[Recurrent chromomycosis of the face and extremities: first case report from Iibya]

Chromomycosis is a chronic cutaneous fungal infection most prevalent in tropical and subtropical countries. It mainly affects adults working in rural areas. This purpose of this report is to describe the first cases in Libya in a 16-year-old girl. This case is also remarkable with regard to location on the face and members, lack of association with trauma and long delay for recurrence, i.e., 6 years after first occurrence.

Chronic craniofacial dematiaceous fungal infection: a case report

Curvularia is a saprobic dematiaceous mold that has been associated with a wide spectrum of human infection. In non-immunosuppressed patients, infections frequently involve the paranasal sinus, skin, and soft tissue, whereas systemic dissemination and endocarditis are extremely rare. The optimal antifungal therapy for Curvularia infection is not known, and responses to treatment with amphotericin B, miconazole, ketoconazole, terbinafine, and itraconazole have been reported. We describe a patient with an invasive dematiaceous fungal sinusitis who was immunocompetent and was infected with Curvularia. The patient was successfully treated with oral itraconazole by otolaryngology and the infectious disease service.

Cervicofacial necrotizing fasciitis: an unusual complication of chronic suppurative otitis media

Necrotizing fasciitis is a rare microbial soft tissue infection characterized by rapidly spreading areas of necrosis and a high mortality rate. It may be of odontogenic or traumatic origin or may arise from insect bites, burns or surgical infections. We present a clinical case of an eight-year-old child with facial and cervical necrotizing fasciitis as a complication of chronic suppurative otitis media. The causes, diagnosis and management of necrotizing fasciitis are reviewed.

[Soft-tissue infections due to non-tuberculous mycobacteria following mesotherapy. What is the price of beauty]

INTRODUCTION

Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy.

METHODS

Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene.

RESULTS

Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively.

CONCLUSIONS

Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment.

[Lupus tuberculosis: a cause of medio-facial mutilation not to be ignored]

Medio-facial mutilations are a real problem from a diagnosis and prognosis point of view. Various etiologies may be in question, namely bacterial, parasitic, mycotic, viral infections or yet predisposing factors such as denutrition or a immunodepression. Among these etiologies, the lupus tuberculosis remains a major concern to be taken into account in poor socio-economic background. We report two cases of lupus tuberculosis in teen-agers whose diagnosis difficulty induced sequellae although limited by a further appropriate care management. The clinical spectrum of the cutaneous tuberculosis and the place of this affection featuring ahead of other medio-facial mutilations etiologies remain important in tropical area.

Unusual orofacial manifestations of histoplasmosis in renal transplanted patient

Histoplasmosis is a fungal infection caused by the Histoplasma capsulatum. Mucosal manifestations are uncommon, but, when present, they are usually associated with pulmonary or chronic disseminated infection. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of unusual involvement of nasal cartilage and septal destruction, and oral lesions of histoplasmosis in an immunosuppressed patient who presented an unusual form of the disease.

First case of an oculofacial lesion due to Mycobacterium haemophilum infection in an immunocompetent child

Oculofacial lesions caused by infections with nontuberculous mycobacterial organisms are unusual, but infections with Mycobacterium haemophilum species in immunocompetent patients have not yet been described. We present a case of an oculofacial lesion in a girl as a result of a Mycobacterium haemophilum infection.

Hyperkeratotic head and neck Malassezia dermatosis

BACKGROUND

Pityriasis versicolor (tinea versicolor) is a common skin disorder due to Malassezia usually affecting adolescents and young adults, more frequently in the tropics. Facial involvement, isolated or not, is not frequent in white adults.

OBJECTIVE

Here, we report a possible atypical hyperkeratotic form of dermatosis of the face, in two young immunocompetent Caucasian patients, particularly recalcitrant to therapy.

RESULTS

Skin scrapings grew yeasts belonging to the genus Malassezia, including both M. globosa and M. sympodialis. This unusual variant needs long-term therapy with systemic and topical imidazoles together with facial cleansing.

CONCLUSION

We propose the name hyperkeratotic head and neck Malassezia dermatosis for this distinctive clinical entity. This variant of pityriasis versicolor should be considered in the differential diagnosis of seborrheic dermatitis and dermatitis neglecta.

Seborrheic dermatitis-like tinea faciei

We report a 10-year-old Caucasian child who had erythema and abundant scaling on the nasolabial folds, the upper lip, and on the nose. Both the abundant scaling and the localization on the central part of the face led us to suspect seborrheic dermatitis. Direct microscopic examination of some scales removed from the lesions showed septate and ramified ectothrix hyphae. Cultural examination on Sabouraud medium led to the identification of the Trichophyton mentagrophytes species. We described this patient to highlight the importance of considering tinea faciei in the differential diagnosis of all facial eruptions and the value of mycologic examination.

Dermatofitosis con lesiones concurrentes a distancia. Importancia pronóstica y terapéutica

INTRODUCTION

Recurrence and a lack of treatment response are common in dermatophytosis. In patients with cutaneous and concurrent toenail lesions, often only the former are investigated, which may result in inappropriate treatment due to misdiagnosis.

METHODS

Between January 2000 and April 2004, we prospectively studied the presence of dermatophytic fungi in lesions other than those prompting the consultation to further investigate the diagnosis.

RESULTS

We prospectively identified 61 patients with dermatophytosis and concurrent lesions caused by the same fungus at sites distant from the primary lesion. Concurrent lesions occurred in 15.9% of culture-confirmed dermatophyte infections. Thirty-six patients (59%) consulted for skin lesions located at sites other than that of the primary lesion in the foot. The most frequently identified species was Trichophyton rubrum (50/61, 82%).

CONCLUSIONS

Localization of all the lesions, as well as isolation and identification of the causative fungus, are essential to establish the prognosis and choose the most appropriate antifungal agent, route of administration, and duration of treatment in dermatophytosis.