Our experience of treating 12 patients with TEN using IVIG, in Kuwait, confirms that it is a safe and effective treatment for these patients.
Analysis of 325 patients (182 males, 143 females) of mycologically proven tinea capitis (TC) seen over a period of two years from January 2001--December 2002 in the Farwaniya region of Kuwait is presented in this study. The age range was 8 months to 17 years. Peak incidence was observed in the 3-14 year age group (79.6%). Positive family history and contact with pets were noted in 22% and 36.7% of the cases, respectively. The non-inflammatory 'gray patch' variety was the most common clinical type, seen in 163 (50.2%) children, followed by the black-dot variant in 100 (30.2%) patients. A significant proportion of the cases (16.6%) had the uncommonly reported seborrheic dermatitis or dandruff like pattern. Highly inflammatory kerion was encountered infrequently (2.5%). Seven species of dermatophytes were isolated; Trichophyton violaceum in 135 (41.5%), followed by Microsporum canis in 89 (27.4%), Microsporum audouinii in 48 (14.8%), Trichophyton mentagrophytes var. mentagrophytes in 31 (9.5%), Trichophyton verrucosum in 15 (4.6%), Trichophyton tonsurans in 6 (1.9%) and Microsporum gypseum in 1 (0.3%) patient. T. violaceum was the most common fungus responsible for the black-dot variety (89/100) and kerion (4/8) patients. Three cases of kerion (33.3%) grew T. verrucosum. M. canis was the most common species isolated from the 'gray patch' cases (79/163; 48.5%) followed by almost equal prevalences of T. violaceum (16.6%), M. audouinii (15.3%), and T. mentagrophytes var. mentagrophytes (12.3%). Among the seborrheic type of cases, M. audouinii was the most common fungus isolated in 20/54 (37%) followed by T. violaceum in 15 (27.8%), T. mentagrophytes var. mentagrophytes in 9 (16.7%), M. canis in 8 (14.8%) and T. verrucosum and T. tonsurans in one (0.3%) patient each. The results are significantly different from those in earlier studies in Kuwait.
A 42‐year‐old healthy Thai male presented with a 1‐week history of painful swelling of the penis following self‐injection of two tablets of vitamin A dissolved in 10 mL of tap water with an unsterilized syringe, in order to achieve a more prolonged erection for sexual intercourse, on a friend's advice. He injected himself all around the penile shaft “just under the skin.” Eight hours after injection, the penis started to become progressively swollen and painful, but it was a further 2 days before he presented to our clinic. He denied a history of any urinary obstructive or irritative symptoms. There was no history of genital ulceration or urethral discharge or any similar acts of self‐injection in the past. Physical examination revealed a markedly edematous, erythematous, and tender penis with multiple yellowish pus discharge points and small superficial ulcerations all around the shaft. The scrotum also showed mild edema and tenderness. There was tender bilateral inguinal lymphadenopathy. The patient was febrile (temperature, 39 °C) and was admitted. Complete blood count revealed a raised white blood cell count of 19.1 × 109/L. Urinalysis was normal. Ultrasonography of the genitalia revealed soft tissue thickening and multiple small collections of pus in the subcutaneous penile tissue; the corpora cavernosa and corpus spongiosum were normal. The patient declined urethrography. Cultures of blood and urine were sterile. Pus culture revealed Staphylococcus aureus. Microscopic examination of the discharge did not show any granular material. A biopsy was deferred at this stage considering the pyogenic nature of the patient's presentation. Parenteral antimicrobials, including ceftazidime, gentamicin, and metronidazole, were started. The patient's temperature rapidly fell to normal and, over a period of 10 days, the pus discharge points and pain and swelling of the penis resolved (Fig. 1) and the inguinal lymphadenopathy subsided. The patient was discharged with advice for regular follow‐up for any late sequelae. The patient refused to undergo psychiatric evaluation and counseling. 1 Edema and induration of the penis after 10 days of therapy. Resolving superficial erosions are also seen
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