Ramon Bartralot

Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts

To evaluate the histopathological features observed in patients with cutaneous infections due to nontuberculous mycobacteria (NTM) and to compare the histopathological patterns observed in immunosuppressed patients and normal hosts. Twenty‐eight biopsy specimens corresponding to 27 patients with cutaneous infections due to NTM were reviewed. Eighteen biopsies corresponded to normal hosts (14 Mycobacterium marinum, 2 Mycobacterium chelonae, 1 Mycobacterium terrae and 1 Mycobacterium gordonae) and 10 biopsy specimens were obtained from 9 immunosuppressed patients (3 Mycobacterium chelonae, one of which had two biopsies, 1 Mycobacterium abscessus, 2 Mycobacterium kansasii, 1 Mycobacterium marinum, 1 Mycobacterium avium complex and 1 Mycobacterium simiae). A panel of histopathological features was evaluated by two independent observers in each biopsy specimen. Epidermal changes (acanthosis, pseudoepitheliomatous hyperplasia, exocytosis) were mainly observed in M. marinum infections. In immunosuppressed patients the infiltrate tended to be deeper, involving the subcutaneous tissue (100%) with a more diffuse distribution and constant abscess formation. A marked granulomatous inflammatory reaction was observed in 83% of immunocompetent and in 60% of immunosuppressed patients. In immunosuppressed patients a relationship between the chronic evolution of the disease and granuloma formation was demonstrated. A diffuse infiltrate of histiocytes with occasionally foamy appearance was noted in three biopsy specimens from three patients with AIDS. Acute and chronic panniculitis was detected in 8 biopsy specimens. In one biopsy (M. chelonae) an acute suppurative folliculitis was observed. Different histopathological patterns can be noted in biopsy specimens from cutaneous nontuberculous mycobacterial infections. The evolution of the disease and the immunologic status of the host may explain this spectrum of morphological changes. Tuberculoid, palisading and sarcoid‐like granulomas, a diffuse infiltrate of histiocytic foamy cells, acute and chronic panniculitis, non‐specific chronic inflammation, cutaneous abscesses, suppurative granulomas and necrotizing folliculitis can be detected. Suppurative granulomas are the most characteristic feature in skin biopsy specimens from cutaneous NTM infections. Some histopathological patterns seem more prevalent in immunosuppressed patients.

Clinical patterns of cutaneous nontuberculous mycobacterial infections.

Background  Cutaneous nontuberculous mycobacterial infections result from external inoculation, spread of a deeper infection, or haematogenous spread of a disseminated infection. There are two species‐specific infections (fish‐tank or swimming‐pool granuloma, due to Mycobacterium marinum, and Buruli ulcer, caused by M. ulcerans). Most infections, however, produce a nonspecific clinical picture.

Eruptive juvenile xanthogranuloma associated with relapsing acute lymphoblastic leukemia.

Abstract:  Juvenile xanthogranuloma is a benign, self‐healing disorder with characteristic lesions mainly involving the skin. Although most patients with juvenile xanthogranuloma have only cutaneous symptoms, recent articles have documented extracutaneous manifestations: systemic involvement of many organs has been reported and there is a known association between juvenile xanthogranuloma and childhood leukemia, most commonly juvenile chronic myelogenous leukemia. This case provides further corroboration, that in rare instances, juvenile xanthogranuloma may be associated with hematologic malignancies.

Vegetant Bromoderma in an Infant

Bromoderma is a cutaneous reaction caused by the use of products containing bromide. In this report we describe a 2‐month‐old girl who was admitted to our institution with vegetative lesions on the face and scalp owing to the administration of a syrup containing sodium bromide.

Systemic lupus erythematosus presenting with red lunulae

Red lunulae have been observed in association with a large spectrum of cutaneous and systemic diseases. We describe a 13-year-old girl with painful red lunulae of the fingernails who subsequently developed systemic lupus erythematosus. The appearance of Beaus lines suggested inflammation of the nail matrix. Oral prednisone produced significant improvement in the nail changes. To our knowledge, red lunulae have not been previously recognized as the presenting sign of systemic lupus erythematosus.

Pitiriasis rubra pilaris aguda postinfecciosa: una dermatosis mediada por superantígenos

Resumen La pitiriasis rubra pilaris (PRP) aguda postinfecciosa es una variante de la forma juvenil de PRP (tipo III de Griffiths) caracterizada por la ausencia de antecedentes familiares, curso agudo relacionado con un episodio febril previo y buen pronostico. Clinicamente puede simular otras enfermedades mediadas por superantigenos, como los exantemas escarlatiniformes o el sindrome de la escaldadura estafilococica; sin embargo, su histologia y tratamiento son distintos. Presentamos 4 casos de PRP aguda postinfecciosa que ilustran las caracteristicas clinicas de este proceso infrecuente y revisamos los posibles mecanismos fisiopatogenicos subyacentes.

Anticoagulation and Antiplatelet Therapy in Dermatology

An increasing number of patients who are receiving anticoagulation or antiplatelet therapy require cutaneous surgery. Such pharmacotherapies are usually suspended based on experience in gynecologic, thoracic, and abdominal surgery. However, this practice may increase the risk of suffering a thromboembolic event. We review perioperative management of anticoagulant and antiplatelet therapy, complications associated with suspending therapy, and side effects.

Cervico‐Thoracic Lipoma Associated with Occult Syringohydromyelia

Abstract:  Cutaneous lesions in the midline may be hallmarks of an occult spinal dysraphism. They rarely may occur in the cervical and thoracic regions. We report a 9‐year‐old girl with a cervico‐thoracic lipoma associated with an underlying syringohydromyelia. Early detection of potentially complicated conditions can prevent the occurrence of irreversible neurologic damage.

Síndrome esclerodermiforme por paclitaxel

Resumen —Los sindromes esclerodermiformes se han relacionado con una larga lista de medicamentos, a la que se han anadido en los ultimos anos los taxanos. Se presenta el caso de una mujer con una neoplasia de mama que recibio tratamiento ciclico con paclitaxel. Tras 17 sesiones presento edema y eritrodisestesia en ambos pies que, a pesar del tratamiento sintomatico y de reducir la dosis de paclitaxel, progresaron hacia un endurecimiento cutaneo en estas localizaciones. Diez meses despues de suspender el taxano las lesiones cutaneas se mantenian estables y no existian otras manifestaciones de esclerosis sistemica. Los taxanos pueden producir un sindrome esclerodermiforme que suele afectar a las extremidades inferiores y esta precedido por edema y/o eritrodisestesia; no se acompana de otras manifestaciones de esclerosis sistemica y tiende a estabilizarse o a involucionar al suspender el tratamiento.

Acute Postinfectious Pityriasis Rubra Pilaris: A Superantigenmediated Dermatosis

Acute postinfectious pityriasis rubra pilaris (PRP) is a variant of juvenile PRP (Griffiths type III) characterized by no family history, an acute course associated with a prior fever, and good prognosis. Clinical features may resemble other superantigen-mediated diseases, such as scarlatiniform rash or staphylococcal scalded skin syndrome, but its histology and treatment are different. We present 4 cases of acute postinfectious PRP that illustrate the clinical features of this uncommon disease and we review possible underlying pathogenic mechanisms.