POEMS syndrome is an unusual plasma cell dyscrasia with multisystemie manifestations featuring polyneuropathy, organomegaly, endocrinopsthy, M protein and skin changes. We have seen a 49-year-old woman presenting with hyperpigmentation, hypertrichosis, hyperhidrosis, and taut thickened skin of the extremities as a skin manifestation of this syndrome. We review the literature and report a case.
Extremities ; Female ; Humans ; Hyperhidrosis ; Hyperpigmentation ; Hypertrichosis ; Middle Aged ; Paraproteinemias ; POEMS Syndrome* ; Polyneuropathies ; Skin ; Skin Manifestations

A 53-year-old woman developed a psinful erythematous papular skin eruption around the biting site by a tick on the left lower abdomen. A excision biopsy specimen from the skin lesion showed perivsscular infiltration of inflammatory cells composed mainly of neutrophiles, lymphocytes, and a few eosinophiles and histiocytes throughout the dermis. Some of the vessels were dilated with protruding and proliferated endothelial cells. The tick was identified as an adult female of Ixodes nipponensis by the scanning electron microscopic examination.
Abdomen ; Adult ; Biopsy ; Dermis ; Endothelial Cells ; Eosinophils ; Female ; Histiocytes ; Humans ; Ixodes* ; Lymphocytes ; Middle Aged ; Neutrophils ; Skin ; Tick Bites* ; Ticks*

Cobb syndrome is a rare neurocutaneous angiomatosis characterized by a vascular skin nevus associated with a spinal cord angioma of the same metamere. A 14-year-old girl had an asymptomatic large cutaneous hemangioma distributed from the TI dermatome downward to the L3 dermatome since birth and complained of a gait disturbance and urination difficulty for 1 year. A biopsy specimen in the skin lesion revealed the findings of capillary hemangioma. From C7 downward to L4 posterior epidural hemangioma composed of arteriovenous and cavernous components was diagnosed by radiological examination and surgical exploration. Because of very extensive cord hemangioma, only partial removal of the tumor at T11, T12 and L1 level was performed and postoperatively she was transferred to a special facility for rehabilitative therapy.
Adolescent ; Angiomatosis ; Biopsy ; Female ; Gait ; Hemangioma ; Hemangioma, Capillary ; Humans ; Nevus ; Parturition ; Skin ; Spinal Cord ; Urination

The pubic louse, Pthirus pubis is a blood-sucking ectoparasite adapted to hold onto pubic, axillary and body hairs. It is usually confined to the pubic and inguinal region. However, it may also rarely involve the scalp and eyelashes. We report two cases of phthiriasis occurring on unusual sites, the first case occurring on the scalp of a 5 month-old male infant, and the second case on the eyelashes of a 49-year-old fe-male.
Eyelashes ; Hair ; Humans ; Infant ; Male ; Middle Aged ; Phthiraptera ; Scalp

Iatrogenically developed immunosuppression-associated Kaposis sarcoma is the result of immunosuppressive therapy after an organ transplantation, particularly after a renal transplantation. Since the advent of powerful immunosuppressive agents such as cyclosporine, recently the incidence of Kaposis sarcoma has been increased. In addition to immunosuppression, other factors, such as genetic predisposition, environmental and geographic factors, and oncogenic viruses, may play a role in the pathogenesis of this tumor. Ilerein we report a case of Keposis sarcoma with multiple organ involvement of the skin, lung, small intestine and mesenteric lymph node in a renal allograft recipient who received cyclosporine and prednisolone. Reduction of the dosage of immunosuppressant for 1 month resulted in improvement of the cutaneous lesions.
Allografts* ; Cyclosporine ; Genetic Predisposition to Disease ; Geography ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Intestine, Small ; Kidney Transplantation ; Lung ; Lymph Nodes ; Oncogenic Viruses ; Organ Transplantation ; Prednisolone ; Sarcoma ; Sarcoma, Kaposi* ; Skin ; Transplants

BACKGROUND: It has been known that the polymerase chain reaction(PCR) test of clinical specimens including blood, sputum, urine, and cerebrospinal fluid collected from patients with systemic fungal infection is a highly sensitive diagnostic method. Recently, the PCR test was applied to the diagnosis of onychomycosis. OBJECTIVE: This study was aimed to explore whether the PCR test would be a more sensitive diagnostic tool than the KOH smear, fungus culture and KONCPA(KOH+Nail Clipping+ PAS(periodic acid-Schiff) stain) test in diagnosing the onychomycosis. METHODS: Using 50 nail samples from 50 patients with onychomycosis, the result of the PCR test was compared with those of the KOH smear, fungus culture and KONCPA test. RESULTS: The results were as follows: 1. The positive rates for detecting the causative fungi from the KOH smear, fungus culture, KONCPA test and PCR test were 64.0%, 46.0%, 90.0%, and 100.0% respectively. 2. The fungus culture identified the causative fungi from 23 samples, of which 21(91.2%) were T. rubrum, 1(4.4%) Candida sp. and 1(4.4%) C. albicans. KONCPA test yielded higher positivity by detecting the pathogenic fungi in 45 samples: dermatophytes 35(77.8%), mixed infections of dermatophytes and Candida sp. 6(13.3%), molds 2(4.4%) and unclassified 2(4.4%). The PCR test yielded the highest positivity by detecting the pathogenic fungi in all samples ; T. rubrum 44(88.0%) and unclassified 6(12.0%). 3. Compared with the results of fungus culture and KONCPA test, that of PCR test showed some differences. The case of Candida sp. in fungus culture was identified as T. rubrum in PCR ; the case of C. albicans in fungus culture as unclassified in the PCR. Five cases of mixed infection and 2 cases of mold infection in the KONCPA test were diagnosed as T. rubrum infection in the PCR test. CONCLUSION: The PCR test is useful in diagnosing the onychomycosis because of its highest positive rate in detecting the causative fungi compared with fungus culture and the KONCPA test. Furthermore, a more accurate diagnostic method such as the PCR test will be necessary in case Candida sp. or mold is cultured from the infected nail specimen.
Arthrodermataceae ; Candida ; Cerebrospinal Fluid ; Coinfection ; Diagnosis ; Fungi* ; Humans ; Onychomycosis* ; Polymerase Chain Reaction* ; Sputum

Infectious endocarditis is associated with five cutaneous findings: subungal hemorrhages, Roth spots, Osler's nodes, the Janeway lesion and petechiae, which are infrequently reported in the current antibiotic era. The Janeway lesion, first described by Edward Janeway in 1899, is an erythematous or hemorrhagic, non-tender macule or nodule several centimeters in diameter occurring on the palms or soles. We report a case of a Janeway lesion in a 30-year-old woman, who had pruritic nontender macules with fever of unkown origin. Our case demonstrates the importance of careful skin examination in systemic diseases such as infectious endocarditis. The findings of the Janeway lesion in this woman were important in securing the early clinical diagnosis of infectious endocarditis.
Adult ; Diagnosis ; Endocarditis* ; Female ; Fever ; Hemorrhage ; Humans ; Purpura ; Skin

Delusions of parasitosis is a type of monosymptomatic hypochondrial psychosis and is defined as the fixed belief that one is infested with living organisms, in t.he abscence of any objective evidence that such infestation exists. A 43 year-old woman had a 2-month history of generalized pruritus and skin ulceration on the buttock representing dermatitis artefacta. She also complained of seeing small black insects crawling on her whole body skin, especially on the pubic area without evidence of cutaneous invasion by the parasites. She had no evidence of other medical diseases. She was treated with oral pimozide, starting with 1mg/day to 3mg/day. In two weeks, clinical symptoms and false belief that she is infested with parasites subsided.
Adult ; Buttocks ; Delusions* ; Dermatitis ; Female ; Humans ; Insects ; Parasites ; Pimozide* ; Pruritus ; Psychotic Disorders ; Skin ; Skin Ulcer

Angiocentric T-cell lymphoma is a subtype of peripheral T-cell lymphoma and histologically characterized by angiocentric and angioinvasive infiltration of lymphoid cells with varying degrees of cytological atypia, leading to angiodestruction. This disease represents the malignant end in the histological spectrum of angiocentric immunproliferative lesions. This malignancy is commonly a disease with considerable morbidity and is often fatal. However, primary cutaneous angiocentric T-cell lymphoma has a tendency to give a favorable prognosis. Epstein-Barr virus can be identified in involved tissue by immunostaining or by in situ hybridization and it is considered significant in the prognosis. We report a case of cutaneous angiocentric T-cell lymphoma, where the Epstein-Barr virus was identified within neoplastic cells. CVP(cyclophosphamide, vincristine, prednisone) chemotherapy was instigated and an initial complete remission was achieved.
Drug Therapy* ; Herpesvirus 4, Human ; In Situ Hybridization ; Lymphocytes ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Peripheral ; Prognosis ; T-Lymphocytes* ; Vincristine

PURPOSE: The clinical significance of Y. pseudotuberculosis infection has recently recognizd in various part of the world, because it can cause a wide range of clinical problems such as mesenteric lymphadenitis, septicemia, reactive arthritis, terminal ileitis, erythema nodosum, and a cute renal failure. We have experienced 19 children with Y. pseudotuberculosis infection confirmed by stool culture. Our aim in this study was to evaluate clinical charactieristics, age and sex distribution, and source of infection. METHODS: Stools were inoculated on CIN(Cefsulodin-Irgasan-Novobiosin) agar (Difco, USA) and incubated for 48hr at 22 degrees C for isolation of Y. pseudotuberculosis. API 20E and VITEC were used for identification of the isolates. The antimicrobial sensitivity tests were performed by GN S(gram negative sensitive) card. Clinical characteristics were analyzed retrospectively. RESULTS: Retrospective analysis of 19 children with Y. pseudotuberculosis infection who visited our hospital between Jun.1993 and Dec.1993 was performed. The most prevalent age group was 6 to 8 years(42%) and monthly distribution showed November, December, June, and July in order of frequency, respectively. The common symptoms and signs were fever(100%), abdominal pain(100%), rash(74%), s trawberry tongue(53%), vomiting(53%), diarrhea(37%), and desquamation(32%), respectively. Four cases among 9 cases showed multiple mesenteric lymph node enlargements on the abdominal ultrasonogaphy. Serogroups of the isolates from stool specimens were type 5(15/19, 79%), and type 4(4/19, 21%), respectively. Y. pseudotuberculosis was also isolated from 3 samples of untreated drinking water which was thought to be the source of infection. There were no resistance strains against Amikacin, Carbenidlin, Gentamicin, and Trimethoprim/Sulfamethoxazole in the antibiotic susceptibility tests. CONCLUSIONS: In this study, the antibiotic susceptibility against Y. pseudotuberculosis was excellent, although the clinical characteristics were various. We have found that untreated drinking water was an important source of this infection. Further epidemiologic study for this infection should be needed.
Agar ; Amikacin ; Arthritis, Reactive ; Child* ; Crohn Disease ; Drinking Water ; Epidemiologic Studies ; Erythema Nodosum ; Gentamicins ; Humans ; Lymph Nodes ; Mesenteric Lymphadenitis ; Renal Insufficiency ; Retrospective Studies ; Sepsis ; Sex Distribution ; Yersinia pseudotuberculosis* ; Yersinia*