tag:blogger.com,1999:blog-9870114.post3799577964376368844..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: Mystery from MicronesiaHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-9870114.post-33709352716525799292007-03-23T15:14:00.000+00:002007-03-23T15:14:00.000+00:00I had patient with similar type of lesion over the...I had patient with similar type of lesion over the neck.culture didn't show any thing.I started her on minocycline as single drug she responded well.<BR/>Dr.A.M.JaaraamanUnknownhttps://www.blogger.com/profile/05758982215863480543noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-46665997429493012032007-01-27T11:58:00.000+00:002007-01-27T11:58:00.000+00:00Although I am in Chennai in India at a conference ...Although I am in Chennai in India at a conference ,such is the power of the Internet that I was able to contact Michael Lee in Australia and receive the following reply.<br /><br /><I>Our `large` series of 3 cases were patients from South Pacific. The clinical photographs that you posted are identical to ours`.<br /> <br />The organism is very difficult to grow and thus sensitivity to antibiotics may not be determined in laboratory.However fortunately there are reported cases including one of ours that responded to Minocycline or Cotrimoxazole as single agent.Needless to say long course will be required.The 2nd line is the traditional antiMb- Rifampicin and Ethambutol etc<br /> <br />The extensive `psoriasiform` disseminated type which was the gist our paper is obviously not amenable to surgery.<br /> <br />This organism grow optimally at 32C and not 37C.Thus the infection is confined to the skin.On the basis of this, heat therapy has been reported to be successful.However I cannot recall the details of how it is done from that paper. I hope this helps.</I>Dr Ian McCollhttps://www.blogger.com/profile/01609385802531645972noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-80454693932821496202007-01-26T19:47:00.000+00:002007-01-26T19:47:00.000+00:00I agree with my colleagues that the history and th...I agree with my colleagues that the history and the picture is suggestive of chronic infection,possibly atypical mycobacterium infection.I have not seen such strange picture in my country.Further biopsies and other investigations are essential.Also epideomological study is urgently needed.<br />khalifa sharquieksharquiehttps://www.blogger.com/profile/05470356253323679747noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-19034699281805643672007-01-25T14:13:00.000+00:002007-01-25T14:13:00.000+00:00I agree with the earlier comments. We have seen s...I agree with the earlier comments. We have seen similar cases in Alor Setar, Kedah, Malaysia where there are lots of paddy fields. Clinically they could go for either atypical mycobacterium infection or deep fungal infection esp chromomycosis.<br />A deep incisional biopsy should be repeated for HPE and culture for mycobacterium infection and fungal infection as well.Henry Foonghttps://www.blogger.com/profile/02804592640968503188noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-57660380571534097582007-01-25T13:31:00.000+00:002007-01-25T13:31:00.000+00:00Clinically this is the delayed hypersensitivity re...Clinically this is the delayed hypersensitivity reaction of mycobacterial, atypical mycobacterial or deep fungal infection. From John Brennan and Michael Lee's description this is indeed an atypical mycobacterial infection and Mycobacterium marinum or a variant would fit the bill.I can try to pass the images on to them for their opinion.Dr Ian McCollhttps://www.blogger.com/profile/01609385802531645972noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-54969798230096315002007-01-25T02:07:00.000+00:002007-01-25T02:07:00.000+00:001. A mycobacterial infection
2. sarcoid
3. drug
4....1. A mycobacterial infection<br />2. sarcoid<br />3. drug<br />4. reaction to coral or something in the ocean<br />5. reaction to some ingested worm from fish<br />6. I have not a clue<br /><br />More biopsies are needed, along with PCR and/or bacterial cultures (for<br />high and low temp organisms)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-52902436561040981252007-01-24T14:03:00.000+00:002007-01-24T14:03:00.000+00:00This is not my area of expertise (I am not sure wh...This is not my area of expertise (I am not sure what is), but I suspect the answer here would be biopsies and perhaps culture of tissue. This would be an ideal project for a dermatology resident or even a medical student (from Hawaii?) The specimens could be brought back to U.H. or perhaps sent to a lab in the U.S. Deep fungal infection or atypical AFB. <br />Here is a reference from PubMed:<br />Australas J Dermatol. 1998 Aug;39(3):173-6.<br /><br />Mycobacterium marinum: chronic and extensive infections of the lower limbs in South Pacific islanders.<br /><br />Lee MW, Brenan J.<br /><br />Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria,<br />Australia.<br /><br />We report three adult cases of very chronic, extensive infection of the lower limbs due to Mycobacterium marinum. The patients were from South Pacific islands and, clinically, the widespread warty plaques resembled chromomycosis. One was associated with severe lymphoedema. All three patients gave a history of at least 20 years duration. The patients were otherwise well and not immunologically compromised. In all cases, the organism was identified on tissue cultures and was not seen on histopathology. The mycobacteria were sensitive to most antibiotics tested in vitro. The patients were treated with a combination of rifampicin and cotrimoxazole with good results.Anonymousnoreply@blogger.com