Cutaneous Cryptococcosis Clinically Mimicking Necrotizing Fasciitis

Secondary cutaneous cryptococcosis may occur earlier than other manifestations of disseminated cryptococcosis. A 68-year-old woman presented with multiple ulcerative lesions on the right calf of 2 weeks duration. She had been treated with antibiotics, but the lesions spread rapidly. The initial clinical impression was necrotizing fasciitis, but routine KOH mounting from the ulcerative lesions showed numerous budding yeast cells with peripheral clear zones and further investigations including a skin biopsy, tissue cultures and India ink preparations allowed a rapid and definitive diagnosis of cutaneous cryptococcosis. Studies for other evidence of infection elsewhere revealed an asymptomatic pulmonary lesion. We report a case of secondary cutaneous cryptococcosis clinically mimicking necrotizing fasciitis that occured before other manifestations of disseminated cryptococcosis.

A Case of Peripheral T-cell Lymphoma Manifesting Bilateral Periobital Infiltration with Swelling / 대한피부과학회지

Periorbital swelling is a rather common symptom. Of the causes, the associated lymphoproliferative diseases rarely involve, and, if any, pseudolymphoma and B-cell type of lymphoma are mostly implicated. We report herein a case of unspecified peripheral T-cell lymphoma presenting as only manifestation of bilateral orbital swelling. A 32-year-old woman had a fluctuant course of bilateral mild erythematous swelling without ocular or lymph node involvement for about 2 years. Biopsy specimens from the left upper eyelid showed infiltration of medium-sized atypical cells with pleomorphism, convoluted nuclei, scant cytoplasm and less prominent nuclei. The cell was LCA, UCHL-1 and CD3 positive, but negative for L26. She received six cycles of CHOP combined therapy, with a marked improvement. No relapse was noted during a period of about a 6-month follow-up.

A Case of Verrucous Carcinoma on the Lower Lip / 대한피부과학회지

Verrucous carcinoma of the oral cavity is a rare tumor representing 4.5-9.0% of oral squamous tumors. Involvement of the lip is less common within the oral cavity. It presents as a slowly enlarging, exophytic warty growth with extensive local invasion, though well-differentiated and rarely metastaticl. We herein repart a case of verrucous carcinoma on the lower lip in a 31-year-old man.

The Electron Microscopic Study of Normal Structures and Post-exposed Structural Changes to Antifungal Agents in Dermatophytes / 대한피부과학회지

BACKGROUND: Dermatophytes are common pathogens of cutaneous fungal infections. Although antifungal agents have been used widely on the dermatophyte infections, the ultrastructural changes of dermatophytes caused by drugs have not been described in detail elsewhere. OBJECTIVE: We compared the ultrastructures of common dermatophytes and their changes after exposure to three antifungal agents, itraconazole, terbinafine and creosote, to inform the effectiveness of drugs on ultrastructures of dermatophytes. METHODS: Two strains of Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum canis were cultivated on Sabouraud dextrose agar(SDA). Conventional electron microscopic specimen preparation was performed and examined by transmission electron microscope. After 24-hour exposure of each strain with 100 microgram/ml of itraconazole, 50 microgram/ml of terbinafine and 100 microgram/ml of creosote on SDA, the ultrastructural changes of their hyphae were investigated. RESULTS: The ultrastructural findings of each dermatophyte were similar. Tube-like hyphae and simple septal pores with Woronin bodies were typical findings. There were one or more than one nuclei and various intracellular organelles between the septa. A greater density of cytoplasm and organelles could be seen in the younger hyphae. Microscopically, destruction of the cell wall, edema and necrosis of intracellular organelles, and an increase in the number and size of vacuoles could be seen after drug exposure. After exposure to itraconazole and terbinafine, edema and necrosis of the cell wall and membranous structures were found, as well as, membranous bodies that represented destructive changes in the cell wall. The hyphae exposed to terbinafine showed various sized of lipid globule in the cytoplasm. Creosote exposure lead to a more non-specific and severer necrotic pattern of the intracellular structures. CONCLUSION: There seemed to be similar features of normal hyphae of dermatophytes. Antifungal agents, itraconazole and terbinafine, affected membranous structures of dermatophytes, whereas creosote acted on internal structures by a nonspecific direct toxic effect. Transmission electron microscope was a useful tool to investigate the changes of internal ultrastructure of dermatophyte by antifungal agents.

Phaeohyphomycosis Due to Exophiala dermatitidis Successfully Treated with Itraconazole / 대한의진균학회지

Phaeohyphomycosis is a subcutaneous and systemic infection caused by dark-walled hyphae and differs from chromoblastomycosis in that it has no sclerotic cells. It commonly occurs in a immunosuppressed host. Exophiala dermatitidis, common pathogen of phaeohyphomycosis, has been commonly reported in Japan, but very rare in Korea. This report describes a case of phaeohyphomycosis due to Exophiala dermatitidis successfully treated with itraconazole.

A Case of Syphilis Probably Transmitted by Abnormal Imposition of Hands / 대한피부과학회지

A 28-year-old man presented with a 6.0 * 5.0 cm sized ulcer on the anterior chest and widespread copper-red colored maculopapular eruptions. There was no past or family history of syphilis sign or STS. He had been taken imposition of hands twice to treat chronic hepatitis about 4 months prior to presentation. Thereby, the ulcerative lesion on the anterior chest developed as a result of erosive trauma through contact with infected fingernails. The clinical features and serologic tests as well as biopsy findings were consistent with syphilis. Spirochetes were observed under the dark field examination of the anterior chest lesion. On Warthin-Starry staining, spirochetes were identified in the epidermal area of the papular lesion. We report a case of unusual transmission of syphilis.

A Case of Multiple Appendage Tumors in Nevus Sebaceus

Nevus sebaceus is a common hamartoma that has a variety of appendage tumors. We report a case of nevus sebaceus with multiple appendage tumors on the scalp of a 43-year-old male. The exudative inflamed patches were admixed with darkly pigmented small nodules which had developed secondarily within a 4.0 × 1.5cm lesion 2 years previously. Histologically, on serial sectioning, there were various types of basal cell carcinoma, syringocystadenoma papilliferum, tubular apocrine adenoma and sebaceous adenoma. Some parts of a biopsy specimen, showed a tumor of the follicular infundibulum-like epidermal changes. There were also calcium depositions in the stroma and apocrine tumors, There was no relapse at 1-year follow-up after surgical treatment.

Antifungal Effect of Jungrowhan(R)and Vinegar to Fungi Causing Skin Infection / 대한의진균학회지

BACKGROUND: Even though recent improvement of antifungal agent is remarkable, side effect makes patient hesitate to use them. Instead, mixture of Jungrowhan(R)and vinegar is traditionally used and it makes contact dermatitis and secondary bacterial infection. OBJECTIVE: We tested antifungal activity of vinegar and Jungrowhan(R)to know their its efficacy. METHOD: Candida albicans(CA), Trichophyton rubrum(TR), Trichophyton mentagrophytes(TM) were cultivated in Sabouraud dextrose agar admixed with various amounts of Jungrowhan(R)and vinegar. We used the standard checkerboard titration for detecting synergy or antagonism of these two materials. Using the individual ingredients of Jungrowhan(R) sensitivity tests were done. RESULTS: Minimum inhibitory concentrations (MICs) of Jungrowhan(R) were 6~8mg/ml in CA, 2mg/ml in ra and 2~4mg/ml in TM. MICs of vinegar were 0.05~0.2m1/m1 in CA, 0.02~0.03m1/m1 in TR and 0.01~0.02m1/m1 in TM. The checkerboard titration of two materials revealed no synergism. MIC of creosote, one of ingredients of Jungrowhan(R), was the same of Jungrowhan(R), and the others revealed no antifungal effect. CONCLUSIONS: Even though Jungrowhan(R) and vinegar showed antifungal activity, using mixture of two material revealed no synergism. Their antifungal activity does not come from its herbal ingredients but just from creosote which is a kind of phenol mixture used for antiseptics, and acid of vinegar.

A Case of Cutaneous B Cell Lymphoma / 대한피부과학회지

We report a case of cutaneous B cell lymphoma in a 68-year-old male who had primarily developed two 2.0 * 2.0 * 0,6cm sized, dome shaped, dark red colored tumors on the medial side of his left thigh about 4 months previously. His general condition was good and laboratory results were within normal limits, except for the enlargement of aortocaval, paraaortic and left inguinal lymph nodes. Histopathological examinations revealed diffuse dense infiltration of large atypical cells with vesicular nuclei and large prominent nucleoli in the entire dermis. They were largely composed of centroblast and immunoblast-like cells and showed positive reactions to the leukocyte common antigen, and L26 and CD22 was related to peripheral B-cell lineage in the immunohistochemical study. The skin lesions improved completely with an m-BACOD regimen. There was no relapse over a 3-year follow-up period.

A Case of Erythema Nodosum-like leukemia cutis / 대한피부과학회지

We have encountered a rare case of erythema nodosum-like leukemia cutis associated with acute myelocytic leukemia(AML) in a 57-year-old male. He was in good health until about 2 weeks prior to admission, when the systemic symptoms of high fever, anorexia, general weakness and malaise, and subcutaneous nodules developed. The nodules were multiple, red and noted bilaterally on the pretibial areas. Histological findings of his skin lesions showed diffuse cellular infiltrates intermingled with leukemic cells predominantly involving the adipose tissues. The cells displayed negative stainirig to antibodies CD3 and CD20, but positive staining to LCA. The diagnosis of AML(M4) was made by blood and bone marrow studies. He had a rapid downhill course and was discharged after 2 weeks of admission, with no anti-cancer chemotherapy.

A Case of Verrucous Hemangioma / 대한피부과학회지

We report herein a gigantic case of verrucous hemangioma occuring in a 15 year-old school- boy. The lesion was a dark red colored, 10.0 x 6.0 x 0.8cm sized, verrucous surfaced, hemangiomatous tumor affecting the posterior aspect of the right thigh. At birth an erythematous macule appeared and insidious]y increased or extended with age. In the last 6 months, it had grown rapidly to the size of the present lesion with a smaller satellite one, assumably ascribing to the repeated minor trauma or pressure. Histological findings from the totally excised lesion showed epidermal hyperplasia with irregular acanthosis and papillomatosis and diffuse marked proliferation and dilatation of blood vessels from the upper dermis to subcutaneous fatty tissue. Wide excision was done. There was no relapse after about one years postoperative follow up.

A Case of Isolated Plantar Collagenoma

Isolated plantar collagenoma with a cerebriform appearance is a hamartomatous lesion consisting of proliferation of normal collagen tissue and has been reported with other systemic alterations described as Proteus syndrome. We report herein a rare case of isolated collagenoma located on the plantar surface with macrodactyly of the 3rd and 4th toes occurring on the right foot, which is considered as an incomplete form of Proteus syndrome. A 36-year-old male with normal intellectual and physical development visited with a pedunculated, soft, dome-shaped tumor and multiple, grouped, slightly elevated nodules on the right plantar region and hypertrophy of the 3rd and 4th toes of the right foot. The lesions appeared during early childhood and have been growing steadily since then. Total excision of the plantar mass with skin grafting and debulking of the 3rd toe and amputation of the 4th toe were done.

A Case of Atypical Polypoid Dermatofibroma / 대한피부과학회지

Atypical polypoid dermatofibroma(APDF) represents a distinctive clinicopathologic variant of dermatofibroma. We describe an unusual case of APDF occuring on the right buttoack in a 27-year-old female. The lesion was a reddish-hued, rounded, hard protuberant tumor with short pedicle, measuring 2,7 x 2.7 x 1.5cm. Excised tumor showed a well circumscribed dermal lesion localized in the protruded ar~ea, and dense proliferation of fibroblasts and capillaries reminiseent of fibrous or scle~rosing hemangioma type, with prominent focal cellular atypia. The tumor cells were vimentin-positive, but did not express CD34. There was no evidence of recurrence after 18 months postoperative follow-up.