Kyu Chul Choi

A case of human immunodeficiency virus infection initially presented with disseminated herpes zoster.

Herpes zoster is characterized by unilateral grouped vesicles along the distribution of a single dermatome. Disseminated herpes zoster usually is defined as a generalized eruption of more than 20 extra-dermatomal vesicles occurring within a week of the onset of classic dermatomal herpes zoster. It occurs chiefly in old or debilitated individuals, and especially in patients with underlying malignancy, immunosuppressive therapy, or human immunodeficiency virus (HIV) infection. A 51-year-old man presented with segmental grouped vesicles on the left upper trunk and arm, and a varicella-like eruption over the entire body. Tzanck smear preparation and punch biopsy done on the vesicles of the trunk indicated a herpetic infection. Later, he was found to be HIV-positive. We report a rare case of HIV infection initially presenting with disseminated herpes zoster.

Calcinosis cutis in systemic lupus erythematosus: A case report and review of the published work

Calcinosis cutis is a common clinical feature of dermatomyositis and scleroderma but rarely reported in association with systemic lupus erythematosus (SLE). Calcinosis cutis in SLE occurs without calcium and phosphorus metabolic abnormalities and may be localized or generalized. The pathophysiology remains unclear and no effective therapy is currently available. We report a 30‐year‐old woman with a 13‐year history of SLE who developed multiple calcinosis cutis around both knees and we review the relevant published work.

Case of herpes zoster duplex bilateralis

Non‐contiguously simultaneous development of herpes zoster is very rare. It is named either herpes zoster duplex unilateralis or bilaterarlis, depending on whether one or both sides of the body are involved. Herein, we report a 21‐year‐old man, who had been treated for ulcerative colitis with prednisolone, and presented with painful grouped vesicles of the lower abdomen and back in a relatively symmetrical distribution. A Tzanck smear and punch biopsy were performed on the vesicles of the back. We report a rare case of symmetrical herpes zoster duplex bilateralis.

Genetic study in a case of birt-hogg-dubé syndrome.

Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominantly inherited disorder characterized by multiple trichodiscomas, fibrofolliculomas, and acrocordons. There is also an increased risk of developing renal neoplasms and lung cysts/spontaneous pneumothorax. We present a 43-year-old man with multiple, 2~4 mm sized, dome-shaped, and skin-colored papules on his cheek and neck. On the basis of clinical finding and histopathologic examination on the cheek lesion, it was diagnosed as multiple trichodiscomas. Subsequently, molecular analysis revealed a mutation in the folliculin gene. We report a rare case of BHDS with a proved gene mutation.

Primary cutaneous nocardiosis due to Nocardia vinacea: first case in an immunocompetent patient

1 Lapins NA, Willoughby C, Helwig EB. Lichen nitidus. A study of forty-three cases. Cutis 1978; 21: 634–7. 2 Nakamizo S, Kabashima K, Matsuyoshi N et al. Generalized lichen nitidus. a case with an immunohistochemical analysis on histiocyte infiltration, successfully treated with narrowband UVB phototherapy. Eur J Dermatol 2010; 20: 816–17. 3 Naito M. Macrophage differentiation and function in health and disease. Pathol Int 2008; 58: 143–55. Primary cutaneous nocardiosis due to Nocardia vinacea: first case in an immunocompetent patient

Recurrent Milia-Like Idiopathic Calcinosis Cutis on the Upper Eyelid

Dear Editor: Milia-like idiopathic calcinosis cutis (MICC) is a distinctive type of idiopathic calcinosis cutis, and shows remarkable clinical and histological features. Most cases of MICC appear in children with Down syndrome, but cases of MICC unassociated with Down syndrome are occasionally reported1. Herein, we report a rare case of recurrent MICC after complete removal in a patient who had no evidence of Down syndrome. A 17-year-old healthy Korean boy presented with a solitary whitish papule on the right upper eyelid for several months. Six years ago, he had complete removal of this lesion but the MICC recurred in the same area (Fig. 1). At the time of the patients arrival at the clinic, physical examination revealed a 5 mm sized firm white papule (Fig. 1B), and it was noted to be similar to the milia that had been there before. His physical and mental development was normal, and he denied any history of previous trauma or dermatosis at the site of the lesion. Also, there were no specific findings in the past history or family history. Histologic examination of the biopsied lesion showed a condensed deposit of basophilic amorphous material within the upper dermis (Fig. 2B). Von Kossa staining showed a black colored reaction (confirmed as calcium) of the lesion, and the serial sectioning did not show the presence of an epidermal cyst. Laboratory findings, including the complete blood count, serum calcium, phosphate, and parathyroid hormone levels, were within normal limits, ruling out the diagnosis of metastatic calcinosis. With all the above findings, we diagnosed the lesion as MICC. After it was removed completely, there has been no recurrence for several months. Fig. 1 (A) Several milia-like whitish papules on the right upper eyelid (6 years ago). (B) A solitary, firm, 5 mm sized whitish papule was observed in the same area (at present). The authors are indebted to the patient for his permission for publication. Fig. 2 (A) Amorphous basophilic material surrounded by collagen fibers and fibroblasts in the papillary dermis (H&E, ×40). (B) Amorphous homogenous and basophilic material that stained black with Von Kossa stain in the upper dermis (H&E, ... MICC appears as smooth, firm, whitish papules resembling milia, and they are occasionally surrounded by erythema and some have a central crust that indicates transepidermal elimination of calcinosis2. So, MICC may clinically be mistaken for warts, epidermal cysts, molluscum contagiosum, and syringomas3. Sites of predilection of the disease are the hands and feet, but the involvement of the face has been reported occasionally although it is rare. In addition, most cases of MICC have been reported in children with Down syndrome and these patients may have palpebral or perilesional syringomas occurring simultaneously with the MICC2. The pathogenesis of MICC remains unknown, but several theories have been suggested. One is the premature aging process, as in Down syndrome. Cultured fibroblasts of Down syndrome patients contain higher levels of calcium than those of controls3. Another theory is that eccrine sweat ducts play a role in calcium deposits, and calcified sweat ducts have been described in several patients4. The last theory proposes that the lesions, including the microepidermal cysts, secondarily produce a chronic inflammatory reaction and calcium deposition2. In our case, serum levels of calcium and phosphate were normal, and tissue or metabolic abnormalities were not observed. And the patient was a healthy boy, with was no evidence of calcified sweat ducts. So, we consider that this lesion might be calcium deposition due to a chronic inflammatory reaction of an intangible lesion. In the case presented here, we think that this is the first description of recurrent solitary MICC of the face in a healthy person who had no evidence of Down syndrome or palpebral or perilesional syringoma. So, we announce a rare form of MICC with a review of the published literature, and alert clinical dermatologists to the existence of this rare phenomenon.