Primary inoculation tuberculosis, also called tuberculosis chancre or tuberculosis primary complex, is the result of direct inoculation of M. tuberculosis in the skin of a host who has not been infected. A 33-year-old laboratory male presents with painless erythematous nodule and central ulcer on the left middle finger for 3 weeks. The skin lesion was developed after he punctured his finger with a needle containing M. tuberculosis. He had no history of tuberculosis. Histopathologic finding showed a wedged shaped abscess mixed with nuclear dust and eosinophils in the epidermis, and inflammatory cell infiltrations and caseation necrosis within the granuloma in the dermis. No bacillus was found in the lesion on AFB stain. We performed polymerase chain reaction with lesional tissue and obtained a positive result. So we diagnosed this case as a primary inoculation tuberculosis, and started antituberculosis medication. After 2 months of treatment, the erythema and ulcer improved. The patient completed a 9 months course of antituberculosis therapy without complication.
Abscess ; Adult ; Bacillus ; Chancre ; Dermis ; Dust ; Eosinophils ; Epidermis ; Erythema ; Fingers ; Granuloma ; Humans ; Male ; Necrosis ; Needles ; Polymerase Chain Reaction ; Skin ; Tuberculosis* ; Ulcer

Intrahepatic sarcomatoid cholangiocarcinomais is a very rare disease with a poor prognosis due to its biologically aggressive tumor behavior. We report a patient who presented with subcapsular hemorrhage and a rapidly growing liver mass. A 57 year-old man was admitted with severe abdominal pain. CT and MRI images showed the presence of a 10 cm-sized subcapsular hemorrhage connected with a multi-lobulated mass with hemorrhage and necrotic foci in the right liver. The patients underwent right hemihepatectomy with caudate lobectomy and lymphadenectomy. The operation findings revealed metastatic nodules to the diaphragm and omentum. Detailed histopathological analysis through immunohistochemistry confirmed the diagnosis of sarcomatoid cholangiocarcinoma with a poorly undifferentiated sarcomatous component. The patient underwent chemotherapy. To date, the patient is doing well for 8 months after initial diagnosis.
Abdominal Pain ; Benzeneacetamides ; Cholangiocarcinoma ; Diaphragm ; Hematoma ; Hemorrhage ; Humans ; Immunohistochemistry ; Liver ; Lymph Node Excision ; Omentum ; Piperidones ; Prognosis ; Rare Diseases

Keratoacanthoma is a rapidly growing tumor that has the tendency of spontaneous involution but it may persist for some times, continue to enlarge and may become invasive and destructive. Many modalities are available for the treatment of keratoacanthoma. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. We report two cases with unusually large or facial keratoacanthoma treated with intralesional methotrexate. One case showed complete resolution over 6 injections and the other after 2 injections. We suggest that intralesional injection of methotrexate is a simple, effective, safe and inexpensive method for the treatment of large keratoacanthoma.
Injections, Intralesional ; Keratoacanthoma* ; Methotrexate*

No abstract available.
Erythroblastosis, Fetal* ; Infant, Newborn

PURPOSE: The purpose of this study was to present a systematic treatment method for nontuberculous mycobacteria (NTM) infection of the hand and wrist to gain better clinical outcomes. METHODS: 10 patients of deep NTM infection of the hand and wrist were reviewed. Extensive debridement was performed in all cases. When biopsy result suggested mycobacterial infection such as granulomatous inflammation, empirical tuberculosis medication was started. After culture confirmed NTM growth, the species was identified and in vitro sensitivity test was performed. Then medication was switched according to the results. Functional outcomes of the hand and wrist were measured by total active motion of the fingers and by range of motion of the wrist respectively. RESULTS: Diagnosis was tenosynovitis in seven patients, infective arthritis and osteomyelitis combined with tenosynovitis of the wrist in three patients. Two patients had recurred skin ulcer during follow-up period and undergone second debridement. After second operation, no patient had a persistent discharging sinus and all patient were completely healed during follow-up period. Functional outcome of the eight patients who had NTM infection of their hand was excellent in two, good in four, fair in one, poor in one. Mean range of motion of the two patients who had osteomyelitis of their wrist was dorsiflexion 20degrees, volar flexion 15degrees, radial deviation 0degrees, ulnar deviation 15degrees. CONCLUSION: Our standardized treatment protocol can be helpful for treatment of deep NTM infection of the hand and wrist.
Arthritis ; Biopsy ; Clinical Protocols ; Debridement ; Diagnosis* ; Fingers ; Follow-Up Studies ; Hand* ; Humans ; Inflammation ; Nontuberculous Mycobacteria* ; Osteomyelitis ; Range of Motion, Articular ; Skin Ulcer ; Tenosynovitis ; Tuberculosis ; Wrist*

PURPOSE: We evaluated the clinical outcomes of the autologous platelet rich plasma injection for the treatment of recalcitrant medial and lateral epicondylitis. MATERIALS AND METHODS: Nineteen cases with recalcitrant medial and lateral epicondylitis despite of conservative treatment for 1 year were enrolled in this study. Each patient underwent autologous platelet rich plasma injection and followed up minimally of 40 weeks. The assessment included a preoperative and postoperative Visual Analogue Scale (VAS) (0~10) at 4, 8, 12, 24 and 36 weeks and overall satisfaction was evaluated with Roles & Maudsley score at 36 weeks after injection. We also compared the clinical outcomes between medial and lateral epicondylitis group. RESULTS: Mean preoperative VAS was 8.7 points and improved to 5.1, 5.2 and 4.7 at 12, 24 and 36 weeks follow up, respectively. Roles & Maudsley score was excellent in 5 cases(26%), good in 7 cases(37%), acceptable in 4 cases(21%) and poor in 3 cases(16%). On the comparison of medial and lateral epicondylitis group, there was no statistical significant difference (p=0.38). CONCLUSION: The autologous platelet rich plasma injection for recalcitrant medial & lateral epicondylitis is thought to be a alternative treatment option.
Blood Platelets ; Elbow ; Follow-Up Studies ; Humans ; Platelet-Rich Plasma

Keloid is proliferative fibrous growths that result from an excessive tissue response to trauma. The earlobe is a common site for the formation of keloid and the frequent cause is ear piercing. Many modalities are available for the treatment of earlobe keloid. Surgical excision has been the most commonly used therapeutic modality but recurrence following excision is common. Intralesional triamcinolon, radiation therapy, compression device, cryosurgery, D-penicillamine or any combination of them were reported to be successful in the treatment of earlobe keloid. We report three cases of earlobe keloid treated with partial surgical keloidectomy of upper part and carbon dioxide laser vaporizing the residual keloid tissue. And then the defect was covered with a primary closure with flap. Pressure earrings were fitted 2 weeks after surgery, and were maintained for 3 months. There was no recurrence of keloid for follow-up period at least 9 months. We suggest that combined modality of CO2 laser vaporization and pressure earring after surgical keloidectomy may offer a better cosmetic and functional improvement in the treatment of primary and recurrent earlobe keloid.
Body Piercing ; Carbon Dioxide* ; Carbon* ; Cryosurgery ; Ear* ; Follow-Up Studies ; Keloid* ; Lasers, Gas* ; Penicillamine ; Recurrence ; Volatilization

BACKGROUND: Nettles, of the plant family Urticae, cause nonimmunologic contact urticaria by stinging hairs. Light application of the leaf or stem to the skin results in the rapid development of a short-lived stinging sensation accompanied by wheal formation and itching. The types of chemical mediators causing the stinging sensation and wheal have not yet been clarified. OBJECTIVE: To investigate stinging and urticating substances causing contact urticaria when the skin is in contact with nettle(Urtica thunbergiana). METHODS: Twenty two volunteers were used for the clinical portion of this investigation. The time to wheal development and the evanescent time of pain and wheal were measured after pricking the forearm skin with nettle trichomes, following the administration of antihistamine, antiserotonin or corticosteroid, respectively or a combination of two, either with or without the application of substance P antagonist(capsaicin cream, 0.025%). Nettle extracts were prepared from dry stems and leaves of Urtica thunbergiana. Histamine, serotonin and substance P(SP) contents of nettle extracts were measured by gas chromatographic mass spectroscopy. RESULTS: After puncture of the skin by trichome of nettle, a stinging sensation developed within a few seconds but disappeared faster at the site where capsaicin cream had been applied than at the nonapplied skin site(p<0.05). The development and evanescent time of wheal were not significantly correlated with the application of capsaicin cream. The evanescent time of pain after pricking the skin with trichome following the administration of antiserotonin was significantly shortened at the nonapplied skin site. Pain disappeared more rapidly at the capsaicin applied site following the administration of antihistamine or antiserotonin than at the nonapplied sites(p<0.05), but not following prednisolone administration. Wheal development was delayed significantly at both the capsaicin applied and nonapplied sites after antihistamine administration(p<0.05). Histamine was detected only in the nettle extract. SP and serotonin were not detected because of their insolubility in solvents. CONCLUSION: These results suggest that wheal-and-flare reaction to nettle stings is due primarily to the histamine and partly to the serotonin and SP introduced by the nettle. SP may be mainly involved and partially involved by serotonin in stinging pain.
Bites and Stings ; Capsaicin ; Forearm ; Hair ; Histamine ; Humans ; Mass Spectrometry ; Plants ; Prednisolone ; Pruritus ; Punctures ; Sensation ; Serotonin ; Skin ; Solvents ; Substance P ; Trichomes ; Urticaria* ; Volunteers

Kaposi's sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 years, and had been treated with corticosteroids. Clinical picture and hormonal study revealed that she had iatrogenic Cushing's syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dermis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing's syndrome.
Adrenal Cortex Hormones ; Aged ; Cushing Syndrome* ; Dermis ; Female ; Forearm ; Herpesvirus 8, Human* ; Humans* ; Leg ; Low Back Pain ; Purpura ; Sarcoma, Kaposi* ; Skin

Creeping eruption is a syndrome characterized by the penetration in human skin of larvae from hookworms of various animals, mainly cats and dogs. A 26-year-old male presents with pruritic erythematous serpiginous linear skin lesion on the left lower leg for 2 weeks. The skin lesion was developed after walking in bare feet along the beach of an island in Philippines. Histopathologic finding showed a burrow containing numerous eosinophils and a few mononuclear cells in the epidermis. No parasite was found in multiple histologic section.
Adult ; Ancylostomatoidea ; Animals ; Cats ; Dogs ; Eosinophils ; Epidermis ; Foot ; Humans ; Larva ; Larva Migrans* ; Leg ; Male ; Parasites ; Philippines ; Skin ; Walking