Polymerase chain reaction-reverse cross-blot hybridization assay in the diagnosis of sporotrichoid Mycobacterium marinum infection

In this paper, we report a patient in whom Mycobacterium marinum sporotrichoid infection was diagnosed using polymerase chain reaction (PCR) amplification of the 16S rRNA gene and subsequent analysis of the amplified product in a reverse cross-blot hybridization assay with mycobacterial species-specific probes. This molecular method allowed us rapidly to detect and identify this organism directly in the patient's lesional skin biopsy rather than in cultures in conventional media. The identification provided by PCR-reverse cross-blot hybridization assay was confirmed by examination of the morphological and biochemical features and by high-performance liquid chromatography analysis of mycolic acid from the clinical isolate, suggesting the validity of our molecular approach.

Positivity of patch tests in cutaneous reaction to diclofenac. Two case reports

Immune-mediated reactions to NSAIDs are unusual. We have observed two cases of maculopapular eruptions occurring 48-72 h after administration of diclofenac sodium. Patch tests performed with diclofenac were positive. The histopathologic findings resembled those of contact dermatitis with different degrees of dermal involvement. Clinical, allergologic, and histopathologic patterns strongly suggest a type IV mechanism of hypersensitivity. Patch tests play an important role in the assessment of possible immunologic mechanisms underlying cutaneous reactions to drugs.

Two cases of toxic epidermal necrolysis caused by delayed hypersensitivity to beta-lactam antibiotics

The authors describe two cases of toxic epidermal necrolysis (TEN) caused by delayed hypersensitivity to semisynthetic penicillins. The first patient developed erythema of the lower limbs following an i.m. injection of ampicillin, which progressed to TEN as therapy was continued. Fever and eosinophilic leukocytosis were also present. In the second case, TEN developed following oral amoxicillin therapy, and was preceded by a diffuse, maculopapular eruption. In both cases, symptoms resolved with the prompt administration of steroids. Both patients underwent allergological testing: prick test and, if results were negative, intradermal tests with penicilloyl-polylysine (PPL), minor determinant mixture (MDM), penicillin, amoxicillin and ampicillin. Patch testing with penicillin, ampicillin and amoxicillin was also performed. Both patients developed positive reactions to the intradermal tests after 6 h, and to patch tests after 48-72 h (for ampicillin, amoxicillin and penicillin in the first case, and for ampicillin and amoxicillin in the second). The lymphocyte transformation test (LTT), performed only in the first case, was positive for ampicillin. As these cases demonstrate, delayed hypersensitivity should be suspected in cases of drug-related TEN. Patch testing is a simple and useful allergological test for these types of cases.

Delayed hypersensitivity to 6-methyl-prednisolone in Henoch Schöenlein syndrome

We report a case of allergic reaction to oral 6-methyl-prednisolone in a patient with Henoch Schöenlein syndrome. When this syndrome was first diagnosed the patient was started on 6-methyl-prednisolone orally and after 4 days he developed a pruriginous generalized maculo-papular eruption. The rash disappeared 1 week after withdrawal of 6-methyl-prednisolone. The skin tests performed 1 month after with main food allergens were negative. Patch test with 0.10 ml of solution containing 6-methyl-prednisolone 40 mg/ml was positive after 48 and 72 h. The cutaneous biopsy on the patch tested skin revealed a perivascular infiltrate of lymphocytes, histiocytes and eosinophils.

Delayed hypersensitivity to diltiazem in two patients

We report two cases of cutaneous adverse reactions during treatment with diltiazem. Both patients developed wide-spread, pruriginous, erythematous, maculopapular eruptions with fever and facial angioedema, 48 to 72 hours after starting diltiazem. Delayed hypersensitivity to diltiazem was suspected and the diagnosis was confirmed by skin patch tests followed by cutaneous biopsy.

A case of epidermal nevus syndrome with carotid malformation

Epidermal Nevus Syndrome (ENS) is characterized by linear verrucous lesions of the skin and congenital anomalies including bone deformities, eye and central nervous system (CNS) malformations. We describe a case of ENS associated with an abnormality of the carotid artery which is considered a risk for stroke.

An evaluation of some inflammatory, coagulative and immune factors in progressive systemic sclerosis

Thirty-five patients affected by Progressive System Sclerosis (PSS) (20 acrosclerosis and 15 diffuse sclerosis) were subjected to the following laboratory tests: Beta 2 microglobulin (B2m), Fibronectin, C3c, C4, Fibrinogen, Factor VIII Coagulant (F. VIII:C), Factor VIII related Antigen (F. VIII:Ag), IgG, ESR, Antithrombin III (AT III), alpha 1 Antitrypsin (alpha 1AT) and alpha 2 Macroglobulin (alpha 2M). The results showed that no difference was observed between the normal group and the groups of PSS patients with respect to alpha 1AT, alpha 2M, and AT III. In contrast the B2m, ESR, IgG, F. VIII:Ag results were significantly higher in the PSS patients, while Fibrinogen and C3c results were slightly higher, but no high enough to be of statistical significance. The two PSS patient subgroups did not produce significant results, only the C4 values were lower in the Diffuse Sclerosis subgroup. From these results it seem that the tests used are not very useful indifferentiating the two subgroups of the PSS patients.

Macro- and microscopic alterations in 2 rabbit skin regions following topically repeated applications of benzoic acid n-alkyl esters

This paper explores the irritancy potential of n-alkyl benzoate preservatives (methyl benzoate, MB; ethyl benzoate, EB; n-propyl benzoate, n-PB; n-butyl benzoate, n-BB), allowable in cosmetic formulations. Comparative experiments were carried out involving repeated daily application for all compounds (up to maximum of 6 days) on clipped rabbit skin in 2 distinct regions: the dorsum (0.5 ml per treatment) and the external surface of the outer ear (0.2 ml per treatment). According to the different anatomo-physiological features, benzoates elicited dissimilar reactions in the dorsum and the external ear. In the first mentioned area, there were widespread inflammatory reactions accompanied, in some cases, by necrotic changes and slight epidermal hyperplasia; on the other hand, hyperplasia was the most prominent and earliest alteration in the ear. The irritancy potential was closely related to the duration of treatment as well to the increase in the molecular weight of benzoates.

[The blood coagulation system in progressive systemic scleroderma]

Twenty-five scleroderma patients have been studied to evaluate blood coagulative and fibrinolytic parameters. An increase in FVIII related activities and a reduction in fibrinolytic activity was observed. These changes may be related to the endothelial damage present scleroderma patients I the consequent "in loco" activation of blood coagulation may cause the microthrombosis that is very often observed in the earliest phases of the disease.

Factor VIII complex in progressive systemic sclerosis

Factor VIII complex and its related activities (Coagulant, Antigen and Ristocetin Cofactor) have been investigated in 23 patients with Progressive Systemic Sclerosis (PSS) divided into two groups: acrosclerosis and diffuse sclerosis. All Factor VIII-related activities were higher in PSS patients than in normal subjects. No difference in F. VIII-related Antigen (F. VIIIR:Ag), F. VIII-related Ristocetin Cofactor (F. VIIIR:Co) and F. VIII Coagulant activity (F. VIII:C) was found comparing the patient groups. F. VIII:C was increased significantly less than F. VIIIR:Ag and F. VIIIR:Co in both patient groups. Some hypotheses about the pathogenesis of this increase are discussed.

Vasculitic purpura in vinyl chloride disease: a case report

Vinyl chloride (VC), a volatile substance mostly used for polyvinyl chloride (PVC) synthesis, is a systemic toxicant particularly noxious to endothelium. Angiosarcoma of the liver, Raynaud's phenomenon, scleroderma-like lesions, acroosteolysis and neuritis are known to be typical vinyl chloride-associated manifestations (VC disease). A so far unknown feature of the disease is purpura. This was first observed by the authors in a worker of a PVC-producing plant. The skin eruption was characterized by small purpuric maculae with tiny, palpable spots and papulae, mostly concentrated on the lower part of the legs, changing into bullae, pustules and crusts and tending to spontaneous regression after withdrawal from VC exposure. A skin biopsy revealed marked inflammatory reaction with a mostly lymphocytic and histiocytic infiltration around and in the walls of dermal arterioles. The finding of increased circulating immune complexes and anti-smooth muscle autoantibodies strengthens the hypothesis that immunologic changes play a role in the appearance of "vinylic purpura."

Serum beta 2-microglobulin in systemic sclerosis

The role of beta 2 microglobulin (beta 2-m) in Systemic Sclerosis (SS) has been evaluated. Twenty-four female patients have been examined: 15 of them were affected by acrosclerosis (Group 1) and 9 of them by diffuse sclerosis (Group 2). 46.6% of Group 1 and 44.4% of Group 2 had values significantly higher than normal controls. (P less than 0.01 and P less than 0.005 respectively). The authors deal with the validity of the use of B2-m as index of inflammatory activity of the disease.

[Immunodiffusion of non-histone chromosomal proteins from human skin tumors]

A previously unpublished reaction of precipitation in agarose between histone and non-histone proteins extracted in saline buffer from nuclei of human skin tumors, is reported. Two bands of precipitation similar to those in an immunodiffusion reaction between NHP and specific antisera, were observed. The reaction described is very similar to the affinodiffusion reaction of glycoproteins and lectins in agarose.

[Presence of clusters of Langerhans cells and lymphoid cells in the peritumoral infiltrate of a case of basal cell naevus syndrome. Ultrastructural study (author's transl)]

A case of naevoid basal cell carcinoma syndrome with clusters of Langerhans' and lymphoid cells in the inflammatory peritumoral infiltrate, is reported. Electron microscopy shows intercellular contacts between eight to ten lymphoid cells and a single Langerhans' cell. These contacts occur over limited areas of the cell membranes by means of zones of high electron density on the outer edge of the cytoplasm. The functional significance of this finding is discussed, bearing in mind that recent observations have established certain analogies between Langerhans' and interdigitating reticulum cells. The latter might, within the thymus-dependent region of the lymph nodes, contribute to the formation of a micro-environment favourable to certain immunological activities of T-lymphocyte populations.

[Ultrastructural observations on amastigote forms of Leishmania donovani in a case of laryngeal leishmaniasis]

An ultrastructural study on the amastigote stage of Leishmania donovani, in a rare case of laringeal involvement, was carried out. Many details of the fine morphology of this protozoon were observed under the electron microscope, i.e.: the outer membrane of host origin, periplast, subpellicular microtubules, kinetoplast, flagellum, flagellar pocket, multivesicular bodies. A presence of a new organelle (4 microtubules structure close to and running parallel to the flagellar pocket), previously not described in Leishmania donovani's species, was demonstrated in this indigenous strain (from Central Italy). The Authors found a limited number of subpellicular microtubules in this strain, i.e.: 72 microtubules. Differences in size and number of microtubules between strains must be investigated in more rigorous morphometric studies. It's possible that the number of the subpellicular microtubules represents a new taxonomic character.

[Ophthalmoplegia in dermatomyositis]

A case in which apparently myasthenic ophthalmoplegia had been observed more than six years prior to the onset of dermatomyositis is reported. The clinical picture is described and the possibility of a partially common pathogenesis for both forms is mooted. It is suggested that initial local disturbance of neuromuscular transmission was eventually followed by "aggression" against the muscle fibres.