Noora Saeed

A case of giant lupus vulgaris

Lupus vulgaris, the commonest form of tuberculosis of the skin, presents with a plaque that enlarges slowly with advancing edges while showing atrophy at other areas. It may be acquired by the blood stream, via lymph, by contiguous spread or from external inoculation. We describe a case of lupus vulgaris with a large erythematous-scaly plaque of 44 × 26 cm over the back and a similar 7 × 5 cm plaque over the right thigh. The plaque over the back was gradually progressive for the previous ten years and showed scarring and atrophy at places. Histopathology of the area showed caseating granulomas with Langhans giant cells, epitheloid cells and lymphocytes. A diagnosis of lupus vulgaris was made. This case is being presented owing to the large size of the lesion.

Retiform hemangioendothelioma of the gluteal region: A case report

Retiform hemangioendothelioma is a locally aggressive, rarely metastasizing, low-grade angiosarcoma characterized by intercommunicating vascular channels lined by hobnail or cuboidal endothelial cells, flanked by lymphocyte and hyaline sclerosis. Neoplastic endothelial cells usually express von Willebrand factor, CD31 and CD34, while the lymphocytic infiltrate shows a mixture of CD3+, T and CD20+ B cells. The authors describe a case of a 76-year-old female who presented with a soft, painless, ill-defined mass measuring 9 cm in her right gluteal region for the past 15 years, clinically suggestive of a lipoma. There was no regional lymphadenopathy. The mass was resected and sent for histopathological examination. The slow-growing lesion and the typical histomorphology led to the diagnosis of retiform hemangioendothelioma. The diagnosis was confirmed by immunohistochemistry using CD34 antibody, which strongly stained the endothelial cells. The patient was followed up for 6 months after the surgery and no recurrence was noted.

Efficacy of Narrow Band Imaging in Detecting Lower Gi Lesions and Its Histologic Correlation

Background: To evaluate the efficacy of Narrow band imaging (NBI) in detecting lower GI lesions and differentiation on the basis of color, vascular pattern and surface pattern findings on NBI with histopathologic correlation. Material and Methods: 94 patients of both gender, with lower GI symptoms were subjected for lower GI endoscopy by conventional white light endoscopy and CLV-190 HD colonoscope having Narrow-band imaging (NBI) as standard feature after obtaining an informed consent. Patients who did not give consent, patients with severe inflammatory bowel disease and who lost during follow up were excluded from the study. All NBI findings of suspected lesions were classified according to NICE (NBI International Colorectal Endoscopic) classification, into hyperplastic lesion, adenomatous and invasive carcinoma. Biopsies were taken and stained with Haematoxylin and Eosin as well as Periodic Acid Schiff stain. Statistical analysis was done to compare NBI diagnosis with the histopathological diagnosis. Results: Majority of the patients were in the third decade of life, with a mean age of 36.22 years. Diarrhea was the commonest clinical presentation, in 60 (63.8%) patients. NBI was suggestive of ulcerative colitis/Inflammatory bowel disease (IBD) in 59 (62.8%) patients, neoplastic polypoidal lesion in 24 patients (25.5%) and polypoidal non-neoplastic lesion in 11 (11.7%) patients. Out of 59 (62.8%) cases of Ulcerative colitis (UC), 35 (37.2%) were polypoidal, among which 24 (68.6%) were suggestive of neoplastic polypoidal lesion (NICE II-III) and 11(31.4%) were non-neoplastic polypoidal lesion (NICE I). Out of 59 cases of UC, clear mucosal vascular pattern (MVP) was found in 11 (18.6%) cases and obscure MVP in 48 (81.4%) cases. Conclusions: NBI provides a unique image with contrast enhancement and can emphasize the capillary pattern and surface architecture and plays a major role in the differentiation of neoplastic and non-neoplastic colorectal lesion, with high sensitivity and specificity.

A Case of Erythema Annulare Centrifugum Following Wood Injury: Is it the First Report?

A 15 year old male presented to us with complaint of a red lesion over the right shin for 3 weeks that was constantly increasing in size. The patient gave history that he sustained injury at the site with a wooden object around 6 weeks back. The wood was implanted in the skin and was removed by an unqualified local practitioner. He was given some topical ointment for application and the wound healed in around 10 days’ time. Three weeks back, he noticed red scaly lesion over the site of trauma that started to spread outwards. There was no history of fever, pain, itching or discharge from the site. There was no history of similar lesions elsewhere on the body. The patient was apparently healthy and had not been ill lately. He was not taking any medications. On examination, a large annular plaque of the size of 10 cm diameter was seen on the lower half of the right anterior leg with erythema and slight swelling of the periphery and central clearing. The erythematous plaque was extending distally towards the ankle (Figure 1). The scales over the lesion were trailing behind the advancing edges. Rest of the cutaneous, mucosal and systemic examination was normal. A potassium hydroxide mount from the edge of the lesion was negative. Lab investigations including complete blood counts, liver and renal function tests, urine and stool examination, thyroid function tests were within normal range. Antinuclear antibodies, Rapid plasma reagin test, hepatitis and herpes viral serology, serology for Borrelia burgdorferi and HIV screening ELISA were negative. Chest radiograph was normal and Montoux test was negative. Histopathology of the skin from the lesion showed mounds of parakeratosis, spongiosis and dense lymphohistiocytic infiltrate in the upper dermis, particularly in the perivascular location (Figure 2). Based on these features,

Unilateral striate-punctate keratoderma: An extremely rare presentation of punctate keratoderma

© 2017 Indian Journal of Dermatology, Venereology, and Leprology | Published by Wolters Kluwer Medknow This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms. Access this article online

Disseminated cysticercosis incidentally diagnosed in a patient of fracture shaft of femur

Cysticercosis is caused by the larval form of Taenia solium tape worm, cysticercus cellulose. The life cycle of T. solium consists of 2 host, the definite host is a man who harbours the adult forms of the worm in the intestine, while the intermediate host is the pig, where the larval form (cysticercus cellulose) is found in the skeletal muscle. Cysticercosis develops when human beings incidentally become the intermediate host and the eggs mature within their small intestine. The route of entry of the eggs into the human intestine may occur through autoinfection or by ingestion of contaminated food or water. Further, these eggs develop into the larval form which spread throughout the intestinal wall and are disseminated by the blood stream to brain, muscles, subcutaneous tissues or any other organ. Until now, only 50 cases of disseminated forms have been reported in the literature, with the majority of the cases being from Indian subcontinent. Regarding the clinical presentations, symptoms usually depend on the location, size and number of cysts in the involved lesion. However, it may present occasionally with dementia, muscular hypertrophy or subcutaneous nodules with relative absence of focal neurological signs or raised intracranial pressure. We, here, report a case of disseminated cysticercosis, detected incidentally in a man aged 52 years who presented with an open fracture of the right femur.

Ultrastructural pathology of human liver in Rift Valley fever

Rift Valley fever (RVF) is a zoonotic disease that primarily affects ruminant animals and can also cause fatal disease in humans. In the current report, we present the ultrastructural changes in the liver of a man aged 60 years who died from RVF in the Aseer Central Hospital, Abha, Saudi Arabia. The main hepatic changes by transmission electron microscopy included the presence of 95–115 nm electron-dense particles consistent with RVF virions, nuclear condensation, vacuolar degeneration, lipid droplet accumulation and mitochondrial damage and dilation. There were also viral inclusion bodies with electron-dense aggregates, dilation of intercellular spaces, damage of sinusoidal microvilli with widening of space of Disse, dilation of bile canaliculi and increasing number of phagolysosomes.

Disseminated cryptococcosis in an immunocompetent child

Cryptococcus is a ubiquitous fungus and is known for causing meningitis and cutaneous infections in immunocompromised individuals. Disseminated cryptococcal infection is very rare and almost always found to occur in immunocompromised individuals especially in persons infected with HIV. This is particularly attributed to its capsulated spores. But there are few reported cases in which it has been found to cause disseminated infections even in immunocompetent individuals. We report a similar case of disseminated cryptococcal infection in an immunocompetent host. Early detection and treatment of disseminated cryptococcosis is essential to reduce morbidity and for better outcome.