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Two patients presenting with subcutaneous nodules, plaques, papules and ulceration caused by Trichophyton rubrum are described in this report. The first case was a 46-year-old woman referred with erythema and desquamation over her trunk, hands and feet for 30 years, progressing to nodules and ulceration over her trunk, arms and scalp for the last 2 years. The second case was a 34-year-old man who presented with a 2-year-history of itchy, erythema and desquamation over the trunk, progressing to papules, nodules and cyst around his ear, on the neck and scalp for 1 year. The diagnoses were suspected after direct microscopical examinations of the discharge materials, which revealed the presence of hyaline hyphae. The histological examinations showed granulomatous inflammatory infiltrates with fungal elements in the dermis including epithelioid cells, giant cells, lymphocytes and eosinophils, and the periodic acid-Schiff stain showed hypha within the granulomas. Cultures of puncture materials, skin biopsies and nails confirmed the diagnosis identifying T. rubrum. Antifungal therapies with itraconazole were successful in both patients, the lesions were completely clear with atrophic scars after 3 months. Side effects were not noticed during the medication. We discuss the clinical types of granulomatous cutaneous lesions caused by dermatophyte infections and evaluate the therapeutic effect of itraconazole.

Cutaneous and systemic plasmacytosis (CSP) is a rare disorder characterized by disseminated reddish brown plaques and polyclonal hypergammaglobulinemia. The lesions of CSP are histologically characterized by an infiltration of mature polyclonal plasma cells, which display similar pathological features to the plasma cell-type Castleman disease (CD). The relationship between CSP and CD is controversial. Herein, we described a 43-year-old man from China with disseminated reddish brown plaques and nodules on the cheek and temple. The serum level of immunoglobulin G and immunoglobulin A were higher than normal. In addition to mature plasma cell perivascular infiltrate in the dermis, the biopsy of the lesions showed small to medium-sized germinal follicles with hyalinized vessels and a concentrically arranged mantle zone. The patient had clinical features of CSP, but the biopsy revealed changes resembling mixed-type CD. To the best of our knowledge, this is the first case of CSP with the pathological features of mixed-type CD reported from China.

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Microvenular hemangioma (MVH) is an uncommon benign vascular neoplasm that usually occurs as a solitary asymptomatic red or purple papule, nodule, or plaque with a predilection for the upper extremities. Patients with more than 1 lesion, that is, multiple MVHs, are extremely rare. We describe the clinicopathologic features of 4 Chinese patients who had a rapidly progressive abrupt onset of numerous MVHs numbering in the tens to hundreds. Clinically, the correct diagnosis of MVH could not be made in any of our patients; however, histologic examination revealed the characteristic features of MVH. Immunohistochemical stains were performed in all cases and showed the vessel lining cells to be positive for CD34, CD31, and factor VIII-related antigen. Polymerase chain reaction for human herpesvirus-8 was negative in all cases. The differential diagnosis and review of the literature of patients with multiple MVHs are presented.