[A tumour mistaken for a scar]. / Een tumor die werd aangezien voor een litteken.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare type of cutaneous soft tissue sarcoma. The tumour metastasises rarely, but the percentage of recurrences is high and the tumour can be locally very aggressive. CASE DESCRIPTION: A 50-year-old man was referred to our clinic for a long existing scar on his back, which had become painful in the last few weeks. In the hospital we decided to take a biopsy. Based on the histopathological investigation, the diagnosis DFSP was made. The patient was referred to a tertiary centre specialising in rare skin malignancies. CONCLUSION: DFSP is clinically heterogeneous with the consequence that several differential diagnoses can be made. Histopathological examination is the gold standard diagnostic approach when there is a possible suspicion of DFSP. Because of the aggressiveness and the high recurrence rate it is very important to make a timely diagnosis, to allow appropriate treatment - preferably radical excision - to take place.

[Intermittent swelling of the eyelid]. / Een intermitterende zwelling van het ooglid.

BACKGROUND: Mucoceles are benign mucous-containing cysts that can occur in the sinuses. They arise as a result of an obstruction of the sinus ostium. There is often a delay in diagnosis because symptoms are so variable. CASE DESCRIPTION: A 52-year-old woman had intermittent swelling of the eyelid. A CT scan of the sinuses showed a mucocele in the frontal sinus with breakthrough to the left orbit. Treatment consisted of marsupialisation by means of functional endoscopic sinus surgery with septum correction. CONCLUSION: Breakthrough of a mucocele to the orbit should be considered in the differential diagnosis in patients with an intermittent swelling of the eyelid.

First evidence of simultaneous occurrence of West Nile virus and Usutu virus neuroinvasive disease in humans in Croatia during the 2013 outbreak.

PURPOSE: We report on first evidence of simultaneous occurrence of West Nile virus (WNV) and Usutu virus (USUV) neuroinvasive infection in humans in Croatia during the transmission season 2013. METHODS: From June to December 2013, a total of 95 patients with clinically suspected WNV infection (WNV fever and neuroinvasive disease) were tested for WNV IgM/IgG antibodies using enzyme-linked immunosorbent assay. Twenty-six reactive samples were further tested by virus neutralization test for confirmation. RESULTS: WNV neuroinvasive infection was confirmed in 20 patients, while in three patients USUV neutralizing antibodies were detected. Cases occurred during the 11-week interval (from 24 July to 07 October 2013). Both WNV and USUV cases were distributed in three north-western Croatian counties. In addition to human cases, recent asymptomatic WNV infection (detection of IgM antibodies) was recorded in 9/3,460 (0.3 %) tested sentinel horses. Infected animals were recorded in two eastern and one north-western county. CONCLUSIONS: Our results indicate co-circulation of WNV and USUV in Croatia. WNV infection could be misdiagnosed with other emerging infectious diseases presenting with neurological symptoms such as USUV infection.

Autochthonous dengue fever in Croatia, August-September 2010.

After information about a dengue case in Germany acquired in Croatia, health professionals and the public in Croatia were alerted to assess the situation and to enhance mosquito control, resulting in the diagnosis of a second case of autochthonous dengue fever in the same area and the detection of 15 persons with evidence of recent dengue infection. Mosquito control measures were introduced. The circumstances of dengue virus introduction to Croatia remain unresolved.

[A pseudo-outbreak of pharyngeal gonorrhoea related to a false-positive PCR-result]. / Een pseudo-uitbraak van keelgonorroe samenhangend met een fout-positieve PCR-uitslag.

Nucleic acid amplification tests, including the polymerase chain reaction (PCR), are sensitive and specific tests that are often used for diagnosing sexually transmitted diseases (STDs). A pseudo-outbreak of pharyngeal gonorrhoea in a group of prostitutes turned out to have been caused by false-positive test results due to commensal oropharyngeal Neisseria species. Specific molecular tests may yield erroneous results. When the results of an STD study have major consequences at a legal or social level, it is advisable, in consultation with a medical microbiologist, to take a sample for culture or to carry out a second molecular test aimed at a different part of the bacterial genome.

Efficacy of the pulsed dye laser in the treatment of localized recalcitrant plaque psoriasis: a comparative study.

BACKGROUND: Localized chronic plaque psoriasis, resistant to local therapy, may be very hard to treat. The treatment of these lesions with a pulsed dye laser (PDL) has been described before, but a comparative study between the PDL and a potent topical treatment has never been performed. OBJECTIVES: To compare the efficacy of the PDL in the treatment of localized, recalcitrant plaque psoriasis with a potent topical therapy, using calcipotriol/betamethasone dipropionate (Dovobet) as an active comparator. METHODS: Eight patients with psoriasis were treated with both PDL (585 nm) and calcipotriol/betamethasone dipropionate in an open, intrapatient, left-right comparison. A plaque severity score (sum score) and photographs were used to document the course of therapy. Patients reported pain on a visual analogue scale. RESULTS: Both treatments were well tolerated, although one patient left the study due to post-PDL treatment pain. A significant difference in the sum score 12 weeks after treatment was seen in favour of the PDL (62% vs. 19% reduction; P<0.05). Scores for erythema declined significantly at week 12 in both the PDL and the calcipotriol/betamethasone dipropionate group (P<0.001). Induration and desquamation scores were significantly reduced at week 12 in the PDL group, without a statistically significant reduction in calcipotriol/betamethasone-treated lesions. The pain scores declined with progressive PDL treatments, although not statistically significantly. CONCLUSIONS: PDL treatment might be considered for the treatment of localized, recalcitrant plaque psoriasis, when other topical therapies have failed.

Tacrolimus ointment for the treatment of severe facial plaque psoriasis.

Recently, tacrolimus ointment has proved to be effective and well tolerated in patients with facial psoriasis. A few months ago we had the opportunity to treat a patient with tacrolimus ointment who had severe and recalcitrant plaque psoriasis of the face. This present case illustrates the impressive improvement of facial plaque psoriasis following 5 months of treatment with tacrolimus 0.1% ointment twice a day. Significant improvement of facial plaque psoriasis was seen after 1 month and complete clearance after 5 months of therapy. Based on the available literature and illustrated by the present case we may conclude that tacrolimus ointment 0.1% can be recommended as a first-line treatment for facial psoriasis.

[Penis friction edema: not a venereal disease]. / Penisfrictie-oedeem: geen seksueel overdraagbare aandoening.

A 35-year-old man presented with a local swelling of the penis, which increased until the entire penis was thick and swollen. After infectious and obstructive causes had been eliminated, a diagnosis of 'penis friction oedema' was made. The swelling disappeared during several weeks of abstinence from sexual intercourse. Penile abnormalities can be divided into venereal diseases (STDs), incidental affections of the skin or mucous membranes in that location, and disorders of vascularisation and lymph drainage. A traumatic disorder of lymph drainage is sometimes referred to, unjustifiably, as 'penile venereal oedema'; it is a result of friction and manifests itself as local or total penile oedema or as a cordlike congestion of the lymphatic vessels. The diagnosis is by exclusion and the treatment is temporary abstinence from sexual intercourse.