Renata Robl

Onychomycosis by Fusarium oxysporum probably acquired in utero

Fusarium oxysporum has been described as a pathogen causing onychomycosis, its incidence has been increasing in immunocompetent and disseminated infection can occur in immunosuppressed individuals. We describe the first case of congenital onychomycosis in a child caused by Fusarium oxysporum. The infection being acquired in utero was proven by molecular methods with the identification of the fungus both in the nail and placenta, most probably as an ascending contamination/infection in a HIV-positive, immunosuppressed mother.

Hematohidrosis: insights in the pathophysiology

Hematohidrosis: insights in the pathophysiology The spontaneous discharge of bloody secretion through normal skin is known as hematohidrosis. We present a case of this rare condition and discuss possible mechanisms to explain the clinical manifestations. Written consent by the patient for this submission was obtained. An 18-year-old Caucasian female presented with episodes of spontaneous bleeding of the palms, back of the hands, forehead (Fig. 1), and tear ducts since the age of 12. No skin lesions were present, and they stopped spontaneously after a few minutes. There was no relation with the menstrual cycle, and sometimes extensive bleeding occurred during her sleep. Physical examination, gynecological evaluation, complete blood cell count, metabolic panel, and coagulation tests were normal. On dermatologic evaluation, no skin lesions were found, and a punch biopsy was performed on the back of the left hand, where spontaneous bleeding had just started. Smear preparation of the bloody secretion had peripheral blood characteristics – many erythrocytes, few leukocytes. Skin biopsy – stained with hematoxylin–eosin and Pearl – revealed normal skin, preserved adnexa, and normal blood vessels. Over 120 histological sections were evaluated, and no erythrocytes were found anywhere outside the vessels (Fig. 2). The patient was admitted to the hospital and carefully watched to rule out malingering; in fact, she presented several bleeding episodes under our close visual monitoring. During follow-up, she was diagnosed with conversion, dissociative, and generalized anxiety disorders, which were controlled with clonazepam, sertraline, valproic acid, and risperidone, but this treatment did not interfere with the bleeding. Although there was no psychiatric evaluation of the patient prior to the bleeding episodes, we can only suppose that the impact of the skin condition helped develop or exacerbate the psychiatric diseases. Curiously, it was noticed that the bleeding episodes were coincident with high blood pressure peaks (180 9 90 mmHg), but the 24-hour ambulatory blood pressure monitoring, Holter, and echocardiogram were normal. To control blood pressure levels, she was started on atenolol. During six months, she showed marked improvement with no more bleeding episodes. Owing to irregular intake of the medication, the bleedings restarted sporadically. Hematohidrosis is a rare clinical condition that manifests as self-limiting episodes of spontaneous discharge of bloody secretion through intact skin or sweat gland orifices, with an unknown cause. Some theories have been proposed, including: increased vascular pressure leading to the passage of blood cells through the ducts of the sweat glands; vasculitis of dermal vessels; and exacerbated sympathetic activation leading to periglandular vessel constriction and subsequent expansion, allowing the passage of blood content into the ducts. Only five reported cases in the literature present a histological description of a skin biopsy performed immediately after the bleeding. They show sporadic and inconsistent findings, such as: periglandular congested vessels; red blood cells in the follicular lumen and among the collagen fibers; leakage of blood around dermal capillaries; or even normal skin. In the patient described herein, the skin biopsy was completely normal. This excludes other causes of bleeding and may also indicate that no permanent anatomical changes occur in the pathophysiology of the disease. Differential diagnosis should include chromhidrosis, factitious dermatitis, vicarious menstruation, vasculitis, and platelet and coagulation disorders.

Nail changes in psoriatic children

Indian Journal of Dermatology, Venereology, and Leprology | May-June 2016 | Vol 82 | Issue 3 314 and mean facial sebum excretion have been detected.[5] Therefore, sleep may affect sebum levels via its interactions with these hormones. We propose that our findings regarding the positive relationship between good sleep quality and higher sebum levels may be related to these physiologic characteristics of sleep and sebum.

Target-shaped edematous purple lesions: is it child abuse?

A 5-month-old girl was admitted to the paediatric emergency with a 2 days history of bilateral infiltrated tender purpuric lesions on cheeks, arms and legs, with associated edema. Her mother did not know of any associated symptoms. The possibility of child abuse was considered, all laboratory tests were normal (urinalysis, blood count, renal and coagulation studies) and the Child Abuse Protection Agency was called. On the fifth day of …

Assemble the puzzle: bizarre-looking lesions

Case 1: A 5-year-old girl showed a skin lesion that appeared 16 days earlier. The lesion was irregularly shaped with hyperpigmentation on the back of the hand covered by blisters (figure 1). Her parents denied any contact with plants or citrus fruit. Case 2: A 3-year-old girl was brought for consultation because of lesions that had begun 6 days before. There were erythema, hyperpigmentation and ulcerated areas on the trunk …

Answers to Dermatophile

The answer is (F)—Erythema infectiosum (EI): EI is a rash caused by parvovirus B19, also known as The Fifth Disease.1 ,2 It is common in school-aged children, especially during winter and spring. The pathogenesis is still not fully understood.2 Infection is transmitted through the respiratory tract and symptoms such as headache, fever and myalgia end after 5 to 7 days with the production of anti-B19 immunoglobulin M (IgM) antibodies.1 ,2 The anti-B19 IgG appears during the third week of illness and coincides with the appearance of the rash and arthralgia.1 It presents as an asymptomatic infection in approximately 50% of cases.2 The most characteristic sign is known as ‘slapped cheek’, due to the fiery-red facial erythema occurring within 3 days of the onset of prodromal symptoms. Exposure to sunlight or heat worsens the rash. In the evolution of the condition, the patient develops an itchy and evanescent reticulate rash on the extremities and trunk. In some cases there are transient joint symptoms, mainly involving …

Nappy (diaper) rash: what else besides irritant contact dermatitis?

Nappy (diaper) rash is a common cutaneous disorder of infancy, and diverse dermatoses may affect this region. To perform a differential diagnosis can be challenging. We present four cases to emphasise the importance of clinical diagnosis.

Not only athlete’s foot survives in feet

From the questions on page 75 . The answer is F, Tinea pedis. Tinea pedis is the most prevalent dermatophyte infection encountered in practice,1–3 which is mostly caused by Trichophyton rubrum and Trichophyton mentagrophytes .1 It has three common presentations.2 The interdigital form of tinea pedis is the most common and, just like the case above, it is characterised by fissuring, maceration and desquamation in the interdigital spaces of the toes.2 Clinically, the moccasin-like form presents with hyperkeratosis and erythema of the soles and sides of the feet.2 The vesiculobullous form of tinea pedis is characterised by the development of vesicles, pustules and bullae, usually on the …

Open season: select the best 'beast' for each skin lesion

Animal bites can cause skin lesions that suggest other conditions, and therefore diagnosis can be a challenge. Four cases of skin injuries caused by arthropods are presented below.

Congenital ulcer: what do you think?

A 19-day-old boy presented an ulcer with erythematous and elevated borders in the superior back (figure 1). The lesion was present at birth and the boy was otherwise healthy. The diagnostic hypothesis included xanthogranuloma, Langerhans cell histiocitosis, mastocytoma, leukaemia cutis and congenital infections. A punch biopsy was performed and the microscopic analysis revealed a dermal–epidermal infiltrate of numerous histiocytes, …