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Leprosy: an atypical reversal reaction
Posters - Infections/hfestatiotts
P236 El
Leprosy:
an atypical
reversal
reaction
ACES. Dionysio, J.A.C. Nery, C.L. Monies, M.J.L.C. Marques. Fiocruz, C.M.S. Mattoel Jose Ferreirn, de Jatteiro,
Rio
Brazil
Leprosy is an endemic disease in our country and its clinical forms are not always characteristic, what causes diagnostic doubts. We describe a 22-year-old black man, born in Rio de Janeiro, with a three months history of well defined erythematous plaques with different sizes and shapes and markedly diminished sensation to light touch, temperature and pain. Some lesions have evolved with extensive central ulceration with erythematous infiltrated borders. Rifampin-Isoniazid-Pyrazinamide therapy had been started for pulmonary tuberculosis four months before the development of skin lesions. The diagnosis of Borderline tuberculoid leprosy in type I reaction has been confirmed by skin biopsy, Mitsuda test, baciloscopy, polymerase chain reaction and motor evaluation. The uncommon presentation of the reversal reaction required a large investigation in order to exclude other diseases such as sarcoidosis, syphilis and cutaneous tuberculosis. Multibacillary polichemotherapy precognized by the World Health Organization associated with oral prednisone (1 mg/kg/day) has been administrated with a good response. in a young population I P237 Erysipelas E. MahC, P. Toussaint, S. Boutchnei’, Y. Guiguen. Service Dertnatologie, Picqut?, Route
Haphal d’hrstruction de Toulouse, 33140
de des Artnees Robert Kllettave d’Ortton, France
Erysipelas is a bacterial dermal and sub-cutaneous infection. Patients are often 50 years old or more. We studied erysipelas in a young military population, in good health. Localization, facilitating or aggraving factors, complications, bacteriological data and were studied. A retrospective study of 81 patients admitted to the Robert Picque Hospital, Bordeaux, between 1991 and 1997 was realised. It revealed: - Mean age was 21.4 f 2.2 (17-27) years. 80 patients were men. - Localization of erysipelas was: face: 2 (2.5%); arm: 4 (4.9%); trunk 1 (1.2%); leg: 74 (91.4%). - Facilitating or aggravating factors were: portal of entry in 8 1 cases (100%): local trauma 44 (54.3%), fungal infections 33 (40.7%); venous insufficiency in 1 case (1.2%); alcohol abuse in 2 cases (2.5%); anti-inflammatory agents in 26 cases (32.1%); and 6 had a recurrent erysipelas (7.1%). - Antibiotics used were: /I-lactams in 76 (93.8%) cases, pristinamycin in 3 (3.7%) cases, and erythromycin in 2 (2.5%) cases. - Complications were: abscess in 8 cases (9.9%) and bursitis in 1 case. There was no septicemia, deep cellulitis, or other septic complications. No facilitating factor was detected. - No bacteraemia was detected (O/21); bacteriological finding of portal of entry (28) were: Staphylococcus aureus (8). Staphylococcus epidermidis (I), Streptococcus sp (3). Serologies were: streptozym. 17+/48; antistteptodomas 8+/16; antistaphylolysin 3+/17. The course was not related with bacterial findings. - Preventive anticoagulation were used for 27 (33.3%) patients. No thrombo-embolic complication was observed.
5241
In this young population in good health, erysipelas is not a rare infection. The main risk factor for developing erysipelas is foot trauma or fungal infections. It seems important in this population to be very attentive to feet problems. Use of antiinflammatory agents is frequent by diagnosis errors: tendinitis is often suspected. Complications are rare and benign. No thrombo-embolic complication was observed. P236 El
Tuberculosis node
cutis colliquativa
in lymph
M.S. Rutowitsch, C.P. Gon9alves, M.P. Braga. Hospital Servidores
do Estado
(HSE-MS)
Rio de Janeiro,
dos RJ, Brazil
We report on the case of a 45-year old man patient with tuberculosis colliquativa cutis (scrofuloderma). The skin lesions had developed from a cervical lymph node. The diagnosis was made by culturing biopsies skin and underlying lymph node. The HIV tests were negative. Under a triple drug therapy the skin lesions cleared. After 6 months the lymph nodes appeared to be normal. nocardiosis I P239 A case of primary cutaneous i. Candan, I. Aydmgoz, G. Hitit, B. Dervent. Deparftnettf of Dertnatology,
Haydarpa
a Nutnune
Hospital,
Istanbul,
Turkey
We report a case of nocardiosis observed in a 65-year-old woman suffering from psoriasis vulgaris for I5 years. She developed arthralgias within the last year. A diagnosis of arthropathic psoriasis was made and she was administered five intralesional steroid injections in the right hand. One month after the last injection multiple lesions appeared on the right hand. Dermatologic examination showed erythematous, superlicial scaling and fluctuating nodules on the metacarpal areas and the proximal phalanx accompanied by numerous papulopustural lesions on the dorsal aspect of the hand. Cultures showed nocardiosis. Trimetboprim-sulfametoxazole (160/800 mg bid) therapy was instituted. Dramatic improvement was noted within 20 days. The authors attributed nocardiosis to decreased local tissue resistance induced by steroid injections. disease I P240 Chronic granulomatous M.A. Ionescu’, P. Trifu?, D. Sabau3, Sanda Popescu’. tDermatology II Clittic; 2Histopathology; Clinic- “N. G/t. Lupu ” Hospital, Bucarest,
30rthopaedy Roumanie
We present a 15 year-old boy with stature-ponderal hypotrophy admitted for a facial ulcered lesion, fistulised osteitis of 113 inf. right radius, several extended scars, edentation. Patient’s medical history showed repeated staphylococcal cutaneous infections (since 3 months old) and similar episodes in patient’s sister. Cultures(skin and bone) have isolated Staphylococcus aur. Skin biopsy show a granulomatous reaction. Laboratory finding revealed (beside anemia, leucocytosis, Ig G and Ig A moderate serum levels) the test Nitroblue tetrazolium-positive. The patient received antibiotherapy, orthopaedic treatment.
P236 El
Leprosy:
an atypical
reversal
reaction
ACES. Dionysio, J.A.C. Nery, C.L. Monies, M.J.L.C. Marques. Fiocruz, C.M.S. Mattoel Jose Ferreirn, de Jatteiro,
Rio
Brazil
Leprosy is an endemic disease in our country and its clinical forms are not always characteristic, what causes diagnostic doubts. We describe a 22-year-old black man, born in Rio de Janeiro, with a three months history of well defined erythematous plaques with different sizes and shapes and markedly diminished sensation to light touch, temperature and pain. Some lesions have evolved with extensive central ulceration with erythematous infiltrated borders. Rifampin-Isoniazid-Pyrazinamide therapy had been started for pulmonary tuberculosis four months before the development of skin lesions. The diagnosis of Borderline tuberculoid leprosy in type I reaction has been confirmed by skin biopsy, Mitsuda test, baciloscopy, polymerase chain reaction and motor evaluation. The uncommon presentation of the reversal reaction required a large investigation in order to exclude other diseases such as sarcoidosis, syphilis and cutaneous tuberculosis. Multibacillary polichemotherapy precognized by the World Health Organization associated with oral prednisone (1 mg/kg/day) has been administrated with a good response. in a young population I P237 Erysipelas E. MahC, P. Toussaint, S. Boutchnei’, Y. Guiguen. Service Dertnatologie, Picqut?, Route
Haphal d’hrstruction de Toulouse, 33140
de des Artnees Robert Kllettave d’Ortton, France
Erysipelas is a bacterial dermal and sub-cutaneous infection. Patients are often 50 years old or more. We studied erysipelas in a young military population, in good health. Localization, facilitating or aggraving factors, complications, bacteriological data and were studied. A retrospective study of 81 patients admitted to the Robert Picque Hospital, Bordeaux, between 1991 and 1997 was realised. It revealed: - Mean age was 21.4 f 2.2 (17-27) years. 80 patients were men. - Localization of erysipelas was: face: 2 (2.5%); arm: 4 (4.9%); trunk 1 (1.2%); leg: 74 (91.4%). - Facilitating or aggravating factors were: portal of entry in 8 1 cases (100%): local trauma 44 (54.3%), fungal infections 33 (40.7%); venous insufficiency in 1 case (1.2%); alcohol abuse in 2 cases (2.5%); anti-inflammatory agents in 26 cases (32.1%); and 6 had a recurrent erysipelas (7.1%). - Antibiotics used were: /I-lactams in 76 (93.8%) cases, pristinamycin in 3 (3.7%) cases, and erythromycin in 2 (2.5%) cases. - Complications were: abscess in 8 cases (9.9%) and bursitis in 1 case. There was no septicemia, deep cellulitis, or other septic complications. No facilitating factor was detected. - No bacteraemia was detected (O/21); bacteriological finding of portal of entry (28) were: Staphylococcus aureus (8). Staphylococcus epidermidis (I), Streptococcus sp (3). Serologies were: streptozym. 17+/48; antistteptodomas 8+/16; antistaphylolysin 3+/17. The course was not related with bacterial findings. - Preventive anticoagulation were used for 27 (33.3%) patients. No thrombo-embolic complication was observed.
5241
In this young population in good health, erysipelas is not a rare infection. The main risk factor for developing erysipelas is foot trauma or fungal infections. It seems important in this population to be very attentive to feet problems. Use of antiinflammatory agents is frequent by diagnosis errors: tendinitis is often suspected. Complications are rare and benign. No thrombo-embolic complication was observed. P236 El
Tuberculosis node
cutis colliquativa
in lymph
M.S. Rutowitsch, C.P. Gon9alves, M.P. Braga. Hospital Servidores
do Estado
(HSE-MS)
Rio de Janeiro,
dos RJ, Brazil
We report on the case of a 45-year old man patient with tuberculosis colliquativa cutis (scrofuloderma). The skin lesions had developed from a cervical lymph node. The diagnosis was made by culturing biopsies skin and underlying lymph node. The HIV tests were negative. Under a triple drug therapy the skin lesions cleared. After 6 months the lymph nodes appeared to be normal. nocardiosis I P239 A case of primary cutaneous i. Candan, I. Aydmgoz, G. Hitit, B. Dervent. Deparftnettf of Dertnatology,
Haydarpa
a Nutnune
Hospital,
Istanbul,
Turkey
We report a case of nocardiosis observed in a 65-year-old woman suffering from psoriasis vulgaris for I5 years. She developed arthralgias within the last year. A diagnosis of arthropathic psoriasis was made and she was administered five intralesional steroid injections in the right hand. One month after the last injection multiple lesions appeared on the right hand. Dermatologic examination showed erythematous, superlicial scaling and fluctuating nodules on the metacarpal areas and the proximal phalanx accompanied by numerous papulopustural lesions on the dorsal aspect of the hand. Cultures showed nocardiosis. Trimetboprim-sulfametoxazole (160/800 mg bid) therapy was instituted. Dramatic improvement was noted within 20 days. The authors attributed nocardiosis to decreased local tissue resistance induced by steroid injections. disease I P240 Chronic granulomatous M.A. Ionescu’, P. Trifu?, D. Sabau3, Sanda Popescu’. tDermatology II Clittic; 2Histopathology; Clinic- “N. G/t. Lupu ” Hospital, Bucarest,
30rthopaedy Roumanie
We present a 15 year-old boy with stature-ponderal hypotrophy admitted for a facial ulcered lesion, fistulised osteitis of 113 inf. right radius, several extended scars, edentation. Patient’s medical history showed repeated staphylococcal cutaneous infections (since 3 months old) and similar episodes in patient’s sister. Cultures(skin and bone) have isolated Staphylococcus aur. Skin biopsy show a granulomatous reaction. Laboratory finding revealed (beside anemia, leucocytosis, Ig G and Ig A moderate serum levels) the test Nitroblue tetrazolium-positive. The patient received antibiotherapy, orthopaedic treatment.