[Chronic recurrent neutrophilic dermatosis: a possible variant in the spectrum of neutrophilic dermatoses]

Neutrophilic dermatoses constitute a clinically heterogeneous group of diseases that share a common histological substrate, consisting of a dense dermal inflammatory infiltrate of mature polymorphonuclear neutrophils and no evidence of vasculitis. We describe the case of a 56-year-old man with a 6-month history of painful generalized erythematous edematous plaques. Histopathology indicated neutrophilic dermatosis but the patient did not have fever, elevated white blood cell count, or systemic involvement. Tests to rule out possible inflammatory, neoplastic, or infectious processes were negative. We consider the term chronic recurrent annular neutrophilic dermatosis, first used by Christensen et al, to be the most appropriate to define this variant with clinical findings that differ from classic Sweet syndrome.

[Palmar filiform parakeratotic hyperkeratosis without underlying malignancy]

Filiform hyperkeratosis (FH) is a rare entity clinically characterized by keratotic spicules on the palms, soles or other areas of the body surface. Its association with several diseases, including neoplasms, has been extensively discussed but currently it is not considered a well-defined paraneoplastic disorder. We report a 72-year-old patient that referred lesions on both palms of three months duration. The rest of the body surface did not show similar lesions. Complementary exams did not reveal any abnormal findings. The histopathological exam showed parakeratotic columns with a slightly decreased granular layer and a mild dermal inflammatory infiltrate. In the last years different terms have been employed to refer to these hyperkeratotic lesions contributing to the lack of clarity that currently persists. Although FH might be classified close to the clinical spectrum of porokeratoses, it presents particular clinical and histological findings that allow it to be considered a separate entity. We report a new case of this rare disorder with exclusive palmar involvement in a patient without underlying malignancy and review the main characteristics of similar cases reported in the literature. Despite the obscure association between this entity and neoplasms, the majority of authors deem it necessary to rule out underlying diseases.

[Malignant syphilis in an HIV-infected patient]

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection may change the classic clinical course of syphilis and increase the incidence of a subtype of secondary syphilis named malignant syphilis. A homosexual patient with HIV infection consulted us about a one-month history of general malaise and widespread cutaneous ulcerative lesions, some with thick hemorrhagic crusts. Serology for syphilis was positive at high titers. Based on clinical, histological and serological findings, a diagnosis of malignant syphilis was made and the patient started treatment with penicillin G benzathine with progressive resolution of lesions. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous lesions.

Perianal ulceration: a case of tuberculosis cutis orificialis

BACKGROUND

Tuberculosis cutis orificialis is an extremely rare variant of cutaneous tuberculosis. Perianal location is a possible site of presentation.

METHODS

We describe the management of a young male with a painless non-specific perianal ulcer, who presented an asymptomatic disseminate pulmonary and intestinal tuberculosis. He had a history of pulmonary sarcoidosis and long-term corticosteroid therapy.

RESULTS

Healing of the ulcer was achieved after three-drug antituberculous therapy, with an improvement of the radiographic pulmonary alterations.

CONCLUSIONS

Tuberculous origin should be considered in persistent perianal ulcers to avoid delays in the treatment of this rare form of tuberculosis.

Multiple myeloma with scleroderma-like changes

We present a case of a patient who presented concomitantly with generalized pruritus, brownish sclerodermatous plaques, sclerodactyly and a monoclonal band for IgG-kappa. The patient was diagnosed as having multiple myeloma by bone marrow examination. The rapidly progressive evolution with acute anuric renal failure, malignant hypertension and the skin sclerosis seem to be related to the neoplastic disorder. The scleroderma-like changes have to be differentiated from systemic scleroderma.

Sign of Leser-Trélat associated with adenocarcinoma of the rectum

The acute onset and/or rapid increase in size and number of multiple seborrheic keratoses associated with internal malignancy is called sign of Leser-Trélat. Although some authors reject its existence, there are more than 80 well-documented case reports in the literature. Here, we report a 75-year-old man who presented with abrupt appearance of multiple seborrheic keratoses without any suspicious symptom of cancer. The screening for malignant neoplasms let us detect a rectal adenocarcinoma that was in a curative stage. This case-report illustrates a true sign of Leser-Trélat, and proves that these patients must be appropriately investigated for underlying malignancy.

Solitary cutaneous metastasis on the buttock: a disclosing sign of pancreatic adenocarcinoma

A 48-year-old man, previously healthy and asymptomatic, showed a unique skin lesion located on the right buttock. The histopathological study of the lesion disclosed an adenocarcinoma metastatic to the skin. The primary tumour was found at the head of the pancreas, and was confirmed by biopsy. Six months after the beginning of treatment with Gemcitabine the patient is still asymptomatic, and the cutaneous lesion has disappeared. Carcinomas of the pancreas represent less than 5% of human malignant neoplasms, skin involvement is rare, and metastasis generally multiple and situated in the periumbilical area. To our knowledge, very few patients have been reported with a solitary cutaneous lesion disclosing a pancreatic adenocarcinoma. The atypical location, the absence of related symptoms or analytical disorders, and the good progress of the patient make this case especially interesting.

Three cases of type 2 segmental manifestation of multiple glomus tumors: association with linear multiple trichilemmal cysts in a patient

We report 3 cases of congenital multiple glomus tumors seen during the last 5 years. One of them showed autosomal dominant inheritance with male-to-male transmission. The remaining patients had no family history of similar lesions. The clinical and histopathological aspects of our patients support the recently described type 2 segmental manifestation of multiple glomus tumors. One of the cases showed associated multiple and giant trichilemmal cysts with a linear distribution in the scalp.

Inflammatory metastatic melanoma

An 87-year-old woman developed erythema, induration and tenderness of the skin overlying each breast. One year before, she had undergone an axillary lymph node dissection because of metastases from melanoma. The primary site was unknown. A skin biopsy showed pigmented tumor nests within the dermal lymphatic vessels, and immunohistochemistry confirmed the melanocytic origin. The diagnosis of inflammatory metastatic melanoma was made.

Eccrine angiomatous hamartoma: report of seven cases

Eccrine angiomatous hamartoma is a rare cutaneous lesion. Histologically it is characterized by the proliferation of eccrine glands, vascular structures and occasionally other elements in the middle and deep dermis; we now report seven further cases of this condition, two with lipomatous involvement and also discuss its nosology.

Desmoplastic trichilemmoma arising within a nevus sebaceus

A 74-year-old man presented with a tumor on his scalp that he had since birth. The authors observed a verrucous pink crusted plaque. The tumor was clinically diagnosed as nevus sebaceus and was removed. Histopathologic study showed, arising from nevus sebaceus, a lobular neoplasm with the classic features of trichilemmoma. Desmoplasia was present in the center of the trichilemmomatous area. This description is typical of a special, uncommon type of trichilemmoma that histologically mimics invasive carcinoma.

Milia en plaque in a bilateral submandibular distribution

Milia en plaque typically occurs in the retroauricular area. We report the case of an 84-year-old woman with this disorder occurring bilaterally in the submandibular region. The diagnosis was confirmed by histological examination.