Mariano Ara

Dermoscopic findings of haemosiderotic and aneurysmal dermatofibroma : report of six patients

Background  The clinical diagnosis of dermatofibroma is commonly easy. However, the differentiation of dermatofibroma from other cutaneous tumours is difficult in some instances, primarily in atypical cases and rare variants. Haemosiderotic dermatofibroma is a variant composed of numerous small vessels, extravasated erythrocytes and intra‐ and extracellular haemosiderin deposits. Aneurysmal dermatofibroma is a variant composed of large, blood‐filled spaces without endothelial lining. Some authors consider that haemosiderotic dermatofibroma is an early stage in the development of aneurysmal dermatofibroma. The clinical differential diagnosis of haemosiderotic or aneurysmal dermatofibroma must include melanoma and other melanocytic tumours, vascular neoplasms, adnexal tumours and nonspecific cysts. Dermoscopy improves the diagnostic accuracy in pigmented and nonpigmented skin lesions.

Mycobacterium chelonae infection with multiple cutaneous lesions after treatment with acupuncture

A 58‐year‐old‐woman was first seen in November 1999 with a 4‐week history of several tender, deep red or purple, suppurating subcutaneous nodules on the skin of the abdomen, suggestive of a panniculitis ( Fig. 1 ). She had no history of systemic immunosuppression. Three months prior to examination, the patient had treated with acupuncture for obesity. Two biopsy specimens of the nodules were taken and sent for culture and histologic examination. Histology showed a pattern of panniculitis with chronic inflammatory cells mixed with areas of polymorphonuclear abscesses and necrosis ( Fig. 2 ). Culture of the biopsy specimen grew acid fast bacilli within 4 days, later identified with biochemical and molecular tests as Mycobacterium chelonae (subspecies chelonae). Polymerase chain reaction‐restriction enzyme pattern analysis (PRA) was used for molecular identification of mycobacteria. In vitro sensitivity tests showed sensitivity to clarithromycin, amikacin, tobramycin, doxycycline and erythromycin and resistance to ciprofloxacin, ofloxacin, trimethoprim‐sulfamethoxazole, imipenem and cefoxitin. Oral clarithromycin (500 mg b.d.) was started and after 3 months of therapy the lesions had cleared completely.

Dermoscopy of molluscum contagiosum: a useful tool for clinical diagnosis in adulthood.

Molluscum contagiosum is a common cutaneous viral infection that occurs most frequently in children and is caused by a DNA virus of the molluscipox genus. In some cases, there are atypical clinical characteristics in adulthood that can complicate the correct diagnosis of these lesions. Dermoscopy is a non-invasive technique that allows the recognition of pigmented and vascular structures in skin tumours. We report the case of an elderly patient, without impaired immunity, with atypical molluscum contagiosum, which showed a particular pattern by dermoscopy that could be characteristic in these lesions.

Recurrent lentigo maligna as amelanotic lentigo maligna melanoma

Amelanotic lentigo maligna and lentigo maligna melanoma are extremely rare tumours. Even rarer is a recurrent amelanotic lentigo maligna or amelanotic lentigo maligna melanoma at the site of a previously removed pigmented lentigo maligna. We describe two cases of recurrent amelanotic lentigo maligna melanoma manifesting as erythematous plaques evolved from previously excised pigmented lentigo maligna.

Foliculitis postdepilación por Mycobacterium chelonae

Resumen .—Mycobacterium chelonae es una micobacteria atipica, no productora de pigmento, perteneciente al grupo IV de la clasificacion de Runyon. En pacientes inmunocompetentes suele producir lesiones aisladas y localizadas, con antecedente traumatico; sin embargo, en pacientes inmunodeprimidos suele producir lesiones multiples. Presentamos el caso de una infeccion por Mycobacterium chelonae en una mujer inmunocompetente de 32 anos que desarrollo lesiones nodulares multiples en extremidades inferiores, simulando los casos de diseminacion hematogena en inmunodeprimidos. El unico antecedente relacionado fue la depilacion con cera. La foliculitis por M. chelonae debe incluirse en el diagnostico diferencial de las foliculitis postdepilacion, ya que la sospecha diagnostica hace posible una terapeutica precoz y eficaz que impedira la aparicion de cicatrices importantes.

Mucormicosis rinocerebral fulminante

Resumen —Se presenta el caso de un varon de 53 anos con mucormicosis rinocerebral que progreso rapidamente, ocasionando una gran placa necrotica centrofacial y la muerte del paciente a pesar de la rapida instauracion de anfotericina B por via intravenosa. El paciente tenia numerosos factores predisponentes para contraer la enfermedad, pues era un paciente desnutrido, que habia sido tratado, 2 meses antes, con quimioterapia por un cancer de laringe, presentaba pancitopenia y estaba siendo tratado, por una neumonia, con antibioticos de amplio espectro. Los numerosos factores predisponentes pudieron ser la causa del curso fulminante de la mucormicosis.

Síndrome de Sweet pruriginoso y recurrente asociado a carcinoma de vejiga urinaria

Resumen —Presentamos un caso de sindrome de Sweet con intenso prurito en un varon de 78 anos de edad. La aparicion de las lesiones cutaneas fue simultanea a la deteccion de un carcinoma de vejiga urinaria. Posteriormente el paciente tuvo varias recurrencias a lo largo de 2 anos, las cuales fueron repetidamente consideradas como procesos urticariformes y tratadas con antihistaminicos y corticosteroides. En dos ocasiones fue ingresado en el Servicio de Medicina Interna para estudiar una «fiebre de origen desconocido» hasta que fallecio por otro proceso.