Biomedical subjects
Publications and source records attributed to Archana Singal.
A 10-year-old boy presented with lymphangioma involving the anterior two-thirds of the tongue. Excellent cosmetic and functional results were achieved with multiple intralesional steroid injections. Various treatment modalities advocated for lymphangioma of the tongue are discussed.
Herpes zoster or shingles is an acute vesico-bullous cutaneous infection characterized by dermatomal distribution, predominantly in adults. Extensive cutaneous dissemination has been reported in immunocompromised patients. However, its existence is documented in immunocompetent individuals as well. We report two children with disseminated herpes zoster, one of whom was immunocompromised secondary to severe mal-nutrition and had associated orbital septal cellulitis.
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Localized tinea cruris and tinea corporis can be treated by topical imidazoles (clotrimazole) or newer topical agents like butenafine, a benzylamine derivative with fungicidal activity. The therapeutic efficacy of these two agents was compared in this study. Eighty patients, diagnosed clinically to have tinea cruris or localized tinea corporis and confirmed on KOH examination, were randomly assigned to one of the two treatment groups in a double-blind manner; butenafine once daily for 2 weeks or clotrimazole twice daily for 4 weeks. Follow-up was done at 1, 2, 4 and 8 weeks. Clinical assessment score and KOH examination were performed at each visit. Butenafine recipients exhibited higher clinical cure as compared with clotrimazole recipients at the end of 1 week (26.5% vs 2.9%) as well as higher mycological cure (61.7% vs 17.6%). However, this difference was not statistically significant at 4 and 8 weeks of treatment.
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BACKGROUND: Lichen scrofulosorum is considered a rare form of cutaneous tuberculosis. Current information is based on case reports and case series with a small number of patients. METHODS: Thirty-nine patients with Lichen scrofulosorum were followed during the period January 1996 to December 2002. Clinical details (age, sex, duration of disease, associated tubercular lesions, extent and distribution of skin lesions), laboratory parameters (hemoglobin, total leucocytic counts, erythrocyte sedimentation rate, Mantoux test, presence of BCG scar), and response to antitubercular treatment were recorded and analyzed. RESULTS: 7.6% patients of all (511) patients with cutaneous tuberculosis had LS. 22 (56.4%) were males and 32 (84%) were below 15 years of age. Twenty-eight (72%) had an associated focus of tuberculosis elsewhere in the body; 13 (33%) had tubercular lymphadenopathy, while 11 (28%), three (8%) and six (15%) had pulmonary tuberculosis, intracranial tuberculosis and other forms of cutaneous tuberculosis, respectively. Six (15%) had tubercular focus at multiple sites. Eleven (28%) had no other identifiable focus of tuberculosis. Twenty-eight (72%) had evidence of receiving BCG vaccination. Trunk was the commonest (100%) affected site. The two groups with and without associated tubercular focus were not different with respect to age, sex, duration of disease, hemoglobin, total leukocyte count, erythrocyte sedimentation rate, Mantoux test positivity, and presence of BCG scar. Mycobacteria tuberculosis could not be detected either on acid fast bacilli (AFB) staining or on culture from biopsies of LS lesions. All patients (including those without evidence of tubercular focus) responded to antitubercular treatment, signifying an underlying occult tubercular focus as etiology. CONCLUSIONS: Lichen scrofulosorum is an uncommon but not rare cutaneous manifestation of tuberculosis. A high index of suspicion and awareness is required for diagnosis. Systemic tuberculosis is often associated with LS and a prior BCG inoculation does not protect against development of LS. Response to antitubercular treatment is good irrespective of the presence or absence of associated tubercular focus.
We describe three cases (one male and two females) of faun tail nevi, which is one of the most important cutaneous marker of spinal dysraphism. One of the patients presented with acro-osteolysis leading to auto amputation of the toes of the left foot, which required operative intervention. This lays stress on the early recognition of lumbar paraspinal skin lesions and early treatment to avoid irreversible sequelae.
We describe the case of a 4-year-old boy, with a positive family history of multibacillary leprosy (borderline-borderline) in his 12-year-old sister. The patient was diagnosed to have borderline lepromatous (BL) leprosy, BI of 4 + and had two erythematous, infiltrated plaques over the scrotum. He developed type reaction, 3 months following initiation of multibacillary multidrug therapy (MB-MDT) and responded favourably to systemic corticosteroids.
Erythema nodosum leprosum necroticans is an uncommon manifestation of type 2 lepra reaction, encountered in lepromatous and borderline lepromatous cases of leprosy. We report an unusual clinical presentation of necrotic erythema nodosum leprosum in a 9-year-old boy with no pre-existing evidence of leprosy. The lesions resolved completely following multi-bacilliary multi-drug therapy for 12 months, non-steroidal anti-inflammatory drugs and corticosteroids.
We describe the first case of a sixty-five-year-old male field worker from India, having lesions of hereditary punctate palmoplantar keratoderma with an autosomally dominant pattern of inheritance. Associations included nail abnormalities in the form of longitudinal ridging, onychorrhexis, onychoschizia, trachyonychia and notching, which has been reported only on one previous occasion. The article also presents a brief review of the literature.
PURPOSE: To study the prevalence, manifestations and severity of ocular involvement in Indian patients with Behcet's disease. METHOD: Prospective analysis of all patients of suspected Behcet's disease between 1997 and 2001. RESULTS: A total of 19 patients were diagnosed to have Behcet's disease. Ocular manifestations were seen in 36% patients. The commonest manifestation was conjunctival ulcer (26.3%), followed by iridocyclitis (10.5%). None of the patients had posterior segment involvement or visual loss. Response to topical corticosteroids was good. CONCLUSION: The prevalence and severity of ocular lesions in Behcet's disease is relatively low in Indian patients. Conjunctival ulcers was a common finding, which is rarely reported in the world literature.
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Tuberculosis and malnutrition continue to be significant health problems in developing countries. Moderate to severe malnutrition can cause immunosuppression and predispose children to various infections. We report disseminated tuberculosis in a severely malnourished Indian child who presented primarily with cutaneous involvement.
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Cutaneous tuberculosis may be associated with concurrent systemic foci in the body such as lung, lymph node, bone or CNS. Phlyctenular keratoconjunctivitis (PKC) is a manifestation of immunological response to a variety of antigens in the eye, tubercular focus (evident or occult) being the commonest in India. Reports in the existing literature have shown lungs and lymph nodes to be the predominant underlying focus associated with PKC, whereas cutaneous tuberculosis has seldom been found in this situation. We report this forgotten association in two children with cutaneous tuberculosis, one each with lupus vulgaris and scrofuloderma, who also had PKC. Interestingly, one of the cases also had simultaneous lichen scrofulosorum, which is also an immunological response to tubercular antigen and manifests in the skin, thus showing immunological manifestation in two different organ systems along with cutaneous focus of tuberculosis.