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Biomedical subjects

C J Cockerell

Publications and source records attributed to C J Cockerell.

At least 19 recordsLinked to original sources
PubMed1992

Widespread cutaneous and systemic calcification (calciphylaxis) in patients with the acquired immunodeficiency syndrome and renal disease.

BACKGROUND: Calciphylaxis is a form of widespread calcification that may occur in patients with renal disease and hyperparathyroidism. The skin is often affected secondary to vascular compromise and ischemia. Patients infected with the human immunodeficiency virus (HIV) are predisposed to renal failure and thus may develop this serious complication. OBJECTIVE: The purpose of this article is to describe two cases of fatal calciphylaxis in patients with the acquired immunodeficiency syndrome and renal disease. METHODS: Two patients were examined clinically and through the performance of serologic studies and skin biopsies. RESULTS: Both patients had a widespread livedo reticularis-like eruption, which rapidly progressed to cutaneous gangrene. Patient 1 had elevated serum calcium and phosphorus levels whereas patient 2 had normal values but had markedly elevated serum parathyroid hormone levels. Biopsy specimens in both cases showed vascular thrombosis and soft tissue calcification. CONCLUSION: Widespread calcification may develop in patients with HIV infection and renal failure and, in some cases, calcium and phosphorus levels may be normal.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The clinical spectrum of bacillary angiomatosis.

Bacillary angiomatosis is a recently recognized bacterial infectious disease that is seen mainly in patients with the acquired immunodeficiency syndrome. Including this publication, 45 patients have been described in the medical literature. In this report we describe examples of the clinical presentations of bacillary angiomatosis and review therapeutic strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pityriasis rubra pilaris in the setting of HIV infection: clinical behaviour and association with explosive cystic acne.

The development of pityriasis rubra pilaris (PRP) in three patients with human immunodeficiency virus (HIV) infection is described. Two of the patients had onset of severe generalized cystic acne concomitant with their development of PRP. PRP and acne conglobata should be added to the group of cutaneous disorders that can present in a more virulent manner in the setting of HIV infection. The association of cystic acne with PRP and their response to treatment are discussed.

Acne Vulgaris↗
PubMed1992

Sensitivity of diagnosis of malignant melanoma: a clinicopathologic study with a critical assessment of biopsy techniques.

Although most examples of cutaneous malignant melanoma are easily recognized by their clinical appearances, in some cases this serious neoplasm may clinically simulate other less serious forms of skin cancer or benign processes. This study was undertaken to assess both the sensitivity of clinical diagnosis of cutaneous malignant melanoma and the efficacy of biopsies of clinically unsuspected melanomas in yielding specimens on which complete and accurate histologic assessments could be made. A retrospective analysis of 1784 cases of histologically proven melanomas diagnosed between 1985 and 1990 was performed in search of lesions not clinically suspected. Biopsy techniques used to sample these lesions were subjected to critique of their efficacy in yielding specimens that could be accurately diagnosed and completely assessed histologically. Of 1784 histologically proven primary cutaneous melanomas, 583 were not clinically suspected, yielding a sensitivity of 67%. Clinical diagnosis included nevi (33%), no diagnosis (17%), multiple diagnoses (13%), basal cell carcinoma (12%), keratosis (9%), and lentigo (9%) among others. The biopsy methods used to sample these lesions were shave (56%), excisional (24%), punch (11%), curettage (2%), and undetermined (6%). Eighty-six percent of shave biopsies could be accurately assessed while only 32% of punches and no curettages provided sufficient material for both definitive and complete evaluation of melanomas. Eighteen percent of specimens histologically reviewed were considered inadequate for complete evaluation. In 34%, the actual diagnosis of melanoma was uncertain because of inability to assess diagnostic features as a consequence of the biopsy technique. Melanoma may be unsuspected clinically in a significant number of cases and may be mistaken for less serious cutaneous neoplasms.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1992

An unusual presentation of secondary syphilis in a patient with human immunodeficiency virus infection. A case report and review of the literature.

BACKGROUND: Syphilis has been reported to assume unusual clinical appearances and to exhibit unusual courses in patients infected with the human immunodeficiency virus (HIV) type 1. We recently observed a distinct manifestation of syphilis in an HIV-infected patient with features not previously described. OBSERVATIONS: A 38-year-old HIV-seropositive homosexual man presented with fever, chills, malaise, and a cutaneous eruption consisting of indurated, shiny, erythematous plaques that were confluent on the face and scalp leading to alopecia and extreme tautness of the skin. Initial clinical diagnoses included lymphoreticular malignancy and infection. Although cultures yielded Staphylococcus aureus, a skin biopsy specimen was diagnostic of syphilis. CONCLUSIONS: This case demonstrates an unusual clinical manifestation of syphilis in a patient with HIV infection and emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of virtually any inflammatory cutaneous disorder in HIV-seropositive individuals.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Accuracy in diagnosis of lymphomatoid papulosis.

This study was undertaken to assess the accuracy of histologic diagnosis of lymphomatoid papulosis (LyP), which may be confused with malignant lymphoma or other entities. It is essential that accurate diagnoses be made because LyP may be a marker for malignant lymphoma. All 15 examples of LyP reviewed in a dermatopathology laboratory during a 14-year period and 180 histologic sections of tissue that could be confused with LyP were reviewed. Criteria for diagnosis of LyP were applied without benefit of clinical history, and revised diagnoses were made where indicated. Clinical follow-up information was obtained and original accuracy of diagnosis was assessed by comparing clinical courses with original histologic diagnoses. In cases of LyP in which numerous atypical lymphoid cells were present, 100% accuracy was noted. When fewer atypical lymphoid cells were present and inflammatory cell infiltrates were less dense, the diagnosis was less certain. Overall, a 64% correlation of clinical course and histologic diagnosis of LyP was noted. We conclude that the histologic diagnosis of LyP is generally reliable and accurate; however, in some cases a precise diagnosis cannot be made with certainty. Cases with fewer atypical lymphoid cells may fail to correlate well with the classic course of LyP and may represent a variant or histologic simulator.

Cell Nucleus↗
PubMed1991

Reliability of prognostic models in malignant melanoma. A 10-year follow-up study.

Certain histologic and clinical features of malignant melanoma have been shown to be indicators of prognosis, both collectively and individually. Even though the predictive value of these features is well established, long-term survival is occasionally seen in individuals with multiple poor prognostic factors. To further examine this phenomenon, histologic sections from 53 patients with malignant melanoma excised between the years 1977 and 1980 in whom reliable clinical follow-up data were obtained were evaluated for the presence of features associated with a poor prognosis (thickness greater than 1.7 mm, Clark level greater than or equal to III, vertical growth phase, high mitotic index, marked cytologic atypia, minimal tumor inflammatory infiltrate, presence of regression, presence of plasma cells, male sex, age greater than or equal to 45 years, and axial anatomic location). Sixty-eight percent of the patients survived for greater than or equal to 10 years. Of these, 26% had lesions greater than or equal to 1.7 thick. Multivariate discriminant analysis of all features provide a model that was 76% accurate in predicting outcome over a 10-year period. Although the predictive value of these prognostic variables is generally reliable, there is a significant population of long-term survivors in whom prognosis could not be accurately predicted using these features.

Adult↗
PubMed1991

Histologic features and sensitivity of diagnosis of clinically unsuspected cutaneous melanoma.

The purpose of this study was to assess the sensitivity of clinical diagnosis of cutaneous malignant melanoma and to evaluate histologic characteristics of lesions not clinically diagnosed as such. Of 1,784 cases of histologically proven cutaneous malignant melanoma submitted routinely to a university dermatopathology laboratory between 1985 and 1990, 583 (33%) were not clinically suspected. The overall sensitivity in clinical diagnosis was 67%. Histologic features evaluated included presence of melanin, pagetoid spread of melanocytes, degree of inflammation, regression, presence and degree of sun damage as evidenced by solar elastosis, presence of melanin in the cornified layer, and coexisting nevus cells. Melanomas clinically thought to be nevi had less solar elastosis and most frequently had associated nevus cells. Those thought to be basal cell carcinomas had less melanin in lesions and less melanin in the cornified layer, and most often had foci of regression. Lesions thought to be keratoses showed melanin in the cornified layer 70% of the time, more often than any other type of lesion. Melanoma may be unsuspected clinically in a significant number of cases and can be mistaken for less serious cutaneous neoplasms. Histologic features of these lesions correlated well with original clinical diagnoses.

Basal Cell Carcinoma↗
PubMed1991

Clinical, histologic, microbiologic, and biochemical characterization of the causative agent of bacillary (epithelioid) angiomatosis: a rickettsial illness with features of bartonellosis.

It has been suggested that bacillary (epithelioid) angiomatosis (BEA) is a manifestation of cat scratch disease (CSD). Because of clinical similarity between this condition and the verruga peruana phase of bartonellosis, we sought to further characterize this disease as well as its causative agent and to compare it to bartonellosis. We isolated a small flagellated pleomorphic bacillus from skin lesions of two patients with BEA. Organisms were stained successfully with Warthin-Starry silver stains, but immunohistochemistry failed to demonstrate binding with a polyclonal antibody directed against the cat scratch bacillus. Whole cell fatty-acid gas chromatography performed on both BEA organisms and Bartonella bacilliformis demonstrated marked similarity between the two. Electron microscopy of BEA organisms in tissue and in suspension revealed features characteristic of a gram negative bacillus. Based on these findings, we propose that this unusual rickettsial infectious disease with vascular proliferation may represent an unusual variant of infection with a bartonella-like organism rather than a manifestation of cat scratch disease.

Adult↗
PubMed1991

Histopathological features of Kaposi's sarcoma in HIV infected individuals.

Kaposi's sarcoma is the neoplasm most commonly associated with HIV infection. Since its presence in the proper clinical context is an AIDS defining event, histopathological confirmation is often required for diagnosis. It is essential that clinicians know the criteria for histopathological diagnosis. When the criteria outlined are followed, the diagnosis can be made with certainty in most cases. A number of conditions may simulate KS both clinically and histologically, and it is important that those who care for patients with HIV infection are aware of these.

Diagnosis, Differential↗
PubMed1991

Noninfectious inflammatory skin diseases in HIV-infected individuals.

Noninfectious inflammatory skin diseases are often a persistent problem for patients with infection with the human immunodeficiency virus (HIV), and they present both diagnostic and therapeutic challenges for the dermatologist. Well-defined diseases such as granuloma annulare, reactions to insect bites, and leukocytoclastic vasculitis may be more severe in these individuals and may be refractory to therapy. More poorly defined conditions with psoriasiform and papular morphologies have also been described. A number of skin conditions, including pityriasis rubra pilaris, cutaneous T-cell lymphoma, and erythema elevatum diutinum, have recently been observed in the HIV-infected host. Because the dermatologist plays an important role in diagnosis and management of patients with HIV infection, it is important that he or she be well versed in the clinical manifestations and natural history of these conditions.

Drug Eruptions↗
PubMed1991

Clinical features of dysplastic nevi.

The clinical features of 100 dysplastic nevi were tabulated. Although certain characteristics were present in most or all of these melanocytic nevi, there was a marked heterogeneity of other clinical features. The preponderant type of large (greater than or equal to 8 mm) melanocytic nevus in patients with classic dysplastic nevi is a papule or plaque with the following characteristics: multicoloration (various shades of tans, browns, reds, or black); slightly raised height for its broad diameter; mamillated surface; and lack of hypertrichosis. An atlas illustrates some of the clinical varieties of melanocytic nevi in this syndrome.

Dysplastic Nevus Syndrome↗
PubMed1991

Cutaneous Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome.

Extrapulmonary infection with Pneumocystis carinii is an uncommon event in which the skin may be affected rarely. All cases heretofore described in immunocompromised hosts have involved the external auditory canal and mastoid areas. We describe two patients with acquired immunodeficiency syndrome and extrapulmonary cutaneous P carinii infection that involved the glabrous skin. The first was a 31-year-old white man seropositive for human immunodeficiency virus with prior episodes of P carinii pneumonia and infection with Mycobacterium avium-intracellulare evaluated for translucent papules on the skin with an appearance similar to molluscum contagiosum infection. Biopsy confirmed the diagnosis of cutaneous pneumocystosis. The second patient was a 36-year-old homosexual man with long-standing liver disease with a persistent cough, fever, and an abnormal chest roentgenogram. Cutaneous evaluation revealed a bluish macule on the sternal notch that on skin biopsy was diagnostic of cutaneous pneumocystosis. Treatment with intravenous pentamidine resulted in resolution of the pulmonary and cutaneous problems in both cases. Extrapulmonary P carinii infection may involve the skin at sites other than the external auditory canal and may have a nondescript appearance. Histologic findings are similar to those of pneumocystosis found elsewhere. Clinicians should be familiar with the nondescript nature of the eruption as skin biopsy may be helpful in establishing a diagnosis of systemic pneumocystosis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Human immunodeficiency virus infection and the skin.

The skin is commonly affected in the course of human immunodeficiency virus (HIV) infection. In many cases, skin findings may be the earliest sign of HIV disease or acquired immunodeficiency syndrome. When cutaneous diseases occur in unusual settings, such as zoster in a young individual, are increased in severity or fail to respond to routine therapy, the possibility of underlying immunodeficiency should be suspected. Skin diseases in HIV-infected hosts include primary infections, such as those caused by herpes simplex virus and molluscum contagiosum, as well as secondary involvement of systemic diseases, such as cryptococcosis and histoplasmosis. Noninfectious inflammatory processes, such as seborrheic dermatitis and psoriasis, as well as neoplasms, such as Kaposi's sarcoma and basal cell carcinoma, may all be seen in these patients. We review a number of these diseases and discuss their treatment. Clinicians must be aware of the cutaneous manifestations of HIV infection so that the disease will be recognized at an earlier point in time and therapy with zidovudine and prophylactic antibiotics will be instituted where appropriate.

HIV Infections↗
PubMed1990

Bacillary angiomatosis: a newly characterized, pseudoneoplastic, infectious, cutaneous vascular disorder.

Bacillary angiomatosis (also called epithelioid angiomatosis) is a newly recognized disease most often characterized by a cutaneous infection with reddish papules of vascular origin. It is caused by a weakly reactive gram-negative bacillus, which can be easily demonstrated in tissue sections with the Warthin-Starry stain. Bacillary angiomatosis usually responds readily to treatment with oral erythromycin, 250 to 500 mg, taken four times a day for 2 weeks to 1 month. Because the skin is the most common site of involvement, it is important that the dermatologist recognize this unusual condition. It is essential that treatment be started as soon as possible because deaths may result from visceral and mucosal involvement. The clinical, histologic, and microbiologic aspects of bacillary angiomatosis are discussed and depicted in detail and speculations regarding the pathogenesis are rendered.

Angiomatosis↗
PubMed1990

Cutaneous manifestations of HIV infection other than Kaposi's sarcoma: clinical and histologic aspects.

The skin is commonly affected in patients with human immunodeficiency virus (HIV) infection. Viral, bacterial, fungal, and protozoal infections and ectoparasitic infestations may affect the skin primarily or secondarily in this patient population. In addition, common inflammatory dermatoses may be severe and persistent. Furthermore, unusual inflammatory conditions not commonly seen in immunocompetent patients may occur. The more common opportunistic infectious diseases, as well as some of the inflammatory dermatoses, in patients with HIV infection are discussed. By recognizing these conditions, patients with HIV infection can be more readily identified and treated.

Acquired Immunodeficiency Syndrome↗