Subcutaneous nodules caused by Pseudomonas aeruginosa without sepsis.

Pseudomonas aeruginosa infection can cause a wide array of skin manifestations. While some infections are mild, as are the cases with hot tub folliculitis and toe web or nail infection, others are a result of sepsis and can be fatal without prompt treatment. The classic skin finding of P. aeruginosa sepsis is Ecthyma gangrenosum, but other signs such as papules, petechiae, and hemorrhagic bullae can also be seen. Suppurative panniculitis can also be caused by P. aeruginosa sepsis and clinically manifests as solitary or multiple subcutaneous nodules. Reports in the literature describe these nodules in the setting of clinical sepsis or with positive blood cultures. We report a case of localized subcutaneous nodules on the leg caused by P. aeruginosa in a patient without sepsis or positive blood cultures. The source of the infection was thought to be from a traumatic inoculation. This raises the possibility that P. aeruginosa can cause subcutaneous nodules from a localized infection, perhaps via lymphangitic spread without the manifestations of sepsis.

Axial myopia in congenital ptosis: an animal model.

Congenital ptosis in humans has been associated with anisometropia, myopia, astigmatism, and amblyopia. Scientific evidence has shown that visual deprivation causes axial myopia in animals. This study using chicks was undertaken to investigate an animal model of congenital ptosis and the effects of lid position on ocular development. Eyelid ptosis was surgically induced in one eye each of white leghorn chickens within 48 hours after hatching. The chicks were raised under natural diurnal lighting. Thirty days after inducing ptosis, the chicks were killed and their eyes enucleated and photographed in a sagittal view. Computerized image analysis was used to measure the size of the globe along five axes. Globe size was significantly greater in the superior part of eyes with ptosis compared with control eyes. No other measurement differences were significant (p < 0.01). Thus, this study demonstrates that regional axial myopia is induced by eyelid ptosis in chicks.

Cutaneous malacoplakia.

Indurated, erythematous plaques of the left arm and left flank developed in a 69-year-old white man with multiorgan failure from Escherichia coli sepsis. Cutaneous malacoplakia was diagnosed. Intravenous antibiotic therapy resulted in resolution of the malacoplakia and the E. coli sepsis.

Congenital neonatal herpes simplex virus infection.

Intrauterine-acquired neonatal herpes simplex virus infection is a severe, often life-threatening infection that has a wide spectrum of clinical presentations. We describe a 31-week-gestation male who had a rarely reported epidermolysis bullosa-like clinical presentation. He acquired herpes simplex virus type II in utero secondary to a primary maternal infection that occurred on the knee. A review of the infection, the need for early therapy, and the prognosis are presented.

Anterior ethmoid anatomy facilitates dacryocystorhinostomy.

The ethmoid air cell labyrinth lies adjacent to the medial orbital wall, extending even beyond the sutures of the ethmoid bone. Its anatomic relationship to the lacrimal sac fossa is important in lacrimal surgery. We evaluated computed tomographic scans of 190 orbits with normal ethmoid anatomy to define the anatomic relationship of anterior ethmoid air cells to the lacrimal sac fossa. In 93% of the orbits, the cells extended anterior to the posterior lacrimal crest, with 40% entering the frontal process of the maxilla. This anatomic relationship may be used to facilitate the osteotomy during dacryocystorhinostomy. During a 10-year period (310 cases), one of us routinely entered the anterior ethmoid air cells to initiate the osteotomy during dacryocystorhinostomy. This technique has helped to avoid lacerations of the nasal mucosa.

Depressed lymphokine activated killer cell activity in mycosis fungoides. A possible marker for aggressive disease.

Peripheral blood mononuclear cells from 24 patients with mycosis fungoides were used to generate lymphokine activated killer (LAK) cells in vitro by culturing with recombinant interleukin 2. Patients with stage la mycosis fungoides were capable of generating normal levels of LAK cell activity, while patients with more active disease (stages IB to IV) had depressed LAK activity. The ability of these patients' cells to respond in a proliferation assay to various mitogens was similar to that of controls, with the exception of patients in the terminal phase of their illness. Patients with active disease who were unable to generate LAK activity were capable of responding in a proliferation assay to interleukin 2. The results of this study suggest that depressed LAK cell activity in patients with mycosis fungoides may serve as an indicator of a more aggressive disease state.

The use of concanavalin A to competitively inhibit Pseudomonas aeruginosa adherence to rabbit corneal epithelium.

Microbial adherence to corneal epithelial cells is the initial step in the development of infectious keratitis. In an attempt to inhibit this process, we evaluated the effects of concanavalin A (Con A) upon the adherence of Pseudomonas aeruginosa to injured rabbit corneal epithelial cells. A sterile 21-gauge needle was used to create linear epithelial injuries. Identical samples from suspensions of a pure strain of P. aeruginosa were placed on two groups of injured corneas. Prior to bacterial application, one group of corneas received topical application of Con A, a lectin that is capable of binding to alpha-D-mannose or alpha-D-glucose. The animals were sacrificed 1 hour after application of the bacteria. Scanning electron microscopy of the excised corneas revealed that, compared to the corneas that had not been exposed to Con A, those exposed to the lectin had significant fewer adherent P. aeruginosa bacilli. Additionally, only rare bacteria were noted adhering to the uninjured superficial epithelial cells. These results suggest that, by competitively binding to the exposed mannose and/or glucose groups on the surfaces of these cells, Con A is capable of inhibiting the adherence of P. aeruginosa to injured epithelial cells.

Eosinophils in skin lesions of erythema multiforme.

To investigate the controversy regarding the presence of eosinophils in skin lesions of erythema multiforme, we undertook a retrospective clinicopathologic study of 19 recent cases that fulfilled clinical and histopathologic criteria for the disease. At least a few eosinophils were observed in 13 of 19 cases, and in four cases there were more than three per high-power field, qualifying as "tissue eosinophilia." Immunofluorescence studies in three cases with eosinophils failed to show the linear basement membrane zone fluorescence characteristic of bullous pemphigoid. Giemsa stains revealed that mast cells were present in lesions both with and without eosinophils. The only clinical features that distinguished patients with tissue eosinophilia from those without were an older age of incidence and a longer duration of disease prior to biopsy. Drugs were implicated as a causative factor in some patients both with and without eosinophils, but all four patients with tissue eosinophilia were believed to have drug-induced disease. We conclude that eosinophils do occur in skin lesions of erythema multiforme and are occasionally numerous.

Lichen planus of the vulva.

Lichen planus is an uncommon cutaneous disease that can affect the vulva. Vulvar pruritus and pain are common symptoms in patients with genital involvement. Examination reveals an erythematous, friable vestibule with adherent exudate. Marked resorption of the labia minor and atrophy may occur in time. Diagnosis is based on associated clinical findings involving the oral mucosa and/or the skin and on vulvar biopsy.