Joyeeta Chowdhury

Non pigmenting mucosal fixed drug eruption due to tadalafil: A report of two cases.

Various ‘sex-stimulant’ medicines with fancy names and attractive packaging are available over the counter. Most contain phosphodiesterase 5 inhibitors in various strengths, often with herbal additions. These drugs are used erratically by the lay public, driven by folklore that such usage leads to increase in the length, girth or firmness of the penis. Such indiscriminate use by an otherwise healthy population leads to undue side effects.

Multiple cutaneous horns due to discoid lupus erythematosus.

Sir, A 9‐year‐old boy presented with multiple asymptomatic horny projections on the skin for 3 years. The lesions first appeared as small erythematous papules which increased in size and developed a hyperkeratotic mass on the surface in due course. New lesions kept appearing and followed the same course. There was no history of photosensitivity or any features suggestive of systemic involvement. None of his family members was affected with a similar condition. Examination revealed multiple grouped cutaneous horns appearing like “mountain range” of various sizes (ranging from 3 mm to 2 cm in height) present all over the body, except on the palms and soles. Multiple smaller cutaneous horns were noticed on the upper lip [Figure 1]; the oral cavity and other mucosal surfaces were spared. A few small lesions were noted on the scalp too; however, there was no hair loss. Nails were unremarkable. Apart from cutaneous horns, mucocutaneous examination was remarkable for well‐defined erythematous scaly plaques with areas of atrophy and depigmented atrophic lesions. Systemic examination was non‐contributory. Considering the morphology, a diagnosis of generalized discoid lupus erythematous (DLE) was considered. A sample for histopathological examination was collected from the base after shave excision of a horn on the face. Follicular plugging, epidermal atrophy, vacuolar alteration of the basal cell layer, pigmentary incontinence, and lymphocytic infiltration in a perivascular, periappendageal, and subepidermal location were observed, thus confirming the diagnosis of DLE. Complete blood count, basic metabolic panel, hepatic function profile, and urinalysis did not reveal any abnormality. Anti‐nuclear antibody (ANA) was detected, albeit in low titer (1:160). Anti‐double‐stranded DNA was not detected. A final diagnosis of generalized DLE with cutaneous horns was made. All the horns were removed by shave excision. Mometasone cream and sunscreen was advised to control DLE lesions, and the response was satisfactory. The boy is under regular follow up and apart from new DLE lesions, no serious morbidity has been observed.

Tendinous xanthoma with familial hypercholesterolemia.

A 10-year-old non-obese boy presented with a painful nodular eruptions over the back of ankles for the last 5 years. On examination smooth, skin colored painful nodules were noted over the lower part of each tendo-achilles [Figure 1] and left elbow [Figure 2]. The skin overlying the nodules was freely movable. Arcus juvenilis was present. His parents and two siblings did not show any such findings. A diagnosis of tendinous xanthoma was considered and the patient was subjected to investigations. The lipid profile and the lipoprotein electrophoresis revealed elevated levels of low-density lipoprotein (LDL) cholesterol (453 mg/dl) and total cholesterol (600 mg/dl). Blood sugar, liver function tests, thyroid profile, chest radiograph, electrocardiogram, glucose tolerance test and ultrasonography of the abdomen were normal. There was no evidence of any coronary artery disease. Biopsy from the nodule revealed infiltration of the dermis with admixture of foam cells, histiocytes and lymphocytes [Figure 3]. The lipid profile of the parents showed a rise in the LDL cholesterol. A final diagnosis of familial hypercholesterolemia with tendinous xanthoma was made. Figure 1 Nodules over tendo-achillis Figure 2 Nodules over elbow Figure 3 Histopathology from lesion showing foam cells, histiocytes and lymphocytes (H and E, ×400)

Cutaneous leishmaniasis: an unusual cause of nasal obstruction

Nasal and sinus-related illnesses are among the most common reasons for appointments to otolaryngologists and allergists. The usual causes include septal deviation, allergic rhinitis, polyps and so on. Apart from the common cold, allergic rhinitis is probably the most common cause of nasal obstruction. Allergic rhinitis is most common during adolescence and improves significantly during middle age and wanes during old age. The anatomical causes including septal deviation and adenoids constitute other common causes of nasal obstruction. The unusual causes include middle turbinate osteoma, concha bullosa of the inferior turbinate, congenital nasal pyriform aperture stenosis, and congenital inferior turbinate hypertrophy. We describe the case of a 44-year-old man with localized cutaneous leishmaniasis, a hitherto unobserved cause of nasal obstruction, cured with intravenous sodium stibogluconate.

Generalized annular lichen planus with a unique morphology in a patient seropositive for HIV

Human immunodeficiency virus (HIV) infection is often associated with an array of skin manifestations, which are frequently more severe and present more atypically than those observed in nonHIV-infected persons. Some of them are acquired immune deficiency syndrome (AIDS) defining, and those such as seborrheic dermatitis, dermatophytosis, herpes simplex, and psoriasis may present in an exaggerated manner.1 Lichen planus (LP) is a common inflammatory dermatosis of unknown origin that presents in a variety of morphologic patterns. Many clinical variants, such as atrophic, hypertrophic, eruptive, linear, and annular, have been described in literature.2 Annular LP (ALP) is often considered one of the rare clinical forms. Various authors report that approximately 7% to 10% of LP lesions may have an annular morphology.3 Here, we report a case of generalized ALP unique in morphology in a patient with HIV infection.

Primary Tuberculosis in Soft Palate: Case Report of a Rare Entity

A 40-year-old male patient presented to our clinic with history of dysphagia and ulceration in the palate for two months. After history-taking and thorough clinical examination, investigations like routine blood parameters, chest skiagram, sputum for acid-fast bacilli, ultrasonography of the abdomen, and biopsy from the palatal lesion were performed. No evidence in support of pulmonary or abdominal tuberculosis was found. Histopathological examination of the biopsy revealed granulomatous inflammation with Langhans giant cells and caseation necrosis. Diagnosis of primary tuberculosis of soft palate was made. Anti- tubercular regimen (CAT I) for 6 months was prescribed, and we got a dramatic response noted within 15 days. As isolated tuberculosis of soft palate is a very rare entity, one should, therefore, consider it in any case of chronic ulcer of the soft palate. Response to CAT 1 was excellent in our case.