A rare cause of recurrent gastrointestinal bleed: Blue rubber bleb nevus syndrome

Congenital venous malformations (VMs) are rare cause of gastrointestinal (GI) bleed in children. Blue rubber bleb nevus syndrome characterized by VMs in GI tract and skin affect at early age in life. Diagnosis is based on typical skin lesion and history of recurrent GI bleed. In this article, we presented a similar case of young girl with typical skin lesion and recurrent GI bleed requiring multiple blood transfusions presenting our department. She was subjected to surgical treatment and endoscopy therapy due to failure of conservative therapy. This case report depicts importance of typical clinical features of rare diseases.

An 8-year-old-girl with juvenile dermatomyositis and autoimmune thyroiditis in Tanzania: a case report

Background Juvenile dermatomyositis is an inflammatory disease of muscles, skin, and blood vessels of unknown cause affecting all age and ethnic groups, with a reported incidence of 1.9–4.1 per million. It manifests with weakness in axial and proximal muscles and typical skin lesions. Historically, the Bohan and Peter classification schema has been used to diagnose juvenile dermatomyositis. Case presentation We report an 8-year-old African female child, who presented with features of juvenile dermatomyositis and a rare association with subclinical autoimmune thyroiditis. This case illustrates the typical presentation, diagnosis, and treatment outcomes of this highly misdiagnosed condition. Conclusion Due to the limited resources and knowledge about this under-reported disease in resource-constrained settings, the characteristic manifestations of juvenile dermatomyositis can be easily missed and thus requires a high index of suspicion for earlier diagnosis and management.

A case series of skin manifestations of infective endocarditis in contemporary era: just another book finding or a useful clinical sign?

Background Infective endocarditis (IE) is a disease of high morbidity and mortality. Infective endocarditis rarely involves skin manifestations in the contemporary era. The identification of typical skin lesions could be helpful in establishing early diagnosis of IE. Case summary We present four cases of IE hospitalized in our institution within a 12-month period. All patients were young and had skin manifestations on initial presentation (petechiae, splinter haemorrhages, Janeway lesions, and Osler’s nodes), which led to a high clinical suspicion of IE confirmed by echocardiography and positive blood cultures. All cases had a complicated course. One patient died and the other three had prolonged hospital stay due to variable complications. Discussion Clinicians should always assess for skin manifestations in patients with fever especially when suspicion of IE is high. Occurrence of skin lesions in the course of IE may be associated with higher rate of complications and worse prognosis.

Seasonal Pattern of Hand Foot and Mouth Disease in an Out-patient Clinic of a Tertiary Care Pediatric Hospital, Dhaka

Background : Hand, foot and mouth disease (HFMD) is a contagious disease of children, occurs primarily under five years of age, characterized by a history of brief febrile illness and a typical skin rash over hands and feet with or without sores in mouth, caused usually by Coxsackie virus[1]A16 viruses. It is mainly the disease of tropical and subtropical countries and bears a complex-relation with meteorological variables like temperature, rainfall and relative humidity, although no study has yet been done in Bangladesh to explain the complex relationship of the disease with these variables. Objective : This study sought to describe the occurrence of HFMD and its association with meteorological factors in Dhaka city. Methods : The present cross-sectional study collected data of 231 HFMD cases from the records of the daily register of Out-patient Department of Dhaka Shishu Hospital, Dhaka between January 2018 to December 2019. According to the study protocol a child was identified as having HFMD who had a history of brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Total numbers of cases treated monthly at OPD during the period were also recorded. Meteorological data were provided by Bangladesh Meteorological Department, which among others, included monthly average temperature, relative humidity and amount of rainfall. While the outcome variable was monthly number of HFMD cases, the predictive variables were average temperature, humidity and rainfall during the study period. Results : Majority (85.3%) children in the present study was < 5 years old. A male preponderance was observed in the series (60%) with male to female ratio being 3:2. A clustering of HFMD cases was observed to occur between June to October when monthly average temperature, total rainfall and humidity all were at their maximum compared to those found between November to April. The clustering of cases was more intense in the year 2019 than that in the year 2018. During the period average monthly temperature was 29.20C, average rainfall was 62.6% (238 mm) of the total annual precipitation and mean relative humidity was 79%. The proportion of HFMD cases out of total cases treated during the period was 2.2% in 2018 and was 4.1% in 2019, which in the dry season (November to April) was 0.4% and 0.5% in 2018 and 2019 respectively. Conclusions : The study concluded that majority of the HFMD cases occur under five years of age and boys are more likely to have the infection than the girls. A seasonality of HFMD occurrence is observed with a higher number of cases occurring in the monsoon season and fewer cases in the dry season.Clustering of HFMD cases occur between May to October when monthly average temperature, total rainfall and humidity all are at peak compared to those in November to April of the year. Northern International Medical College Journal Vol.11 (2) Jan 2020: 453-457

Clinical and Forensic Aspects of the Different Subtypes of Argyria

Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from localized dark-blue macules to a generalized slate-gray/bluish tinge following systemic absorption. This work aims to fully review the state of the art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic features of argyria. Argyria has been diagnosed in a wide range of ages, both sexes and varied ethnicities, with no known individual predisposing factors. Ultraviolet radiation with subsequence increases of melanin production aggravates the discoloration due to a reduction in the silver deposits. Physical examination and silver exposure in the anamnesis can be highly suggestive of the diagnosis, but a histopathological analysis with Energy-Dispersive X-ray Spectroscopy is required to unequivocally determine the discoloration etiology. Safe and effective treatment has only been accomplished with laser techniques, though only a few cases have been reported and with limited follow-up time. In conclusion, argyria typically has an occupational or iatrogenic etiology. It should be suspected when a patient presents with typical skin or eye lesions. A seemingly viable treatment modality, with laser technology, is finally within the horizon.

Erythema Elevatum Diutinum: A Neutrophilic Dermatosis Presenting as Bullae

Background: Erythema elevatum diutinum (EED) is a rare disease that is associated with streptococcal infection, blood disorders, and autoimmunity. It is a chronic inflammatory dermatosis in the spectrum of cutaneous leukocytoclastic vasculitis. Typical skin lesions include nodules, erythema, and plaques; however, the presence of blister lesions is rare, especially on the limbs. Case presentation: We report a rare case of EED that presented as blisters on both limbs and the trunk of a 62-year-old woman. She responded well to oral corticosteroid and hydroxychloroquine treatment. The lesions were significantly improved after 2 weeks of treatment. Conclusions: EED is a rare form of cutaneous vasculitis. It is a good mimic of other types of skin diseases because of its diverse clinical presentations. It can even rarely present as blisters.

Skin Infection Caused by Serratia marcescens in a Patient with Diabetes Mellitus

Serratia marcescens is an uncommon gram-negative bacterium strain that does not cause skin infections in healthy individuals. However, it is rarely reported as the causative agent of infection in immunosuppressed patients or in nosocomial infections. A 51-year-old man was admitted to a hospital presenting with pus and pain that had developed a month ago on a hypertrophic scar area of the back. Although he was on medication for diabetes mellitus, his blood sugar level was poorly controlled. In addition, two months earlier, he received an intralesional injection of 40 mg/mL triamcinolone twice for the hypertrophic scar of the back. S. marcescens was identified in the wound culture. His condition improved after ceftriaxone administration, debridement, and split-thickness skin grafts. Although S. marcescens is an infrequent cause of skin infections, it is important to remember that it may cause infection in some patients and that the course of the disease may be worse than that in a typical skin infection with poor prognosis.

Aggressive systemic mastocytosis presenting as rapidly progressive ascites, generalised lymphadenopathy and osteosclerosis

Rapidly progressive ascites is a frequent clinical manifestation of advanced abdominal malignancies or portal hypertension due to liver diseases. We report a case of 61-year-old man who presented with rapidly progressive ascites. The presence of ascites, generalised lymphadenopathy, osteosclerosis on imaging and hepatosplenomegaly initially pointed towards the diagnosis of advanced high-grade lymphoma or accelerated myeloid neoplasm. Lymph node biopsy revealed infiltration by CD45, cKIT and CD30; tryptase and toluidine blue-positive mast cells (MCs). Bone marrow examination revealed infiltration by MCs and next generation sequencing revealed the pathognomic exon 17 D 816V KIT mutation. The patient was started on weekly pegylated interferon with significant symptom relief. Systemic mastocytosis should be considered as a differential diagnosis in a clinical case of ascites of unknown aetiology even in the absence of typical skin manifestations.

The influence of disease-inducing agents other than Dermatophilus congolensis on the severity of bovine dermatophilosis

This study was designed to assess the influence of disease-inducing agents other than Dermatophilus congolensis on the incidence of bovine dermatophilosis from cattle farms in Federal University of Agriculture, Abeokuta and Olabisi Onabanjo University, Ogun State and also from Akinyele cattle market in Oyo State. Skin scrapings collected from cattle with typical lesions of dermatophilosis were examined for the presence of bacteria, fungi and ectoparasites. Out of the 57 animals examined with typical skin lesions of dermatophilosis, Dermatophilus congolensis organism was cultured from 23 cases. Other bacterial organisms identified included Staphylococcus aureus (28 cases), Staphylococcus albus (35 cases), Bacillus mycoides (14 cases), Bacillus cereus (1 case), haemolytic Streptococcus (5 cases) Pseudomonas aeruginosa (13 cases), Escherichia coli (16 cases), Proteus spp (4 cases) and Norcardia spp (5 cases). Ticks (mostly Amblyomma variegatum) were seen in all the 57 animals while Demodex bovis, Sarcoptes scabiei var bovis and lice were seen in 15, 4 and 8 cases respectively. It was inferred that secondary bacterial invasions are associated with the pathogenesis and severity of the infection and the presence of ticks and mange mites may serve as the portal of entry for dermatophilosis infection. The control of dermatophilosis should take into account of arthropod vectors and secondary bacterial complications.

Chitosan Woven Meshes: Influence of Threads Configuration on Mechanical, Morphological, and Physiological Properties

This study aimed to develop meshes from the weaving of mono- and multifilament wet-spun chitosan (CS), for possible biomedical applications. In the wet-spinning process, CS solution (4% w/v) was extruded in a coagulation bath containing 70% sodium hydroxide solution (0.5 M), and 30% methanol was used. The multifilament thread was prepared by twisted of two and three monofilaments. CS threads obtained were characterized by tensile tests and scanning electron microscopy (SEM). Moreover, it was verified from the morphological tests that threads preserve the characteristics of the individual filaments and present typical “skin-core” microstructure obtained by wet spinning. CS woven meshes obtained were evaluated by optical microscopy (OM), tensile test, swelling degree, and in vitro enzymatic biodegradation. Mechanical properties, biodegradation rate, and amount of fluid absorbed of CS woven meshes were influenced by thread configuration. Hydrated CS meshes showed a larger elastic zone than the dry state. Therefore, CS woven meshes were obtained with modular properties from thread configuration used in weaving, suggesting potential applications in the biomedical field, like dressings, controlled drug delivery systems, or mechanical support.