Leni George

Frontal rhytidectomy as surgical treatment for pachydermoperiostosis: A case report

The thickened folded skin of Touraine‐Solente‐Golé syndrome can result in cosmetic and functional deformities. The treatment of pachydermoperiostosis is usually centered around improving the cosmetic appearance through plastic surgery. We describe the case of a 27‐year‐old male who had pachydermoperiostosis with a leonine facies that was managed with frontal rhytidectomy. A greatly improved cosmetic appearance was achieved with this procedure.

Novel multidrug therapy for disseminated rhinosporidiosis, refractory to dapsone – case report

Rhinosporidiosis is a chronic granulomatous disorder, caused by Rhinosporidium seeberi endemic in India and Sri Lanka. The most common sites are the nasal mucosa and the nasopharynx and cutaneous lesions usually occur as a part of disseminated rhinosporidiosis. Dapsone has been frequently used in treating disseminated disease in immunocompetent individuals. Here we report a case of disseminated rhinosporidiosis in an immunocompromised individual on antiretroviral drugs, non-responsive to Dapsone and therefore treated with a multidrug therapy of Cycloserine, Dapsone and Ketoconazole with good response.

Trichoscopic features of various types of alopecia areata in India: application of a hand-held dermoscope

Trichoscopy is a new diagnostic tool for the evaluation of hair disorders. Trichoscopic findings described in alopecia areata are black dots, tapering hair corresponding to exclamation mark hair, broken hair, yellow dots and clustered short vellus hair. Exclamation mark hair is considered by some authors to be a pathognomonic diagnostic finding in alopecia areata. This study aims to describe the trichoscopic patterns seen in alopecia areata in an Indian population, depending on disease type and severity.

Skin lesions in renal transplant recipients: A single center analysis

BACKGROUND The chronic use of immunosuppressants in renal transplant recipients (RTRs) predisposes them to a variety of skin manifestations. Studies on skin lesions in RTRs from India have been limited. AIM To study the prevalence and clinical spectrum of skin diseases in RTR in patients attending the Nephrology clinic of a tertiary care hospital in South India. METHODS Between October 2002 and June 2003, 365 RTRs were evaluated for skin lesions, including 280 examined after renal transplant (group A) and 85 examined once before and then monthly after transplant for a period of 6 months (group B). RESULTS A total of 1163 skin lesions were examined in 346 RTRs (94.7%) including lesions of aesthetic interest (LAI) [62.3%] followed by infections [27.3%]. All LAI were drug-related manifestations, making it the most common skin lesion, while fungal (58.7%) and viral (29.3%) infections constituted majority of lesions caused by infection. Lesions related to neoplasms were relatively uncommon (2.1%) and all lesions were benign. Miscellaneous lesions constituted 8.3% of skin lesions, which included vaccine-induced necrobiotic granulomas at the site of Hepatitis B vaccination and acquired perforating dermatoses. CONCLUSION Skin lesions among RTRs from India consist predominantly of drug-related LAI and infections and are different from the West in view of the paucity of neoplastic lesions.

Yellow nail syndrome in rheumatoid arthritis: an aetiology beyond thiol drugs

Yellow nail syndrome (YNS) is a rare entity characterized by a triad of nail changes, lymphoedema and lung involvement. We report a 57-year-old man with rheumatoid arthritis (RA) and YNS. We have reviewed the previous case reports of RA and YNS and discuss the pulmonary manifestations.

Toxicity and clinical outcomes in patients with HIV on zidovudine and tenofovir based regimens: a retrospective cohort study.

BACKGROUND Adverse drug reactions are a major concern with zidovudine/stavudine treatment regimens. The less toxic tenofovir regimen is an alternative, but is seldom considered due to the higher costs. This study compared adverse drug reactions and other clinical outcomes resulting from the use of these two treatment regimens in India. METHODS Baseline, clinical characteristics and follow-up outcomes were collected by chart reviews of HIV-positive adults and compared using univariate/multivariate analysis, with and without propensity score adjustments. RESULTS Data were collected from 129 and 92 patients on zidovudine (with lamivudine and nevirapine) and tenofovir (with emtricitabine and efavirenz) regimens, respectively. Compared to patients receiving the zidovudine regimen, patients receiving the tenofovir regimen had fewer adverse drug reactions (47%, 61/129 vs 11%, 10/92; p<0.01), requiring fewer regimen changes (36%, 47/129 vs 3%, 3/92; p0.01). With the propensity score, the zidovudine regimen had 8 times more adverse drug reactions (p<0.01). Opportunistic infections were similar between regimens without propensity score, while the zidovudine regimen had 1.2 times (p=0.63) more opportunistic infections with propensity score. Patients on the tenofovir regimen gained more weight. Increase in CD4 levels and treatment adherence (>95%) was similar across regimens. CONCLUSIONS Patients on a tenofovir regimen have better clinical outcomes and improved general health than patients on the zidovudine regimen.

Systemic T cell lymphoma presenting as cutis verticis gyrata

Sir, A 34-year-old man, presented with progressive swelling and serous discharge on his face and scalp for 4 months. General examination revealed pallor and multiple, enlarged, non-tender, discrete, mobile lymph nodes in bilateral cervical, axillary, and inguinal regions, the largest of which was 5 cm × 6 cm in the right axillary region, associated with hepatosplenomegaly. He had a leonine facies. The skin of the scalp was thrown into cerebriform folds with diffuse loss of hair [Figure 1a]. There was generalized xerosis with a few scattered infiltrated nodules [Figure 1b] on the trunk and extremities ranging in size from 1-2 cm and diffuse scaling over the palms and soles. The differentials considered were lymphedema secondary to a lymphatic obstruction, leukemoid/lymphomatous infiltration and sarcoidosis. On hematological examination, he was found to have anemia (10.8 g/ dl) and leukocytosis (63.4 × 109/L) associated with a serum lactate dehydrogenase of 1110 U/L. Serology for Epstein-Barr virus and human T-lymphotrophic virus were negative. Skin biopsies done from the scalp and a nodule on the back showed mild lamellar hyperkeratosis, focal parakeratosis and irregular acanthosis of the epidermis. There was a pan-dermal, moderate to dense infiltrate of medium sized lymphoid cells with vesicular nuclei, irregular nuclear membranes, small nucleoli and scant cytoplasm. Numerous apoptotic bodies were seen [Figure 2a and b]. On immunohistochemistry, these cells were positive for CD3 [Figure 3a], CD4 [Figure 3b], focally positive for CD25 [Figure 3c] and negative for CD5, CD7, CD20, CD34 and terminal deoxynucleotidyl transferase. The MIB-1 proliferation index [Figure 3d] was 85%. Lymph node biopsy from the right axilla was consistent with high grade T-cell lymphoma on histopathology and immunohistochemistry [Figure 4]. Bone marrow biopsy showed myeloid hyperplasia with increased eosinophils and its precursors. T cell receptor re-arrangement studies demonstrated clonality for the alpha-beta type. CD 3 and CD 4 positivity indicated a T cell lymphoma. CD 20 negativity ruled out a B cell lymphoma. CD 7, CD 34 and terminal deoxynucleotidyl transferase negativity ruled out a T cell lymphoblastic leukemia/lymphoma. CD 25 positivity is usually seen in adult T cell lymphoma, which was ruled out in view of the human T lymphotropic virus serology being negative. A high MIB-1 proliferation index indicated a high grade lymphoma. On this basis the diagnosis of high grade T cell non-Hodgkin lymphoma was

Generalized pustular psoriasis following allogeneic stem cell transplantation

Development of psoriasis following allogeneic stem cell transplantation (SCT) is rare, and has been described once previously, following SCT from a sibling donor with psoriasis. This condition should be differentiated from psoriasiform graft‐versus‐host disease (GvHD) by histopathology. We describe a 9‐year‐old boy who developed generalized pustular psoriasis 2 months after allogeneic SCT from an HLA‐identical sibling donor with no history of psoriasis. Diagnosis was confirmed by clinical features and multiple skin biopsies, which helped to exclude GvHD. The skin lesions responded well to treatment with acitretin. Psoriasis should be considered in the differential diagnosis of skin rash following SCT.

Ross syndrome: A case report and review of cases from India

Ross syndrome is a rare dysautonomia characterized by a clinical complex of segmental anhidrosis or hypohidrosis, areflexia, and tonic pupils. A very few cases (≃50) have been reported in literature since its original description in 1958. Here, we report the case of a middle-aged homemaker from Odisha, India, who presented with complaints of segmental hypohidrosis for the past 7 years.

Acquired cutis laxa associated with light and heavy chain deposition disease

Acquired cutis laxa (ACL) is a rare connective tissue disorder characterized by pendulous and coarsely wrinkled skin. There have been few cases of its association to monoclonal immunoglobulin deposition disease (MIDD), which constitutes the light chain (LCDD), heavy chain (HCDD), and light and heavy chain (LHCDD) deposition disease. MIDD predominantly involves the kidney. Skin is the next common organ to be affected by HCDD, which presents as ACL. We report the case of a 40-year-old male who presented with ACL associated with LHCDD. The clinical features of ACL in the present case appeared prior to the development of clinical features related to LHCDD.