Annular elastolytic giant cell granuloma in association with Hashimoto's thyroiditis

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease characterized clinically by annular plaques with elevated borders and atrophic centers found mainly on sun-exposed skin and histologically by diffuse granulomatous infiltrates composed of multinucleated giant cells, histiocytes and lymphocytes in the dermis along with phagocytosis of elastic fibers by multinucleated giant cells. We report a case of AEGCG in a 50-year-old woman and is highlighted for the classical clinical and histological findings of the disease and its rare co-existence with Hashimoto's thyroiditis.

Aggressive angiomyxoma

Myxoid tumors are a heterogeneous group of lesions characterized by a marked abundance of extra cellular mucoid (myxoid) matrix.[1] The term aggressive emphasizes the often infiltrative nature of the tumor and its frequent association with recurrence.[2] A case of aggressive angiomyxoma arising from the vagina in a 55-year-old woman is reported for its rarity.

In-transit metastases from squamous cell carcinoma penis

An in-transit metastasis is one that is located between the primary tumor and the closest lymph node region and results from tumor emboli getting trapped in the lymphatic channels. A 65-year-old male patient who had undergone partial amputation of the penis and bilateral inguinal lymph node resection for squamous cell carcinoma of the penis 4 months earlier developed multiple cutaneous metastatic lesions in the pubic region and scrotum. The case is reported for the uncommon presentation of in-transit metastases.

Lupus vulgaris and tuberculosis verrucosa cutis (TBVC)--a clinical, pathological and epidemiological study of 71 cases

BACKGROUND

The epidemiological aspects and diagnostic problems encountered in a rural set up are largely unknown. The present study on cutaneous tuberculosis encompassing clinical, pathological and epidemiological aspects was undertaken at Rajah Muthiah Medical college and Hospital (RMMC&H), a teaching hospital mainly catering to the health needs of a predominantly rural population from villages and hamlets around Chidambaram, a taluq headquarters, located in Cuddalore district ofTamil Nadu.

MATERIAL AND METHODS

During the period of study, 5744 cases (82%) of pulmonary tuberculosis and 1261 (18%) of extra-pulmonary tuberculosis were encountered. Cutaneous tuberculosis accounted for 117 (1.67%) of tuberculosis cases.

RESULTS

Of the seventy-one patients with cutaneous tuberculosis, 39 had lupus vulgaris and 32 with TBVC. Lupus vulgaris was more prevalent with male pre-ponderance. The maximum incidence was seen in the second decade of life. Both LV and TBVC showed a male pre-ponderance, M:F ratio being 3:2 and 2:1 in LV and TBVC respectively. A majority of patients with LV (27 cases; 69.2%) and TBVC (31 cases; 96.8%) manifested with a single site of involvement. Lower extremities were more commonly involved among patients hailing from poor economic strata who were not habituated to the use of footwear while working out doors. Over crowding was also a contributing factor. The relationships between BCG vaccination and Mantoux test with cutaneous tuberculosis, association with pulmonary tuberculosis in addition to the underlying predisposing socio-economic factors are discussed.

Psoriasiform lupus vulgaris

Tuberculosis is a major public health problem in both developing and developed countries. Cutaneous Tuberculosis constitutes a minor proportion of extra-pulmonary manifestations of Tuberculosis. Lupus Vulgaris (LV) is one of the clinical variants of Cutaneous Tuberculosis. A case of a large plaque type psoriasiform lesion of lupus vulgaris on the thigh, of 15 years' duration, in an 18-year-old girl is reported. This case highlights the ignorance level among the patients and consequent failure to avail proper anti-tuberculous treatment despite campaign in print and audio visual media.

Tuberculosis verrucosa cutis (TBVC)--foot with miliary tuberculosis

Tuberculosis Verrucosa Cutis (TBVC) or warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity (CMI) to Mycobacterium Tuberculosis, while Miliary Tuberculosis is associated with very poor CMI. Two widely different clinical presentations in the same patient are very rare and being reported.

Ulcerative lupus vulgaris of face: an uncommon presentation in India

Tuberculosis affects the population world wide, more among those living in developing countries. The incidence of tuberculosis registered an upward trend even in developed countries, with the advent of HIV infection. Cutaneous tuberculosis accounts for about 1% of cases of extra-pulmonary tuberculosis. Cutaneous tuberculosis presents with various lesions ranging from ulcerative to proliferative or hyperkeratotic lesions. The lesions may sometimes be associated with marked destruction of the tissues resulting in marked disfigurement, especially when it involves face as seen in cases of Lupus Vulgaris. A case of Lupus Vulgaris in a young woman with extensive ulceration of face which responded to ATT resulting in scarring of the face is reported for its rarity amongst Indian population as against western population.

Cutaneous larva migrans--a case report

Cutaneous larva migrans or creeping eruption is an uncommon parasitic skin infection caused by the filariform larvae of dog or cat hook worms. We report a case of larva migrans on the anterior abdominal wall, in a 52 year old lady, who did gardening as a hobby.

Unilateral linear pansclerotic morphea affecting face and limbs

Disabling pansclerotic morphea is a rare atrophying and sclerosing disorder of the subcutaneous tissue, muscle and bone. It is characterized by atrophy of the skin, subcutaneous fat, muscle and bone involving half of the face. In some patients the atrophic lesions extend to involve the ipsilateral or contralateral upper and lower limbs with radiological evidence of hemiatrophy. The patients may present with arthralgia, convulsions or cramps. We report a case of a woman with deformity of face, and left upper and lower limbs that had started as an indurated plaque on the left half of forehead at the age of 5 years and had gradually enlarged, followed by the development of atrophic changes in left eye. The case is being reported in view of its rare occurrence.

Utility of polymerase chain reaction as a diagnostic tool in cutaneous tuberculosis

BACKGROUND

Differentiation of cutaneous tuberculosis from other infective granulomas of the skin is difficult due to paucity of the organisms in tissue biopsies. Polymerase chain reaction (PCR) is a newer technique to identify the DNA of Mycobacterium tuberculosis in the tissues.

AIM

We examined the utility of PCR as a tool for rapid diagnosis of cutaneous tuberculosis especially in cases negative by ZN staining and culture.

MATERIAL AND METHODS

Twenty five random skin biopsies from patients with various types of cutaneous tuberculosis were subjected to PCR.

RESULTS

An overall positivity of 64% was observed, which is comparable to other series. Seventy five percent of lupus vulgaris cases, 62.2% of tuberculosis verrucosa cutis and 50% of scrofuloderma cases showed PCR positivity.

CONCLUSION

Though useful, the cost and the technique involved limit the use of PCR in developing countries like ours.

Disseminated cutaneous rhinosporidiosis in a HIV sero--positive patient

Rhinosporidiosis is a chronic disease, classically involving the nose and nasopharynx, clinically presenting as polypii. However,disseminated rhinosporidiosis, involving various other sites including lips, conjunctiva, uvula, vagina, larynx. trachea. scalp and skin is also known to occur. A case of rhinosporidiosis, with nasal, oropharyngeal and multiple cutaneous lesions, in a patient who is sero--positive for HIV is reported.

Generalised morphoea with lichen sclerosus et atrophicus and unusual bone changes

A 26-year-old male patient presented with multiple plaques on the limbs and trunk suggestive of morphoea. He also exhibited multiple, small, atrophic, hypopigmented macules on the left side of the trunk, the histopathology of which was consistent with lichen sclerosus et atrophicus (LSA). The patient developed large ulcers on the left leg and foot, and contractures with flexion deformity of the left ring and little fingers. This combination of generalised morphoea with LSA and unusual osteolytic bone changes is uncommon.

Xeroderma Pigmentosum with Mailgnant Melanoma and Squamous Cell Carcinoma

A 25 year old female with xeroderma pigmentosum since 3 ye4ws of age, developed a nodular growth on the left ala of the nose since 4 months. Histopathology revealed m ant melanoma of the nodular variety. A squamous cell carcinoma was also detected at the fimbus in the right eye. There were no metastases.

Dapsone Induced Methaemoglobinemia

A 33 old I female developed methaemoglobinemia manifesting as cyanosis fatigue, malaise and headache 3 weeks after being put on l00 mg of dapsone daily for borderline - tuberculoid leprosy. Similar manifestations develope4 in a 15 year old boy 9 days after he, was put on 50 mg of dapsone daily for suspected indeterminate leprosy. withdrawal of dapsone resulted in reversal of methaemoglobinemia.

Kyrle's Disease with Diabetes Meuxfus and Chronic Renal Failure

A 54 year old male had Kyrle's disease manifestion as multiple, discrete papules with cone-shaped keratotic plugs. The lesions were severly pruritic and located symmetrically on the extensor aspects of the limbs and the trunk. Histopatholggical examination confirmed the diagnosis. The patient was known to be diabetic for 18 years and developed chronic renal failure 4 months prior to the onset of the skin lesions. Treatment with 6% salicylic acid topically did not produce any improvement of the lesions.