Primary cutaneous infection with Mycobacterium avium intracellulare complex resembling lupus vulgaris.

We describe a 56-year-old woman with Mycobacterium avium complex infection of the skin. She presented with a granulomatous plaque studded with pustules and crusts on the cheeks and bridge of the nose. The appearance resembled lupus vulgaris. The lesion responded well to antituberculous treatment within 9 months. An association of Mycobacterium avium complex with squamous cell carcinoma of the cervix is emphasized.

Mycobacterium marinum cutaneous infections acquired from occupations and hobbies.

BACKGROUND: Non-tuberculous mycobacterial (NTB) infections are not commonly diagnosed in Thailand. The dissertation of reported cases among 10 published reports of 44 cases within 20 years revealed only six cases of cutaneous infections in which M. marinum was not included. METHODS: The proven cases of M. marinum infection were studied at the Institute of Dermatology, Bangkok from 1981 to 1990. The clinical data, histopathology, tuberculin test, chest x-ray, and treatments were recorded. RESULTS: M. marinum skin infection accounted for 18 cases (81.8% of NTB skin infection), 10 men and 8 women. A history of preceding trauma occurred in 11 cases (61.1%), most of which were negligible wounds or minor abrasions. Twelve cases (66.7%) were in contact with organisms in their occupations and hobbies associated with fish and water exposure. CONCLUSIONS: Eighteen cases of M. marinum cutaneous infection acquired from occupations and hobbies were reported. The term "M. marinum cutaneous infection" or "M. marinum granuloma" instead of swimming pool granuloma or fish tank granuloma was proposed. According to this study, cotrimoxazole was the most appropriate drug for the treatment of M. marinum cutaneous infection.

Papulonecrotic tuberculid. Necessity of long-term triple regimens.

Eleven cases of papulonecrotic tuberculid (PNT) were seen at the Institute of Dermatology, Bangkok, over a 2-year period (1985 to 1986). The diagnosis was supported clinically by symmetric, scattered, papulopustular necrotic lesions, healed with atrophic scars; strongly positive tuberculin test; histopathologic findings; and a rapid improvement after antituberculous therapy. Despite multiple-drug therapy, three cases had recurrences after discontinuation of treatment. Long-term treatment is recommended for the treatment of PNT.

Vitamin B12 deficiency: report of a childhood case.

An 11-year-old boy who presented with anemia, premature grey hair, hyperpigmented skin, paresthesia, recurrent aphthous ulcers and epistaxis was eventually proved to be a case of vitamin B12 deficiency. Due to the paucity of this deficiency, the diagnosis may easily be delayed and overlooked resulting in unfavorable consequences. Therapeutic response to vitamin B12 was dramatic in this reported case.

The use of low dose cyclosporin A in a case of recalcitrant erythrodermic psoriasis.

A 48-year-old Thai female, who had stage 2 carcinoma of the breast presented with recalcitrant erythrodermic psoriasis which was unresponsive to conventional therapies. She was prescribed 6 mg/kg.day cyclosporin A. The erythroderma responded rapidly and was completely cleared within 3 weeks. The dosage was reduced in a step-wise manner to 4 and then 2 mg/kg.day and was stopped after 2 months of treatment. Complete clearing of the skin lesion was observed without any side-effects except mild nausea. The patient was then referred to surgery for mastectomy and chemotherapy. There was no clinical relapse during more than 1 year of follow-up and at present she is continuing to do well.

Juvenile blistering diseases: the problems of diagnosis and treatment.

Correct clinical diagnosis in cases of chronic, relapsing, non-hereditary, blistering diseases in childhood could not be made without the aid of histopathology and immunofluorescence, since the morphology and the distribution of the lesions of bullous pemphigoid (BP), linear IgA bullous dermatosis (LAD) and dermatitis herpetiformis (DH) may be similar. Histopathology was helpful in about half of the cases. The results of immunopathology were very useful for the final diagnosis. Of twenty-one cases of juvenile blistering diseases, two cases which showed IgG on direct test with circulating antibodies were BP; three cases with deposition of IgG but without circulating antibodies were probably BP; three cases were either BP or LAD (IgG and IgA on direct test without circulating antibodies); nine cases were definite LAD (linear IgA only); one case which showed granular IgA in the dermal papillae and linear IgA was DH; and the last three cases were probably LAD and BP with non-immunoreactant deposits. Regardless of the diagnosis, dapsone and co-trimoxazole controlled eight cases and could be discontinued without relapse, while the other six cases were maintained on dapsone therapy alone. Prednisolone, when added in cases of poor response to either dapsone or co-trimoxazole, caused remission and was discontinued in three out of the five cases. Two cases were lost to follow up.

A case of penile gnathostomiasis in Thailand.

A living young adult female Gnathostoma spinigerum 1.9 cm in length was extracted from a perforating hole on the left laterodorsal aspect of the proximal part of the inflamed glans penis of a 3-year-old Thai boy, the first such case to be recorded in the literature.