Co-existence of cutaneous leishmaniasis with pleural effusion: a case report from Iran.

Herein, a 12-year-old Afghan boy with chronic cutaneous leishmaniasis on the face and verrucous lesions on the body and pleural effusion suspected of having co-existent tuberculosis has been presented. The cutaneous lesions were appeared for five years before his admission. Leishman-Donovan bodies were seen in H&E (Hematoxylin and eosin) slide of skin lesion specimens. The pathogenic species was proved to be Leishmania tropica using Polymerase Chain Reaction (PCR) method. Purified Protein Derivative (PPD) and Leishmanin Skin Test (LST) were strongly positive. The patient was treated with systemic and intralesional meglumine antimoniate (Glucantime) for cutaneous leishmaniasis and then with anti-tuberculosis drugs for pleural effusion. Afterwards, pleural effusion was disappeared and cutaneous leishmaniasis cured.

Crusted scabies in a patient with brain astrocytoma: report of a case.

A 31-year-old man was referred to our clinic complaining of generalized erythematous and scaly papules and plaques. He suffered from a brain tumor (astrocytoma) and was immunosuppressed because he was receiving systemic steroids and chemo-radiation therapy. He also had psychomotor retardation and behavior changes due to the pressure effect of his brain tumor. The diagnosis of crusted scabies was established based on direct positive skin smears from the lesions.

Weekly intramuscular methotrexate in the treatment of low-risk gestational trophoblastic neoplasia.

OBJECTIVE: The objective of this study was to determine the efficacy of weekly intramuscular (IM) methotrexate without dose escalation as first-line chemotherapy for low-risk gestational trophoblastic neoplasia (LRGTN). METHODS: Thirty-three women with post-molar LRGTN in the division of gynecology oncology at the Shiraz University of Medical Sciences were treated with weekly IM methotrexate at 30 mg/m(2) without dose escalation. The serum level of beta-hCG was detected every week. After the first negative beta-hCG level, one more cycle was administered as consolidation. Complete response (CR) was defined as the attainment of serum beta-hCG level of 5 IU/L or less measured on three consecutive weeks. RESULTS: Twenty-one of 33 women (63.6%) achieved CR with weekly IM injection of 30 mg/m(2) methotrexate. Ten of 12 patients with weekly IM methotrexate failure had a CR after one to three courses of dactinomycin administered at 1.25 mg/m(2) intravenously every 2 weeks. Two patients needed multiple-agent chemotherapy for remission. CONCLUSIONS: Weekly methotrexate without dose escalation may be an appropriate option for primary chemotherapy of patients with LRGTN.

Desmoglein ELISA in the diagnosis of pemphigus and its correlation with the severity of pemphigus vulgaris.

Anti-desmoglein 3 and 1 autoantibodies are involved in the pathogenesis of pemphigus diseases. Our objective was to assess the value of ELISA in the diagnosis of pemphigus and its correlation with the severity of pemphigus vulgaris. Based on clinical presentation and histopathologic confirmation for the diagnosis of the pemphigus, 38 patients took part in the study. Sera of the patients were tested by desmoglein 1 and desmoglein 3 ELISA. Also, direct immunofluorescence was performed for all patients which revealed positive results in 36 patients (94.7%). ELISA was positive in 37 of 38 pemphigus patients (Sensitivity: 97.3%). The relationship between desmoglein 1 index values and skin severity was statistically significant (p<0.05). Desmoglein 3 index values increased with oral severity although this was not statistically significant. Iranian patients similar to Indian patients had higher positive anti-desmoglein 1 autoantibodies. Desmoglein-ELISA test is appropriate in the diagnosis of pemphigus. Desmoglein 1 index value is statistically correlated with the severity of pemphigus vulgaris.

Assessment of androgens in women with adult-onset acne.

BACKGROUND: Acne is generally recognized as a disorder of young adults; however, the referral of patients aged over 25 years with acne is increasing. Disturbed androgen production in the ovaries or adrenal gland and impaired plasma transport of androgens in women with adult-onset acne or acne associated with hirsutism have been described. METHODS: Thirty-five white women with adult-onset acne (onset after the age of 25 years) and hirsutism (A + H), 35 white women with adult acne without hirsutism (A - H), and 35 age-matched white female controls were recruited in this case-control study. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, dihydroepiandrosterone sulfate (DHEA-S), and sex hormone binding globulin (SHBG) were determined in all patients and compared. RESULTS: The mean SHBG, free androgen index (FAI), and DHEA-S were significantly different between A + H and control subjects. The only significant difference between A - H and control subjects was observed for DHEA-S. CONCLUSION: DHEA-S plays a key role in the pathogenesis of adult-onset acne. Measurement of circulating androgens, including DHEA-S, especially in patients presenting with adult-onset acne and hirsutism, is helpful, and patients with elevated levels can benefit from hormonal therapy.

Pimecrolimus cream in repigmentation of vitiligo.

BACKGROUND: Vitiligo is a chronic disease that mostly affects children and young adults. Nowadays many treatment options are available; however, most of them have limited efficacy and in most cases would result in undesirable complications. OBJECTIVE: To determine the extent of repigmentation according to the location of the lesions after applying topical cream pimecrolimus 1% in vitiligo patients. MATERIALS AND METHODS: Thirty consecutive patients with vitiligo lesions affecting less than 20% of body surface area without any previous history of spontaneous repigmentation were treated with pimecrolimus cream 1% twice daily for 12 weeks. The extent of repigmentation in vitiligo lesions was determined in each patient after 6 and 12 weeks. RESULTS: Moderate to excellent response (repigmentation >26%) was observed in 6.6 and 25.9% of vitiligo lesions 6 and 12 weeks after treatment, respectively. More responsive lesions were located on the trunk, face and elbow (85.7, 75 and 70%). CONCLUSION: Pimecrolimus cream 1% results in repigmentation in vitiligo in different extents according to the location of the lesion; however, to clearly prove its efficacy as monotherapy or in combination with other available treatment options, double-blind placebo-controlled studies are essential.