Mary Seabury Stone

Paraneoplastic Pemphigus, Cicatricial Conjunctivitis, and Acanthosis Nigncans with Pachydermatoglyphy in a Patient with Bronchogem*c Squamous Cell Carcinoma

A 77-year-old man with chronic conjunctivitis, acanthosis nigricans with pachydermatoglyphy, and pemphigus-like mucocutaneous lesions was found to have a well-differentiated bronchogenic squamous cell carcinoma. Histopathologic and immunofluorescence studies confirmed the diagnosis of paraneoplastic pemphigus. Skin lesions resolved with oral prednisone and azathioprine therapy, but the conjunctivitis and mucous membrane erosions persisted. The conjunctiva later became scarred with foreshortening of the fornices and development of symblepharon. External beam irradiation arrested the growth of the tumor but did not have any effect on the diseased conjunctiva and other mucous membranes. This case demonstrates that cicatrizing conjunctivitis with bullous mucocutaneous lesions may be a clinical sign associated with an occult neoplasm.

Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus and the spectrum of the acute syndrome of apoptotic pan-epidermolysis (ASAP): a case report, concept review and proposal for new classification of lupus erythematosus vesiculobullous skin lesions.

The acute clinical syndrome of toxic epidermal necrolysis (TEN) is currently thought to be a distinct clinical-pathological entity typically resulting from drug hypersensitivity. We describe an adult woman who experienced a fulminate pattern of apoptotic epidermal cell injury following tanning bed exposure while taking naproxen that resulted in a clinical presentation having combined features of drug-induced TEN and an infrequently recognized form of bullous cutaneous lupus erythematosus (LE). This case calls attention to the fact that TEN-like injury can occasionally be seen in settings other than drug hypersensitivity (e.g., LE, acute graft versus host disease) and illustrates the need for a unifying concept in this area. We therefore propose the term ‘Acute Syndrome of Apoptotic Pan-Epidermolysis (ASAP)’ to designate a clinical syndrome that is characterized by life-threatening acute and massive cleavage of the epidermis resulting from hyperacute apoptotic injury of the epidermis. We also review vesiculobullous skin disorders that can be encountered in LE patients and suggest a new classification scheme for such lesions.

Acne rosacea in blacks

Acne rosacea has been considered to be a rare disease among black patients. Three cases of rosacea in blacks are described and illustrated. Acne rosacea may be more common in black patients than heretofore believed.

Agar disk elution method for susceptibility testing of Mycobacterium marinum and Mycobacterium fortuitum complex to sulfonamides and antibiotics.

An agar disk elution method using round well plates, supplemented Mueller-Hinton agar, and commercial drug disks is described for susceptibility testing of Mycobacterium marinum and the rapidly growing mycobacteria to antibiotics and sulfonamides. By this method, 14 of 14 strains of M. marinum were susceptible to rifampin, doxycycline, minocycline, and trimethoprim-sulfamethoxazole. Identical results were obtained with Middlebrook 7H10 agar and drugs prepared from standard powders. With 58 isolates of Mycobacterium fortuitum and Mycobacterium chelonei, this method had a 92% correlation with broth minimal inhibitory concentration determinations for cefoxitin and greater than 98% for doxycycline, kanamycin, amikacin, and the sulfonamides. Sixty-nine percent of isolates of M. chelonei susceptible to amikacin on supplemented Mueller-Hinton agar were resistant on 7H10 agar, and 15 of 16 M. chelonei isolates susceptible to erythromycin in broth were resistant by disk elution when an endpoint of no growth was used with either agar. The agar disk elution method offers a practical method for testing of most antibacterial agents against these mycobacterial species. Images

Nature and determinants of skin "burns" after transthoracic cardioversion.

Skin biopsies obtained 24 hours after elective cardioversion of 30 patients showed variable epidermal necrosis and upper dermal perivascular inflammation, most noticeably in patients receiving high individual peak (> or = 300 J) and cumulative (> or = 350 J) shock energies. Thus, damped sine wave shocks cause skin injury--first degree burns--the severity of which is a function of peak and cumulative shock energy.

Cutaneous parachordoma: A light microscopic and immunohistochemical report of two cases and review of the literature

Parachordomas are rare cutaneous tumors that show virtually identical histologic findings to chordomas. Therefore, the major differential diagnosis in a case of parchordoma is metastatic chordoma. Parachordomas are benign neoplasms and most often develop on the extremides adjacent to tendons, synovium or os‐seotis structures, as opposed to chordomas, which are malignant tumors located along the craniospinal axis. While recurrences may occur in cases of parachordoma, metastases have not been reported. In this report, two cases of parachordomas are reported and the literature reviewed. By light microscopy, parachordomas show eosinophilic bands of fibrous tissue separating lobules of cells with variably vacuolated cytoplasm (physaliphorous cells) admixed with more epithelioid cells in a myxoid stroma. Para‐chordomas and chordomas share immunohistochemical and ultrastructiral features. Both stain with S‐100 protein and vimentin, and ultrastrueturally both demonstrate cytoplasmic vacuoles, intermediate filaments, pinocytotic vesicles, cell junctions, and cytoplasmic membranes with microvillous processes. Chordomas more frequently express cytokeratin (98% vs. 66% in parachordomas) and epithelial membrane antigen (90% vs. 20% in para‐chordomas) and chordomas have a larger number of rough endoplasmic reticulum–mitochondrial complexes. Thus, positive staining with epithelial membrane antigen and the identification of a large number of rough endoplasmic reticulum–mitochondrial complexes are suggestive of metastatic chordoma. However, the definitive distinction remains a clinical one after appropriate radiologic studies of the skull and spinal chord.

Cutaneous vasculitis in the newborn of a mother with cutaneous polyarteritis nodosa

Vasculitis in an infant of a woman who had a long history of cutaneous polyarteritis nodosa is reported. During the neonatal period the child developed cutaneous vasculitis manifested by livedo reticularis, cutaneous nodules, and acral necrosis. The infants vasculitis remitted by age 7 months. This is the third such report and strongly suggests the presence of a circulating factor that is capable of crossing the placenta and inducing cutaneous polyarteritis nodosa.

Papular elastorrhexis: A variant of connective tissue nevus: Case reports and review of the literature

Two unrelated young women with papular elastorrhexis have recently been seen at the University of Iowa Hospitals and Clinics. This entity, recently described in a single patient, is a distinct variant of a connective tissue nevus. Although the histologic features of papular elastorrhexis may mimic those of other connective tissue nevi, clinical characteristics allow differentiation. The clinical and histologic characteristics of papular elastorrhexis, as well as its differential diagnosis, are discussed.

Ultraviolet Light Burn:A Cutaneous Complication of Visible Light Phototherapy of Neonatal Jaundice

Abstract: Visible light phototherapy is an easily administered and effective treatment for neonatal indirect hyperbilirubinemia. Reported cutaneous side effects include transient rashes and the uncommon bronze baby syndrome. A more hazardous side effect is ultraviolet burn. Two premature infants developed phototherapy‐induced erythema, one associated with a second‐degree burn, after exposure to fluorescent daylight bulbs inadvertently used without Plexiglass shields, thus allowing prolonged ultraviolet A (UVA) exposure. Premature infants, especially during the first two weeks of life, may be significantly susceptible to UVA‐Induced erythema. Plexiglass shields should always be In place during visible light phototherapy, and nursery staff should be made aware of their purpose.

Torre's syndrome: Exacerbation of cutaneous manifestations with immunosuppression

Torres syndrome is characterized by the association of sebaceous neoplasms and keratoacanthomas with visceral malignancies. We report on a patient in whom the cutaneous manifestations of Torres syndrome dramatically increased following immunosuppression.