Wanee Wisuthsarewong

Hematidrosis: a pathologic process or stigmata. A case report with comprehensive histopathologic and immunoperoxidase studies.

Cases of hematidrosis (bloody sweat) are extremely rare. This disease has been described in various terms and has been often tied to religious belief as stigmatization. We report a typical patient with hematidrosis in a 14-year-old girl who frequently bled from her scalp and palms, and, occasionally, from trunk, soles, and legs. The bloody sweat from her scalp contained all blood elements. Immediate biopsy after there was bleeding on her scalp showed multiple blood-filled spaces that opened directly into the follicular canals or on to the skin surface. Immunoperoxidase studies failed to demonstrate vascular nature of these spaces. Our study explained how and why there was bleeding in our patient and in patients with related conditions as described in earlier literatures. We also explained why this phenomenon was intermittent because the spaces indicated above will disappear after exuding their content but then reoccurred after the blood flow was reestablished.

Outbreak of Tinea capitis caused by Microsporum ferrugineum in Thailand.

There was an outbreak ofTinea capitis at the Pak-kred Home for Mentally and Physically Handicapped Babies, Bangkok, Thailand in 1993. One hundred and thirty-eight cases were diagnosed as tinea capitis based on clinical signs and positive laboratory investigations. The results of Woods light examination, KOH preparation and fungal culture were positive in 89.9, 75.9 and 27.4% respectively. The non-inflammatory form had a higher rate of positive KOH and culture than in the inflammatory form.Microsporum ferrugineum was the major pathogen (66.7%) and most of its infections (80.4%) caused a non-inflammatory type of tinea capitis. Griseofulvin, in a dosage of 10–15 mg/kg/day and selenium sulfide shampoos, yielded an 84.8% cure rate within 14.9 weeks. No recurrence or obvious adverse reactions were observed.

A dot-blot and immuno-blot assay for the detection of mosquito saliva specific IgE in mosquito bite allergic subjects

Allergic reactions to mosquito bites are common problems worldwide. The reactions are often cutaneous and difficult to distinguish from non-specific histaminic phenomena. Moreover, the presentation might be similar to be a potential cutaneous sign of mantle cell lymphoma or would be characterized in some cases of natural killer cell lymphocytosis associated with Epstein-Barr virus infection [1]. Therefore, a reliable laboratory test for mosquito bite allergy is required. This study is the first report of a dot-blot assay using purified saliva allergens of Culex quinquefasciatus. The potential clinical relevance of the test as an in vitro diagnostic tool for mosquito bite allergy was evaluated and compared to the previously established immuno-blot assay [2]. Forty nine patients with history of mosquito bite allergy and skin lesions which clinically suggested mosquito bite reactions (19 with immediate reactions, 10 with immediate and delayed reactions and 20 with delayed reactions) were included in this study. A wheal or flare lesion occurred within several minutes and peaked at twenty minutes after an exposure indicates an immediate reaction while an indurated pruritic papule developed within a few hours, peaked at 24–36 h and diminished over several days or weeks indicates a

Juvenile gout in methylmalonic acidemia

Methylmalonic acidemia (MMA) is an inborn error of metabolism caused by either deficiency of the enzyme methylmalonyl‐CoA mutase or a defect in adenosyl‐cobalamin synthesis. Chronic kidney disease is its common complication and, in combination with persistent acidosis, leads to hyperuricemia. Symptomatic hyperuricemia or gout, however, has not been reported in MMA. We herein report two pediatric cases of MMA caused by MMAB mutations (cblB defect) with renal tubular acidosis, chronic kidney disease, hyperuricemia, and gout. The clinical findings of gout in these cases included recurrent first metatarsophalangeal arthritis and/or tophi. The patients responded to treatment with colchicine and allopurinol.

Histiocytoid neutrophilic dermatitis, an unusual histopathology in neonatal lupus erythematosus

The authors reported histiocytoid neutrophilic dermatitis in neonatal lupus erythematosus (NLE). One‐month‐old male infant presented with annular erythematous plaques at the face and trunk. Serologic studies revealed positive anti‐ribonuclear protein antibodies (RNP) and antinuclear antibodies (ANA). Histopathology showed predominant myeloid lineage mononuclear cells admixed with segmented neutrophils. This finding is uncommon in cutaneous NLE. Cutaneous NLE and LE should be included in the differential diagnosis of histiocytoid neutrophilic dermatitis. Additional immunohistochemistry studies with clinical and serologic correlations are important to differentiate histiocytoid neutrophilic dermatitis from the other diagnoses, especially leukemic cutis in young patients.

Exfoliative dermatitis in Thai children

Background: Exfoliative dermatitis (ED) is an inflammatory skin disorder in which generalized skin erythema and scaling affect at least 90% of the body. Aims: To determine the etiology, clinical presentations, laboratory findings, management, and outcomes of ED. Materials and Methods: This retrospective study was conducted at the Department of Pediatrics, Siriraj Hospital. Data of pediatric patients diagnosed with ED during January 1992 and June 2014 were reviewed. Results: Forty-seven patients were identified. The median age at diagnosis was 4 years and 8 months (range 1–164 months), and 10 cases (21.3%) were infants. Presenting symptoms included itching (76.6%), fever (38.3%), painful sensation (17.0%), and diarrhea (12.8%). Physical findings were dehydration (42.6%), fever (34.0%), failure to thrive (29.8%), tachycardia (29.8%), hepatomegaly (17.0%), edema (12.8%), lymphadenaopathy (8.5%), and splenomegaly (6.4%). Common laboratory abnormalities revealed thrombocytosis (51.4%), eosinophilia (48.6%), elevated erythrocyte sedimentation rate (42.9%), and elevated liver enzymes (30.3%). Hepatosplenomegaly and lymphadenopathy were found to be statistically significantly correlated with immunodeficiency syndrome (P < 0.05). No other clinical or laboratory findings were associated with any specific etiology. Preexisting skin diseases (53.2%), including atopic dermatitis (23.4%), psoriasis (17.0%), pityriasis rubra pilaris (10.6%), and seborrheic dermatitis (2.1%), were the most common causes of ED. Other causes were primary immunodeficiency (12.8%), congenital ichthyosis (10.6%), drugs (10.6%), metabolic disorders (4.3%), and unknown etiology (8.5%). Mortality rate was 8.5%. Limitation: Some data from this retrospective study may have been missing and some investigations may not have been performed in all patients. Conclusion: The most common etiology of ED in children was preexisting skin diseases. Prognosis was poor in immunodeficiency disorders.