Hepatitis: Gül U

Kiliç A, Gül U, Soylu S, Kaya I, Albayrak L. · Dermatology Clinic Ankara Numune Education and Research Hospital, Ankara, Turkey. · Skinmed. · Pubmed #17975356 links to  free full text

Abstract: A 30-year-old woman was evaluated in our clinic with swelling localized to the left submandibular region and extending to the anterior part of the neck. Her symptoms first appeared 2 years earlier in the mid region of her neck. After a few months, the lesion enlarged to the left side of her neck and became crusted. She had been treated by several physicians with antibiotics, analgesics, and anti-inflammatory drugs without response. On physical examination, the patient had an axillary temperature of 38.2 degrees C. Bilateral axillary, cervical, and supraclavicular lymph nodes were detected. Dermatologic examination revealed erythematous nodules of varying sizes starting at the middle of the neck and extending to the left cervical region; an ulcerated lesion on the mid portion of the neck; and a sinus tract in the left cervical region (Figure 1). Laboratory findings included an erythrocyte sedimentation rate of 62 mm/h, but no irregularities were detected in the other hematologic and biochemical parameters. The results were negative for hepatitis markers, human immunodeficiency virus, and syphilis. A purified protein derivative test revealed an 18-mm induration with a scar of bacilli Calmette-Guérin at 48 hours. Results of chest radiography were normal, but a computerized tomographic scan of the lung revealed emphysematous changes. Acid-fast bacilli examination of the sputum was performed 3 times, all with negative results, and sputum cultures were negative for tuberculosis and deep fungal infections. Results of polymerase chain reaction testing of skin tissue, sputum, and urine were negative as well. Abdominal and pelvic ultrasonographic finding were normal; no tuberculous focus was detected from detailed examinations of pulmonary, genitourinary, and skeletal systems. Staining of a biopsy specimen obtained from lesions in the cervical region was positive for acid-fast bacilli, and cultures were positive for Mycobacterium tuberculosis. The histopathologic features of the biopsy specimen included caseation necrosis at the center and epithelioid histiocytes, lymphocytes, plasma cells, and Langhans cells at the periphery of the granulomas (Figure 2). These findings confirmed the diagnosis of scrofuloderma. The patient received multiagent (isoniazid, rifampicin, ethambutol, and pyrazinamide) antituberculosis treatment for 3 months. The treatment was continued with isoniazid, rifampicin, and ethambutol for 1 year, with follow-up clinic visits throughout the period. The lesions improved within the first 3 months of treatment (Figure 3).

Gül U, Soylu S, Demiriz M. · Second Dermatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey. · Skinmed. · Pubmed #17618176 links to  free full text

Abstract: A 28-year-old man with a diagnosis of vitiligo universalis for 6 years presented with reddish polygonal papules that had developed on his left hand first and then on his right hand. On dermatologic examination, porcelain-white hypopigmented appearance was observed all over his body, and there were violaceous, flat-topped papules changing from 2 to 5 mm in diameter localized on the hypopigmented areas of the dorsum of both hands and flexor sites (Figure 1). The physical examination and laboratory investigations including hemogram, erythrocyte sedimentation rate, serum biochemistry, and urinanalysis were normal. Antibodies to thyroid tissue, hepatitis viruses, human immunodeficiency virus, nuclear, and streptolysine were negative. Repeated IgA levels in serum were found to be decreased; however, the other immunoglobulins (IgG, IgM) and C3, C4 and cryoglobulins were in normal ranges. Histopathologic examination of the polygonal papules revealed hyperkeratosis, focal thickening of the granular layer, and irregular acanthosis in triangular saw-tooth pattern. The basal layer was invaded by the lymphocytic inflammatory infiltrate and had numerous necrotic keratinocytes. The infiltrate in the upper dermis was band-like and sharply demarcated at its lower border. There were also a few melanophages in the upper dermis. Melanocytes were decreased in number, and in some areas they were absent at the basal layer of epidermis. Clinical and histopathologic diagnosis were consistent with lichen planus and vitiligo (Figure 2).

Soylu S, Gül U, Kiliç A. · Department of Dermatology, Ankara Numune Education and Investigation Hospital, Ankara, Turkey. · Acta Derm Venereol. · Pubmed #17225016 No free full text.

Abstract: Cutaneous diseases can indicate the presence of hepatitis C virus (HCV) infection. The aim of this study was to analyse the frequency of cutaneous findings in HCV infection and HCV RNA positive cases in Turkey. Fifty consecutive patients positive for anti-HCV antibodies,negative controls, and patients positive and negative for HCV RNA were examined for any cutaneous findings that could be associated with HCV infection. The risk of infected patients developing cutaneous finding was higher than for non-infected individuals. Only pruritus showed a statistically significant difference in separate assessment of cutaneous symptoms. There were no differences in cutaneous findings in HCV RNA positive and negative cases. The risk of developing a dermatological finding, especially pruritus, was increased in HCV infection.However, because the number of patients in this study was too low to allow statistical evaluation of the prevalence of dermatological symptoms and diseases, multicentre studies including large numbers of patients are needed.