INTRODUCTION

Childhood Polyarteritis Nodosa (PAN) is a rare, systemic necrotizing vasculitis of the small to medium-sized vessels with an uncertain global distribution. The primary etiology is unknown. However, PAN is commonly associated with preceding Group A streptococcus infection in children. The most common cutaneous manifestations of PAN include tender subcutaneous nodules, livedo reticularis, digital ischemia and ulceration. To date, no reports have documented cutaneous PAN as a sequela of rheumatic fever.

CASE REPORT

This is a report of a 7-year-old Filipino male who presented with multiple, well-defined erythematous to hyperpigmented, firm, tender nodules, with some areas of lace or net-like macules and patches, some resolved leaving hyperpigmentation measuring 1x1 cm to 2x2 cm on the lower back, bilateral upper and lower extremities accompanied by fever, malaise, arthralgia and myalgia with a previous history of rheumatic fever. A 6mm skin punch biopsy revealed findings consistent with PAN. The patient was managed with prednisone. Due to the limited response to treatment, he was eventually given mycophenolate mofetil.

CONCLUSION

Childhood polyarteritis nodosa (PAN) is a rare form of necrotizing inflammation of the medium-sized blood vessels primarily linked to Group A streptococcal infection in children, with no known reported cases associated with rheumatic fever. However, in this case, we were able to observe that PAN could present as a probable rare sequela of rheumatic fever. This warrants close follow-up among such patients.

Human ; Male ; Child: 6-12 Yrs Old ; Polyarteritis Nodosa ; Rheumatic Fever ; Vasculitis

Nevus comedonicus is a rare developmental anomaly of the pilosebaceous unit presenting as grouped dilated follicular orifices plugged with keratin. The comedones are usually arranged unilaterally along the lines of Blaschko. As of year 2000, only 200 cases have been reported.

BACKGROUND: Superficial bacterial infection is among the most common reasons for dermatologic consult. Numerous published articles suggest that the dried leaf of malunggay exhibits antibacterial property.
OBJECTIVES: To compare the effectiveness and safety of 15% malunggay ointment with 2% mupirocin ointment in treating localized pyoderma.
METHODS: Sixty-three patients with localized pyoderma (?10% of total body surface area) were enrolled in this randomized, double-blind study to apply either 15% malunggay or 2%  mupirocin ointment twice daily for 14 days. Clinical evaluation using the Global Assessment Score (GAS) for pruritus, pain, erythema, vesiculation, moistness and crusting were conducted at baseline and days 3, 7 and 14 of clinic visit.
RESULTS: Both malunggay and mupirocin groups showed significant decreases in GAS from baseline to days 3, 7 and 14 of treatment (p=0.000, Repeated measures, ANOVA). By days 7 and 14, median GAS of malunggay ointment was higher than mupirocin (1 vs. 0, p<0.05, Mann Whitney U Test). Cure rates were higher in the mupirocin arm comapred to the malunggay arm in Day 3 (53.13% vs. 38.71%), Day 7 (93.75% vs. 70.97%) and Day 14 (96.88% vs. 77.42%). No adverse events were noted after application of malunggay-based ointment at the end of the study period. There were no recurrence two weeks post treatment.
CONCLUSION: Patients in the mupirocin treatment arm had significantly lower global assessment scores and higher cure rates compared to those in the malunggay treatment arm.

Human ; Male ; Female ; Adult ; Child ; Ambulatory Care ; Anti-bacterial Agents ; Bacterial Infections ; Erythema ; Mupirocin ; Ointments ; Pain ; Pruritus ; Pyoderma