS) are the most common causative agents of perianal streptococcal dermatitis (PSD). This study evaluates the distribution of BHS isolates in perianal bacterial cultures. We retrospectively reviewed microbiological results for perianal BHS that were isolated in our laboratory between 2006 and 2015. We identified a total of 105 BHS isolates from rectal swabs and swabs of clinically intact perianal skin. The majority of BHS were of group A (GABHS) (73/105; 69.5%), followed by group B BHS (GBBHS) (27/105; 25.7%), and non-group A or B BHS (5/105; 4.8%). The distribution of GABHS was age-specific, with the majority of GABHS obtained from young children. All BHS isolates were susceptible to penicillin. GABHS were universally susceptible to clindamycin, whereas 1.4% were resistant to erythromycin. GBBHS were resistant to erythromycin and clindamycin in 14.8% and 7.4% of cases. In addition, we wanted to emphasize the importance of correct diagnosis of PSD. Hence, we provide a review of protocols that can decrease the time to diagnosis and treatment of PSD, reduce patients' discomfort, and prevent unnecessary diagnostic procedures.