Cutaneous chromoblastomycosis is a chronic subcutaneous fungal disease of the skin caused by Blastomyces dermatitidis, especially by Fonsecaea, Phialophora, and Cladophialophora species affecting the skin, lungs, intestines, stomach, and central nervous system. It is treated using itraconazole in mild cases and amphotericin B in severe cases. A six-year-old female child presented to the Dermatology Outpatient Department with pigmented brown to blackish tanned plaques and verrucous lesions on the face and extremities. These lesions were present for the past two and a half years and were slowly enlarging and involving other areas like the trunk. The lesions were proven on biopsy to be cutaneous blastomycosis. The patient was put on infusions of amphotericin B in a calculated pediatric dose. Her blood pressure and renal function tests were checked daily to avoid any electrolyte derangements, nephrotoxicity, and systemic infusion reactions caused by amphotericin B. Amphotericin B reduced the size of the cutaneous lesions, and treatment response was assessed on regular follow-ups. Chromoblastomycosis should be considered in the differential diagnosis to enable timely treatment and to prevent its lethal complications such as epidermoid carcinoma. Treatment should continue for two to three months until histopathology is negative to ensure complete eradication.
Primary hepatic lymphoma (PHL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL). A 55-year-old male patient presented to us with jaundice and right upper quadrant pain. Investigations showed elevated alkaline phosphatase, lactate dehydrogenase, total bilirubin, normal alanine transaminase, and negative viral profile. Sonographic and computed tomographic scans show hepatosplenomegaly with hypodense lesion in liver associated with lymph nodes enlargement in the region of porta hepatis celiac axis, mediastinal and axillary lymphadenopathy. On immunohistochemistry, cells were positive for cluster of differentiation (CD)-19, CD-20, CD-21, c-myelocytomatosis oncogene (c-MYC), B-cell lymphoma 2 (Bcl-2), multiple myeloma oncogene-1 (MUM-1), same as B cell markers so it is diagnosed as PHL. DLBCL especially PHL shall be considered among the differentials of space-occupying lesions of liver. Early diagnosis of primary hepatic lymphoma is not a difficult task if excisional lymph node biopsy is taken following detection on ultrasound or CT scan which will lead to improved treatment, improvement in survival, and cost-effectiveness with good prognostic outcomes.
Acute Rheumatic fever (ARF) is the most common cause of acquired heart disease in the developing world. It is an immunological reaction to group A beta-hemolytic streptococcus Pyogenes. It occurs 2-4 weeks after group A streptococcal pharyngitis due to the development of antistreptococcal antibodies that cross-react with antigens in various tissues of the body, especially cardiac and basal ganglia neuronal antigens. Clinical features of acute rheumatic fever include fever, joint pain, myocarditis, nodules in subcutaneous tissue, Erythema Marginatum, and chorea. Patients with immunodeficiency like mucocutaneous candidiasis are especially prone to recurrent mucocutaneous infections (tonsillopharyngitis, thrush, skin abscess), which can predispose to acute rheumatic fever and subsequent development of rheumatic heart disease over the years. Keywords: Acute rheumatic fever, chronic mucocutaneous syndrome, skin rash,
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