Ambresh Badad

First reported case of subcutaneous hyalohyphomycosis caused by Paecilomyces variotii

Hyalohyphomycosis is a rare opportunistic fungal infection caused by saprophytes of genera such as Fusarium, Paecilomyces, Scedosporium, Penicillium, Scopulariopsis Acremonium, and similar fungi. The literature includes only one previous report of Paecilomyces variotii human infection and very few reports of subcutaneous mycosis caused by any of the hyalohyphomycosis group of fungi.

A case of reticulate acropigmentation of Kitamura: Dowling Degos disease overlap with unusual clinical manifestations

Reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of Kitamura (RAPK), Dowling-Degos disease (DD), reticulate acropigmentation of Dohi (RAPD), Habers syndrome, and Galli-Galli disease. A 25-year-old male presented with asymptomatic dark-colored lesions on his hands and feet with light-colored skin lesions involving the trunk since three years. Dermatological examination revealed hyperpigmented macules in a reticulate pattern involving the dorsa of the hands and feet, front and sides of the neck, axillae, periorbital region, and groin. Multiple pits were present over both palms, with breaks in dermatoglyphics. He also had multiple nonacne facial scars predominantly on the nose and malar areas. The patient had overlapping features of RAPK and DDD. In addition, he also had hypopigmented macules and acneiform facial scars. Such an overlap of features of reticulate pigmentation has not been previously reported in the literature.

A Rare Case of Secondary Syphilis Manifesting as Immune Reconstitution Syndrome in an HIV-Positive Patient

A 44-year-old HIV-infected male, having a low CD4 count, was on antiretroviral therapy for the last 2 months, when he developed a skin rash. He gave a history of solitary unprotected extramarital sexual contact 6 months before onset of the rash. Dermatological examination revealed a bilaterally symmetrical, maculopapular erythematous rash involving the palms, forearms, and neck. He showed a positive sign of Buschke-Ollendorff. In the meanwhile, the CD4 count had improved to 196 cells/mm3 from the previous count of 92 cells/mm3 and the viral load had decreased. Serum venereal disease research laboratory (VDRL) test was reactor at 1:64. He was found to be positive result for treponema pallidum hemagglutination test. Skin biopsy revealed features of secondary syphilis. The rash responded well to a single injection of benzathine penicillin, resulting in the lowering of the VDRL titers. There was no evidence of neurosyphilis. This is a very rare instance of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient.

A rare case of woolly hair with unusual associations

Woolly hair is a congenital abnormality of scalp hair manifesting as short, kinked hair, which may also involve the hair over the other parts of the body. Keratosis pilaris has been a well known association of woolly hair, and can also be a part of the Naxos or Carvajal syndromes. We herein present a case of woolly hair with associated keratosis pilaris, canaliform dystrophy of nails, increased interdental spaces and recurrent bullous impetigo. Although keratosis pilaris and teeth abnormalities have been reported as isolated associations with woolly hair, such a combination of findings as seen in our patient has not been reported before.

Bullous lichen planus

Sir, Lichen planus (LP) is a chronic inflammatory dermatosis involving mucocutaneous surfaces and nails. The world-wide prevalence of the disease is estimated to be 1%.[1] Bullous lichen planus is a rare variant which usually presents with blisters occurring over typical lesions of lichen planus. Raely, a few lesions occur in the adjoining skin. It is to be differentiated from lichen planus pemphigoides in which the blisters are more generalized and extensive and the course is prolonged.

A case of extensive multifocal tuberculosis verrucosa cutis

Tuberculosis is probably as old as the human race itself. Cutaneous tuberculosis constitutes a very small proportion of extra pulmonary tuberculosis. Extensive, multifocal involvement of cutaneous tuberculosis is a very rare manifestation. We report one such case of extensive, multifocal tuberculosis verrucosa cutis in a 30-year-old immunocompetent male patient in the absence of any primary tubercular focus.

Congenital atrichia with papular lesions

Congenital alopecia has broad differential diagnosis and poses diagnostic and therapeutic challenges. It is a rare form of irreversible alopecia inherited autosomal recessively. Atrichia congenita with papular lesions represents a complex and heterogeneous group of genodermatoses characterized by irreversible complete hair loss soon after birth, and associated with the development of keratin-filled cysts over the body. We report a case of 4-year-old boy presenting with complete loss of hair over scalp, eye brows, eye lashes, and body since birth. Patient also had papular lesions over body.

Livedo reticularis due to pellagra in a two year old child

A two-year-old girl child was admitted with complaints of diarrhoea of one week duration in the paediatric ward. She was referred to the skin OPD for gradually progressive skin rashes on both lower limbs noticed since two days. Dermatological examination revealed finding of livedo reticularis. Dietary history revealed maize forming a significant portion of the childs diet since the age of nine months. The child was treated with a course of Niacin in the form of Nicotinamide 50 mg twice a day for 4 weeks and the parents were advised not to give her maize in the diet. The skin lesions and diarrhoea regressed in duration of two weeks. This is probably the first time that a case of pellagra causing livedo is being reported, that too in a child.