Unusual Maculopapular Rash on the Scalp of a Patient with Mediterranean Spotted Fever

OBJECTIVE

To report a rare case of maculopapular rash on the scalp in a patient with Mediterranean spotted fever (MSF).

CLINICAL PRESENTATION AND INTERVENTION

A 58-year-old woman with breast cancer and chemotherapy-induced alopecia contracted MSF. Her clinical features were typical, except for a maculopapular rash covering the scalp. The diagnosis of MSF was confirmed by immunofluorescent assay. The disease had a favorable course and the patient was discharged in good condition.

CONCLUSION

The rash on the scalp described in this report enriches our knowledge on the clinical characteristics of MSF.

Méningococcémie chronique

INTRODUCTION

Chronic meningococcemia is a rare clinical form of invasive Neisseria meningitidis infection. We report 2 cases.

OBSERVATIONS

A 39 year-old man and a 42 year-old woman had developed a widespread, fleeting and painful maculopapular cutaneous eruption over the past few weeks, associated with intermittent fever and inflammatory arthralgia. In both cases blood cultures isolated a serogroup B meningococcus that confirmed the diagnosis. Cutaneous histology revealed a non-specific image of leukocytoclastic vasculitis. Treatment with beta lactamin antibiotics was successful after respectively 3 weeks and 12 days.

DISCUSSION

This septicemia is characterized by the clinical triad of cutaneous eruption, fever and arthralgia. It must not be mistaken for connectivitis because inappropriate corticosteroid prescription may provoke severe complications. Confirmation of the diagnosis is provided by the blood cultures, which should be repeated. In the case of strong clinical suspicion, the rapid improvement with antibiotics confirms the diagnosis.

Fixed drug eruption due to influenza vaccine

Two females, one 28 years old and the other 32 years old, developed dusky red macules with pain and a burning sensation within 24 hours of receiving influenza vaccine. One patient had blisters within the lesion. A clinical diagnosis of fixed drug eruption (FDE) due to influenza vaccine was made. Histopathology was consistent with the diagnosis of FDE. The lesions subsided within 2 weeks of topical corticosteroid treatment. The diagnosis was confirmed by topical provocation test with influenza vaccine. A Medline search revealed these cases to be the second report of this kind of reaction due to influenza vaccine.

The aetiology of maculopapular rash diseases in Niterói, State of Rio de Janeiro, Brazil: implications for measles surveillance

A study investigating the causes of rash diseases using systematic laboratory testing was conducted in Niterói, Rio de Janeiro, between January 1994 to April 1998. Sera from 327 patients were tested for evidence of anti-rubella virus, measles virus, human parvovirus B19 and dengue fever virus specific immunoglobulin IgM and anti-human herpes virus type 6 (HHV-6) IgG antibodies. A laboratory confirmed diagnosis was achieved in 71.3% of the cases investigated: dengue fever (33.0%), rubella (20.2%), parvovirus B19 (9.2%), measles (6.7%) and HHV-6 (2.1%). No diagnosis was established for 94 cases (28.7%). An outbreak of measles was detected during 1997, with a peak in September and October. All of the diseases studied here presented with clinical features similar to measles and classical symptoms were found in all measles confirmed cases. The large overlap of combinations of signs and symptoms seen in this study highlights the difficulties of diagnosing a rash illness on clinical grounds alone.

[Severe initial manifestations of psoriasis in staphylococcal infections]

Psoriasis vulgaris is a chronic disease with certain restrictions of life quality, but rarely life threatening. However, psoriatic erythroderma or pustular psoriasis can be a diagnostic or therapeutic challenge, especially when it arises as the primary manifestation of disease. Here we report on two patients with severe clinical course of pustular psoriasis or psoriatic erythroderma, both possibly induced by Staphylococcus aureus. This microorganism was cultivated from skin scrapings in both patients, in the patient with pustular psoriasis from the blood, and in the patient with erythroderma from the nose. Both patients had anti-staphylolysin antibodies. Both patients showed resolution of their disease only by the action of systemic antibiotics. We suggest that staphylococcal superantigens which activate T-cells might play an important role in severe psoriasis by inducing a systemic Köbner phenomenon and thus a progression of disease.

Parakeratosis variegata: a possible role of environmental hazards?

We report 2 cases of parakeratosis variegata (PV) evolving from lesions beginning with characteristics of ashy dermatosis. Both patients presented with a reticulated, poikilodermatous and hyperpigmented eruption with bizarre coalescent lichenoid papules. Histology showed lichenoid epidermotropic infiltrates, more pronounced in case No. 1, consistent with early malignancy. The course was chronic: after more than 10 years, systemic symptoms were not present. In patient No. 1, a monoclonal T-cell population was detected 12 years after the onset of the disease. Both patients had close contact with fertilizers and insecticides. In patient No. 2, the lesions spontaneously regressed within 3 years after cessation of exposure. PV may be a prelymphomatous stage of mycosis fungoides or some closely related cutaneous T-cell lymphoma and does not always evolve into overt malignancy. Gene rearrangement detection techniques may be helpful in predicting the course of the disease.

Rapid reversal of manifestations of acquired zinc deficiency in alcoholic cirrhosis with diet therapy

Features of acquired zinc deficiency syndrome occurred in an alcoholic cirrhotic during hospital stay while he was on parenteral nutrition. Rapid reversal of symptoms occurred with resumption of normal diet without additional zinc supplementation.

Graft-versus-host disease after liver transplantation

We describe a case of graft-versus-host disease that developed in the recipient of an orthotopic liver transplant. A maculopapular eruption developed on postoperative day 25. After the diagnosis of graft-versus-host disease was made aggressive therapy was instituted, which resulted in a complete recovery.

[Lichenoid pityriasis (parapsoriasis guttata) in children. Report of 17 cases]

Seventeen cases of pityriasis lichenoides diagnosed over a nine-year period in children under 15 years of age are reported. Patients with this benign disease develop papular skin lesions covered with thick, coherent scales which detach in a single piece (reminiscent of sealing wax). Pruritus is not marked. Lesions may be necrotic (Mucha Habermann's small pox-like form, n = 6) or mild (leukodermic form, n = 2). Half of the patients studied developed several episodes and total duration of the disease exceeded two years in one third of cases. Recovery occurred after one or two episodes in half the children. Scars developed in some patients with severely necrotic lesions. None of the patients developed lymphoma. All patients with lymphomatoid papulosis progressing to lymphoma reported in the literature were adults. Pathogenesis of pityriasis lichenoides remains unknown but may involve lymphocytic vasculitis. No truly effective therapy is available. However, oral macrolides can be used especially in patients with early manifestations suggesting an infectious disease. Emollients, heliotherapy and ultraviolet therapy may also be recommended.

Unusual chronic maculopapular rash associated with human immunodeficiency virus infection

A 21-year-old black man with sickle cell disease who has received blood transfusions for 11 years because of recurrent stroke has had a decline in numbers of circulating lymphocytes and T4 cells over the past four years. Two and a half years ago persistent generalized lymphadenopathy developed, associated with a positive test for human immunodeficiency virus (HIV) antibody. For the past seven months he has had a pruritic maculopapular rash, primarily on the extensor surfaces of the extremities. Multiple skin biopsies revealed only nonspecific perivascular infiltrates of mononuclear cells. This rash appears to be an unusual manifestation of HIV infection, and may be an indicator of impending AIDS.

Pruritic maculopapular skin lesions in sarcoidosis. An unusual clinical presentation

Pruritic maculopapular rash occurred in a 23-year-old black man. The lesion remained undiagnosed and required frequent hospital admissions. Twenty years after the onset of symptoms, the skin and lymph node biopsy specimens showed noncaseating granulomas. Sarcoidosis should always be included in the differential diagnosis of pruritic skin lesion.

[Mycosis fungoides]

The classical characteristics of Myocsis Fungoides are discussed. 1) The clinical characteristics of the three forms: tumour from the start, erythrodermic and polymorphic forms of Alibert-Buzin. 2) Histological characteristics : dense dermal infiltrates or epidermotropic infiltration, or around a more or less malignant histiocytic reaction, there develops a host reaction, resembling a granuloma. During the course of the disease, one may observe lymphocyte depletion, whilst delayed hypersensitivity tests become negative. The various types of lymphadenopathy are analysed, the possibility of visceral lesions confirmed. However, knowledge of Sezary's syndrome makes his concept of the disease doubtful. A pathological picture similar to Mycosis Fungoides may be observed during Sezary's syndrome, with circulating giant cells. The presence of small Sezary cells, Lutzner-Flandrin variety, is common in the dermal infiltrate, and even more common in the lymph node visceral infiltrates of Mycosis Fungoides. Thus, one is led to the concept according to which the primary phenomenon is probably pathological proliferation of abnormal T lymphocytes (large and small Sezary cells), the histiocytic proliferation would then simply be a secondary reaction. This theory is then discussed.