Fusarium spp are molds found in the soil and may be saprophytic or fa c u l t a t ive plant p a t h ogens. These are rare but important opportunistic pathogens in immunocompromised patients especially those with hematologic malignancies. Fusarium spp usually cause local infections such as onychomycosis and infections of surgical and burn wound. However more importantly, these pathogens can lead to severe disseminated infection with invo l vement of multiple organs including skin. This disseminated form of fusariosis occurs exclusively in patients with prolonged, severe neutropaenia especially in patients with acute leukaemia or those u n d e rgoing bone marrow transplantation. Prognosis of disseminated fusariosis is usually guarded if not recognized early. We report a rare case of disseminated fusariosis in a patient with acute lymphoblastic leukaemia.

Background Antibiotic therapy directed against Propionibacterium acnes has been a mainstay of treatment in acne vulgaris for more than 40 years. Prolonged antibiotic usage has been associated with emergence of antibiotic-resistant P. acnes and is linked to treatment failure. Little work has been done in Malaysia on drug resistance in P. acnes and there is no surveillance data on this aspect to guide the clinical decision. Objective This study aims to evaluate antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital, Malaysia. Methods This is a non interventional, single centered, cross-sectional hospital-based survey of antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital from January 2010 to June 2010. Results A total of 100 patients were recruited in our study. P. acnes was isolated in 53% of patients and 11% had gram negative organism. Antibiotic resistant P. acnes was found in 15.1% of positive isolates. Clindamycin resistance was most common (15.1%) followed by erythromycin (7.5%), doxycycline (5.7%), tetracycline (1.9%) and minocycline (0%). Isolates of antibiotic resistant P. acnes was significantly higher in patients treated with antibiotics within the last 6 months (29%) as compared with non antibiotic treated patients (0%) (p<0.05). The mean duration of prior antibiotic treatment was significantly longer in the group of antibiotic resistant P. acnes as compared with antibiotic sensitive P. acnes (17.13 weeks vs 5.74 weeks, p<0.05). Conclusion Antibiotic resistant P. acnes is present locally with clindamycin and erythromycin conferring the highest resistance. Longer duration of antibiotic treatment predisposes to antibiotic resistant P. acnes and may also induce emergence of gram negative organisms. Strategies to reduce antibiotic resistance should be emphasized when prescribing antibiotic for acne vulgaris in order to achieve optimal therapeutic results while reducing the potential for antibiotic resistance.

No abstract available.

Background: Alopecia areata (AA) is the most common cause of non-scarring alopecia.1 Many studies reported decreased serum vitamin D levels in patients with AA compared to healthy subjects.1-8 This study aimed to assess the prevalence of vitamin D deficiency in patients with AA compared to patients without AA. The secondary objective was to determine the correlation between vitamin D deficiency with disease severity and the pattern of AA. Methods: This research was a case control study involving patients with AA from the dermatology clinic in Hospital Raja Permaisuri Bainun. All the subjects and controls were age, sex and Fitzpatrick skin type matched. Serum vitamin D (25-hydroxyvitamin D) (25 OHD) levels were obtained and analysed by the chemiluminescence immunoassay method. AA severity was assessed by Severity of Alopecia Tool (SALT) score. Results: A total of 50 subjects, out of which 25 patients with AA and 25 controls, were recruited. The median serum vitamin D level was 54.15 nmol/L (IQR 139) in the AA group and 53.79 nmol/L (IQR 64.47) in the control group. However, the difference was not statistically significant (p=0.823). The prevalence of vitamin D deficiency was higher in the AA group (12%) compared to the control group (4%), but it was not statistically significant (p=0.304). There was no statistical significance in serum vitamin D levels with disease severity (SALT score) (p=0.171) and pattern of AA (p=0.657). Conclusion There was no statistical difference in the prevalence of vitamin D deficiency between patients with and without AA. There was no correlation between serum vitamin D levels with disease severity and pattern of AA. Further studies using a larger sample size is needed to justify measuring serum vitamin D levels in patients with AA.
Alopecia Areata ; Vitamin D

Summary Cutaneous serratia marcescens (S. marcescens) infection is very rare and most cases had history of skin trauma or cutaneous procedure done before. It presents in various forms like non-healing ulcers, abscess formation, nodules with an intermittent course or as granulomatous lesions, thus mimicking non-infective lesions. Antibiotic choice is challenging due to multiple antibiotic resistant strains. We are reporting a case of cutaneous S. marcescens in a 70-year old lady with diabetes mellitus presented with non-healing ulcers over the dorsum of left hand for 6 months.
Serratia marcescens ; Dermatomycoses

Summary Sarcoidosis is a multisystem disease characterised by granulomatous inflammation possibly due to hyperactivation of the immune system; with unknown etiology. Subcutaneous sarcoidosis (also known as Darier Roussy sarcoid) is a rare type of specific cutaneous lesion of sarcoidosis characterised by multiple firm, asymptomatic to mildly tender, mobile, round to oval, and skin coloured nodules. Herein we report a rare case of subcutaneous sarcoidosis.
Sarcoidosis