Guglielmo Pranteda

Postherpetic paresis mimicking an abdominal herniation.

Sir, Herpes zoster (HZ) is caused by reactivation of latent infection with varicella zoster virus established in the sensory ganglia after an earlier primary infection with chickenpox. The usual neurological postherpetic complication is a dermatomal distribution pain that persists for months to years after resolution of HZ rash. Although segmental motor paralysis, both visceral and somatic, is an unusual and less well known complication, it sometimes occurs in the same or in the adjacent involved dermatomes (1). We present a case of HZ complicated by motor involvement of T10–T11 segments with an abdominal bulge mimicking a herniation. CASE REPORT A 75-year-old man presented a left flank wall herniation that had gradually developed in size over the previous 2 months and burning pain over the involved area. Four months before the consultation he suffered from left flank HZ rash complicated by persistent neuralgia. At that time, therapy with oral acyclovir was administered (800 mg five times daily for 1 week) with regression of the skin eruption. Five years before, he was curatively resected for a sigmoid colon cancer through a midline laparotomy and subsequently received cycles of systemic chemotherapy. On physical examination, the skin evidenced hyperpigmentated macules in the dermatomes previously involved by herpetic rash; a reducible, painful swelling, 20 cm × 15 cm in diameter, increasing in prominence with intra-abdominal straining, protruded in an area of flaccid muscles of the left flank (Fig. 1). The la parotomy incision evidenced uncomplicated healing. General laboratory tests and the tumour markers were normal. Thoraco-abdominal computed tomography (CT) showed no abdominal mass, the flank wall bulged asymmetrically and the left abdominal large muscle was thinner than the right side. Thoracic and lumbar spine magnetic resonance imaging (MRI) evidenced no mechanical nerve root damage. On neurological examination superficial abdominal reflexes were absent in the left side and hyperaesthesia was present in this area. The sensory examination was otherwise normal. Concentric needle electromyography (EMG) of external and internal oblique abdominal muscles, rectus abdominis muscles and paravertebral thoracic muscles from T9 to L1 revealed membrane irritability with positive waves and fibrillations of left-sided muscles, most prominently at T10–T11 level. Motor unit action potentials were present in left-sided muscles, although reduced in number and in amplitude. EMG recordings on the right side were normal. The neurological findings were consistent with an involvement of left anterior roots at T10–T11 level by shingles. A treatment with

Lichen sclerosus et atrophicus induced by carbamazepine: a case report.

We report a case of Lichen Sclerosus in a 73-year-old man who had been treated for epilepsy with carbamazepine. Lichen sclerosus et atrophicus (LSA), also called lichen sclerosus (LS), is a chronic inflammatory cutaneous condition characterized by white plaques with epidermal atrophy and scarring. To date no cases of LSA has been linked to carbamazepine, although in a few cases lichenoid eruptions but without sclero-atrophy have been described after exposure to this drug. Therefore, to our knowledge, this is the first report of a Lichen sclerosus et atrophicus induced by carbamazepine

Acquired unilateral naevoid telangiectasia in a healthy boy.

Sir, Acquired unilateral naevoid telangiectasia (AUNT) is a rare disease predominantly affecting women in a hyperoestrogenaemic state. In some cases hypersensitivity of oestrogen and progesterone receptors is postulated. Few cases have been reported in males, and these are usually associated with liver dysfunction and hyper-oestrogenism. We observed a young boy with AUNT. No other disease was associated and no oestrogen and progesterone receptor abnormality was evident in the skin sample.

A case of Scalp Rosacea treated with low dose doxycycline and probiotic therapy and literature review on therapeutic options

Rosacea is a common chronic inflammatory disorder showing a wide range of clinical features such as telangiectasia, erythema, papules, and pustules primarily involving the central part of face (forehead, cheeks and nose) although extra facial manifestation have been described. We describe a case of rosacea with predominant scalp involvement successfully treated with a 8‐week‐course of doxycycline 40 mg once a day and probiotic therapy twice a day (Bifidobacterium breve BR03, Lactobacillus salivarius LS01 1 × 109 UFC/dose).

Systemic mastocytosis presenting with gastrointestinal, bone and skin involvement

Ultrasonography (US) is often the first imaging study performed in patient with abdominal pain or vague symptoms related to the gastrointestinal tract. To this end, it has been demonstrated that transabdominal sonography achieves good to excellent results in potential bowel disorders; especially, if ultrasonography findings are framed in the context of clinical information. Systemic mastocytosis is not a common disease and it usually involves skin, gastrointestinal tract and bone. It results from a clonal neoplastic proliferation of abnormal mast cells and clinically it can ranges from ‘asymptomatic’ with normal life expectancy to ‘highly aggressive’. Symptoms are caused by the release of mast cells mediators, such as histamine, and by the increase bulk of mast cells in the tissue. We present herein a case of systemic mastocytosis presenting with abdominal symptomatology due to thickened colonic involvement showed by US associated with bone and skin involvement.RiassuntoL’ecografia è spesso considerata l’indagine di primo livello nei pazienti con dolore addominale o con altra sintomatologia aspecifica del tratto gastrointestinale. A tal proposito, è stato dimostrato che l’ecografia transaddominale è in grado di raggiungere anche eccellenti risultati nello studio dei disturbi intestinali, soprattutto se inquadrata nel contesto di specifiche informazioni cliniche. La mastocitosi sistemica è una rara patologia che generalmente coinvolge cute, tratto gastrointestinale e osso. Si tratta di proliferazione neoplastica di tipo clonale di mastociti, che clinicamente può variare da una sintomatologia lieve con normale aspettativa di vita fino ad un quadro altamente aggressivo. I sintomi sono causati dal rilascio dei mediatori contenuti nei mastociti, tra i quali l’istamina, e dall’incremento dei mastociti nei tessuti. Presentiamo qui un caso di mastocitosi sistemica caratterizzato dalla comparsa di sintomatologia addominale dovuta a ispessimento del grosso intestino identificato all’esame ecografico, associato a interessamento osseo e cutaneo della patologia.

An incomplete form of childhood Behçet's disease treated with infliximab.

Behçets disease (BD) is a multi-systemic vasculitis characterized by the possible presence of cutaneous, ocular, articular and neurological manifestations. In this report, we examine the case of a fifteen-year-old boy with an incomplete form of juvenile Behcets disease which began with joint involvement and developed into a complete form only after several years. The patient showed a rapid response to anti-TNF-alpha (infliximab) with an improvement of mucocutaneous lesions (oral and genital ulcers, pseudofolliculitis) and arthritis.

Pharmacological management of pediatric Kerion celsi.

We report a case of severe tinea capitis, treated successfully with griseofulvin. In our opinion, the treatment of this severe dermatophytosis with griseofulvin is safe and effective. Other treatments, such as itraconazole pulsed therapy, failed, despite an initial improvement, leading to an aggressive recurrence of the lesion. We chose griseofulvin for its well-known large spectrum activity, also against uncommon species, like Microsporum Gypseum, which are responsible for the most severe cases.

Churg-Strauss and montelukast.

Churg-Strauss syndrome (CSS) is a systemic small vessel vasculitis involving lungs, skin, heart, gastrointestinal tract and peripheral nerves. We report the case of a 36-year-old woman with a necrotic lesion on the left foot of two months duration, associated with hypereosinophilia, patchy lung infiltrates, cardiac damage and a mononeuritis. The personal history was remarkable only for an asthma, treated with Montelukast, a leukotriene receptor antagonist (LRA). Clinical symptoms, laboratory exams and instrumental examinations led us to the diagnosis of CSS. In recent years several studies have reported the possible relationship between use of leukotriene receptor antagonist (LRA) and CSS expression. We report this case to underline the possible relationship between LRA and CSS and its etiopathogenetic mechanism.

Transient acantholytic dermatitis and Parkinson's disease

© 2008 The Authors JEADV 2009, 23, 441–496 Journal compilation

The management of pseudomyogenic hemangioendothelioma of the foot: A case report and review of the literature

Pseudomyogenic hemangioendothelioma (PMH) is a rare, mostly indolent, endothelial neoplasm of low‐grade malignancy, often mimicking myoid and epithelioid tumors histologically. It is more frequent in young adult males and it usually presents with multiple cutaneous nodules, mostly localized at the extremities. It traverses several tissue planes simultaneously and can involve dermis, subcutis, skeletal muscle, and bone. Histologically, it is characterized by plump spindle cells with eosinophilic cytoplasm, often arranged in fascicles and epithelioid cells with “pseudomyogenic” morphology. Immunohistochemically, PMH is positive for Factor VIII, FLI‐1, INI‐1, vimentin, MDM2, CDK4, CD31, AE1/AE3, EMA, and P63. The efficacy of treatments is only partially known. Because of the frequent multifocal aspect of PMH, which contraindicates surgery, systemic treatments, such as gemcitabine, sirolimus, and everolimus are used. Based on our observation of multifocal PMH of the foot in a 17‐year‐old male patient, treated with gemcitabine with complete cutaneous response in a 2‐year follow‐up, we decided to discuss this rare tumor and underline its progression and therapeutic approaches. Thanks to a correct diagnosis, it is possible to avoid aggressive therapeutic approaches, which would be necessary for nonindolent diseases, such as sarcoma, which often needs amputation.