Chronic generalized fibrotic skin lesions from disseminated leishmaniasis caused by Leishmania martiniquensis in two patients from northern Thailand infected with HIV.

BACKGROUND: Leishmaniasis is a newly emerging infection in Thailand. Most of the previous human cases have presented with the clinical features of visceral leishmaniasis and were mainly found in southern Thailand. Here we report the first two patients from northern Thailand presenting with disseminated cutaneous leishmaniasis. OBJECTIVES: To determine the nature of the infection of leishmaniasis and to identify the species of parasite responsible. METHODS: Clinical investigations included the taking of biopsy samples and histology. Parasitological diagnosis was performed by establishment of Leishmania promastigote cultures, and identification was performed by DNA sequencing of four independent gene loci (ribosomal RNA internal transcribed spacer 1; large subunit of RNA polymerase II; heat shock protein 70; RPL23a intergenic sequence). RESULTS: Both patients were infected with HIV, and had multiple cutaneous lesions and accompanying visceral leishmaniasis. They had similar cutaneous manifestations characterized by chronic generalized fibrotic lesions, which were more prominent on traumatic areas. In both patients the parasite was identified as Leishmania martiniquensis. This is a recently described species that is distinct and only distantly related to the classical agents of cutaneous leishmaniasis in Asia (Leishmania major and Leishmania tropica) or of visceral leishmaniasis (Leishmania donovani and Leishmania infantum). Each patient responded well to therapy with intravenous amphotericin B followed by oral itraconazole. CONCLUSIONS: Leishmania martiniquensis is a cause of cutaneous leishmaniasis in Thailand.

Oral non-Hodgkin lymphomas: studies of EBV and p53 expression.

OBJECTIVES: The aims of the study were to assess sociodemographic and clinicopathologic characteristics of patients with oral non-Hodgkin lymphomas (NHLs) and the expression of Epstein-Barr virus (EBV) and p53. MATERIALS AND METHODS: The clinical and pathologic features of 11 patients with oral NHLs were studied. The expression of EBV mRNA and p53 protein were studied by means of in situ hybridization and immunohistochemical methods in 11 formalin-fixed, paraffin-embedded specimens from these patients. RESULTS: The patients' age ranged from 13 to 70 years with the mean of 42 years. Human immuno-deficiency virus (HIV) status was documented in five of the 11 patients and three were known to be HIV-positive. The most common locations were gingiva and alveolar mucosa. Pain and tenderness were major symptoms of the patients. The most common histologic subtype was diffuse large-cell, intermediate-grade NHL. Eight of 11 cases (72.7%) showed positive expression of p53 protein. Four of 10 cases (40%) expressed EBV-encoded RNA (EBER) transcripts. All known HIV-positive cases were EBV-positive. CONCLUSIONS: The findings suggest that appropriately expressed p53 protein may play a role in tumorigenesis of oral NHLs. In addition, EBV may be involved with the pathogenesis of oral NHLs particularly in patients with HIV infection.

Cutaneous tuberculosis in three HIV-infected patients.

Although tuberculosis is a common disease in patients infected with HIV, cutaneous presentation is not commonly found. The authors report three HIV-infected patients with cutaneous tuberculosis and lung involvement. Patient 1 presented with a nodular skin lesion on the right forearm and the diagnosis was confirmed by histopathology and PCR study. Patients 2 and 3 presented with generalized erythematous papules and vesicopustules on the trunk and extremities. Culture grew M. tuberculosis in patient 2 and M. tuberculosis DNA was detected in the skin lesion of patient 3 by the PCR method.

Uncommon manifestations of opportunistic infections in an HIV infected patient.

A case of an HIV infected patient complicated with Penicillium marneffei and Rhodococcus equi infection is reported. He presented with chronic ulcer as pyoderma gangrenosum-like on his right calf and submandibular lymphadenitis as scrofuloderma-like. Penicillium marneffei and Rhodococcus equi were isolated from the ulcer and lymph node respectively.

Congenital erythropoietic porphyria: a case report.

Congenital erythropoietic porphyria is a rare autosomal recessive disorder of heme synthesis resulting from deficiency of uroporphyrinogen III synthase (UROIIIS). It is the most severe porphyria. The clinical manifestations are markedly variable due to the different mutation in the UROIIIS gene. We recently diagnosed a case of congenital erythropoietic porphyria. A 9-year-old boy presented with recurrent ulcers on the skin especially dorsum of the hands and feet since aged 3. The physical examination revealed ulcers on the dorsum of the feet, mutilation of the fingers, fluorescent erythrodontia, and darkening and hypertrichosis of the sun exposed area. Laboratory findings showed mild hemolysis, red urine, increased serum alkaline phosphatase level, and fluorescence of the red blood cell and urine. The histopathology was consistent with porphyria. The urine and plasma porphyrin levels confirmed the diagnosis of congenital erythropoietic porphyria. The administration of oral ultracarbon and topical zinc oxide has been tried.

Carcinoma ex-pleomorphic adenoma of the nasal cavity: a report of two cases.

Carcinoma ex-pleomorphic adenoma is exceedingly rare in sites other than the major salivary glands and the oral cavity. We present the first two histopathologically documented examples to occur in the nasal cavity.

Disseminated cryptococcosis presenting as molluscum-like lesions in three male patients with acquired immunodeficiency syndrome.

Cryptococcosis is an opportunistic infection caused by a ubiquitous encapsulated yeast, Cryptococcus neoformans. The pulmonary infection is primary site and most frequently self-limited and may be asymptomatic. The most common recognized site of disseminated cryptococcosis is the central nervous system. The cutaneous cryptococcosis is rare and nonspecific. More recently, in patients with AIDS, some cases of cutaneous cryptococcosis resembling molluscum contagiosum have been described and occasionally appeared before systemic signs and symptoms. To our knowledge, this has not previously been reported in Thailand. This is a report of 3 males with acquired immunodeficiency syndrome who developed disseminated cryptococcosis with cutaneous lesions resembling molluscum contagiosum. Skin findings in disseminated cryptococcosis indicate a poor prognosis, however, earlier recognition and treatment would improve survival.

Cutaneous manifestations of disseminated Penicillium marneffei mycosis in five HIV-infected patients.

Five cases of disseminated Penicillium marneffei mycosis of Thai HIV patients, presented between November 1990 and April 1991, have been investigated. All patients were male and had bone marrow involvement. They showed mucocutaneous lesions with papules predominantly on the faces and upper extremities (5 cases), palatal papules (3 cases), and chronic genital ulcer (2 cases). P. marneffei was cultured, and the specific tissue form of the fungus was demonstrated histopathologically from skin and bone marrow specimens. In future, with increasing awareness of mucocutaneous lesions, disseminated penicilliosis in HIV-infected patients might be diagnosed sooner, thus leading to earlier therapy and better prognosis of the disease.