Cases reported "Impetigo"

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1/7. Generalized pustular psoriasis of pregnancy (impetigo herpetiformis).

    A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj's spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis.
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2/7. Neonatal erythema multiforme major.

    A 25-day-old neonate developed an unusual eruption with bullae and marked systemic symptoms. Investigation for bacterial, viral, autoimmune and immunobullous causes did not reveal any identifiable trigger and histological examination was highly suggestive of bullous erythema multiforme. Pulmonary infiltrates were noted late in the course of the disease. Differential diagnoses included bullous impetigo, primary herpes simplex infection, immunobullous disease, neonatal lupus and erythema multiforme. This case illustrates the difficulties in diagnosing and managing an unwell child with bullae and emphasizes the need to exclude treatable underlying causes.
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3/7. Relapsing bullous staphyloderma.

    Relapsing eruptions of bullae rapidly turning into pustules were seen in a 69-year-old woman of good general health. At different times during several months of observation, strains of S. aureus were grown from various lesions, including one (phage group III) producing enterotoxin C. Systemic involvement except for high BSR was absent and repeated blood cultures were negative. Histopathological findings resembled impetigo. Antibiotic treatment was effective. As this disease does not fit into any of the well-known pustular infectious dermatoses, we suggest calling it relapsing bullous staphyloderma.
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4/7. Acropustulosis of infancy.

    Acropustulosis of infancy (Al) is a syndrome consisting of pruritic pustules that are found primarily on the extremities of infants. It is uncommon, but not rare, and persists about two years. In two infants in whom Al began at birth, there was a striking response to sulfones. There was no response to other therapy. Laboratory findings are not diagnostic for Al. Similar histopathologic changes (subcorneal pustules) can be found in other eruptions of infancy.
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5/7. tinea faciei in an infant caused by microsporum gypseum simulating a dry impetigo.

    We report a 14-month-old White boy who was referred to our dermatology unit for evaluation of a skin eruption on his nose. The initial examination led us to the clinical diagnosis of impetigo. The mycologic studies found an uncommon dermatophyte agent, microsporum gypseum. The main differential diagnosis of tinea faciei is discussed.
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6/7. Familial juvenile generalized pustular psoriasis.

    The acral form of generalized pustular psoriasis is characterized by macroscopic pustules surmounting erythematous plaques that may progress from a localized distal eruption to involve the entire cutaneous surface. Juvenile-onset and familial-generalized pustular psoriasis are rare; familial-juvenile-generalized pustular psoriasis is exceptionally uncommon. A kindred of three children in the same generation had chronic, localized-acral pustular psoriasis and episodic-generalized pustular psoriasis.
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7/7. Childhood pemphigus initially seen as eosinophilic spongiosis.

    The condition of a 3-year-old boy with an intermittent, generalized, bullous eruption was initially diagnosed as (and treated as) bullous impetigo. After a relapse, two skin biopsies were performed. Each biopsy specimen showed the changes of eosinophilic spongiosis. A third biopsy specimen was also examined by direct immunofluorescence microscopy. The specimen showed deposition of IgG in the intercellular region of the epidermis. The patient's serum contained intercellular antibodies in a dilution of 1:160, confirming the diagnosis of pemphigus. A biopsy should be performed in the case of a child with a persistent or recurring bullous eruption; immunofluorescence microscopy of the biopsy is essential.
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