Biomedical subjects
Publications and source records attributed to S S Raimer.
A 5-month-old male was examined in our dermatology clinic with numerous palmoplantar milia. The child had early congenital syphilis with palmoplantar desquamation, which was followed by the development of milia. Histologic and electron microscopic features suggested that these secondary milia probably derived from the epidermis.
Tinea faciei has been observed periodically in children, however, it is a relatively rare occurrence in infancy. We examined three infants with tinea faciei caused by Trichophyton tonsurans. Two of the patients were potassium hydroxide (KOH) negative for fungal hyphae but culture positive, while the third was both KOH and culture positive. Trichophyton tonsurans was isolated from the scalp of family members in two of the three infants.
Electron microscopic examination in a case of papular xanthoma revealed the presence of myelinlike laminated bodies in the cytoplasm of the foam cells. To our knowledge, similar bodies have been described in large numbers in only two cases of congenital self-healing histiocytosis and one case of generalized eruptive histiocytoma. The presence of laminated bodies may be a morphologic characteristic of papular xanthoma. However, this possibility should be confirmed by identification of the same inclusions in other cases of this disease.
Although microscopic areas of panniculitis may frequently occur in patients with dermatomyositis and polymyositis, large, clinically obvious plaques are unusual. We report a patient with polymyositis who initially had panniculitis of the thigh. Histologically, a lobular lymphoplasmacytic infiltrate was present in the subcutis.
Bullous pemphigoid often affects the elderly but is not common in children. At least two localized variants, cicatricial pemphigoid and localized, chronic pemphigoid of Brunsting-Perry, have been described. A case of bullous pemphigoid in a 9-year-old girl was unusual because erosions were limited to the vulvar area. Other bullous dermatoses were considered in the differential diagnosis. Histopathologic examination and immunofluorescence microscopic studies, as well as immunoelectron microscopic studies, which yielded unique results, were performed to confirm the diagnosis.
The pigmented purpuras comprise a group of dermatoses that are most commonly located on the lower extremities and share related clinical and histopathologic appearances. Included is a discussion of the following entities: progressive pigmentary disease of the skin (Schamberg's disease), purpura annularis telangiectodes (Majocchi's disease), pigmented purpuric lichenoid dermatosis (Gougerot and Blum's disease), and lichen aureus.
A neonate was noted to have two depressed scars on the upper part of the back at birth that we believe resulted from midtrimester amniocentesis; no underlying injury was apparent. Scar formation from needle puncture occurs in an estimated 1% to 3% of the infants whose mothers have undergone midtrimester diagnostic amniocentesis. The scars most commonly are depressed, dimplelike, and measure 1 to 2 mm in diameter, although linear scarring may also occur. Single or multiple scars may be present, and, in seven of the 36 infants previously described in the literature, internal injuries also occurred as a result of the needle puncture.
Calcinosis cutis may be associated with metastatic calcification, dystrophic calcification, tumoral calcinosis, or may be deemed idiopathic. The association of cutaneous calcification with metastatic or tumoral calcinosis is quite rare. A case of metastatic calcinosis cutis in a woman with chronic renal failure and secondary hyperparathyroidism is presented. Other causes of calcinosis cutis are discussed briefly.
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A recurrent, episodic illness that occurs in as many as 20% of patients who undergo ileojejunal bypass surgery for morbid obesity has been well characterized and includes inflammatory cutaneous lesions with a histologic appearance like that of neutrophilic vasculitis, a nondeforming polyarthritis, and other systemic manifestations. Current concepts of pathogenesis center on overgrowth of bacterial flora in the bypassed bowel segment with subsequent development of a circulating immune complex disease. We report, for the first time to our knowledge, an identical clinicopathologic syndrome in four patients who have not had jejunoileal bypass surgery. Each patient, however, had other gastrointestinal disease that we believe predisposed to this syndrome, possibly via circulating immune complexes with bowel-associated antigens. We propose the expanded term, bowel-associated dermatosis-arthritis syndrome, to incorporate these new cases. We believe that this is not a rare syndrome and that it is easily distinguishable from other types of cutaneous necrotizing vasculitis.
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Child abuse is a well-established clinical entity affecting over one million children each year in this country. All physicians are responsible for the recognition of this syndrome and for the initiation of prompt treatment. Presented are some of the classical cutaneous signs of child abuse, including physical abuse, neglect, and sexual assault. The abusive pattern is described and the need for physician awareness noted.
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A dystrophic bullous eruption that met all the criteria for epidermolysis bullosa acquisita (EBA) developed in a 19-year-old woman five years before the onset of clinical and serologic evidence of systemic lupus erythematosus (SLE). Electron microscopic studies of skin lesions both before and after the development of SLE were consistent with the previously reported electron microscopic findings in patients with EBA. Direct immunofluorescence microscopic studies done on bullae before and after the diagnosis of SLE showed linear depositions of immunoglobulin and complement; indirect immunofluorescence microscopic study findings consistently showed no abnormalities. These findings have been noted in other cases of EBA and may implicate autoimmune, immunologic factors in the pathogenesis of the disease process. To our knowledge, the finding of SLE in association with EBA has not been previously reported.
Toxic shock syndrome (TSS) is a recently recognized condition associated with toxin-producing strains of Staphylococcus aureus. Patients affected with this syndrome are frequently young and have multisystemic complaints such as fever, headache, edema, myalgia, scarlatiniform rash, conjunctival injection, confusion, diarrhea, oliguria, hypotension and shock, This is followed by desquamation of the skin, especially the palms and soles. The majority of cases reported have been in menstruating women who used vaginal tampons regularly. Because similarities exist between toxic shock syndrome and Kawasaki's disease (mucocutaneous lymph node syndrome), as well as other conditions, proper diagnosis and management are of the utmost importance.
A 32-week-old (gestational age) female infant with epidermolysis bullosa letalis (EBL) (confirmed by light and electron microscopy) had a gastric-outlet obstruction on routine roentgenographic examination. An autopsy showed a fibrous cord connecting the stomach and first part of the duodenum in the area of the pylorus. A review of the literature indicated 12 additional cases of epidermolysis bullosa (EBL where type was confirmed) associated with pyloric atresia. The possibility of coexistent pyloric atresia should be considered in a newborn who has suspected EBL.
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