Papular Lesions Research Articles

Multiple Vascular Papular Lesions on Left Sole

Multiple Vascular Papular Lesions on Left Sole

Case Report: Hypercalcemia and Acute Kidney Injury Associated with Disseminated Paracoccidioidomycosis

Paracoccidioidomycosis is an acute to chronic systemic mycosis caused by the fungi Paracoccidioides. Hypercalcemia is a rare and not fully understood presentation of this infection. We present a case report of paracoccidioidomycosis associated with hypercalcemia and acute kidney injury (AKI) in an immunocompetent patient. An immunocompetent 30-year-old man from Brazil presented with papular erythematous-violaceous skin lesions, disseminated lymphadenopathy, pain in the left hypochondrium, fever with night sweats, and loss of 25 kilograms in 5 months. The result of a biopsy of the lesions was positive for Paracoccidioides brasiliensis. Laboratory findings were high total calcium and 1,25-dihydroxy vitamin D, with low parathyroid hormone, low albumin, and AKI. Computed tomography scans revealed splenic infarcts without bone lesions. Treatment was performed with methylprednisolone and liposomal amphotericin B. Calcium levels and kidney function normalized within 20 days of hospitalization. The patient was discharged 49 days after admission. A follow-up 6 months later revealed total clinical and serological remission.

Keratosis Lichenoides Chronica with Pulmonary Tuberculosis: A Possible Association.

Keratosis Lichenoides Chronica also known as Nekam’s disease is a rare papulosquamous dermatosis of unknown etiology. It is characterised by violaceous papular and nodular lesions typically arranged in linear and reticulated pattern. Here we report a case of a 72 year old male patient diagnosed with pulmonary tuberculosis who subsequently developed a constellation of features suggestive of Keratosis Lichenoides Chronica.

Caught by a Medieval Disease: A Monoarthritis Revealing Syphilis

Syphilis is a sexually transmitted bacterial infection that first appeared in Europe in the 15th century, responsible for deadly epidemics before the discovery of penicillin. It typically progresses through three phases: primary syphilis, characterized by a syphilitic chancre that may appear on the genital area, anus, or oral cavity and can go unnoticed; secondary syphilis, which corresponds to the hematogenous dissemination of the treponema, leading to skin eruptions occurring in two waves, also known as "florid" phases, with the second wave being the most characteristic, involving papular lesions on the palms and soles. During this phase, there may also be lymphadenopathy, early neurosyphilis, and osteoarticular manifestations such as periostitis and arthritis [1,2,3]. Finally, tertiary syphilis, a historical form, is characterized by cardiac, vascular, and/or neuropsychiatric involvement. We report the case of a patient with risky sexual behavior who presented with an oral ulceration possibly corresponding to an oral syphilitic chancre in the primary phase. The patient did not seek medical attention at that time and developed secondary syphilis with joint involvement two months later. This article aims to remind that syphilis should not be excluded when faced with the combination of oral ulceration and arthritis, alongside chronic inflammatory bowel diseases, Behçet's disease, and lupus. The infection has to be confirmed in the joint aspiration either by isolating the treponema or by finding the pathogen’s DNA or simply by TPHA and VDRL technique ; as for the syphilitic arthritis should be treated as a secondary siphilis.

Molluscum contagiosum virus protein MC089 inhibits interferon regulatory factor 3 activation.

Molluscum contagiosum virus (MCV) is a human-specific poxvirus that causes a highly common but mild infection characterized by distinctive and persistent papular skin lesions. These lesions can persist for long periods without an effective clearance response from the host. MCV, like all poxviruses, encodes multiple known immunosuppressive proteins which target innate immune signalling pathways involved in viral nucleic acid sensing, interferon production and inflammation which should trigger antiviral immunity leading to clearance. Two major families of transcription factors responsible for driving the immune response to viruses are the NF-κB and the interferon regulatory factor (IRF) families. While NF-κB broadly drives pro-inflammatory gene expression and IRFs chiefly drive interferon induction, both collaborate in transactivating many of the same genes in a concerted immune response to viral infection. Here, we report that the MCV protein MC089 specifically inhibits IRF activation from both DNA- and RNA-sensing pathways, making it the first characterized MCV inhibitor to selectively target IRF activation to date. MC089 interacts with proteins required for IRF activation, namely IKKε, TBKBP1 and NAP1. Additionally, MC089 targets RNA sensing by associating with the RNA-sensing adaptor protein mitochondrial antiviral-signalling protein on mitochondria. MC089 displays specificity in its inhibition of IRF3 activation by suppressing immunostimulatory nucleic acid-induced serine 396 phosphorylation without affecting the phosphorylation of serine 386. The selective interaction of MC089 with IRF-regulatory proteins and site-specific inhibition of IRF3 phosphorylation may offer a tool to provide novel insights into the biology of IRF3 regulation.

Lower Limb Elephnatiasis Nostras Verrucosa: Excision with full thickness skin grafting with aid of dermal regeneration template

Elephnatiasis Nostras Verrucosa (ENV) is a rare clinical condition, a progressively disfiguring disorder characterized by verrucous, nodules and cobblestone-like papules associated with non-pitting edema of the lower extremities. Histopathology is characterized by epidermal hyperkeratosis and dermal fibrosis. We report the history of a 32-year-old man who presented with 5 years history of right lower limb edema covered by nodular and papular skin lesions. Proper investigations put the diagnosis of ENV. The patient was successfully treated by debridement followed by skin graft using the technique of dermal regeneration. Management of ENV remains challenging. In the absence of randomized controlled trials on the best modalities of treatment, it is important to report such rare cases and their treatment outcome.

Hepatitis colestásica por sífilis secundaria en paciente con VIH: a propósito de un caso

Syphilis is a sexually transmitted disease caused by Treponema pallidum, and presents a variety of symptoms. Liver involvement in secondary syphilis is uncommon (1%), and can reach up to 3% in patients with HIV infection. We present the case of a 49-year-old man with the diagnosis of HIV on treatment with TARGA and an undetectable viral load, who attended the health center for jaundice, persistent headache, and hyperpigmented papular lesions on palms and soles. After laboratory tests and a cholangiopancreatography, the patient was diagnosed with cholestatic hepatitis due to secondary syphilis. The patient was treated with intravenous penicillin G sodium 3 million IU every 4 hours for 14 days, with a favorable clinical evolution and improvement of cholestasis.

Novel pathogenic variants in HR underlie atrichia with papular lesions in a cohort of 10 families.

Atrichia with papular lesions (APL) is a hair abnormality characterized by loss of hair on the scalp and rest of the body. In a few cases, hair loss is accompanied by the appearance of keratotic papules on the body. It is inherited in an autosomal recessive manner. Sequence variants in the HR (hairless) gene are responsible for this hair abnormality. Here, we present nine consanguineous families and one nonconsanguineous family with clinical manifestations of APL. Whole exome followed by Sanger sequencing and/or direct Sanger sequencing was performed to identify pathogenic variants. The study revealed seven novel pathogenic variants c.794del;p.(Pro265Argfs*98), c.2921-2936del;p.(Tyr974Leufs*16), c.2889C>A;p.(Cys963*), c.2689C>T;p.(Gln897*), c.3186_3187dup;p.(Gln1063Profs*43), c.560dup;p.(Tyr188Ilefs*131), c.2203+5G>C, c.2776+5G>A, and the previously reported variant c.1837C>T;p.(Arg613*) in HR in these families. The study not only expands the mutational spectrum in the HR gene but also highlights the unusual phenotypic findings and will facilitate genetic counseling of families with members showing various types of hair loss disorders in the local population.

A phase II, non-comparative randomised trial of two treatments involving liposomal amphotericin B and miltefosine for post-kala-azar dermal leishmaniasis in India and Bangladesh.

In Southeast Asia, treatment is recommended for all patients with post-kala-azar dermal leishmaniasis (PKDL). Adherence to the first-line regimen, twelve weeks of miltefosine (MF), is low and ocular toxicity has been observed with this exposure period. We assessed the safety and efficacy of two shorter-course treatments: liposomal amphotericin B (LAmB) alone and combined with MF. An open-label, phase II, randomized, parallel-arm, non-comparative trial was conducted in patients with parasitologically confirmed PKDL, 6 to ≤60 years. Patients were assigned to 20 mg/kg LAmB (total dose, in five injections over 15 days) alone or combined with allometric MF (3 weeks). The primary endpoint was definitive cure at 12 months, defined as complete resolution of papular and nodular lesions and >80% re-pigmentation of macular lesions. Definitive cure at 24 months was a secondary efficacy endpoint. 118/126 patients completed the trial. Definitive cure at 12 months was observed in 29% (18/63) patients receiving LAmB and 30% (19/63) receiving LAmB/MF (mITT), increasing to 58% and 66%, respectively, at 24 months. Most lesions had resolved/improved at 12 and 24 months for patients receiving LAmB (90%, 83%) and LAmB/MF (85%, 88%) by qualitative assessment. One death, unrelated to study drugs, was reported; no study drug-related serious adverse events were observed. The most frequent adverse drug reactions were MF-related vomiting and nausea, and LAmB-related hypokalaemia and infusion reactions. Most adverse events were mild; no ocular adverse events occurred. Both regimens are suitably safe and efficacious alternatives to long-course MF for PKDL in South Asia. CTRI/2017/04/008421.

Clinical polymorphism of zoonotic cutaneous leishmaniasis: combination of the clinical and the parasitological diagnosis.

Zoonotic cutaneous leishmaniasis (ZCL) is a neglected tropical disease caused by Leishmania (L.) major. This zoonosis is characterized by a broad-spectrum clinical polymorphism and may be underestimated and poorly treated since it is a simulator of various dermatoses. The aim of our study was to analyze the clinical polymorphism of patients with ZCL. A total of 142 patients with confirmed CL based on the microscopic examination of skin lesion biopsies were included in this study. Molecular typing of Leishmania species revealed that all patients were infected with L. major.In total, 14 clinical formswere observed. Six were typical and eight were atypical. The typical ZCL forms are grouped as follows: papular (26.76%), ulcero-crusted (26.05%), ulcerated (13.38%), impetiginous (9.86%), nodular (9.15%), and papulo-nodular (5.63%) lesions. In atypical ZCL forms, we described erythematous (2.81%), erysipeloid (1.4%), sporotrichoid, (1.4%), keratotic (0.7%) lupoid (0.7%), lichenoid (0.7%), psoriasiform (0.7%), and zosteriform (0.7%) lesions. Here, the lichenoid and the keratotic forms caused by L. major were reported for the first time in Tunisia. These findings will help physicians to be aware of the unusual lesions of ZCL that could be confused with other dermatological diseases. For this reason, it will be necessary to improve the diagnosis of CL especially in endemic areas. Such large clinical polymorphism caused by L. major may be the result of a complex association between the vector microbiota, the parasite, and the host immune state, and further studies should be carried out in order to reveal the mechanisms involved in clinical polymorphism of ZCL.

Eruptive Xanthomas – A Case Report with a Review of the Literature

Eruptive xanthomas are most often the result of impaired lipid metabolism. They can be caused by a primary dysregulation in lipid metabolism (familial hyperlipoproteinemias) or by an increase in serum lipids from concomitant diseases (diabetes mellitus, obesity, chronic renal failure, nephrotic syndrome, pancreatitis, hypothyroidism, rarely hyperthyroidism, alcohol abuse, cholestasis or biliary cirrhosis, monoclonal gammopathy, multiple myeloma and leukemia) or from the use of certain medications (beta-blockers, estrogens, retinoids, protease inhibitors, cyclosporine, the antimycotic Miconazole and the antipsychotic Olanzapine (secondary hyperlipoproteinemias). Early diagnosis and adequate therapy of the skin changes and the comorbid underlying disease prevent serious life-threatening complications. A case of a 34-year-old man with papular yellowish lesions on the elbows is presented. The patient has accompanying diseases of diabetes mellitus, alcohol addiction, liver cirrhosis, chronic acute pancreatitis and chronic cholecystitis. The clinical diagnosis of eruptive xanthomas was confirmed by histopathological examination revealing foam cells in the dermis. Laboratory blood tests revealed an accelerated ESR and elevated blood glucose, transaminases, uric acid, total cholesterol, and triglycerides. Hepatoprotective and antidiabetic therapy combined with a dietary regimen improved the patient's condition and laboratory parameters. A partial reversal of skin lesions occurred. An overview of the epidemiology, etiopathogenesis, clinical picture, laboratory tests, differential diagnosis, dietary regimen, and treatment of eruptive xanthomas are presented.

A mysterious skin rash outbreak over Pescadores Islands in Taiwan Strait: An airborne contact dermatitis by Euproctis taiwana revealed by ultrastructure mapping

Abstract Background: A mysterious skin rash (papular lesions) outbreak broke out for unknown reasons in Taiwan’s Pescadores Islands in mid-autumn 2021, causing much anxiety in the population already nervous about the ongoing COVID-19 epidemic. Objectives: We conducted a field survey for possible culprit agents. Methods: Skin samples were taken with rapid-glue adhesives from the affected skin. Electron microscopy from the skin samples as well as caterpillar seta was performed. Additional neurotransmitter analysis by mass spectrometry (MS) was conducted on the skin samples. Results: A field survey found a large increase in caterpillars, Euproctis taiwana, in September 2021, the warmest September in recent years. Electron microscopy performed on superficial skin samples (3–6 cells thick) of affected and healthy skin (n = 5 and 3, respectively) and caterpillar setae revealed ultrastructural similarities between setae spurs (0.15–0.2 μm) and tiny pits (0.2 μm) on the affected skin as well as similar vegetative debris (0.75 μm) on both setae and affected skin. MS showed large increases in tyrosine, serine, and histamine, known mediators of arthropod insult. Conclusion: The co-occurrence of E. taiwana population growth, excessive warming, and strong monsoon winds may lead to this unusual autumn outbreak in late September. The lifting of COVID-19-related travel restrictions against earlier that month probably exacerbated it.

Clinical and molecular detection of fowl pox in domestic pigeons in Basrah Southern of Iraq

Bird species, particularly poultry and other bird types, including domestic pigeons, are susceptible to fowl pox, a contagious viral disease. The main goal of this study was to validate clinical avipoxvirus diagnoses using molecular analytical methods. The essential components of the investigation were the clinical signs, visible abnormalities, histological changes, and polymerase chain reaction analysis. Twenty out of 120 pigeons had clinical symptoms, which included yellowish crust or nodules near the feet, eyes, and beak. An erosive epidermal lesion and an epidermal acanthotic papular lesion with basal vacuolation were maculopapular evidence associated with significant epidermal hyperkeratosis, as confirmed by histological analysis. In addition, the results showed keratinocyte necrosis beneath the hyperkeratotic epidermal layer, together with superficial and deep dermal perivascular lymphocytic infiltration. In addition, the P4b core protein gene underwent phylogenetic analysis. The sequence analysis results indicated a high degree of similarity across the local strains, with just minor variations observed. Five sample sequences were selected and submitted to the NCBI database. These sequences were identified as OR187728, OR187729, OR187730, OR187731, and OR187732. All the various strains in this research may be classified under clade A of the chicken pox virus phylogenetic classification. This study presents the first description and characterization of pox virus infections in domestic pigeons inside the Basrah governorate.

CUTANEOUS DERMATOPHYTOSIS MIMICKING AUTOIMMUNE BLISTERING DISORDER

Some infectious diseases can clinically present as vesiculobullous disorders. A case of 33-year-old male patient presented with red, itchy skin lesions and few fluid filled lesions over both groins since 2 months. On clinical examination, multiple tense bullae with clear fluid over background of well defined erythematous plaques over both groins were noted.Histopathological examination showed subepidermal blister with abundant fibrin and numerous eosinophils in the blister cavity.Based on the diagnosis of biopsy proven bullous pemphigoid patient was started on steroids ( Inj. Dexamethasone 2cc IV OD in morning ) as treatment for 5 days. But on day 6 patient developed papular lesions over the original site where erythematous plaques were present.To rule out infectious etiology, KOH(10%) wet mount examination of the scales from the borders of the lesion showed numerous thin septate fungal hyphae and culture for fungus from skin scrappings showed growth for trichophyton mentagrophytes.So here, a case of 33 year-old male with cutaneous dermatophytosis having presentation mimicking bullous pemphigoid both clinically and histopathologically has been described.

Expressions of Interleukin-4 and Interleukin-5 in Nodular Prurigo and Pruritic Papular Lesions

Highlights:1. An examination of IL-4 and IL-5 expressions in nodular prurigo and pruritic papular eruption is crucial for enhancing the effectiveness of biological agent therapy, specifically for HIV/AIDS patients.2. The findings offer evidence suggesting the possibility of IL-4 as a treatment target for individuals diagnosed with nodular prurigo, as well as IL-4 and IL-5 for those diagnosed with pruritic papular eruption. AbstractPruritic papular eruption is a dermatosis characterized by pruritic symptoms in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Similarly, nodular prurigo is an itchy dermatosis with lesions and histopathological features that resemble those of pruritic papular eruption. Both conditions share a common etiopathogenesis, which involves the cytokines produced by T helper 2 (Th2) cells. Nodular prurigo and pruritic papular eruption are chronic and frequently recalcitrant, thus posing challenges in treatment. The use of biological agents represents a treatment development for chronic and recalcitrant dermatoses. This study aimed to determine the difference in the mean percentage of interleukin-4 (IL-4) and interleukin-5 (IL-5) expressions between nodular prurigo and pruritic papular eruption lesions, which may establish a basis for further biological agent therapy. A cross-sectional study was conducted using paraffin block preparations of the skin lesions of patients diagnosed with nodular prurigo (n=16) and pruritic papular eruption (n=16). Each paraffin block preparation involved immunohistochemical staining using IL-4 and IL-5 monoclonal antibodies. The expressions of IL-4 and IL-5 were assessed through ImageJ for Windows, version 1.53 (National Institutes of Health and the Laboratory for Optical and Computational Instrumentation, University of Wisconsin, USA) by pathologists. The data were analyzed using an unpaired t-test with a significance level of p<0.05. The analytical results indicated that data on the average age of the two groups, disease duration, and storage sample duration followed a normal distribution (p>0.05). The mean percentage of IL-4 expression was significantly different between the nodular prurigo and pruritic papular eruption groups (p=0.000). However, the mean percentage of IL-5 expression was not significantly different between the two groups (p=0.060). In conclusion, the expression of IL-4 was higher in the nodular prurigo group in comparison to the pruritic papular eruption group. Nonetheless, the expression of IL-5 was comparably high in both the nodular prurigo and pruritic papular eruption groups.

Bullous skin disease occurring due to bedbug bite: Case report

Bedbug bites are arthropod bites which are mostly seen in especially developing countries and in countries which have low socio-economical status. If allergic reaction occurs due to these bites; urticarial skin rashes, macules, papular lesions can be observed. Its aetiology is not known clearly. Aim of this case example is to present the skin reactions occurring in a 40 year old male patient, who has come to our emergency service, due to bedbug bite.

ATRICHIA WITH PAPULAR LESIONS : A CASE REPORT

Atrichia with papular lesions is a rare Autosomal recessive disorder characterized clinically by complete and irreversible hair loss shortly after birth, and is associated with the development of keratinfilled cysts all over the body. We present a 10 year old girl with extensive alopecia and papular lesions over scalp,upper limbs,lower limbs, abdomen and back . A clinical diagnosis of Atrichia with papular lesions was made after excluding Vit D dependent Rickets. An accurate diagnosis is important to prevent unnecessary treatment of APL with systemic steroids when misdiagnosed as alopecia universalis.

Difficult Airway in a Patient with Well-Differentiated Epidermoid Carcinoma: A Case Report

Introduction: Cutaneous epidermoid carcinoma (SCC) is a common skin tumor that can arise from precursor lesions or de novo. It is the second leading cause of death from skin cancer and its incidence is expected to double by 2030. Risk factors include gender, ionizing radiation, alcohol and tobacco use, and HPV infection. SCC can be classified into five types according to the Peniche classification, with the ulcerative form being the most frequent. Anesthesia management for head and neck cancers is challenging due to airway complications. Case presentation: An 82-year-old female with a history of biomass combustion smoke exposure and hypertension presented with a painful papular lesion on the left nasal wing. Biopsy revealed well-differentiated epidermoid cancer. Despite treatment, the lesion progressed rapidly, leading to a request for surgical resection. The patient had predictors of difficult intubation and ventilation, and initial intubation attempts were unsuccessful. After aspiration of secretions and intracavitary bleeding, successful intubation was achieved on the second attempt. Controlled ventilation was initiated with specific settings. Clinical discussion: A difficult airway can pose challenges for anesthesiologists, especially in patients with head and neck cancer. Pre-anesthetic evaluation and preparation for rescue devices or maneuvers are crucial. In this case, the patient had a difficult Intubation Prediction Index. General anesthesia allowed for invasive monitoring, venous access, and reliable mechanical ventilation. Direct laryngoscopy was performed due to retro nasal bleeding, with equipment available for difficult airway management and aspiration. Conclusion: Anesthetic management for patients with head cancer presents challenges in airway management and carries the risk of complications. Pre-anesthetic and airway assessment are crucial to prevent complications and ensure successful intubation.

Sporothrix schenckii complex in felines: Analysis of clinical, mycological, environmental and epidemiological factors

Sporotrichosis is an infectious and chronic fungal disease caused by fungi belonging to the Sporothrix schenckii complex that affects humans and animals through traumatic implantation of the fungus in the skin. They are dimorphic, saprophytic and geophilic fungi that are widely distributed in nature, especially in soils rich in organic matter. The aim of this study was to understand the clinical, mycological, environmental and epidemiological aspects of the Sporothrix schenckii complex in felines. In order to meet the objectives of this research, a qualitative, descriptive and exploratory data survey was carried out through a bibliographic review based on works published in the last 23 years. Sporothrix spp. is considered to be a complex of at least six cryptic species, in other words, they have similar morphological characteristics but different genotypes. In cats, the incubation period is variable; it usually lasts 14 days. On penetrating the tissue, the micellar form transforms into yeast, which generates an inflammatory response and proliferation of the microorganism at the site, causing papular and nodular lesions which, in some cases, heal spontaneously. Therefore, it is clear that sporotrichosis is caused by dimorphic fungi of the Sporothrix schenkii complex. It is a zoonotic disease of great importance in the context of public health, since it is still a neglected disease and requires robust measures to control. As well as being the most seriously affected, felines are the main transmitters to humans and animals, making them a key point in controlling outbreaks of the disease.

Papular lesions on the vulva.

Papular lesions on the vulva.