Palisaded neutrophilic and granulomatous dermatitis in association with subcutaneous nodular and systemic sarcoidosis

Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare entity that has been clearly defined neither clinically nor histopathologically. PNGD has been associated with some immune-mediated disorders such as rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitis, Behçet's disease, as well as with lymphoproliferative conditions, bacterial endocarditis, sarcoidosis, and various drugs. We present a 44-year-old Caucasian woman with roundish erythematous-livid plaque and erythematous papules on the left calf that were present for three months. Histopathology of plaque lesion showed palisading neutrophilic and granulomatous dermatitis. Subsequently, she developed a firm and tender nodule on the right calf. Histopathology of the nodule showed typical naked sarcoid granulomas in the dermis and subcutis. Additionally, the patient developed non-tender subcutaneous nodules on the cheeks, submandibular region and left breast with normal overlying skin, which were histopathologically diagnosed as sarcoid granuloma. Red eyes and lower visual acuity on the right eye were diagnosed as anterior uveitis. Therefore, systemic sarcoidosis was established. This is a case of PNGD described in an adult patient with sarcoidosis with cutaneous, breast, eye and lung involvement established by clinical, radiographic, laboratory, and histopathologic criteria.

Drug induced psoriasis

Psoriasis is a chronic inflammatory skin disorder clinically characterized by erythematous, sharply demarcated papules and rounded plaques covered by silvery micaceous scale. While the exact causes of psoriasis have yet to be discovered, the immune system and genetics are known to play major roles in its development. Many external factors including infections, stress and medications may exacerbate psoriasis. Some of the most common medications know to trigger or worsen existing psoriasis include lithium, gold salts, beta blockers and antimalarials. Exacerbation of psoriasis due to the following medications has also been observed: adrenergic antagonists, interferon, gemfibrozil, iodine, digoxin and chlonidine. Having reviewed a variety of cases, we observed a relationship between certain medications and documented their involvement in exacerbating or inducing psoriasis.

Pyoderma chronica vegetans treated with mesh skin grafting

Pyoderma chronica vegetans is a rare condition clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Although the etiology is unknown, it is generally believed that vegetating reaction is due to an immune system dysfunction or immunosuppressive state. We report on a 72-year-old man with pyoderma chronica of the buttocks. The lesion on the left buttock worsened two years before with gradual onset of fistulas, scarring and verrucous plaques. Laboratory test revealed medium high erythrocyte sedimentation rate, anemia, shift to left in differential white blood cell count, and polyclonal hyperglobulinemia. Streptococcus species and Escherichia coli were detected in tissue samples. T-cell functional tests for mitogens were decreased. Flow cytometry analysis of phagocytic capability of monocytes and granulocytes by was normal. Inflammatory bowel diseases were excluded with clinical and radiological examination. Anti-HIV test was negative. Histology revealed hyperplasia and irregular acanthosis of the epidermis, sinus and abscess formation, fibrosis and diffuse infiltration of inflammatory cells such as plasma cells, lymphocytes, histiocytes, eosinophils and neutrophils. Surgery was chosen as a therapeutic option as conservative treatment proved ineffective. Therefore, complete excision of the lesion was performed and skin grafting was required to close the defect because of extensity of the lesions. The skin-graft donor site was normal skin. Good postoperative result was achieved, without recurrence of the pyodermatic process.

Effects of various cryopreservation media and freezing-thawing on the morphology of rat testicular biopsies

Currently, testicular sperm extraction is successfully combined with intracytoplasmic sperm injection into the oocyte (ICSI). Several pieces of a testicular biopsy can be frozen and thawed until the ICSI attempt. In this study, the effects of freezing-thawing on the morphology of rat testicular biopsies stored in different cryopreservation media were analysed. Each cryopreservation medium contained glycerol and/or dimethyl sulfoxide (DMSO) as cryoprotectants. In general, both glycerol and DMSO, when applied at moderate concentrations (6-25%), preserved the structure of the seminiferous epithelium. The freezing-thawing procedure had no significant effect on tubular diameter; however, it caused a 'folding' of the lamina propria and notable damage to Sertoli cells, spermatogonia and spermatocytes. Round and elongated spermatids and spermatozoa displayed occasional nuclear damage, vacuolization, and shrinkage/swelling of the cytoplasm. However, the vast majority of these cells maintained their normal structure in nearly all the applied cryomedia. It is concluded that freezing-thawing of testicular biopsies, and the cryopreservation medium, have a significant impact on the structure of the seminiferous epithelium, particularly on its basal compartment.

Sepsis as an unusual event in dyskeratosis follicularis

Dyskeratosis follicularis is a genetic disorder characterized by pathogenetic changes of keratinization. We report on a severe case of the disease with an unusual manifestation involving Staphylococcal sepsis. The patient was treated systemically with infusions, oral antibiotics, and retinoids. Antiseptics, keratolytic ointments, and creams were given topically to promote epithelization. His condition improved dramatically after 14 days of treatment. All erosions of the trunk, extremities, neck, and head had epithelized. We suspect that extreme sun exposure and neglect of care on genetically susceptible sites triggered the sepsis.

Sensitivity to metals in 40 patients with failed hip endoprosthesis

Hypersensitivity to metals and tissue reaction around a failed implant were investigated in 40 patients undergoing revision hip arthroplasty. Metal sensitivity was tested using a standard cutaneous patch test. Nine patients were positive for chromium, nickel, cobalt, metal rust or endoprosthesis scrapings, or combinations of these allergens. Patients with positive or negative patch test did not differ in terms of their age, sex, primary diagnosis, number of endoprosthesis revisions, length of implant function, presence of other metal parts around the implant, circulating immunocomplexes, and histological appearance of the tissue around the implant. We conclude that stainless steel endoprostheses may be safely used for repeated revision hip arthroplasty, and that hypersensitivity to metals probably does not play a significant role in the loosening of the endoprosthesis.

[Cutaneous symptoms and diagnosis of drug hypersensitivity]

At the Department of Allergy, Clinic of Dermatovenerology, School of Medicine University of Zagreb, Clinical Hospital Centre Zagreb, patients with different clinical features of drug allergy during the period of two years (1990-1991) were analyzed. The research included 475 patients with positive history of drug allergy and typical clinical symptoms. The aim of the study was to correlate the clinical diagnosis and history with the results of diagnostic tests in vitro and in some cases in vivo. Positive history and clinical diagnosis were confirmed in 117 of the 475 patients (24.6 percent) by an indirect basophil degranulation test (Shelley's test) and in 59 of the 345 patients (17.1 percent) by means of a lymphoblast transformation test. Patients positive in tests in vitro (or on TTL or on Shelley's test) from unselected 56 patients in vivo (prick test, scratch test) showed positive results. We consider therefore that provocative tests are more precise and exact than in vitro tests in the diagnosis of drug allergy. The most common causes of drug allergy and 17 clinical types are presented.

Neomycin--a frequent contact allergen

The incidence of allergic contact dermatitis from neomycin evaluated in relation to 1381 verified cases of allergic contact dermatitis showed a progressive increase (5.00, 7.69, 10.18%) over a three-year period (1990-1992). Sensitivity to neomycin was investigated with special reference to possible cross-reactions between neomycin and the allergens that are commonly used in the manufacture of cosmetic products. Contact sensitivity to neomycin was found to be present with the other diagnoses, such as atopic dermatitis, seborrhoeic dermatitis, hypostasic dermatitis and psoriasis vulgaris.

Contact allergy and psoriasis

The study was conducted over a two-year period and included 48 psoriatic patients with palmar and plantar lesions and 61 psoriatic patients without palmar and plantar lesions who served as controls. The objective was to establish the incidence of contact sensitization and its importance as the causative factor in palmar and plantar psoriasis. The most frequent contact allergens were: nickel sulphate, mercapto mix, balsam of Peru, potassium dichromate, mercury mix and fragrance mix. Patch tests were positive in 41.7% psoriatics with palmar-plantar psoriasis and in only 6.6% of psoriatics without palmar-plantar involvement. The study showed an increased incidence of contact allergy in patients with palmar-plantar psoriasis.

[Immunologic and clinical definition of the rejection reaction in kidney transplantation]

In the evaluation of the immunological state of a kidney transplant there is no reliable diagnostic test. Therefore, several various tests should always be applied. The aim of this study was to define the type of immunological reaction (cellular or humoral) that causes the rejection of transplanted kidney. A group of 45 patients with a kidney transplant were tested 175 times, in various phases of the kidney transplant, starting on the day of transplantation up to several months posttransplant. Specific antibodies (SA) and specific cytotoxic lymphocytes (SCL) directed against donor cells in lymphocyte-mediated cytolysis tests in the presence of antibodies (ADLMC) or without them (LMC) were determined. LMC was significantly correlated with acute rejection (85%). In the phase of clinical quiscence of the kidney transplant LMC was positive in 4% of the cases. During the period of chronic rejection it was positive in 75% of the cases. ADLMC test is significantly correlated with chronic rejection (88%). In the period of acute rejection it was positive in 27% while in clinical quiscence in 11% of the cases. Twenty-two patients with non-immunological disorders of the kidney transplant were tested 62 times. LMC test was always negative, while ADLMC test was positive in 6.4% of the cases. These tests prove to be good parameters for defining immunological reaction. Thus, they can be of great importance in determining adequate immunosuppressive therapy. Negative results of tests in non-immunological disorders of graft function are highly significant.