Amyloidosis cutis dyschromica in two female siblings: cases report

<p>Abstract</p> <p>Background</p> <p>Cutaneous amyloidosis has been classified into primary cutaneous amyloidosis (PCA, OMIM #105250), secondary cutaneous amyloidosis and systemic cutaneous amyloidosis. PCA is the deposition of amyloid in previously apparent normal skin without systemic involvement. Amyloidosis cutis dyschromica (ACD) is a rare distinct type of PCA. Here, the unique clinical and histological findings of two Chinese female siblings with ACD were described.</p> <p>Cases presentations</p> <p>Patient 1 was a 34-year-old female, presented with mildly pruritic, diffuse mottled hyperpigmentation and hypopigmentation. The lesions involved all over the body since she was 10 years old. There were a few itchy blisters appearing on her arms, lower legs and truck, especially on the sun-exposed areas in summer. Some hypopigmented macules presented with slight atrophy. Patient 2 was 39-year-old, the elder sister of patient 1. She had similar skin lesions since the same age as the former. The atrophy and blisters on the skin of the patient with amyloidosis cutis dyschromica have not been described in previous literature. Histological examinations of the skin biopsies taken from both patients revealed amyloid deposits in the whole papillary dermis. Depending on the histological assessment, the two cases were diagnosed as amyloidosis cutis dyschromica.</p> <p>Conclusion</p> <p>The two cases suggest that the atrophy and blisters may be the uncommon manifestations of amyloidosis cutis dyschromica. It alerts clinicians to consider the possibility of ACD when meeting patients with cutaneous dyschromia. Skin biopsy is essential and family consultation of genetic investigation is very important in such cases.</p

A Cross Sectional study of Sexually Transmitted Infections among High Risk Groups attending Sexually Transmitted Infections Clinic in a Tertiary Care Hospital

INTODUCTION: Sexually Transmitted Infections (STIs) are combination of infection and syndrome that are epidemiologically heterogeneous and often transmitted sexually. They show various trends in different parts of the country. Men who have Sex with Men (MSM) and female sex workers (FSW) must be screened for HIV and STI. FSW is a person who provides sexual service for money and material. MSM are a diverse and often hard-to-reach group, spanning all age group and socioeconomic backgrounds. MSM in India can be divided into various sub groups: self-identified MSM, behaviorally MSM with no identity and Bisexual men. STIs commonly diagnosed are Herpes Simplex Virus (HSV) infection, genital warts, balanoposthitis, syphilis, molluscum contagiosum, gonorrhoea occasionally chancroid, lymphogranuloma venereum and donovanosis. AIM OF THE STUDY: 1. To assess and provide clinical and epidemiological data of STIs among high risk groups attending STI OPD. 2. To study the Age wise distribution of STIs in high risk groups. 3. To study the sexual behaviour pattern and mode of sex among high risk groups. 4. To study the prevalence of HIV infection in high risk. MATERIALS AND METHODS: The study included 460 high risk patients who attended STI OPD from 1st January 2018 to 30th June 2019 in Tirunelveli medical college. The diagnosis of various types of STI’s were made clinically and confirmed by relevant investigations. HIV screening, HBsAg, Anti- HCV were carried out in all patients. Other investigations like Tzanck smear, KOH mount, wet mount, gram staining, Rapid Plasma Reagin tests (if positive TPHA will be done for confirmation), pus culture and sensitivity were done. CONCLUSION: High risk groups are the ― bridging population for transmission of STIs and HIV. ◈ The prevalence of STIs is seen commonly in 2nd to 4th decade of age, hence they are main target population to be focused in order to prevent STI/HIV. ◈ Men are most commonly indulged in high risk sexual practice than female so, they need to be screened regularly. ◈ The population with EMC/PMC sexual behaviour had more STI’s than MSM and most of them had unprotected intercourse. ◈ Increased prevalence is seen among married high-risk groups with unknown paid partners. ◈ Increased prevalence of STIs are seen in high risk groups with unprotected sex. ◈ Most common mode of sex in high risk groups with STI’s was vaginal route among heterosexual and ororeceptive among MSM. ◈ Most common examination findings among high risk groups was painful ulcer, fissure, and papules over genitals. ◈ Viral STIs are on the rise when compared to the bacterial infections among high risk groups. Among viral STIs HIV, Herpes genitalis and Warts is the commonest, and among bacterial infections, Latent Syphilis is the common infection and it shows increase in trend of syphilis among high risk groups. Hence consistent screening with RPR and ELISA for HIV is a must in high risk groups. ◈ Among 101 HIV reactive individual 31 persons were co-infected with other STIs. ◈ Sex education is essential for high risk groups as earlier the age of sexual activity. ◈ Discourse the stigma among FSW and TGs to increase the health care awareness among them. ◈ Partner identification treatment needs to be initiated. ◈ Vaccination for Hepatitis B should be advised. ◈ Counselling for consistent use of condom should be done especially when contact with unknown partners and during anal sex. ◈ Promoting awareness about HIV-AIDS transmission & its prevention may alert them to use condom properly during each sexual act. ◈ STIs management in high risk groups requires the expert clinician to be conversant with risk valuation, the clinical presentation, and current diagnosis of certain diseases, and to be familiar with new medications. Successful STI care can be achieved because many infections are easily identified and treatable with simple single dose therapy. ◈ The current challenges lie in effective risk reduction and enhancing preventive care in a cost-effective way. Newer diagnostic studies will offer visions into the etiology of several clinical syndromes, but the basis of care will always rely on listening and talking to patients. ◈ More work is required to govern how to help high risk group minimize sexual risk, address their mental health concerns, and engage them in disease free lives. ◈ Regular monitoring of programs and research are necessary for further success of prevention and control of HIV in this HRG

An Analysis Of Nail Involvement In Pemphigus

Nail involvement in pemphigus is relatively rare. A five year analysis of pemphigus cases admitted in our institute revealed 6 cases (15.6&#x0025;) with nail involvement. Nail changes were part of the initial presentation along with skin and oral lesions in 4 cases, preceded mucocutaneous disease by months to year in one case and occurred with a relapse of pre-existing disease by months to year in one case and occurred with a relapse of pre-existing disease in another case. The nail dystrophy, periungual and subungual haematoma and proximal nail fold vesicles. All the patients responded well to dexamthasone cyclophosphamide pulse therapy

Patterns of occupational exposure to human immunodeficiency virus and post-exposure prophylaxis among health care personnel in a tertiary care institute in south India – A retrospective case series

Background: Post-exposure prophylaxis (PEP) for occupational human immunodeficiency virus (HIV) exposure involves the comprehensive measures used to prevent transmission of blood-borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus through various strategies such as first aid, counseling, risk assessment, relevant laboratory investigations with informed consent, the provision of short-term anti-retroviral drugs, and follow-up testing. Aim and Objectives: We sought to investigate the patterns and causes of occupational exposure in health care workers (HCWs) in our institute and the usage of PEP in our center, a tertiary care hospital in south India. Materials and Methods: The study involved a retrospective analysis of data extracted from the records of PEP usage from the anti-retroviral treatment (ART) center attached to the dermatology, venereology and leprosy out-patient department of a tertiary care center in south India. The data were extracted into a pre-designed proforma and analyzed using descriptive statistics. Results: A total of 352 health care professionals reported to the ART center for PEP from 2010 to 2020. One hundred and thirty-four patients took only the first dose as the source patient later tested to be HIV-negative. Among the 218 remaining patients, 84 were male and 134 were female patients. Only 56 health care workers started the regimen within 2 hours. One hundred and thirty-four patients completed the full course of PEP. Most HCWs (n = 68, 31%) sustained the exposure while doing a procedure on the patient followed by re-capping a needle (n = 64, 29%). Gastritis and drowsiness were the most common adverse effects. Limitations and Conclusions: The study was limited by the retrospective nature of data collection and the lack of detailed interviews with HCWs. Knowledge about PEP, needle safety training, and training of early first aid measures should be increased among health care workers

Kaposi&#x2032;s Varicelliform Eruption In Allergic Contact Dermatitis

A 42 year old male having airborne allergic contact dermatitis suddenly developed high grade fever, chills and prostation on 7th day of admission. Two days later he developed generalized papulovescles which became haemorrhagic and crusted within one to two days. These lesions later evolved into grouped erosions. Simultaneously, he developed swelling of the face and generalized lymphadenopathy. Tzanck smear demonstrated giant cell and the patients was diagnosed as having kaposis&#x00E2;&#x20AC;s varicelliform eruption. He responded to oral acycolvir. The case is reported for its rarity

HIV Associated Psoriasiform Dermatitis Or Reiter&#x2032;s Syndrome

A 23 year old male presented with psoriasiform dermatitis of one month duration in April 1999 and was found to be HIV seropositive. He was managed with PUVA therapy. His cutaneous lesions improved but no improvement in arthritis and in nail changes occurred. Patient discontinued the therapy and presented with relapse in July 1999 with a different clinical picture, now suggestive of Reiter&#x00E2;&#x20AC;s syndrome. He had keratoderma blenorrhagica and severe deforming arthritis. Such a case presents with difficulties in arriving at the diagnosis in the HIV era and allows limited therapeutic options for management