Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty: a report of 2 cases and review of the literature.

Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty (PTCA) constitutes a distinct clinical and histopathologic entity. Pseudoaneurysms are a potential complication of both cardiac catheterization and PTCA. Repeated or prolonged catheterization increases the risk of bacterial seeding of these sites, resulting in septic embolization. Characteristic clinical features include fever within 2 to 5 days, unilateral embolic disease, and Staphylococcus aureus septicemia. Culture and examination of biopsy specimens of the embolic lesions typically demonstrate gram-positive microorganisms. We describe 2 patients presenting with ipsilateral palpable purpura, petechiae, and livedo reticularis caused by septic emboli from infected pseudoaneurysms. The recommended treatment includes administration of appropriate systemic antibiotics and surgical resection of the infected pseudoaneurysm. Both cholesterol and septic emboli should be considered in the differential diagnosis of ipsilateral embolic disease induced by invasive vascular procedures.

Porphyria cutanea tarda and AIDS.

Two male patients, each of whom had one or more risk factors for human immunodeficiency virus, subsequently developed findings of porphyria cutanea tarda preceding diagnosis of acquired immune deficiency syndrome (AIDS).

Lupus erythematosus panniculitis.

A young woman had a history of subcutaneous nodules, migratory arthralgia, myalgia, and lymphadenopathy. Histopathologic characteristics of the nodular subcutaneous lesion showed a massive lobular panniculitis characteristic of lupus erythematosus (LE) panniculitis. The diagnosis of LE panniculitis was established by demonstration of a positive linear basement membrane zone stain of the involved skin by direct immunofluorescence microscopy. Initial serologic findings showed negative antinuclear antibody (ANA) and anti-DNA antibody test results and a negative LE cell preparation. Subsequently, a positive ANA test result developed. The test result for extractable nuclear antigen was strongly positive, although initial test results for antibodies to ribonucleoprotein and Sm antigens were negative.

BCG vaccine-induced lupus vulgaris.

A case of intradermal BCG vaccination was complicated by a lupus-like tuberculosis cutis progressive for over 30 years. The patient had been vaccinated twice with BCG in the affected site. A review of other BCG vaccine-induced cases of lupus vulgaris indicates that the incidence of this complication is markedly increased following multiple BCG vaccinations, but is rare following a single BCG vaccination. In our patient a skin biopsy specimen was characteristic for lupus vulgaris. Acid-fast stains from the tissue and cultures from the affected site were negative. The patient was successfully treated with rifampin.

Allergic contact gingivostomatitis due to gold.

The sixth case of an allergic contact gingivostomatitis to gold crowns previously misdiagnosed as erosive lichen planus is reported. Patch tests to gold chloride (0.5%) and 0.05 cm3 intradermal gold sodium thiomalate (Myochrysine 50 mg/cm3) were positive at 48-72 h. Histopathology of the allergic contact gingivitis revealed a pseudolymphomatous inflammatory dermal reaction with a dense lymphohistiocytic and plasma cell infiltrate. Removal of the gold crowns resulted in a gradual resolution of the gingivostomatitis in 4-6 months, and the patient has remained free of clinical disease for over 3 years. A review of the reported cases of allergic gingivostomatitis to gold crowns revealed that each patient clinically presented with an erosive and ulcerative inflammatory response was usually associated with a clinical history of gold jewelry intolerance.

Perforating porokeratosis of Mibelli.

A case of perforating porokeratosis of Mibelli is presented. Clinically, the lesion was typical for porokeratosis of Mibelli. Nothing suggested a perforating disorder. Histologic examination revealed a well-developed cornoid lamella, and other histologic features typical of porokeratosis. A breach in the basal cell layer beneath the cornoid lamella resulted in transepithelial elimination of an amorphous material which on special stains proved to be collagen.

Mycobacterium marinum infections treated with tetracycline.

Five cases of Mycobacterium marinum skin infections were successfully treated with 2 gm of tetracycline hydrochloride daily for periods from four to 12 weeks. In each case, the isolated M marinum was sensitive in vitro to tetracycline at levels from 25 to 50 microgram/ml. Tetracycline is recommended as treatment for extensive or sporotrichoid M marinum infections.