Zygomycosis is an opportunistic fungal infection with a high mortality rate. It is known to cause invasive disease in immunocompromised hosts but it may produce only cutaneous/ subcutaneous infections in immunocompetent hosts. Treatment is difficult due to its fulminant course and lack of effective anti-fungal drugs. Here, we report a rare case of subcutaneous zygomycosis caused by Mucor hiemalis in an immunocompetent patient without any debilitating illness. The patient was successfully treated by aggressive surgical debridement and anti-fungal therapy.
A 35‐day‐old baby girl presented with a history of sudden onset of skin lesions of 4 days’ duration. The skin lesions initially appeared on the cheeks, but progressed to involve the trunk and limbss within 4 days. There was a history of upper respiratory tract infection 10 days prior to the onset of the skin lesions. The skin lesions were associated with fever. There was no history or symptoms suggestive of systemic involvement. The child was not on any drugs prior to the onset of the skin lesions.
On examination, the child was febrile with a temperature of 100 °F and a pulse rate of 120 beats/min, and weighed 3.8 kg. Cutaneous examination revealed multiple, erythematous, nodular lesions on the face (Fig. 1). A few large bullous lesions were present on the thighs and gluteal region. Multiple tender nodules and a few annular lesions with well‐defined discrete papules at the margins and central erythema were also seen on the trunk and limbs. There was no involvement of the mucous membranes. Systemic examination was within normal limits.
Figure 1
Face showing erythematous nodular lesions
The investigations revealed a hemoglobin of 7.2 g%, a total count of 30,000 cells/mm3 with a differential count of 79% neutrophils, and an erythrocyte sedimentation rate of 50 mm at 1 h.
Urine examination, USG, and pus culture were normal. Human immunodeficiency virus (HIV) screening in the baby and mother was negative. The histopathologic section revealed a dense inflammatory cell infiltrate involving the epidermis and upper dermis, composed mainly of neutrophils. The epidermis also showed edema and spongiotic vesicles. The inflammatory cell infiltrate was distributed around small blood vessels, as well as the entire upper dermal tissue, together with leukocytoclasis (Fig. 2).
2
Histopathology of a nodule showing perivascular and upper dermal neutrophilic infiltrate with leukocytoclasis and spongiosis of the epidermis (× 40)
The baby was treated with oral prednisolone, at a dose of 1 mg/kg body weight, and oral potassium iodide (100%), five drops, three times daily. With this regimen, the skin lesions regressed in 4 weeks. Steroids were gradually tapered and oral potassium iodide was continued for four more weeks and then stopped. The lesions resolved with secondary cutis laxa. There was no relapse at the end of a follow‐up period of 12 months.
Cutaneous angiosarcoma is a rare, highly malignant vascular tumor with three clinical types. It is predominantly seen in the white-skinned people and rarely dealt with among the colored races. Cutaneous angiosarcoma of head and neck of the elderly is a great mimicker with many clinical presentations. The condition needs to be differentiated from several other common conditions and the diagnosis may be extremely difficult in some cases. Herein, we report the case of a 65-year-old man with type 5 skin who presented with an unusual and extensive involvement of the scalp and face presenting a diagnostic challenge.
Background: Music is a safe, non-invasive and affordable adjunct to office surgery with several studies based on the effect of music on anxiety levels in varying age groups proving beneficial. The main aim of the current study was to evaluate the effect of music intervention on the anxiety levels of patients going through dermato-surgery under local anesthesia. Methods: Participants (n=150) undergoing dermato-surgery were divided equally as control (no music intervention) and experimental group (music intervention). The demographic data, physiological parameters (blood pressure (BP), heart rate (HR) and respiratory rate (RR)) at varying time intervals (baseline, 10 minutes after the commencement of surgery and 20 minutes after the end of surgery) along with the psychological parameter (anxiety) were recorded. Results: Participants listened to the music of their interest during surgery. The anxiety levels decreased significantly within both the experimental and control groups at varying time intervals (p<0.0001). Within each group, BP, HR, and RR at all time intervals were statistically significant (p<0.0001). On comparing the control and experimental groups, only systolic BP at all time intervals was statistically significant (p<0.05). A negative correlation was observed in RR at 10 minutes with respect to interest in music and social avoidance; at 20 minutes only with interest in music (p<0.05).
Conclusions:The anxiety level of patients going through dermato-surgery under local anesthesia was reduced due to music intervention at varying time intervals.
flatten hierarchies, inspire a new generation of dermatology educators and have implications for widening participation. We have therefore developed principles that could be implemented to overcome these educational challenges (Table 1).Dermatologists should not fear new SoMe platforms; rather, our community has a responsibility to reach out to patients and learners alike. We should act as leaders in this domain, holding ourselves to high professional standards and learning from past mistakes as we adopt a flexible, evidence-based approach to SoMe educational delivery.
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