1/8. A fatal case of craniofacial necrotizing fasciitis.A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occurred with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. streptococcus and Staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/8. An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
3/8. protein c and protein s levels in two patients with acquired purpura fulminans.purpura fulminans (PF) is a cutaneous manifestation of a dramatic and deadly syndrome of systemic disseminated intravascular coagulation (DIC). It is characterized by microvascular thrombosis in the dermis followed by perivascular haemorrhage. Since two other related syndromes involve the protein c (PC) system, we undertook a serial study to investigate the levels of PC and protein s (PS) in two patients with acquired PF. Laboratory findings were consistent with DIC, and both patients were treated with blood replacement and heparin therapy. The levels of PC activity were very low during the initial 24-36 h after onset and gradually increased until returning to normal levels. The total and 'free' PS were also abnormal during the initial onset of PF. The total and free PS increased to normal after 4-6 d. Although the pathogenesis is not fully understood, the infection and sepsis appears to consume PC and PS selectively during the PF and DIC phase. Acquired PF appears to selectively involve the PC system in a similar fashion to two other syndromes of PF-like lesions.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
4/8. vibrio vulnificus septicemia.We report a case of vibrio vulnificus infection in a middle-aged alcoholic man with Laennec's cirrhosis. The patient had recently received a puncture wound from the shell of a shrimp while fishing in the gulf of mexico. He presented with acrally distributed urticarial plaques, purpura, and bullae, as well as signs and symptoms of septic shock. vibrio vulnificus was isolated from the blood, and histologic examination of the skin biopsy specimen demonstrated a devitalized, inflammatory, cell-poor superficial dermis and an acute cellulitis of the subcutis, with extensive tissue destruction. In addition, a necrotizing vasculitis, with a relative paucity of inflammatory cells but numerous bacilli around dermal vessels, was noted.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
5/8. disseminated intravascular coagulation and purpura fulminans in a patient with Candida sepsis. biopsy of purpura fulminans as an aid to diagnosis of systemic Candida infection.disseminated intravascular coagulation and purpura fulminans developed in association with septicemia and meningitis due to candida tropicalis in an 18-year-old female immunosuppressed renal allograft recipient. Although systemic Candida infection was initially suspected, blood cultures showed no growth of this organism until after its identification in the dermis of a skin biopsy specimen obtained from the site of purpura fulminans. This case illustrates the association between Candida sepsis and purpura fulminans, and demonstrates the usefulness of skin biopsy of purpura fulminans in the early diagnosis of Candida sepsis.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
6/8. Bacterial esophagitis in immunocompromised patients.We studied the clinical and pathologic features of bacterial esophagitis in three index cases identified by endoscopic biopsy and in 20 autopsy cases. Fourteen of the 23 patients had malignant hematologic conditions, aplastic anemia, or solid tumors; ten were profoundly neutropenic (white blood cell count, less than 100/mm3 [less than 0.1 X 10(9)/L]). The organisms involved in bacterial esophagitis were gram-positive cocci in 14, gram-negative bacilli in three, mixed gram-negative bacilli and gram-positive cocci in five, and gram-positive bacilli in one. Four patients had bacteremic bacterial esophagitis; all were immunocompromised, three by profound neutropenia and one by gestational prematurity. bacteria causing bacteremic bacterial esophagitis were all gram-positive: viridans-group streptococci. staphylococcus aureus, Staphylococcus epidermis, and bacillus species. Our study suggests that bacterial esophagitis is more common than has been recognized in the past and should be considered as a potential source of bacteremia in immunocompromised patients.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
7/8. Spontaneous vibrio vulnificus peritonitis and primary sepsis in two patients with alcoholic cirrhosis.Two patients with alcoholic cirrhosis were seen on two separate occasions for fever, swollen legs, petechial hemorrhage, purpura, and cutaneous bullae. One patient ate oysters 2 days before the onset of illness. vibrio vulnificus, a lactose-positive halophilic vibrio, was isolated from the ascitic and cutaneous fluid in both cases, and from the blood in one of the two cases. Both isolated strains were sensitive to the antibiotics given to the patients from the beginning; however, both patients died, one from septicemic shock and the other from massive esophageal variceal hemorrhage. Autopsies in both patients revealed alcoholic cirrhosis, hemorrhagic necrosis of the terminal ileum, intraalveolar hemorrhage, petechial hemorrhage in the peritoneum, and nonspecific acute inflammation of the dermis with vasculitis. physicians should consider V. vulnificus in the differential diagnosis of cirrhotic patients with sepsis, primary skin lesions, and spontaneous bacterial peritonitis with or without history of recent oyster ingestion.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
8/8. Histopathology of marine vibrio wound infections.Although marine vibrio wound infections and septicemia are being reported with increasing frequency, description of the histopathologic changes has been scanty. The histologic alterations in three patients with primary marine vibrio wound infections are presented. The lesions are characterized by intense acute cellulitis of the subcutis with much tissue destruction and extension into the adjacent dermis. The superficial dermis is devitalized and lacks an inflammatory cellular infiltrate. Subepidermal noninflammatory bullae are formed. Many organisms are seen both within the areas of intense acute inflammation and in devitalized areas. Organisms and inflammation are especially oriented around vessels, with associated acute vasculitis. It is concluded that the morphologic picture in marine vibrio wound infections is nonspecific yet characteristic.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |