Tuberculosis of the vulva masquerading as a sexually transmitted disease

Tuberculosis of the vulva is a rare condition usually seen by a gynecologist. We report a case of chronic ulcer on the vulva of four months duration, which, on detailed investigation, turned out to be a case of primary inoculation tuberculosis. The patient was subsequently put on antitubercular therapy with a good the therapeutic response. The rarity of this presentation in dermato-venereology is emphasized.

Status of soil transmitted helminthic infections in India--observations on sample surveys using Kato-Katz technique

Results of surveys conducted in eight different ecologically homogenous zones in the country, using WHO sampling design methodologies and Kato-Katz technique are presented in this communication. Hilly and coastal areas had high STH prevalence ranging from 34%-36% with total epg ranging from 53,952-4,67,976. Apart from this, Chitradurga urban area had STH prevalence of 39.6% with epg of 81,792. However, except in few cases, in all these surveyed areas, intensity of STH infection was found to be light. A national programme for control of soil transmitted helminthic infections is advocated.

Porokeratosis of mibelli: Disseminated non actinic form

Two cases of nonactinic - disseminated porokeratosis of Mibelli are reported. Autosomal dominant mode of inheritance was observed in one case.

A suspected case of primary cutaneous actinomycosis on the buttock

Primary cutaneous actinomycosis is rare and can mimic mycetoma, tuberculosis and nocardiosis. The results of cultures (aerobic and anaerobic) are not always positive. A high degree of clinical suspicion should be entertained and a combination regimen of penicillins with sulphonamides should be used for treatment. We report a patient with primary cutaneous actinomycosis over the buttock, who was successfully treated with amoxicillin and sulphonamides.

Linear and whorled nevoid hypermelanosis

Linear and whorled nevoid hypermelanosis (LWNHM) is a reticulate pigmentary disorder with a sporadic occurrence, representing genetic mosaicism. It is characterised by hyperpigmented macules in a reticulate pattern along Blaschko's lines, sparing the mucous membranes and stabilising after one to two years. It may be associated with various neurological abnormalities. The disorder may resemble incontinentia pigmenti, epidermal nevus, or zebra-like hyperpigmentation clinically. We report LWMNHM in a 15-year-old girl with progressively increasing streaks of reticulate hyperpigmented macules arranged in a whorled pattern over the trunk and extremities, which appeared soon after birth. There was no history of any preceding eruption or any associated systemic abnormality. Histopathological examination revealed basal cell hyperpigmentation without any pigmentary incontinence. CT scan of the brain was normal.

Internal dosimetry of plutonium using the late urinary excretion

An attempt has been made to standardize the methodology of internal dose computation from the late urinary excretion data. The methodology was selected keeping in mind the most recent ICRP publications and the results of internal dosimetry intercomparison studies reported in literature. The key element of this methodology is the PC-based computational software LUDEP 2.05, which implements the new model of the human respiratory tract. Late urinary excretion data of three male subjects involved in accidental intakes of plutonium aerosols more than 25 years ago were interpreted in terms of intakes and internal doses with the aid of the standardized methodology. An important implication of this work is that late urinary excretion data of the occupational workers of any plutonium handling facility could be used to show the compliance with the life-time dose limit.

Three unusual siblings with Harlequin icthyosis in an Indian family

Harlequin fetuses occurring as three siblings in an Indian family are described here. All three were preterm, low birth weight, and did not survive. There was no history of consanguinous marriage in the parents or in the family. Thus autosomal recessive inheritance appears to be a remote possibility, although not impossible or, as recently described, these recurrent harlequin fetuses could be the result of new dominant mutations with parental mosaicism.

Lichen Planus-a Clinico-histopathological

The clinico-histopathological features of 75 patients of lichen planus were studied. The male to female ratio was 1:13. The largest number of patients (30.6%) fell into the 31-40 year age group. Two patients had systemic hypertension. There was no history of lichen planus in the family. All patients presented with severe itching within 1-2 months of onset. Papular lesions were seen in 72% and papules with plaques were seen 16%. Lower limbs were involved in 38% of cases. Mucosal involvement was seen in 24% in addition to skin involvement ; nail involvement hypertrophicus (17.3%). Lichen planopilaris and oral lichen planus were uncommon. Clinico-histopathological discrepancies were observed in 7 patients. Civatte bodies were seen in only 37% of cases.

Transition of pemphigus vulgaris to pemphigus foliaceus

We report a case of pemphigus vulgaris in a 46-year-old woman who presented with scaly and crusted erosions over erythematous base associated with itching and burning mainly over the chest, submammary folds, face, abdomen and the back. Histopathology was consistent with pemphigus foliaceus. The patient responded to oral prednisolone (60 mg/day). The above findings suggest that pemphigus vulgaris showed a transition to the pemphigus foliaceus variant.

A study of filarial transmission in a non-endemic area of Pathankot (Punjab)

A filariasis survey was conducted in July 1998 in Pathankot town of Punjab covering a population of 28, 041. A total of 2136 blood smears were collected from migratory and local inhabitants. Microfilaria (Mf) rate and mean Mf density was 1.19 and 15.05 respectively. Disease rate was nil. All the 20 microfilaria carriers detected were known to hall from filaria endemic areas of different states. Mf rate was highest in 20-49 years age-group, whereas Mf density was high in younger age group. Wuchereria bancrofti was the only infection encountered. 10 Men Hour Density of Culex quinquefasciatus ranged between 343 in the North Command unit to 400 in an engineering unit. A total of 339 female Culex quinquefasciatus were dissected. None was found positive for human microfilaria parasite, thus negating any indigenous filariasis transmission in this town. These findings were compared to earlier surveys in the same area and other non-endemic areas. Non-endemic areas continue to be non-endemic for filariasis despite considerable increase in MF rate among migratory population and vector density.

Trichotillomania and trichophagia leading to trichobezoar

A 14-year-old female presented with the complaints of loss of hair, scalp pruritus, and pain in the abdomen. On careful work-up, she was found to have trichotillomania as well as trichophagia. Investigations also revealed a trichobezoar which completely filled the stomach. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like obsessive hand washing, knuckle cracking, nose picking and body rocking. Her trichobezoar was removed surgically, and she had an uneventful post-operative recovery. She is being maintained on fluoxetine and is doing well. The role of a multi-disciplinary approach to trichotillomania patients is highlighted.

Chromoblastomycosis in India

BACKGROUND

Four patients with chromoblastomycosis are presented. An additional 30 infected Indian patients are reviewed.

RESULTS

These 34 patients ranged in age from 12 to 80 years with a male to female ratio of 5.8 : 1. Onset before the age of 20 years was seen in 24% of cases which was comparatively high. Culture was positive in 72% of cases and sclerotic bodies were observed in 84% of cases. A relatively higher prevalence (15%) of Fonsecaea compacta was observed. Unusual cutaneous sites afflicted were the penile shaft, vulva, and ala of the nose, and unusual extracutaneous spread was seen in the pleural cavity, ileocecal region, laryngotracheal area, and tonsils. Extracutaneous involvement was seen in 24% of cases. Overlapping infection with another fungus, Geotrichum candidum, was seen in one case.

CONCLUSIONS

Combination therapy with two azoles was attempted with some success for clinical cure.

Linear attenuation coefficients of tissue-equivalent materials of differing compositions for low energy photons

Total linear attenuation coefficients of three tissue equivalent materials differing in their fat contents were experimentally determined for low energy photons in the range 13-51 keV. It is found that their variations with photon energy for each of these materials are describable by two distinct power functions with the validity ranges being (13-23 keV) and (32-51 keV), respectively. Therefore, to adequately represent the variation of total linear attenuation coefficients over the full photon energy range i.e., 13-51 keV, a sum of two power functions is needed. Least squares fitted equations to the entire experimental data are thus included. For muscle, the experimental data show a reasonably good agreement with the theoretically computed values that are available in literature.

Erythroderma in children: a clinico-etiological study

Although there are various published studies on erythroderma from western and Asian countries, most of them have only included patients in the adult age groups. As we have an exclusively pediatric dermatology unit, we thought it would be intriguing to study the clinical, etiological and laboratory parameters of erythroderma in children. Seventeen erythroderma patients of both sexes were inducted into the study between 1993 to 1998. The mean age of onset was 3.3 years and the male:female ratio was 0.89:1. Eight (47%) of the patients were infants; 9 (53%) others belonged to the preschool and school going age group (age range between 1 to 12 years). An acute onset of the disease was seen in 47% of the patients while 53% of the patients had a chronic onset. The main presenting complaints were itching in 41% and burning in 18% of patients. Scalp involvement (71%), nail involvement (18%), and alopecia (6%) were the main cutaneous features observed while fever (53%), tachycardia (53%), pedal edema (12%), lymphadenopathy (18%), and hepatomegaly (12%) were the main systemic features observed in this study. Etiologically, drugs (29%), showed the highest incidence, followed equally (18%) by genodermatoses, psoriasis, and staphylococcal scalded skin syndrome (SSSS). Two (12%) patients had erythroderma due to atopic dermatitis, while one was (5%) due to infantile seborrheic dermatitis coexisting with dermatophytosis. Laboratory parameters contributed little towards diagnosis of the underlying dermatological condition. Thus, though erythroderma is a striking entity, it is yet uncommon in the pediatric age group. Because the drug induced group was the largest in this study, we recommend that drugs should be suspected as important causative factors of erythroderma in children.

Increased incidence of allograft rejection in stable heart transplant recipients after late conversion from mycophenolate mofetil to azathioprine

Mycophenolate mofetil (MMF) is a safe and effective immunosuppressive agent in kidney and liver transplantation. Preliminary studies also support its use in heart transplantation. However, the cost of MMF is substantially greater than azathioprine (AZA), the current alternative. Since the majority of rejection episodes occur within the first few months of transplantation, using MMF early after transplantation and subsequently converting to AZA, after the risk of rejection has diminished, might be cost-effective. In order to evaluate the safety of such a strategy in heart transplant recipients, we reviewed the rejection profiles of a group of patients who were converted from MMF to AZA late after transplantation. Forty-three stable patients on chronic MMF therapy as part of an open-label, long-term safety study were converted to either commercially available MMF (CellCept) or AZA, at the conclusion of the study. Demographic variables, rejection histories before and after conversion, and immunosuppressive regimens were examined. Twenty-three patients were continued on commercial MMF and 20 were converted to AZA therapy. The average duration of MMF therapy prior to conversion was 41 months in each group. Baseline demographics were similar in the two groups. Treated allograft rejection occurred in 10 of 20 patients converting to AZA, as compared to only 1 of 23 patients remaining on MMF; p = 0.002. Additionally, mean scores (1-5 scale) for the three biopsies before and after conversion favored continued MMF therapy (1.5+/-0.6 before and 1.2+/-0.4 after conversion in MMF group vs. 1.3+/-0.5 before and 1.7+/-0.9 after conversion to AZA; p = 0.02). No allograft loss occurred as a result of conversion. These data suggest that conversion from MMF to AZA, even late after transplantation, can be associated with allograft rejection. The costs associated with these rejection episodes (the additional immunosuppressive agents, endomyocardial biopsies, and physician visits) may exceed the potential cost savings of converting stable heart transplant recipients from MMF to AZA.

Clinico-bacteriological study of pyodermas in children

One hundred cases of pyodermas in children were investigated clinically and bacteriologically. Nasal and throat swabs from all cases were subjected to bacteriological examination. Most of the children (42%) were in the 1-4 year age group. The majority (58%) belonged to lower socio-economic groups with poor standards of hygiene. A history of over-crowding was obtained from 87% of cases, 82% were undernourished. Most of the children (68%) reported during the hot and humid months of June, July, August, and September. Primary pyodermas were observed in 72% of the children, and secondary pyodermas in 28%. Impetigo was the commonest primary pyoderma (48.61%); among secondary pyodermas, infected scabies was noted predominantly (42.86%). The face and legs were more commonly involved. Bacteriological cultures from pyoderma lesions revealed a single microorganism in the majority of the patients (84%). Staphylococcus aureus was isolated in pure culture from 48% and pure beta-hemolytic streptococci from 36%. A combination of both was obtained from 16%. No other organism was isolated from any case. A similar pattern was also observed in cultures from the nose and throat. Only 46 out of the 64 strains (84.3%) of Staphylococcus aureus isolated from pyoderma were typable. The majority (39.1%) showed a mixed pattern of phages; the second commonest was the non-allocated phage type (30.4%). Nasal flora had more of the non-allocated phage type (50%); two out of the three strains (66.6%) isolated from the throat showed a mixed pattern. All the strains of beta hemolytic streptococci, isolated either from lesions of pyoderma, nose, or throat belonged to group A. Staphylococcus aureus and showed a high sensitivity to netilmycin (100%), ofloxacin (98.4%), amoxycillin/clavulanic acid (96.9%), ciprofloxacin (89.1%) and gentamycin (84.4%) but a high resistance to penicillin (85.9%). A greater correlation was noted between nasal flora and organisms causing pyodermas. A change in the pattern of organisms causing pyodermas in children and their antibiotic sensitivities in this part of the globe has been observed in this study. The role of endogenous nasal and throat flora in the causation of pyodermas has also been highlighted.

Relationship between lichen planus and hepatitis C virus

The present study was conducted on 75 patients of lichen planus to observe the relationship of hepatitis C virus. Only 2 cases (2.66%) were positive for the hepatitis C virus antibody, which is almost parallel to the prevalence of hepatitis C virus in the general population in India (1.5 to 2.2%).

Early development of acute filariasis in a migrant from non-endemic to hyper endemic area: a case report

A case report of a European woman who contracted filariasis after staying for a few weeks in a filaria endemic area of south India is presented in this paper.