Chromoblastomycosis: A Rare Presentation With Polymorphic Cutaneous Lesions And Bone Involvement, Caused By Exophiala Janselmei.

Chromoblastomycosis, a chronic fungal infection of skin and subcutaneous tissue arises as a result of traumatic inoculation of exposed areas of the body. We present a unique case of chromoblastomycosis caused by Exophiala janselmei in a female farmer who presented with multiple smooth non-tender nodules on trunk and limbs for 5 years and pigmented indurated plaques on her face for 2 years along with deformities of her hands. Imaging investigations revealed multiple lytic lesions in the bones of the upper and lower limbs. Histopathological findings showed characteristic sclerotic bodies, consistent with the diagnosis of chromoblastomycosis. She was started on a combination of oral antifungals with a good response. This case highlights the importance of high suspicion and early diagnosis of deep fungal infections in order to avoid disfigurement and comorbidities.

Erythrodermic Psoriasis and Hepatitis C Infection Treated with Pegylated Interferon and Anti-TNFα α(Etanercept) Therapy.

Treatment of psoriasis and its variants with concomitant hepatitis C virus (HCV) infection is complex. The treatment options are limited because the immunosuppressive drugs used for managing severe psoriasis are mostly associated with end-organ damage particularly hepatotoxicity. On the other hand, Interferon therapy has the potential to exacerbate psoriasis and psoriatic arthropathy. There is emerging data regarding the use of etanercept, a TNFα inhibitor in such cases. Though its cost and availability limits its use; but when combined with Interferon therapy and ribavirin for HCV, it has shown good results. Here, we report a case of 28-year male, suffering from erythrodermic psoriasis with arthropathy and concomitant HCV infection, who was successfully treated with etanercept and pegylated interferon and ribavirin. Pegylated interferon was given for 6 months and etanercept for 8 months. At the end of the therapy, not only the patient's polymervese chain reaction (PCR) for HCV became undetectable, but his erytherodermic state also improved.

Cutaneous Leishmaniasis with HIV.

Cutaneous Leishmaniasis (CL) is a vector borne disease caused by various species of the Leishmania parasite. CL is endemic in the province of Balochistan in Pakistan. In certain instances a Human Immunodeficiency Virus (HIV)-related immunocompromised is associated with atypical clinical presentation and occurrence of reactivated lesions of CL. Such presentations respond poorly to the standard treatment and frequent relapses are noted. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which responded to meglumine antimoniate. Due to the fact that CL is endemic in Balochistan, we did not consider HIV infection as a causative organism. It was their presentation with history of weight loss and fever that prompted Enzyme-linked Immunosorbent Assay (ELISA) tests for HIV, which turned out to be positive. CL is becoming visible as an opportunistic infection associated with HIV/AIDS and may even be the first symptom in HIV positive patients in an endemic area.