Syringocystadenocarcinoma papilliferum (SCACP) is an extremely rare adnexal neoplasm, believed to arise in a preexisting nevus sebaceus of Jadassohn (NSJ) through a multistep progression process. This hypothetical process involves an NSJ giving rise to syringocystadenoma papilliferum, which then presumably undergoes malignant transformation in rare circumstances to give rise to SCACP in situ, which finally progresses to an invasive SCACP. Of the 30 SCACP cases reported so far, none have documented the process from a birthmark to the final invasive lesion, with histological evidence of each step, in a single tumor. Here, the authors report just such a case. A 74-year-old man presented with a recently enlarging birthmark on the scalp. Excisional biopsy showed an invasive SCACP, in the background of SCACP in situ, syringocystadenoma papilliferum, and NSJ. Furthermore, this tumor showed a concurrent pigmented trichoblastoma and histological evidence of lymphovascular invasion, events that have not been documented with SCACP. Interestingly, all these component lesions were present on a single histological section of this solitary tumor. Regional lymph node metastasis, a rare occurrence in SCACP, was also present in this remarkable case. The authors discuss the implications of these findings in light of the review of relevant literature.

In recent years, Aeromonas species has been reported to cause extraintestinal infections with a growing frequency. Meningitis due to Aeromonas species is, however, a rare entity. We report a case of aeromonas meningitis in a 54-year-old man with a history of chronic alcoholic liver disease who, after an episode of gastroenteritis, developed an acute clinical picture characteristic of meningitis with septic shock and ecthyma gangrenosum. Aeromonas veronii (biogroup sobria) was isolated from cultures of blood as well as from cultures of stool, peritoneal fluid, skin lesion, and CSF specimens (obtained by lumbar puncture). Our review of seven additional cases of aeromonas meningitis in the world literature revealed that this condition is generally secondary to metastatic dissemination from primary bacteremia. Aeromonas meningitis, which may or may not be preceded by gastroenteritis, presents clinically as bacterial meningitis, although the presence of skin lesions may increase suspicion of the diagnosis. Third-generation cephalosporins are probably the therapy of choice for patients with aeromonas meningitis.

Isolation rates of Aeromonas hydrophila from stool samples of symptomatic and asymptomatic individuals were examined for several common enteric media. Sheep blood agar with 10 ,ug of ampicillin per ml, preceded by overnight enrichment in alkaline peptone water, yielded 2.6 times the number of isolates as the other media examined and is recommended for the isolation of A. hydrophila from humans. Aeromonas hydrophila has been implicated as an etiologic agent of diarrheal disease (1-3, 8). As more is learned about the ecology and interactions with human illness, more emphasis is being placed on A. hydrophila isolation and identification. The low level of isolations presently reported in most clinical laboratories may not be a true reflection of prevalence or medical significance. This is supported by the fact that isolation rates of Aeromonas sp. frequently increase in laboratories which have taken specific measures to isolate it (4, 7, 10). Perhaps the leading reasons for increased isolation are enrichment coupled with the use of an optimal plating medium for primary isolation (6, 9). Currently, we are investigating the etiologic agents of diarrheal disease in an ongoing community-based surveillance study in Canto Grande, a low-income suburb of Lima, Peru. We are interested in isolating Aeromonas sp. in both symptomatic and asymptomatic individuals. Our initial isolation methods included the use of the following media: MacConkey agar, salmonella-shigella agar, xylose-lysinedeoxycholate agar, Hektoen agar, cefsulodin-irgasannovobiocin agar, thiosulfate-citrate-bile salts-sucrose agar, and Butzler Campylobacter agar (Oxoid, Ltd.). Isolations with these media were coupled with screening of suspicious colonies for their oxidase reaction. Although these media were not specifically designed for the isolation of Aeromonas sp., we encountered a modest number of isolates, i.e., 19 (1.5%) of 1,248 specimens examined during a 6-month period. We subsequently considered the exclusive use of these media unsatisfactory for primary isolation of Aeromonas sp. for at least three reasons. First, Aeromonas strains are variable in their ability to ferment carbohydrates. Therefore,

No abstract

No abstract

No abstract

Rectal swabs from 391 infants less than 18 months of age who were hospitalized with acute diarrhea and from 138 similarly aged healthy infants were examined for the etiologic agents of diarrhea. Aeromonas spp. were recovered from 205 of 391 (52.4%) diarrheic patients, whereas they were recovered from 12 of 138 (8.7%) controls (P < 10-11). Among the 205 Aeromonas-positive diarrheic patients, 118 (57.6%) were found to be coinfected with other common enteropathogens. Of the 164 Aeromonas-positive initial diarrheic specimens, 82 (50.0%) had one or more other enteropathogens present; 30 patients were coinfected with rotavirus, 20 with enterotoxigenic Escherichia coli, 16 with Campylobacter spp., 14 with Shigella spp., 13 with enteropathogenic E. coli, 4 with Vibrio spp., 1 with Salmonella spp., and 1 with Plesiomonas spp. The high frequency of isolation of Aeromonas strains from cases compared with that from controls supports an etiologic role for this organism. However, frequent concomitant infections with other well-recognized enteropathogens and a lack of disease correlation with common Aeromonas phenotypes suggest that only a subset of Aeromonas strains may be diarrhea causing and that such strains may be common to several of the existing species.

Although an uncommon entity, familial glomangiomatosis is often a source of significant discomfort to affected patients and impacts quality of life. Patients develop numerous painful vascular lesions, beginning in childhood. Because management strategies for this entity are sparsely reported in the literature, additional study is needed to establish best practice. We report positive results with the use of Nd:YAG laser in treating symptomatic lesions of familial glomuvenous malformation