Acid-fast bacteria as causative agents of skin and soft tissue infections: case presentations and literature review.

Acid-fast bacteria can be implicated in skin and soft tissue infections. Diagnostic identification can be challenging or not feasible by routine laboratory techniques, especially if there is no access to the Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) technology. Here, we present two cases of skin and soft tissue infections caused by two different acid-fast bacteria, Nocardia brasiliensis and Mycobacterium marinum. They both grew on Löwenstein-Jensen medium, Sabouraud agar medium and blood agar medium. Both bacteria appeared acid-fast by Ziehl-Neelsen stain and Gram-positive by Gram stain. The identification was performed by MALDI-TOF MS and gene analysis. N. brasiliensis and nontuberculous mycobacterium M. marinum represent rare pathogens that cause severe skin and soft tissue infections. Failure to identify the causative agent and subsequent inappropriate or inadequate treatment may lead to severe complications or even disseminated disease, especially in immunocompromised individuals.

Acid-fast bacteria as causative agents of skin and soft tissue infections: case presentations and literature review

ABSTRACT Acid-fast bacteria can be implicated in skin and soft tissue infections. Diagnostic identification can be challenging or not feasible by routine laboratory techniques, especially if there is no access to the Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) technology. Here, we present two cases of skin and soft tissue infections caused by two different acid-fast bacteria, Nocardia brasiliensis and Mycobacterium marinum. They both grew on Löwenstein-Jensen medium, Sabouraud agar medium and blood agar medium. Both bacteria appeared acid-fast by Ziehl-Neelsen stain and Gram-positive by Gram stain. The identification was performed by MALDI-TOF MS and gene analysis. N. brasiliensis and nontuberculous mycobacterium M. marinum represent rare pathogens that cause severe skin and soft tissue infections. Failure to identify the causative agent and subsequent inappropriate or inadequate treatment may lead to severe complications or even disseminated disease, especially in immunocompromised individuals.

Don't worry about a thing every little thing gonna be all right (except for acral lentiginous melanoma).

Bob Marley was a Jamaican singer, songwriter, and musician, considered one of the pioneers of reggae. In July 1977, he was diagnosed with acral lentiginous melanoma on his right great toe, which presented as a pigmented subungual lesion. Marley was advised to have his digit amputated, but he refused and opted for less invasive solutions. Unfortunately, he died at the age of 36 of metastatic disease in May 1981 after a 4-year battle with the disease. Marley has served as the posthumous poster child for skin cancer in people with skin of color for decades and has raised public awareness of this rare form of malignant melanoma.

Synophrys: The societal implications of the bad ol' unibrow.

The complete or partial meeting of medial eyebrows at midline above the bridge of nose, forming a single band of hair, is known as synophrys or unibrow. With a few rare exceptions, when it may serve as a cutaneous marker lesion of several genetic disorders, with Cornelia De Lange syndrome being the commonest, synophrys is usually a normal variation. Although various cultures have prized synophrys as an attractive physical trait throughout history, in modern Western culture, the unibrow is frequently regarded as an undesirable and unappealing feature with negative connotations. Synophrys, derived from the Ancient Greek σύν (together, with) and ὀφρύς (eyebrow), meaning "with meeting eyebrows," refers to the complete or partial fusion of medial eyebrows at midline. The hair above the nasal bridge is often of the same color and thickness as the eyebrows, thus giving the appearance that they converge to form one uninterrupted line of hair, a single eyebrow.

Widow's peak: a usually overlooked, yet significant morphogenetic trait.

Originally believed to be an omen for early widowhood, widow's peak, a V-shaped descending extension of the anterior hairline at the center of the forehead is now known to be a morphogenetic trait. Although in the majority of cases, widow's peak is a normal variant, its presence has also been associated with several genetic syndromes.

Skin in the game: Video-game-related cutaneous pathologies in adolescents.

BACKGROUND: Following the inception of video games and the subsequent development of progressive innovations in videogame technology, many reports of videogame-related dermatologic conditions soon emerged in literature. Children and adolescents, in particular, are among the most avid consumers of online digital entertainment. METHODS: In an effort to better detail the impacts of these cutaneous manifestations and provide recommendations for injury prevention as it relates to video games, we performed an extensive systems-based literature review pertaining to the clinical features, etiology, diagnosis, and treatment of reported cases of dermatoses resulting from the misuse of video games. RESULTS: A literature review using PubMed, SCOPUS, Ovid MEDLINE and EMBASE was performed. Hardware implicated in the reported cases include video games consoles, personal computers, laptop computers, mobile phones and tablets. The dermatologic conditions are primarily localized to the extremities, particularly the palms and fingers. The majority are associated with repetitive friction and trauma, as well as allergic contact sensitivities. For all cutaneous manifestations induced by video gaming, early recognition and removal of the offending agent was most often described as effective in symptom resolution. CONCLUSIONS: The universal use and pervasive popularity of video games for recreational purposes present an emerging dermatological concern. As videogames become increasingly advanced and immersive, various cutaneous conditions arising from intensive gaming will likely become common over time. Consequently, it is critical that dermatologists consider video games with a high index of suspicion when encountering dermatological ailments in underage patients engaging in persistent gaming behavior.

More than meets the eye(brow): Dermatologic imagery in Frida Kahlo's self-portraiture.

Renowned for her self-portraiture that acts as her visual autobiography, Frida Kahlo (1907-1954) is one of the leading woman painters of all time and an enduring feminist icon. Aside from the personal and societal commentary, both subtle and overt, that is evident within her artwork, the use of medical imagery shifts the viewer's perspective beyond Kahlo's self-portraits to offer accurate interpretations of her own singular history. The incorporation of dermatologic iconography within Kahlo's self-portraiture to record her skin, as well as its unique features, have rebuked conventional standards of beauty and exploded preconceptions of what is permissible in high art.

Occlusive treatment enhances efficacy of tacrolimus 0.1% in a pediatric patient with severe alopecia areata: Case report and literature review.

Tacrolimus is an immunomodulatory drug, available for topical and systemic treatment of several dermopathies that are characterized by immune dysregulation. In the case of alopecia areata, standard application has proven insufficient to yield satisfactory results. Herein, we present a 6-year-old patient with Down syndrome who was treated with topical tacrolimus 0.1% ointment under occlusion overnight with remarkable clinical improvement within 4 months.

Cancer stem cells, epigenetics, tumor microenvironment and future therapeutics in cutaneous malignant melanoma: a review.

This review provides an overview of the current understanding of the ontogeny and biology of melanoma stem cells in cutaneous malignant melanoma. This article also summarizes and evaluates the current knowledge of the underlying epigenetic mechanisms, the regulation of melanoma progress by the tumor microenvironment as well as the therapeutic implications and applications of these novel insights, in the setting of personalized medicine. Unraveling the complex ecosystem of cutaneous malignant melanoma and the interplay between its components, aims to provide novel insights into the establishment of efficient therapeutic strategies.

Acremonium nail bed mycetoma masquerading as subungual squamous cell carcinoma.

Acremonium is a large fungal genus that is comprised of approximately 150 species, found ubiquitously in nature. Although the majority are recognized as being saprophytes in soil and pathogens of plants, several species are emerging as causative agents of a variety of human infections, including mycetomas. Herein, we present a young man that was referred to our department with a painful subungual mass that developed following traumatic inoculation of Acremonium spp. In recent years, the role of Acremonium spp. has been increasingly recognized in localized infections, such as mycetoma, in humans. Other locally invasive as well as disseminated infections are also described. Optimal treatment of Acremonium spp. mycetoma is not well defined owing to the rarity of cases, thus posing a therapeutic challenge.

Multiple Primary Melanomas in a Young Patient.

A 45-year-old HIV-negative Caucasian man with no reported past medical history was referred to our Department with a large (7 cm in diameter) oozing nodule on the occipital region of the scalp with spontaneous periodical bloody or purulent discharge. The lesion had appeared over a period of six months, had an irregular color, non-specific dermoscopic features, and resembled squamous cell carcinoma. The physical examination revealed three more atypical melanocytic lesions (on the abdomen, back, and buccal mucosa), and multiple swollen occipital, postauricular, as well as superficial and deep cervical lymph nodes. After clinical evaluation, the patient reported having another in situ melanoma (submammary region) excised 7 years ago. All the lesions were excised and sent for histopathologic examination, which was compatible with primary cutaneous melanoma. Total body computed tomography revealed the presence of multiple visceral metastases, and the patient was referred to an oncologist. He did not consent to proceed to genetic testing. The occurrence of multiple primary melanomas (MPM) is a rare but recognized phenomenon. The estimated incidence of a second primary tumor ranges from 0.2% to 8.7% in large retrospective reviews. While 63% to 88% of patients with MPM are reported to have two primary tumors, the occurrence of more than four primary melanomas is considered exceedingly rare (1-2). Whether the presence of multiple primary melanomas is a function of increased genetic susceptibility of the individual, consistent exposure to a common exogenous promoter of malignancy, or a combination of these two factors remains to be elucidated. These patients should undergo intensive dermatologic screening for the rest of their lives and should consider genetic testing.