Eosinophilic cellulitis is a rare dermatosis first described by Wells, and characterized by recurrent episodes of sudden outbreaks of erythematous cutaneous swellings often painful or pruritic. Microscopically, the lesion shows diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. The cause is still unknown but the triggers which have been thought to precipitate the disease include insect bites, parasitic infections such as toxocara, onchocerciasis, nasopharyngeal carcinoma, rheumatoid arthritis and spider bites. However many cases are idiopathic. The author experienced a case of eosinophilic cellulitis of a 52-year-old woman with multiple cutaneous tender plaques of cellulitis for approximately 10 years with history of repeated remission and recurrent episodes. Biopsy was taken from ulcerated edematous nodule of inguinal region under the clinical impression of deep fungal infection, pyoderma gangrenosum and polyarteritis nodosa. Cultures for fungal and common organisms were negative. Histologically, the entire dermis was infiltrated by numerous eosinophils and scattered histiocytes. There were scattered flame figures showing necrobiotic foci in the collagen with accumulation of eosinophils, granulated free cosinophilic granules and histiocytes.
Biopsy ; Cellulitis/pathology* ; Cellulitis/therapy ; Eosinophilia/pathology* ; Eosinophilia/therapy ; Female ; Humans ; Middle Aged

Eosinophilic cellulitis is a rare dermatosis first described by Wells, and characterized by recurrent episodes of sudden outbreaks of erythematous cutaneous swellings often painful or pruritic. Microscopically, the lesion shows diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. The cause is still unknown but the triggers which have been thought to precipitate the disease include insect bites, parasitic infections such as toxocara, onchocerciasis, nasopharyngeal carcinoma, rheumatoid arthritis and spider bites. However many cases are idiopathic. The author experienced a case of eosinophilic cellulitis of a 52-year-old woman with multiple cutaneous tender plaques of cellulitis for approximately 10 years with history of repeated remission and recurrent episodes. Biopsy was taken from ulcerated edematous nodule of inguinal region under the clinical impression of deep fungal infection, pyoderma gangrenosum and polyarteritis nodosa. Cultures for fungal and common organisms were negative. Histologically, the entire dermis was infiltrated by numerous eosinophils and scattered histiocytes. There were scattered flame figures showing necrobiotic foci in the collagen with accumulation of eosinophils, granulated free cosinophilic granules and histiocytes.
Biopsy ; Cellulitis/pathology* ; Cellulitis/therapy ; Eosinophilia/pathology* ; Eosinophilia/therapy ; Female ; Humans ; Middle Aged

A healthy, 14-year-old boy presented with right hip pain and consequent fever after falling out of bed while sleeping. The patient could not walk and complained of severe pain with active and passive motion, which consisted mainly in extension and internal rotation of the right hip. Laboratory analysis of the peripheral blood identified leukocytosis and increased levels of acute phase reactants. Magnetic resonance imaging of the hip, which was performed with the expectation of right hip pathology, revealed cellulitis and abscess in the right psoas muscle and associated inflammatory changes in the adjacent presacral fat plane but showed no abnormal lesions in the adjacent pelvic bone and spine. Staphylococcus hominis was cultured from the blood. With empirical antibiotic therapy, the patient recovered fully. We report a case of primary psoas abscess confused with hip pathology in an immunocompetent child without underlying disease.
Abscess ; Acute-Phase Proteins ; Adolescent ; Cellulitis ; Child ; Fever ; Hip* ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Male ; Pathology* ; Pelvic Bones ; Psoas Abscess* ; Psoas Muscles ; Spine ; Staphylococcus hominis

A healthy, 14-year-old boy presented with right hip pain and consequent fever after falling out of bed while sleeping. The patient could not walk and complained of severe pain with active and passive motion, which consisted mainly in extension and internal rotation of the right hip. Laboratory analysis of the peripheral blood identified leukocytosis and increased levels of acute phase reactants. Magnetic resonance imaging of the hip, which was performed with the expectation of right hip pathology, revealed cellulitis and abscess in the right psoas muscle and associated inflammatory changes in the adjacent presacral fat plane but showed no abnormal lesions in the adjacent pelvic bone and spine. Staphylococcus hominis was cultured from the blood. With empirical antibiotic therapy, the patient recovered fully. We report a case of primary psoas abscess confused with hip pathology in an immunocompetent child without underlying disease.
Abscess ; Acute-Phase Proteins ; Adolescent ; Cellulitis ; Child ; Fever ; Hip* ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Male ; Pathology* ; Pelvic Bones ; Psoas Abscess* ; Psoas Muscles ; Spine ; Staphylococcus hominis

INTRODUCTIONThis study aims to analyse the clinico-epidemiological characteristics of Asian patients diagnosed with livedo vasculopathy (LV).

MATERIALS AND METHODSWe performed a retrospective analysis of all patients diagnosed with LV from 1997 to 2007 at our centre.

RESULTSSeventy patients were diagnosed with LV with a mean age of 39 years, female: male ratio of 3:1 and no racial predilection. Most cases remained purely cutaneous, presenting with painful leg ulcers and atrophie blanche. Peripheral neuropathy was the only extra-cutaneous complication (9%). In patients who were screened, associations included hepatitis B (7%) and hepatitis C (4%), positive anti-nuclear antibody (14%), positive anti-myeloperoxidase antibody (5%), positive anti-cardiolipin antibodies (7%) and positive lupus anticoagulant (2%). In 49 patients who achieved remission, 55% required combination therapy, most commonly with colchicine, pentoxifylline and prednisolone. In those treated successfully with monotherapy, colchicine was effective in 59% followed by prednisolone (17.5%), pentoxifylline (17.5%) and aspirin (6%). Mean follow-up period was 50 months.

CONCLUSIONLV in Asian patients is a high morbidity, chronic relapsing ulcerative skin condition. Most patients require induction combination therapy for remission. As further evidence emerges to support a procoagulant pathogenesis, a standardised protocol is needed to investigate for prothrombotic disorders during diagnosis.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Cellulitis ; complications ; epidemiology ; pathology ; Female ; Humans ; Livedo Reticularis ; complications ; epidemiology ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Skin ; pathology ; Time Factors ; Young Adult

OBJECTIVE: To analyse the clinical aspects of vaginal approach for gynecologic pelvic surgery, we evaluated age distribution, parity, indications for hysterectomy, postoperative pathology, operating time, bleeding amount, weight of uterus, postoperative complications. resected uterus weight, operating time and bleeding amount based on operative procedure type. METHODS: We reviewed the medical records of the 136 patients who underwent vaginal approach for gynecologic pelvic surgery for the indications other than uterine prolapse from Jan. 1998 to April. 1998, and from July. 1999 to Sep. 2001 at Chosun University Hospital. RESULTS: We performed 136 cases of vaginal approach for gynecologic pelvic surgery. We performed 132 cases of total vaginal hysterectomy, 4 cases of transvaginal ovarian cystectomy, a high increased rate of vaginal approach for gynecologic pelvic surgery significantly. The most common indication for vaginal approach for gynecologic pelvic surgery was uterine leiomyoma (63.2%), followed by HSIL, adenomyosis, MIC of the cervix, and ovarian cyst. The operating time was within 90 min in almost cases (47.1%). The most common postoperaive pathologic finding was uterine leiomyoma (47.1%), followed by adenomyosis, uterine leiomyoma with adenomyosis, MIC of the cervix, HSIL, LSIL, ovarian serouscys- tadenoma, and endometrioma. There were 4 cases (2.9%) of cuff cellulitis, 2 cases of pelvic cellulitis (1.5%), 3 cases of hematoma formation (2.2%), 1 case of laparatomy (0.7%) as postoperative complications. etc. CONCLUSION: Vaginal approach for hysterectomy and ovarian cystectomy is a safe method for removing uterus even in the absence of prolapse. Recently it's indication is widened to the patient who has larger uterus and history of previous pelvic surgery. Because of it's advantage, Vaginal approach for hysterectomy and ovarian cystectomy would be the preferred method of gynecologic pelvic surgery in the future.
Adenomyosis ; Age Distribution ; Animals ; Bleeding Time ; Cellulitis ; Cervix Uteri ; Cystectomy ; Endometriosis ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Leiomyoma ; Medical Records ; Ovarian Cysts ; Parametritis ; Parity ; Pathology ; Postoperative Complications ; Prolapse ; Surgical Procedures, Operative ; Uterine Prolapse ; Uterus

Vibrio vulnificus infection can lead to the rapid expansion of cellulitis or sepsis and can be lethal. Vibrio vulnificus is transmitted through seawater or ingestion of raw or undercooked shellfish. We experienced an uncommon case of death due to Vibrio sepsis, which was confirmed by autopsy. A 56-year-old man who was a sailor was found dead in a fishing boat. Autopsy was performed 3 days later. External examination revealed a few blisters and erythematous lesions on both legs. Internal examination revealed a fatty liver and edema of the legs. The skin lesions on the legs showed blisters that extended from the epidermis to the dermis, accompanied by massive acute inflammation in the dermis and subcutaneous tissue with multinuclear giant cells, as noted on the histologic examination. Vibrio vulnificus was isolated from postmortem blood and subcutaneous tissue of the leg. To the best of our knowledge, this is the first autopsy case in Korea in which Vibrio vulnificus was isolated from postmortem blood. Herein, we present a case of sepsis due to Vibrio vulnificus which was confirmed by autopsy, pathological findings, and postmortem microbiological culture.
Autopsy* ; Blister ; Cellulitis ; Dermis ; Eating ; Edema ; Epidermis ; Fatty Liver ; Giant Cells ; Humans ; Inflammation ; Korea ; Leg ; Middle Aged ; Military Personnel ; Pathology ; Seawater ; Sepsis* ; Shellfish ; Ships ; Skin ; Subcutaneous Tissue ; Vibrio ; Vibrio vulnificus*