Cutaneous pneumocystosis.

A 42-year-old man with the acquired immunodeficiency syndrome (AIDS) presented with a 9-month history of progressive hearing loss and bilateral external auditory canal masses. Biopsy of the right ear mass detected Pneumocystis carinii. The patient was treated with a 7-day course of intravenous trimethoprim, followed by a 3-week course of oral trimethoprim-sulfamethoxazole, with a marked reduction in the size of his ear masses. This is the first reported case of skin involvement by P. carinii in a patient with AIDS. Because of our patient's documented response to treatment, we stress the importance of biopsy of cutaneous lesions in this group of patients, who may have a potentially treatable condition.

Pathogen factors and host factors in murine pulmonary blastomycosis.

Factors related to pathogenesis were studied in a murine model of pulmonary fungal infection with strains of Blastomyces dermatitidis. Strain 26199V was greater than or equal to 10(5)-fold more lethal in pulmonary challenge than strain GA-1. This relationship between the two strains also occurred after intraperitoneal challenge. Serial studies with lung cultures and histology of sacrificed animals after pulmonary challenge with similar doses, and challenge studies in mice of differing maturity, indicated GA-1 is impaired in initial replication in situ, although the two strains grow equally well in the presence of murine substrates in vitro. In vitro studies indicated the two strains were indistinguishable in most studies of biochemical and metabolic markers, and in studies with chemical and physical inhibitors. The exceptions were their morphologic appearance in the yeast phase, ability to hydrolyze esculin, and susceptibility to crystal violet dye and bile. The last finding and previous work suggested possible differences in lipid content; these were confirmed in studies which also included two other strains. Greater phospholipid and palmitic acid content were associated with greater virulence.

Ossifying fibroma of the head and neck: involvement of the temporal bone- and unusual and challenging site.

Ossifying fibroma of the head and neck is most commonly described in the mandible and maxilla. A few isolated reports in the literature exhibit the rare existence of this lesion in the nasal bones, orbit, ethmoid sinus, sphenoid sinus, occiput, and in only two well-documented cases, the temporal bone. We present the case of an extensive ossifying fibroma of the temporal bone that presented as a suspected case of hyperostosis of the external auditory canal and conductive hearing loss, without any cosmetic deformity. A review of the recent literature concerning the sites, radiologic presentation, difficulty of pathologic differentiation, and modality of therapy is discussed.

Perforation of an adenocarcinoma of the small bowel affected by regional enteritis.

This report is of a patient with long-term small bowel regional enteritis who presented with a perforation of an adenocarcinoma involving a diseased portion of ileum. Adenocarcinoma of the small bowel is rare. The incidence of small bowel adenocarcinoma may be higher in patients with regional enteritis, but a definite relationship cannot be established on the basis of data presently available. Small bowel adenocarcinoma in regional enteritis usually presents with obstructive symptoms.

Childhood cirrhosis associated with alpha-1-antitrypsin deficiency. A genetic, biochemical, and morphologic study.

A study of 27 relatives of a child with fatal hepatic cirrhosis due to homozygous Z variant alpha-1-antitrypsin deficiency revealed 15 members with heterozygous MZ phenotypes. Levels of circulating alpha-1-antitrypsin and trypsin-inhibiting capacity were shown to be unreliable in identifying the heterozygous state, Pi typing being necessary for definitive diagnosis. The morphologic evolution of the hepatic changes in this condition have been studied, and the importance of the PAS stain in identification of the characteristic cytoplasmic bodies is stressed.