Nódulos "arrosariados" en antebrazos / Beaded Nodules on the Forearms

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Dermatitis shiitake / Shiitake dermatitis

La dermatitis por shiitake fue descrita por primera vez en 1977 en Japón por Nakamura, y se desarrolla tras la ingesta de setas shiitake poco cocinadas o crudas en determinadas personas. Esta dermatitis es muy característica por la presencia de pápulas, placas o vesículas muy pruriginosas diseminadas que adoptan una disposición lineal o flagelada. Presentamos un varón de 38 años, remitido por erupción pruriginosa de 3 días de evolución, tras el interrogatorio reconoció haber comido unas se tasen un restaurante chino (AU)

Shiitake dermatitis was first described in 1977 in Japan by Nakamura and takes place after the intake of little cooked or raw shiitake mushrooms in certain persons. This condition is very characteristic for the presence of papules, plaques or vesicles, scattered highly pruritic that adopt a linear or flagellate disposal. We present a man of 38 years, submitted by pruritic eruption of 3 days duration, after questioning admitted some mushrooms eaten in a Chinese restaurant (AU)

Nódulo centrofacial de reciente aparición / A Midfacial Nodule of Recent Onset

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[Leishmaniasis and rheumatoid nodulosis in a patient with HIV infection]. / Leishmaniasis y nodulosis reumatoide en paciente con infección por el virus de la inmunodeficiencia humana.

We describe the case of a 44-year-old homosexual man diagnosed with HIV infection and visceral leishmaniasis. He presented nodules on the dorsum of the hands. Histological study of one of the nodules revealed necrobiotic palisading granulomas with abundant Leishmania amastigotes within the histiocytes and in the adjacent extracellular space. Tissue and peripheral blood cultures were positive for Leishmania infantum, zymodeme MON-24. A biopsy of healthy skin did not reveal the presence of Leishmania. A diagnosis of rheumatoid nodulosis with Leishmania was made and treatment was started with intravenous liposomal amphotericin, leading to slight improvement. We believe that the presence of the parasite within the nodules was the result of its dissemination during visceral leishmaniasis in an immunocompromised patient with HIV infection, and that the Leishmania did not have an etiological role in the appearance of the nodules. We present the first case of the association between Leishmania and rheumatoid nodulosis.

Leishmaniasis y nodulosis reumatoide en paciente con infección por el virus de la inmunodeficiencia humana / Leishmaniasis and rheumatoid nodulosis in a patient with HIV infection

Describimos el caso de un paciente varón de 44 años, homosexual, infectado por el virus de la inmunodeficiencia humana (VIH) y diagnosticado de leishmaniasis visceral. Clínicamente presentaba unos nódulos en el dorso de las manos. El estudio histológico de uno de ellos mostraba granulomas necrobióticos en empalizada y abundantes amastigotes de Leishmania dentro de los histiocitos y extracelularmente en la proximidad. Los cultivos tisulares y de sangre periférica fueron positivos para Leishmania infantum, con el análisis isoenzimático zymodema 24. Una biopsia de piel sana no reveló la presencia de Leishmania. El diagnóstico fue de nodulosis reumatoide con Leishmania, y se inició tratamiento con anfotericina liposomal intravenosa con leve mejoría. Consideramos que la presencia del parásito en los nódulos fue producida por la diseminación durante la leishmaniasis visceral, en el contexto de un paciente inmunosuprimido, como en una infección por el VIH, y no tiene un papel etiológico en su origen. Es decir, no pensamos que los parásitos hayan producido los nódulos. Presentamos el primer caso de asociación entre leishmania y nodulosis reumatoide (AU)

We describe the case of a 44-year-old homosexual man diagnosed with HIV infection and visceral leishmaniasis. He presented nodules on the dorsum of the hands. Histological study of one of the nodules revealed necrobiotic palisading granulomas with abundant Leishmania amastigotes within the histiocytes and in the adjacent extracellular space. Tissue and peripheral blood cultures were positive for Leishmania infantum, zymodeme MON-24. A biopsy of healthy skin did not reveal the presence of Leishmania. A diagnosis of rheumatoid nodulosis with Leishmania was made and treatment was started with intravenous liposomal amphotericin, leading to slight improvement. We believe that the presence of the parasite within the nodules was the result of its dissemination during visceral leishmaniasis in an immunocompromised patient with HIV infection, and that the Leishmania did not have an etiological role in the appearance of the nodules. We present the first case of the association between Leishmania and rheumatoid nodulosis (AU)

Carcinoma verrugoso facial. Descripción de dos casos / Verrucous Carcinoma of the Face: A Report of 2 Cases

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Lesión policroma indurada en antebrazo / Polychromic and indurated lesion in the forearm

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Pápulas eritemato-parduscas en tronco y extremidades / Brown erythematous papules on trunk and limbs

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[Ofuji's disease: description of a case]. / Enfermedad de Ofuji: descripción de un caso.

Eosinophilic pustular folliculitis (EPF) is a rare, chronic disease of unknown cause, characterized by itchy papules or pustules and an infiltration of eosinophiles in the biopsy. EPF occurs rarely outside Japan and very few cases have been described in non-Japanese race people. The causes of the disease and its definitive treatment have not yet been established. In our patient, the presence of subcorneal pustules in the biopsies initially favored a diagnosis of pustulosis and several biopsies were necessary before a diagnosis of EPF was reached. A new case of EPF recently presented at our clinic and we have carried out an extensive revision of the disease.

Sequential study on the treatment of moderate-to-severe chronic plaque psoriasis with mycophenolate mofetil and cyclosporin.

BACKGROUND: There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis. On the contrary, we can hardly find studies that compare each other. OBJECTIVE: To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective, sequential, cross-over, non-randomized, two-phase, open-label study. PATIENTS/METHODS: Eight patients (five women and three men; mean age 57, range 35-78) with moderate-to-severe chronic plaque psoriasis were included in the study. They were treated with oral mycophenolate mofetil (30 mg/kg/day) over a period of 16 weeks. Following a variable washout period and after a new outbreak of the disease, oral cyclosporin was introduced at a dose of 4 mg/kg/day. During both treatment regimens, follow-up visits were performed at 3, 8 and 16 weeks. RESULTS: In both groups, the PASI started to decrease once treatment was begun. Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil, reaching a higher number of complete remissions and better percentages of PASI improvement from baseline (45.7%, 60.2% and 60.5% at 3, 8 and 16 weeks respectively for mycophenolate mofetil, and 89.7%, 95.3% and 95.3% respectively at the same intervals for cyclosporin). Cyclosporin was also more predictable in its action as the percentage of improvement along the follow-up visits had a much wider range for mycophenolate mofetil. Overall, the tolerability of both drugs was good. None of the patients had to discontinue treatment because of an adverse event. Two patients treated with cyclosporin showed increased plasma levels of creatinine. CONCLUSIONS: Cyclosporin is more effective, fast, and predictable in its effect than mycophenolate mofetil to control moderate-to-severe chronic plaque psoriasis. Both drugs are well tolerated in short courses of treatment.

Enfermedad de Ofuji: descripción de un caso / Ofuji's disease: description of a case

La foliculitis pustulosa eosinofílica (FPE) es una enfermedad crónica, rara y de causa desconocida, que cursa con pápulas y/o pústulas pruriginosas y un infiltrado de eosinófilos en la biopsia. La FPE suele ocurrir con poca frecuencia fuera de Japón y son escasos los casos descritos en pacientes de raza no japonesa. Los factores causales de la enfermedad y su tratamiento definitivo no están establecidos todavía. En nuestra paciente, inicialmente, la presencia de pústulas subcorneales en las biopsias orientaba hacia un diagnóstico de dermatosis pustular; y fueron necesarias repetidas biopsias para obtener el diagnóstico de FPE. Presentamos un nuevo caso de FPE recientemente visto en nuestra consulta y hemos realizado una revisión extensa de la enfermedad

Eosinophilic pustular folliculitis (EPF) is a rare, chronic disease of unknown cause, characterized by itchy papules or pustules and an infiltration of eosinophiles in the biopsy. EPF occurs rarely outside Japan and very few cases have been described in non-Japanese race people. The causes of the disease and its definitive treatment have not yet been established. In our patient, the presence of subcorneal pustules in the biopsies initially favored a diagnosis of pustulosis and several biopsies were necessary before a diagnosis of EPF was reached. A new case of EPF recently presented at our clinic and we have carried out an extensive revision of the disease

Sweet's syndrome on the area of postmastectomy lymphoedema.

BACKGROUND: Sweet's syndrome (SS) has been reported in association with many conditions, including malignancy, infections, autoimmune disorders, pregnancy and drugs. MATERIALS AND METHODS: We reviewed patients with SS-like lesions on the lymphoedema area seen in our department. Clinical manifestations, histopathologic characteristics, treatment and outcome data were recorded and analysed. RESULTS: We report seven women with a history of surgery for breast cancer with axillary lymphadenectomy. Six of them were on tamoxifen. All of them had various lesions consistent with SS localized predominantly on the limb affected by the postmastectomy lymphoedema, and on the ipsilateral chest, trunk and back. One of them presented bullous lesions. Three of the cases underwent spontaneous remission, two resolved with antibiotic therapy, one healed with corticosteroids, and one with corticosteroids plus antibiotic. CONCLUSIONS: Erythematous tender plaques on the area of postmastectomy lymphoedema could be considered an unusual manifestation of Sweet's syndrome. We have found only three similar cases in the literature. Although it is difficult to elucidate the pathogenesis of this entity, it has been suggested that it could be due to immune surveillance impairment.