Thepatientisa63- year-old woman who presented to her dermatologist for the removal of two nevi near her mouth. Histologic examination revealed melanocytic nevi showing maturation with dermal descent. Within the dermis...Thepatientisa63- year-old woman who presented to her dermatologist for the removal of two nevi near her mouth. Histologic examination revealed melanocytic nevi showing maturation with dermal descent. Within the dermis, adjacent to these nevoid cells, were multiple large hair follicles that were surrounded by dense fibrosis. The fibrous sheaths contained thickened,dense collagen bundles and were well circumscribed, resembling perifollicular fibromas. Further discussion with the patient and the dermatologist revealed that the patient had “ plucked” hair from these nevi. We, therefore, believe that the perifollicular fibrosis that we observed is secondary to trauma. We present this case to remind all that posttraumatic events can simulate perifollicular fibromas and that the erroneous diagnosis of such could lead to the erroneous diagnosis of Birt- Hoggs Dubé syndrome.展开更多
Erythema induratum (EI)/nodular vasculitis (NV) is characterized by recurrent crops of tender oedematous nodules on the lower legs. A lobular panniculitis with granulomatous inflammation, vasculitis, focal necrosis an...Erythema induratum (EI)/nodular vasculitis (NV) is characterized by recurrent crops of tender oedematous nodules on the lower legs. A lobular panniculitis with granulomatous inflammation, vasculitis, focal necrosis and septal fibrosis is present. Mycobacterium tuberculosis DNA has been detected in some lesionsbymeansofpolymerasechainreaction(PCR).Tencases of EI/NV were found. H& E slides were reviewed. PCR assays for M.tuberculosis and mycobacteria other than M.tuberculosis (MOTT) were performed. PCR did not reveal M. tuberculosis (0% ) or MOTT (0% ) DNA, with positive controls, indicating the reliability of the assays. Among the MOTT, cutaneous infections are most commonly caused by M. marinum. Subcutaneous tuberculoid granulomas may be seen with M. kansasii, M. marinum, M. scrofulaceum and M. avium complex. M. gordonae, M. szulgai and M. malmoense rarely cause cutaneous infections. M. simiae, M. gastri and M. asiaticum are probably not cutaneous pathogens. M. tuberculosis and MOTT DNA was not found in EI/NV. EI/NV has diverse aetiologies with varying pathogeneses leading to similar histologic changes. The cases analysed may not have had an infectious aetiology. However, in EI/NV, performance of PCR for MOTT as well as M. tuberculosis complex may still be beneficial, particularly in cases from immunocompromised hosts.展开更多
Colchicine toxicity is a rare, but well-described clinical entity. The histopathologic findings in various organ systems have been delineated in colchicine intoxication; however, skin findings have only been described...Colchicine toxicity is a rare, but well-described clinical entity. The histopathologic findings in various organ systems have been delineated in colchicine intoxication; however, skin findings have only been described in rare cases. We present a case of colchicine toxicity diagnosed on skin biopsy in a patient presenting with mental status changes. Her cutaneous manifestation consisted of a diffuse, blanchable, violaceous, morbilliform rash involving the trunk and proximal extremities. The histopathologic findings included metaphase-arrested keratinocytes with underlying basal vacuolization. These features, considered in the setting of multiorgan dysfunction and a known exposure of colchicine, led to the diagnosis.展开更多
文摘Thepatientisa63- year-old woman who presented to her dermatologist for the removal of two nevi near her mouth. Histologic examination revealed melanocytic nevi showing maturation with dermal descent. Within the dermis, adjacent to these nevoid cells, were multiple large hair follicles that were surrounded by dense fibrosis. The fibrous sheaths contained thickened,dense collagen bundles and were well circumscribed, resembling perifollicular fibromas. Further discussion with the patient and the dermatologist revealed that the patient had “ plucked” hair from these nevi. We, therefore, believe that the perifollicular fibrosis that we observed is secondary to trauma. We present this case to remind all that posttraumatic events can simulate perifollicular fibromas and that the erroneous diagnosis of such could lead to the erroneous diagnosis of Birt- Hoggs Dubé syndrome.
文摘Erythema induratum (EI)/nodular vasculitis (NV) is characterized by recurrent crops of tender oedematous nodules on the lower legs. A lobular panniculitis with granulomatous inflammation, vasculitis, focal necrosis and septal fibrosis is present. Mycobacterium tuberculosis DNA has been detected in some lesionsbymeansofpolymerasechainreaction(PCR).Tencases of EI/NV were found. H& E slides were reviewed. PCR assays for M.tuberculosis and mycobacteria other than M.tuberculosis (MOTT) were performed. PCR did not reveal M. tuberculosis (0% ) or MOTT (0% ) DNA, with positive controls, indicating the reliability of the assays. Among the MOTT, cutaneous infections are most commonly caused by M. marinum. Subcutaneous tuberculoid granulomas may be seen with M. kansasii, M. marinum, M. scrofulaceum and M. avium complex. M. gordonae, M. szulgai and M. malmoense rarely cause cutaneous infections. M. simiae, M. gastri and M. asiaticum are probably not cutaneous pathogens. M. tuberculosis and MOTT DNA was not found in EI/NV. EI/NV has diverse aetiologies with varying pathogeneses leading to similar histologic changes. The cases analysed may not have had an infectious aetiology. However, in EI/NV, performance of PCR for MOTT as well as M. tuberculosis complex may still be beneficial, particularly in cases from immunocompromised hosts.
文摘Colchicine toxicity is a rare, but well-described clinical entity. The histopathologic findings in various organ systems have been delineated in colchicine intoxication; however, skin findings have only been described in rare cases. We present a case of colchicine toxicity diagnosed on skin biopsy in a patient presenting with mental status changes. Her cutaneous manifestation consisted of a diffuse, blanchable, violaceous, morbilliform rash involving the trunk and proximal extremities. The histopathologic findings included metaphase-arrested keratinocytes with underlying basal vacuolization. These features, considered in the setting of multiorgan dysfunction and a known exposure of colchicine, led to the diagnosis.
