Lidia Pérez-Pérez

Malignant Syphilis in an HIV-Infected Patient

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection may change the classic clinical course of syphilis and increase the incidence of a subtype of secondary syphilis named malignant syphilis. A homosexual patient with HIV infection consulted us about a one-month history of general malaise and widespread cutaneous ulcerative lesions, some with thick hemorrhagic crusts. Serology for syphilis was positive at high titers. Based on clinical, histological and serological findings, a diagnosis of malignant syphilis was made and the patient started treatment with penicillin G benzathine with progressive resolution of lesions. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous lesions.

Dermacentor-borne Necrosis Erythema and Lymphadenopathy (DEBONEL): A case associated with Rickettsia rioja.

© 2010 The Authors. doi: 10.2340/00015555-0801 Journal Compilation

Ulcerous lesions disclosing cutaneous infection with Fusarium solani.

Fusarium spp. are emergent opportunistic moulds capable of producing life-threatening diseases, usually in immunocompromised hosts. When they infect immunocompetent patients, they usually cause localized diseases. We describe here a case of cutaneous fusariosis in a patient with a medical history of diabetes mellitus and non-Hodgkins lymphoma who presented with two painful lesions on her left leg. The diagnosis was made on the basis of histopathological findings and skin biopsy culture. The lesions resolved after treatment with oral itraconazole. Cutaneous fusariosis manifests clinically as lesions that can be grouped into a few clinical patterns, and should always be considered in the differential diagnosis of necrotic cutaneous lesions.

Localized Cutaneous Amyloidosis Secondary to Porokeratosis: A Retrospective Histopathologic Study of 30 Patients

INTRODUCTION Porokeratosis is a rare disorder of keratinization. The presence of amyloid deposits has been observed in inflammatory and tumoral skin diseases. OBJECTIVES The aim of this study was to determine the frequency of cutaneous amyloidosis in histology samples from various types of porokeratosis diagnosed in our department from 1988 to 2005. MATERIAL AND METHODS Thirty patients were selected and 34 biopsies of lesions clinically and histologically compatible with porokeratosis were performed. Sections were stained with hematoxylin-eosin and thioflavin T. RESULTS Amyloid deposits were observed in 11 biopsies from 9 patients. Most were women in their sixties, with disseminated superficial actinic porokeratosis that had begun at least 5 years earlier. No notable histologic differences were observed between porokeratosis specimens with and without amyloid deposits. CONCLUSIONS The coexistence of porokeratosis and amyloidosis is a rare occurrence but may be underdiagnosed. In our opinion, the advanced age of the patients and the chronic nature of the lesions would have been predisposing factors for amyloid deposition. The possibility of racial or genetic influences, however, cannot be ruled out.

Induction of pustular lesions during infliximab therapy for Crohn's disease.

Sir, Infliximab is a chimerical monoclonal antibody that has rapidly become a highly useful tool in the therapeutic management of a variety of inflammatory conditions. Its effects are due to the blockade of tumour necrosis factor (TNF)-α on the surface of inflammatory cells and soluble TNF-α. This cytokine is known to play a relevant role in autoimmune diseases, rheumatoid arthritis (RA), inflammatory bowel disease and psoriasis (1). Infliximab may cause both systemic and local adverse effects. We wish to report an unusual cutaneous side effect.

Photoallergic dermatitis induced by diltiazem

Diltiazem is used as an antihypertensive and vasodilator drug. It can produce a variety of adverse effects, some of which are dose-dependent. However, cutaneous manifestations account for up to 48% of the adverse effects (1) and are not dose-related. We report a cutaneous photodistributed reaction associated with diltiazem in which photopatch test was useful for setting the definitive diagnosis.

Delayed Adverse Subcutaneous Reaction to a New Family of Hyaluronic Acid Dermal Fillers With Clinical, Ultrasound, and Histologic Correlation.

Hyaluronic acid (HA) is considered the safest filler due in part to its supposed low risk of immunogenicity and to claims of reversibility with hyaluronidase. Over the past years, the industry has tried to create more differentiated and longer-lasting products by modifying the chemical structure of

Psoriasis pustulosa generalizada y hepatitis citolítica asociada a colangitis neutrofílica

Resumen La psoriasis pustulosa generalizada (PPG) de von Zumbusch puede asociarse a alteraciones hepaticas, resultando habitualmente en una hepatitis colestasica con colangitis neutrofilica. Describimos el caso de una mujer con un primer episodio de de PPG que presento durante el mismo una elevacion de los parametros hepaticos de citolisis. La ecografia abdominal y los estudios serologicos no mostraron anomalies significativas. La biopsia hepatica mostro la presencia de un infiltrado neutrofilico alrededor de los conductos biliares del espacio portal. En definitiva, este hecho sugiere que la colangitis neutrofilica en el contexto de esta enfermedad puede mostrar inicialmente otros patrones de alteraciones analiticas distintos del patron colestasico clasicamente descrito.

Palmar Filiform Parakeratotic Hyperkeratosis Without Underlying Malignancy

Filiform hyperkeratosis (FH) is a rare entity clinically characterized by keratotic spicules on the palms, soles or other areas of the body surface. Its association with several diseases, including neoplasms, has been extensively discussed but currently it is not considered a well-defined paraneoplastic disorder. We report a 72-year-old patient that referred lesions on both palms of three months duration. The rest of the body surface did not show similar lesions. Complementary exams did not reveal any abnormal findings. The histopathological exam showed parakeratotic columns with a slightly decreased granular layer and a mild dermal inflammatory infiltrate. In the last years different terms have been employed to refer to these hyperkeratotic lesions contributing to the lack of clarity that currently persists. Although FH might be classified close to the clinical spectrum of porokeratoses, it presents particular clinical and histological findings that allow it to be considered a separate entity. We report a new case of this rare disorder with exclusive palmar involvement in a patient without underlying malignancy and review the main characteristics of similar cases reported in the literature. Despite the obscure association between this entity and neoplasms, the majority of authors deem it necessary to rule out underlying diseases.

Pénfigo vulgar. Comienzo como fenómeno de Koebner

Resumen El penfigo vulgar es una enfermedad autoinmunitaria caracterizada por acantolisis y formacion de ampollas intraepidermicas. El fenomeno isomorfico de Koebner es una respuesta a diversos estimulos, y ha sido descrito en muchas alteraciones cutaneas. La asociacion entre ambos ha sido descrita en escasas ocasiones. Aportamos un caso de penfigo vulgar que aparecio sobre cicatrices quirurgicas. El penfigo vulgar sobre cicatrices es muy raro. En nuestro caso, la reactivacion de los antigenos del penfigo en la cicatriz quirurgica causa, con bastante probabilidad, una respuesta de autoanticuerpos generalizada con formacion de ampollas sobre el tronco de la paciente.