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A case of syphilitic keratoderma in concurrence with syphilitic uveitis
P2309
P2311
Clinical-epidemiologic profile of patients hospitalized for erysipelas in a Brazilian tertiary care hospital Camila Silveira, MD, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Marco Andrey Frade, PhD, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Mariana Coelho, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Vagner Silveira Jr, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil Erysipelas is defined as an infection of dermis and superficial subcutaneous tissue, predominantly caused by Streptococcus spp. It is clinically characterized by local signs of inflammation and fever. The diagnosis is basically clinical and the standard treatment is penicillin. This study was a retrospective review of the hospitalizations for erysipelas in S~ao Paulo University Hospital, Ribeir~ao Preto, between 2001 and 2005. The patients were selected by the hospital registry and their medical records were reviewed in order to record their clinicaleepidemiologic characteristics. Data were analyzed by the software EpiInfo version 3.3.2. There were 428 hospitalizations of 378 patients analyzed, of which 53% were men and 47% women. Age varied between 1 and 97 years (average, 57.35 yrs). It had predominance of the white etnia (89.5%), followed for medium brown (5.8%) and black (4.7%), most of the patients had their residence in Ribeir~ao Preto. More than half (55.3%) of the patients were hospitalized in the internal medicine department, and the emergency room was the main way of access to the hospital. The average time of hospitalization was of 10.1 days, with mode of 1 day and 8% of the patients had more than one hospitalization. The most commonly associated diseases were hypertension (41.4%), diabetes mellitus (25.5%), and heart disease (23.6%), and 12.3% had no other disease. More than one quarter (25.5%) of the patients had bullous lesions and 47.4% had an ulcer. The cultures were done in 40.8% of the cases and 39.9% of those were positive. Great variation of species was found, including 21% of Streptococcus spp. and 24% of Staphylococcus aureus. The antibiotic’s resistance rate was 40.2%. The most used treatments were first generations cephalosporin and penicillin. The mortality rate was 0.5%. It was concluded that erysipelas was most prevalent in white males, with average age of 57.35 years. The hospitalization’s average time was 10 days, and hypertension and diabetes mellitus were the main disease associated. The legs were the main site of infection and the portal of entry was unknown in most of the cases. Bullous were found in 25.5% of the patients and ulcer in 47.4%. Cultures were done in 40.8% of the hospitalizations, and 39.9% of those were positive, showing multiples agents. The most used treatment in and after hospitalization was first generation’s cephalosporin. The study’s great limitation was the inadequate filing of medical records.
21st-century department, 19th-century diseases Mark Griffiths, MD, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Adrian Heagerty, MD, MBBS, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Bavani Arun, MBBCh, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Irshad Zaki, MBBS, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Stephen Orpin, MBBCh, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom At a time when medicine, including dermatology, is moving ever faster towards the ‘‘magic bullet’’ with biologic therapies, immune modulators, and the prospect of gene therapy, we were recently surprised by three patients who presented to our 21st-century department with disorders more reminiscent of the 19th. Case 1: A 37-year-old Anglo Asian woman gave a 1-year history of five hypopigmented patches over her arms, face, back, and left buttock. These had reduced sensation to pin prick, and a biopsy revealed well circumscribed confluent granulomatous foci consisting of both epithelioid histiocytes and inflammatory cells in the dermis. ZiehleNeelsen staining for acid-fast bacilli was positive. The histology was consistent with borderline tuberculoid leprosy and she was started on the National Hansen Disease Program regimen of rifampicin 600 mg and dapsone 100 mg daily. Case 2: A 41-year-old female presented with a widespread nonpruritic papular eruption of 2 weeks’ duration. She was otherwise well apart from a recent onset of intermittent headache. Her medical history was remarkable for excess alcohol consumption. She settled with a new partner 8 weeks earlier. A clinical examination revealed widespread coppery red papules with fine scale. The palms and soles were involved. There were no ulcers or oral involvement. Treponemal serology was positive and a diagnosis of secondary syphilis was established. There was no recollection of a primary chancre. She was referred to the genitourinary physicians for definitive management and contract tracing. Case 3: At routine follow-up following a wide excision for superficial spreading malignant melanoma, a 28-year-old female pointed out five firm lumps on the right side of her neck that had been present since shortly after her primary excision. Computed tomographic scan confirmed that they were enlarged lymph nodes and also showed lymphadenopathy in the mediastinum and calcification in the apex of the left lung. Lymph node biopsy revealed caseating granulomas and numerous acidfast bacilli that proved to be Mycobacterium tuberculosis. She was started on rifampicin, isoniazid, and pyrazinamide. It is easy to think that the infectious diseases that formed the bulk of the physician’s workload before the advent of antibiotics are things of the past. Our recent experience suggests otherwise. The 21st-century dermatologist, it appears, is still on the front line in the fight against these old enemies.
Commercial support: None identified.
Commercial support: None identified.
P2310
P2312 A case of syphilitic keratoderma in concurrence with syphilitic uveitis Deborah Lee, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Ho Suk Sung, MD, PhD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Ju-Hyun Kang, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Sang-Hyun Kim, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Seon-Wook Hwang, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea A 69-year-old female presented with steroid-resistant hyperkeratotic patches on the palms and soles with uveitis for 4 months. Because steroid-resistant uveitis must be evaluated for syphilis, viral infections, and autoimmune diseases, we checked several laboratory tests and found serologic test for VDRL reactive (titer, 1:128). After treatment with penicillin G 4 million units intravenously every 4 hours for 2 weeks, her skin lesions and visual disturbance were completely resolved. Therefore, she was diagnosed as having syphilitic keratoderma and uveitis. Syphilitic keratoderma is a rare type of cutaneous manifestation of secondary syphilis, characterized by symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, the cases of syphilitic keratoderma and uveitis have not been appeared in the dermatologic literatures. Here, we report a rare case of syphilitic keratoderma in concurrence with syphilitic uveitis and suggest that an evaluation for syphilis may be required when the skin lesions and ocular disturbances are resistant to long-term steroid therapy. Commercial support: None identified.
MARCH 2009
J AM ACAD DERMATOL
AB109
P2311
Clinical-epidemiologic profile of patients hospitalized for erysipelas in a Brazilian tertiary care hospital Camila Silveira, MD, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Marco Andrey Frade, PhD, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Mariana Coelho, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Vagner Silveira Jr, Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil Erysipelas is defined as an infection of dermis and superficial subcutaneous tissue, predominantly caused by Streptococcus spp. It is clinically characterized by local signs of inflammation and fever. The diagnosis is basically clinical and the standard treatment is penicillin. This study was a retrospective review of the hospitalizations for erysipelas in S~ao Paulo University Hospital, Ribeir~ao Preto, between 2001 and 2005. The patients were selected by the hospital registry and their medical records were reviewed in order to record their clinicaleepidemiologic characteristics. Data were analyzed by the software EpiInfo version 3.3.2. There were 428 hospitalizations of 378 patients analyzed, of which 53% were men and 47% women. Age varied between 1 and 97 years (average, 57.35 yrs). It had predominance of the white etnia (89.5%), followed for medium brown (5.8%) and black (4.7%), most of the patients had their residence in Ribeir~ao Preto. More than half (55.3%) of the patients were hospitalized in the internal medicine department, and the emergency room was the main way of access to the hospital. The average time of hospitalization was of 10.1 days, with mode of 1 day and 8% of the patients had more than one hospitalization. The most commonly associated diseases were hypertension (41.4%), diabetes mellitus (25.5%), and heart disease (23.6%), and 12.3% had no other disease. More than one quarter (25.5%) of the patients had bullous lesions and 47.4% had an ulcer. The cultures were done in 40.8% of the cases and 39.9% of those were positive. Great variation of species was found, including 21% of Streptococcus spp. and 24% of Staphylococcus aureus. The antibiotic’s resistance rate was 40.2%. The most used treatments were first generations cephalosporin and penicillin. The mortality rate was 0.5%. It was concluded that erysipelas was most prevalent in white males, with average age of 57.35 years. The hospitalization’s average time was 10 days, and hypertension and diabetes mellitus were the main disease associated. The legs were the main site of infection and the portal of entry was unknown in most of the cases. Bullous were found in 25.5% of the patients and ulcer in 47.4%. Cultures were done in 40.8% of the hospitalizations, and 39.9% of those were positive, showing multiples agents. The most used treatment in and after hospitalization was first generation’s cephalosporin. The study’s great limitation was the inadequate filing of medical records.
21st-century department, 19th-century diseases Mark Griffiths, MD, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Adrian Heagerty, MD, MBBS, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Bavani Arun, MBBCh, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Irshad Zaki, MBBS, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; Stephen Orpin, MBBCh, Department of Dermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom At a time when medicine, including dermatology, is moving ever faster towards the ‘‘magic bullet’’ with biologic therapies, immune modulators, and the prospect of gene therapy, we were recently surprised by three patients who presented to our 21st-century department with disorders more reminiscent of the 19th. Case 1: A 37-year-old Anglo Asian woman gave a 1-year history of five hypopigmented patches over her arms, face, back, and left buttock. These had reduced sensation to pin prick, and a biopsy revealed well circumscribed confluent granulomatous foci consisting of both epithelioid histiocytes and inflammatory cells in the dermis. ZiehleNeelsen staining for acid-fast bacilli was positive. The histology was consistent with borderline tuberculoid leprosy and she was started on the National Hansen Disease Program regimen of rifampicin 600 mg and dapsone 100 mg daily. Case 2: A 41-year-old female presented with a widespread nonpruritic papular eruption of 2 weeks’ duration. She was otherwise well apart from a recent onset of intermittent headache. Her medical history was remarkable for excess alcohol consumption. She settled with a new partner 8 weeks earlier. A clinical examination revealed widespread coppery red papules with fine scale. The palms and soles were involved. There were no ulcers or oral involvement. Treponemal serology was positive and a diagnosis of secondary syphilis was established. There was no recollection of a primary chancre. She was referred to the genitourinary physicians for definitive management and contract tracing. Case 3: At routine follow-up following a wide excision for superficial spreading malignant melanoma, a 28-year-old female pointed out five firm lumps on the right side of her neck that had been present since shortly after her primary excision. Computed tomographic scan confirmed that they were enlarged lymph nodes and also showed lymphadenopathy in the mediastinum and calcification in the apex of the left lung. Lymph node biopsy revealed caseating granulomas and numerous acidfast bacilli that proved to be Mycobacterium tuberculosis. She was started on rifampicin, isoniazid, and pyrazinamide. It is easy to think that the infectious diseases that formed the bulk of the physician’s workload before the advent of antibiotics are things of the past. Our recent experience suggests otherwise. The 21st-century dermatologist, it appears, is still on the front line in the fight against these old enemies.
Commercial support: None identified.
Commercial support: None identified.
P2310
P2312 A case of syphilitic keratoderma in concurrence with syphilitic uveitis Deborah Lee, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Ho Suk Sung, MD, PhD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Ju-Hyun Kang, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Sang-Hyun Kim, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Seon-Wook Hwang, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea A 69-year-old female presented with steroid-resistant hyperkeratotic patches on the palms and soles with uveitis for 4 months. Because steroid-resistant uveitis must be evaluated for syphilis, viral infections, and autoimmune diseases, we checked several laboratory tests and found serologic test for VDRL reactive (titer, 1:128). After treatment with penicillin G 4 million units intravenously every 4 hours for 2 weeks, her skin lesions and visual disturbance were completely resolved. Therefore, she was diagnosed as having syphilitic keratoderma and uveitis. Syphilitic keratoderma is a rare type of cutaneous manifestation of secondary syphilis, characterized by symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, the cases of syphilitic keratoderma and uveitis have not been appeared in the dermatologic literatures. Here, we report a rare case of syphilitic keratoderma in concurrence with syphilitic uveitis and suggest that an evaluation for syphilis may be required when the skin lesions and ocular disturbances are resistant to long-term steroid therapy. Commercial support: None identified.
MARCH 2009
J AM ACAD DERMATOL
AB109