Pemphigus foliaceus-like, immunologically negative dermatosis in a patient with T cell chronic lymphocytic leukemia.

A 56-year-old black man developed a pemphigus foliaceus-like bullous eruption as the initial presentation of chronic T cell lymphocytic leukemia. Histologic examination disclosed superficial acantholysis consistent with pemphigus foliaceus and an infiltrate of atypical lymphoid cells in the papillary dermis. Repeated direct and indirect immunofluorescence studies yielded negative results. Acantholysis could be reproduced in vitro by incubation of normal human skin with the patient's serum and plasma but not with blister fluid. In the following months, the course of the bullous eruption paralleled that of the leukemia.

Acute miliary tuberculosis in a child with anhidrotic ectodermal dysplasia.

A 20-month-old boy with anhidrotic ectodermal dysplasia developed fever and papulopustular skin lesions. A skin biopsy showed the histologic changes of acute miliary tuberculosis. Anhidrotic ectodermal dysplasia is characterized by an absence of seromucous glands in the oropharynx and tracheobronchial tree, making children with this disease prone to viral and bacterial respiratory infections. Mild defects in their immunologic system have also been reported. We suggest that these abnormalities may have predisposed the patient to this rare form of cutaneous tuberculosis.