C. Varotti

Serum specific IgA antibody to Chlamydia trachomatis in patients with chlamydial infections detected by ELISA and an immunofluorescence test.

Sera obtained from 34 men with Chlamydia trachomatis positive non-gonococcal urethritis, 34 men with C trachomatis negative non-gonococcal urethritis, 42 women with acute salpingitis, 38 healthy women, and 34 healthy men were studied for the presence of specific serum C trachomatis IgA and IgG antibodies. Serological results were correlated with C trachomatis isolation in cell culture. An enzyme linked immunosorbent assay (ELISA) for C trachomatis specific serum IgA was employed using highly purified elementary bodies of C trachomatis serotype L2 grown in LLC-MK2 cells. Results obtained for C trachomatis IgA antibody by the ELISA test were compared with results obtained for the same sera by a single antigen immunofluorescence technique. A good correlation (r = 0.91) was found between two methods. Serum IgG antibody was also determined in the same sera by the immunofluorescence technique. Patients with C trachomatis positive non-gonococcal urethritis had a significantly (p less than 0.0005) higher prevalence (94.1%) of serum IgA antibody by ELISA compared with patients with C trachomatis negative non-gonococcal urethritis (20.5%) or healthy men (5.9%). Similarly, women with acute salpingitis had a significantly (p less than 0.005) higher prevalence of serum IgA antibody (45.2%) compared with healthy controls (5.2%). Comparable results were obtained for C trachomatis serum IgA antibody using the immunofluorescence technique. The prevalence of C trachomatis IgG antibody was significantly higher in patients with C trachomatis positive non-gonococcal urethritis (97.0%) compared with those with C trachomatis negative non-gonococcal urethritis (33.3%) and healthy controls (23.5%). The importance of using specific C trachomatis serum IgA in the identification of chlamydial infection is discussed.

Telogen Effluvium due to Recombinant Interferon α-2b

Five of 10 patients receiving long-term recombinant interferon α-2b therapy complained of considerable hair loss. The pull test and the trichogram showed a telogen count consistent with a telogen effl

Pseudoxanthoma-elasticum-Like Papillary Dermal Elastolysis: Another Case

Pseudoxanthoma-elasticum-like papillary dermal elastolysis is a rare acquired idiopathic non-inflammatory elastolytic disorder. This disease, described in aged females, is characterized by asymptomatic skin lesions of the neck and supraclavicular regions clinically resembling pseudoxanthoma elasticum. Histological and ultrastructural examinations show a total loss of the elastic fibres in the papillary dermis. We report another case of this entity in a 69-year-old Italian woman.

Graham Little-Piccardi-Lasseur syndrome following HBV vaccination.

A 48-year-old man, who was at risk for HBV infection as he worked as a nurse in an emergency department, received HBV vaccine Recombivax (Merck-Sharp & Dohme, MSD). The ¢rst dose of vaccine (1 ml) was given to the patient in July 1995 and the second (1ml) 4 weeks later. At the end of September 1995 the patient noted an eruption of numerous, polygonal, red and itchy papules localized on the trunk, limbs and wrists. No mucosal involvement was present. All routine laboratory tests results were normal, HBsAg and HBeAg results were negative while HBsAb and HBcAb were positive. The patient therefore consulted his general practitioner who diagnosed this condition as drug eruption and for which he prescribed antihistamines per os for 1 month. The condition healed in 6 weeks leaving a hyperpigmentation. Six months after the ¢rst dose the patient received the third vaccine dose (1 ml); 5 months later spinous, acuminate, follicular papules a¡ecting the scalp occurred. In November 1996 he consulted us. The dermatological examination revealed hyperpigmented polygonal, £at papules localized on the wrists and ankles and brown spots on the lateral surface of the trunk, probably the result of previous episodes of LRP. On the scalp some cicatricial alopecic areas as well as di¡use alopecia with ¢ne and coarse hair were present. The diagnosis of GLPLS was therefore formulated and con¢rmed on histological examination. The patient was treated with systemic and topical corticosteroids for 4 months, leading to healing of the hyperkeratotic papules, the alopecia still persisting.

Treatment of refractory pemphigus vulgaris with anti‐CD20 monoclonal antibody (rituximab): Five cases

Background: Pemphigus vulgaris is an autoimmune disease characterized by blisters and widespread erosions, involving skin and mucous membranes, caused by autoantibodies to desmoglein 1 and 3. This pathology is associated with increased morbidity and mortality if untreated. The treatment of pemphigus vulgaris requires multiple immunosuppressive agents, but often it is particularly resistant. Objective: To evaluate the efficacy and safety of rituximab therapy in refractory pemphigus vulgaris. Methods: Five patients diagnosed as having pemphigus vulgaris were treated with anti‐CD20 monoclonal antibody (rituximab). Each patient was treated with rituximab intravenously at a dosage of 375 mg per square metre of body surface area once weekly for 4 weeks. Results: All the patients presented clinical resolution. No adverse effects were observed. It is important to observe the clinical evolution in the future, but our experience is still limited to a short lifetime and follow‐up. Conclusion: In our experience rituximab has been an effective and safe treatment for refractory pemphigus vulgaris.

Immunological Parameters in Darier’s Disease

Patients with Dariers disease have frequently been observed to develop severe bacterial and viral infections. Previous studies have indicated some derangement in the immune system, even though no consistent or specific abnormality has yet been demonstrated. We performed the results of immunologic studies in 10 patients with Dariers disease. In each patient humoral immunity and cell-mediated immunity (in vivo and in vitro) were evaluated and leukocyte chemotactic function was assayed. Humoral immunity was normal; as regards clusters of differentiation (CD), a slight increase in CD4 lymphocyte subpopulations was observed in 7 patients and of CD4/CD8 ratio in 1 case. The lymphocyte responses to phytohemagglutinin and concanavalin A were normal, whereas the response to pokeweed mitogen was decreased slightly, but not significantly. Normal random and chemotactic mobility was found in all the patients except one. The data obtained do not show important immunological alterations. Our patients did not have a high propensity to develop severe infections and this may explain the absence of significant immunological derangement. Our data confirm that no immunological derangement is associated with Dariers disease.

Presence of high-risk mucosal human papillomavirus genotypes in primary melanoma and in acquired dysplastic melanocytic naevi

Summary  Background  Some studies have shown that cutaneous and mucosal melanoma biopsy specimens harbour human papillomavirus (HPV), suggesting that this virus may play a role in development and progression of the tumour.

Mid-dermal elastolysis: a pathological and ultrastructural study of five cases

The aim of this study was to evaluate the presence of inflammatory phenomena and elastic fiber phagocytosis in mid‐dermal elastolysis. The pathological and ultrastructural features of 5 Caucasian female patients (ranging from 26 to 40 years) with acquired diffuse asymptomatic areas of skin wrinkling have been reviewed. The clinical features of all cases were characteristic of this condition and only in one patient were erythematous urticaria‐like, non pruriginous patches also observed. In 4 cases a history of prolonged sun bathing was present and in 3 cases there was a short history of oral contraception. The pathological study confirmed the typical absence of elastic fibers in the mid‐reticular dermis. In two cases elastic fibers were still detectable in the periadnexal dermis. Hematoxylin and eosin sections showed a mild perivascular infiltrate in two cases, while in three patients histiocytes were scattered among collagen bundles. Multinucleated giant cells containing fragmented elastic fibers were detectable in one patient. Ultrastructural analysis revealed large mononuclear cells with phagocytic aspects toward elastic fibers in all cases.

Keratosis lichenoides chronica: A Pediatric Case

Keratosis lichenoides chronica (KLC) is a rare chronic disorder of keratinization characterized by lichenoid hyperkeratotic papules arranged in a linear pattern, erythematosquamous plaques and seborrhea-like dermatitis on the face. Adults between 20 and 50 years of age are usually affected, but the disease is very uncommon in childhood. Our purpose was to study the clinical and histopathologic findings and course of KLC in one pediatric case. Detailed clinical data were studied. Two punch biopsies were performed and histopathologic features were compared with those of other reported cases of KLC. In our patient, a 4-year-old boy, the clinical features of the lesions did not deviate notably from those of other cases of KLC. The histologic pattern of the papules was typical of KLC, while that of the erythematosquamous plaques showed some dyskeratotic keratinocytes. The histologic pattern of the erythematosquamous lesions is peculiar in our case, whereas only a nonspecific pattern is reported in the literature. The papular and erythematosquamous lesions showed similar histopathologic features suggesting that they could be different degrees of evolution of the same lesion.

Xanthoma disseminatum: A case with extensive mucous membrane involvement

A 37-year-old man had red or brownish papules on his face, chest, and groin, where they coalesced into plaques. Endoscopic examination revealed the presence of small xanthomatous papules on the mucous membrane of the stomach. A biopsy specimen revealed a dense infiltrate of histiocytes, foam cells, Touton giant cells, and inflammatory cells. The diagnosis of non-X histiocytosis was confirmed by immunohistochemical studies of the infiltrate.