Cryoglobulinaemic vasculitis, cryofibrinogenaemia and low-grade B-cell lymphoma.
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Biomedical subjects
Publications and source records attributed to M M Medenica.
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We describe a 3-year-old male patient with an unusual congenital lesion on the plantar surface of the left foot that had been asymptomatic until shortly before presentation. Histologic examination of the plaque revealed a thinner keratin layer, increased pigmentation, and a pilosebaceous unit with a visible vellus hair. We tentatively hypothesize from this single case that a disruption in the normal sequence of events of morphogenesis, and particularly in dorsal-to-ventral orientation, may have occurred in this patient.
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We report a case of tinea of the face caused by Trichophyton rubrum in which the histologic changes were consistent with granuloma faciale. We recommend that local infection with dermatophytes be considered in all cases of histologic granuloma faciale, especially when the clinical presentation is atypical for this dermatosis.
A distinctive acral erythema developed in four patients with myelogenous leukemia, subsequent to blood transfusions and intensive chemotherapy with cytarabine. The clinical and histopathologic features of the eruption were suggestive of a drug-induced toxic eruption. To our knowledge, only one previous similar case has been reported in the literature. For patients in whom this self-limited condition develops, reassurance should serve as the mainstay of therapy.
Diabetics may have an increased susceptibility to cutaneous blister formation clinically manifest as the bullous eruption of diabetes. We evaluated the mechanical force necessary to induce suction blisters in fifteen insulin-dependent diabetics and twenty age-matched normal controls. The mean suction blister threshold for the diabetics was 31.9 minutes versus 68.0 minutes for the controls, a highly significant difference (p less than 0.01). Histologic appearance of suction blisters was similar in diabetic and normal skin, under both light and electron microscopic examination, with a noninflammatory subepidermal separation in the lamina lucida between the cell membrane and the basal lamina. These results demonstrate that insulin-dependent diabetics have a marked reduction in suction blister threshold as compared to age-matched controls.
Skin necrosis is a rare complication of heparin administration that is usually localized to injection sites. A 32-year-old insulin-dependent diabetic patient, receiving intravenous (IV) and low-dose heparin sodium therapy, had cutaneous necrosis in areas distant to the sites of injection. Prior to the onset of cutaneous lesions, thrombocytopenia develop]ed in the patient that may have been heparin induced. Heparin may induce the production of platelet aggregating immunoglobulins that predispose persons who are sensitive to the drug to thrombocytopenia, skin necrosis, and thrombotic events. Obesity, diabetes, and treatment with broad-spectrum antibiotics seem to increase the risk of such complications. Cutaneous necrosis secondary to heparin administration may serve as a warning of the potentially lethal complications of IV use. In patients in whom skin necrosis or thrombocytopenia develops, heparin therapy should be discontinued and anticoagulation with an oral agent should be considered.
We report herein the concurrent appearance of childhood pemphigus foliaceus and Graves' disease in a 14-year-old girl who was initially seen with crusted and hyperpigmented plaques on her chest, back, abdomen, and legs. The diagnosis of pemphigus foliaceus was confirmed by biopsy and immunofluorescent microscopic studies while the diagnosis of Graves' disease was based on clinical and laboratory findings. The coexistence of these two immune-mediated diseases in a single patient suggest that some persons may bear a unique predisposition to the development of two or more autoimmune-type disorders that may affect diverse organ systems.
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