A 24-year old woman presented with hemorrhagic vesicles on her legs. She had taken sibutramine (Reductil(R), Abbott Labs., Seoul, South Korea) for 3 months and developed skin lesions the week before. A skin biopsy showed leukocytoclastic vasculitis with conspicuous eosinophilic infiltration of the tissue. These lesions showed improvement after discontinuation of sibutramine. However, 3 months later the skin lesions recurred on other sites on the lower extremities when the patient was rechallenged with the same drug for 2 weeks. Herein, we report the first case of necrotizing vasculitis induced by sibutramine.
Biopsy ; Cyclobutanes ; Eosinophils ; Female ; Humans ; Leg ; Lower Extremity ; Skin ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous

No abstract available.
Psoriasis*

We present 2 cases of invasive extramammary Paget disease occuring in the vulva area of a 60 year old female, and in the scrotal and penile area of a 63 year old male patient. The histologically typical Paget cells were not only seen in the surface epithelium but were also involved in the outer root sheath of the hair follicles. Stromal infiltration of tumor cells into the upper dermis were present in both cases, however, no underlying primary sweat gland carcinoma was present. Metastatic foci of inguinal lymph nodes showed apocrine-type epithelium with abundant eosinophilic granular cytoplasm, which were positive for anti-CEA and GCDFP-15, as well as eccrine-type epithelium containing mucinous secretory materials in the lumen and the cytoplasm. Ultrastructural findings showed interdigitating plasma membranes with prominent desmosomes between the Paget cells, intracytoplasmic tonofibrils, intracellular tubules, lipid vacuoles, and enlarged mitochondria. Histological, immunohistochemical, and ultrastructural findings suggested that Paget cells showed both eccrine and apocrine differentiation.
Female ; Male ; Humans ; Neoplasm Metastasis

Three cases of congenital pseudarthrosis of the tibia were treated at Department of Orthopedic Surgery, Seoul national University Hospital during last four years. In all cases, many Cafe-au-lait spots and subcutaneous nodules were shown on the whoIe body skin, which are suggestive of neuro-fibromatosis. Case 1, A thirteen years old boy was treated with plate and screw fixation with massive iliac cancellous and cortical graft. In a follow-up of three and one half years, solid bony union has been obtained with successful result. Case 2, A 5 years old boy was treated with Boyds dual cortical graft with plate and screw fixation. In a follow-up to eight months, bony union were satisfactory. Case 3, A six months old boy who is young brother of case 2, was treated with Charnleys intramedullary nailing and iliac cancellous and cortical graft. The patient is still in the Iong leg cast, six months postoperatively. The evidence of familial and hereditary factor in pedigree is elicited on case 2 and 3. This congenital pseudarthrosis of the tibia in the sibling is regared as the first report in Korean literature.
Cafe-au-Lait Spots ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Leg ; Male ; Orthopedics ; Pedigree ; Pseudarthrosis ; Seoul ; Siblings ; Skin ; Tibia ; Transplants

Dermatitis neglecta (unwashed dermatosis) presents as pigmented hyperkeratotic plaques with adherent scales which clinically resembles psoriasis. This condition is the result of avoiding washing the affected areas, so the lesions are characteristically resolved with normal washing or with gentle wiping from an alcohol swab. We report a 29-year-old man who presented with an asymptomatic hyperkeratotic scaly plaque on umbilicus. A skin biopsy was done under the clinical impression of psoriasis. During skin biopsy, gentle swabbing with H2O2 and saline gauze was done. The patient revisited our clinic 10 days after the skin biopsy and the hyperkeratotic lesion had cleared. Histologic examination showed orthokeratotic hyperkeratosis and anastomosing rete ridges. There has been no previous report of dermatitis neglecta with histologic confirmation, and so this case could be the first report to provide the histologic characteristics of dermatitis neglecta. Because this condition might be overlooked and underdiagnosed, recognizing its existence and cause are important to avoid unnecessary biopsies and potentially aggressive therapeutic measures.
Adult ; Biopsy ; Dermatitis ; Humans ; Psoriasis ; Skin ; Umbilicus ; Weights and Measures

X-linked recessive bulbospinal muscular atrophy (Kennedy's syndrome) is a variant of the spinal muscular atrophies caused by mutation of androgen receptor gene on X-chromosome. A 69-year-old man had suffered from slowly progressive lower extremity weakness and gynecomastia. Muscle weakness was more severe in proximal muscles and showed symmetrical features. He had fascicular contraction on his face and tongue. All tendon reflexes were absent and pyramidal signs were not detected. Nerve conduction studies were normal except low amplitude of sensory nerve action potential in median nerve. Needle electromyography revealed widespread chronic denervation potentials in all sampling muscles of extremities, facial and tongue muscles. Histopathologic findings showed chronic denervation atrophy. DNA analysis showed abnormal expansion of CAG repeats in the androgen receptor gene and we confirmed this case as Kennedy's syndrome. If an adult patient has slowly progressive muscle weakness, bulbar symptoms and signs of male genital failure, DNA analysis should be taken to differentiate Kennedy syndrome from other motor neuron disease or myopathy.
Action Potentials ; Adult ; Aged ; Atrophy ; Bulbo-Spinal Atrophy, X-Linked ; Denervation ; DNA ; Electromyography ; Extremities ; Gynecomastia ; Humans ; Lower Extremity ; Male ; Median Nerve ; Motor Neuron Disease ; Muscle Weakness ; Muscles ; Muscular Atrophy* ; Muscular Diseases ; Needles ; Neural Conduction ; Receptors, Androgen ; Reflex, Stretch ; Tongue ; Trinucleotide Repeats

Cutaneous lymphadenoma is a rare distinctive benign adnexal tumor of unknown histogenesis. It usually presents as a slowly growing, skin-colored nodule on the head and neck. Histologically, this tumor is composed of dermal lobules with a biphasic pattern of epithelial and lymphoid cells. We report two additional examples of this peculiar neoplasm.
Head ; Lymphocytes ; Neck

We report here on a 63-year-old woman who presented with recurrent bruise-like infiltrative plaques on the left leg without systemic symptoms or laboratory abnormalities. The histopathologic findings showed an infiltration of panniculus by small to medium-sized atypical lymphocytes. But the prominent lymphoid atypia, fat necrosis, vascular thrombosis, erythrophagocytosis and striking dominance of CD8+ lymphocytes seen in subcutaneous panniculitis-like T-cell lymphoma (SPTCL) were not detected. The diagnosis of atypical lymphocytic lobular panniculitis (ALLP) was made based on these histopathologic and clinical features. The lesions responded well to systemic steroid treatment. But the CD4/CD8 ratio in the later lesion was more decreased than that of the initial lesion, and the patient is under clinical follow up.
Fat Necrosis ; Female ; Follow-Up Studies ; Humans ; Leg ; Lymphocytes ; Lymphoma, T-Cell ; Middle Aged ; Panniculitis ; Strikes, Employee ; Thrombosis

We report a case of cutaneous Mycobacterium (M.) abscessus infection in a 32-year-old woman who presented with a red infiltrated plaque on her left shin. No history of prior trauma was reported, but she had a history of habitual leg shaving. Skin biopsy specimen showed neutrophilic abscesses with poorly defined granulomas in the lower dermis and subcutaneous tissue, as well as some acid-fast bacilli. The microorganism was identified as M. abscessus by tissue culture and PCR-restriction fragment length polymorphism (PCR-RFLP) analysis. The patient was treated with clarithromycin and cefaclor for 4 months, and there was no evidence of recurrence at 6 month follow-up.
Abscess ; Adult ; Biopsy ; Cefaclor ; Clarithromycin ; Dermis ; Female ; Follow-Up Studies ; Granuloma ; Humans ; Leg ; Mycobacterium ; Neutrophils ; Recurrence ; Skin ; Subcutaneous Tissue

No abstract available.
Tuberculosis*