Michael J. Ford

Congenital cutaneous candidiasis associated with respiratory distress and elevation of liver function tests: A case report and review of the literature ☆ ☆☆ ★

We describe congenital cutaneous candidiasis (CCC) in a term newborn. The mother had candidal vaginitis 1 week before delivery. At birth, the infant had a generalized, intensely erythematous, papulovesicular eruption, respiratory distress and elevation of liver function tests. The child responded well to intravenous amphotericin B plus topical and oral nystatin. There have been 13 previously reported cases of CCC in infants weighing more than 1500 gm who had evidence of systemic infection. Two deaths were attributed to candidal pneumonia and sepsis. The majority of infants with CCC have infection localized to the skin, but if there is any evidence of respiratory distress or signs of sepsis the possibility of systemic candidiasis and the need for parenteral antifungal therapy must be considered.

Cutaneous lymphangiectases associated with severe photoaging and topical corticosteroid application.

We report an elderly patient with lymphangiectases arising within skin affected by photoaging, steroid atrophy, and inflammation. Bullous lesions appeared in several sites following a year of topical corticosteroid applications for neurodermatitis. Light and electron microscopy showed that the bullae consisted of dilated lymphatic vessels within the dermis. There was also marked nodular elastosis and attenuation of dermal collagen. We suggest that this patients lymphangiectases resulted from abnormal structure and function of the dermis due to photoaging and steroid atrophy.

Extramammary Paget's disease associated with prostate adenocarcinoma

A case of scrotal and penile extramammary Pagets disease (EMPD) and concurrent prostate adenocarcinoma in a 59-year-old patient is presented. Immunohistochemically, the tumor cells of both the EMPD and prostate stained positively for prostate-specific antigen. Six previously reported cases of EMPD associated with prostate adenocarcinoma are reviewed, along with a discussion of current theories of the pathogenesis of EMPD.

Annular atrophic plaques of the skin (Christianson's disease)

A 69‐year‐old Caucasian man presented to the Gainesville Veterans Administration Medical Center for evaluation of several asymptomatic enlarging lesions on the face and forearms that had been present for 10 to 15 years. They were initially small but had progressively enlarged, especially during the previous 5 years. He reported having sustained a concussive grenade blast injury of the left temple and right forearm during the Korean Conflict in 1951. The injured areas healed uneventfully in 2–3 weeks. The patient was otherwise healthy, and the review of systems was noncontributory. Laboratory work‐up (complete blood count, chemical profile, erythrocyte sedimentation rate, rheumatoid factor, hepatitis profile, antinuclear antibodies, urinalysis, and chest X‐ray) was within normal limits. Lyme antibody titers were negative.

Histoplasmosis presenting as erythroderma in a patient with the acquired immunodeficiency syndrome

A 36‐year‐old African–American man was hospitalized because of a 2‐week history of alternating bright red and tarry stools, vomiting, anorexia, lower leg edema, fever, and a desquamating eruption. Four months previously, during the course of evaluation for fever and cough, the patient had been discovered to be seropositive for the human immunodeficiency virus (HIV): bronchoscopy had revealed acid‐fast bacilli. No cultures were performed at that time. He had been started on isoniazid, rifampin, ethambutol, and zidovudine. Although he denied intravenous drug use and other HIV risk factors, he admitted to cocaine addiction. He also denied any previous history of atopic dermatitis, psoriasis, or seborrheic dermatitis.

Angiokeratomas in Juvenile Dermatomyositis

Abstract: Juvenile dermatomyositis (JDM) is an uncommon disease that features muscle weakness, a characteristic rash, and vascular changes in skin, muscle, and other organs. We report a patient with JDM who developed multiple angiokeratomas, one of which was calcified. Electron microscopy of an angiokeratoma revealed altered connective tissue consistent with abnormal collagen. To our knowledge, angiokeratomas occurring in association with JDM have not been previously reported. Abnormal collagen distinguishes the angiokeratomas in our patient from those seen in other conditions. We propose that the angiokeratomas resulted from a progressive compensatory response to the obliterative angiopathy of JDM.

Penile purpura as a manifestation of lichen sclerosus et atrophicus

Abstract: Heightened public and professional awareness of the sexual abuse of children demands that physicians be able to distinguish lesions associated wtth sexual abuse from those caused by primary skin disor‐ders. Purpura to an occasional manifestation of pediatric lichen aderosus et atrophicus (LSA), especially when the vulva is affected. We report a 12‐year‐old boy with penile purpura that occasioned a consideration of sexual abuse but proved to be due to LSA.