SUBCUTANEOUS ZYGOMYCOSIS PRESENTING WITH MULTIPLE SWELLINGS

Subcutaneous mycoses are a heterogenous group of fungal infections of the dermis and subcutis. They affect population in rural communities, often in humid, tropical, or subtropical regions of developing countries. They are directly inoculated into the dermis or subcutaneous tissue through a penetrating injury from vegetative materials.30 year old homemaker presented with two discrete painful hyperpigmented swellings with no surrounding satellite lesions, gradually increasing in size, on right thigh of six months duration. There was a history of penetrating trauma. No comorbidities were present .Histopathology showed septal and lobular panniculitis with foreign body granuloma. Fungal stains showed broad hyphae and Basidiobolus species growth was observed in Sabaroud dextrose agar. A diagnosis of subcutaneous zygomycoses was made and treatment with Itraconazole and potassium iodide was started, to which she responded well within 3 months of therapy. Histopathological examination is reliable and less time consuming. But culture is the gold standard investigation for conrming the diagnosis. The positivity in culture ranges from 40 to 60%, hence histopathology is the main tool for diagnosis. Treatment with itraconazole and potassium iodide has produced excellent results.</jats:p

SKIN LESION – A WINDOW TO A SYSTEMIC DISEASE

Sarcoidosis is considered as one of the “great masqueraders” in the eld of dermatology. Polymorphic cutaneous lesions are seen in around 20- 35 % of patients with sarcoidosis. We report a 49 year old male who presented with cough and hypopigmented atrophic plaques over the back. Serum ACE levels and CRP were elevated. HRCT chest revealed parenchymal and hilar, mediastinal lymph node involvement. Skin biopsy was done and showed multiple naked non- caseating granulomas in upper dermis. Pulmonary function test was suggestive of peripheral obstructive airway disease. Bronchoalveolar lavage identied CD4+ lymphocytosis. The patient was started on topical tacrolimus and topical corticosteroids with which he showed improvement. The patient was referred to pulmonology for further management. The case is presented for its rarity, with skin manifestations being one of the presenting signs of the disease.</jats:p

Cutaneous Sarcoidosis- A Report of Two Intriguing Cases

Sarcoidosis is an inflammatory disease which leads to formation of noncaseating granuloma in the affected organs like lungs, lymph nodes and less commonly the skin. Cutaneous sarcoidosis occurs in about 20-35% of individuals with systemic sarcoidosis. Skin involvement serves as an early marker and may be the presenting sign of systemic sarcoidosis. Wide variety of morphological forms of cutaneous sarcoidosis is known to occur simulating several other dermatoses. Isolated skin involvement is very rare. Histopathological examination and special stains plays an important role in ruling out other granulomatous conditions like cutaneous tuberculosis, leprosy, foreign body granuloma and granuloma annulare from sarcoidosis. Corticosteroids remain the main cornerstone in the treatment of cutaneous sarcoidosis. Here, the authors reported two interesting cases of cutaneous sarcoidosis without systemic involvement, of which one presented as micropapular sarcoidosis and the other was mimicking lupus vulgaris. Both of them responded well to corticosteroid treatment and are in regular monitoring for development of systemic symptoms. Informed consent was obtained was obtained from both the patients.</jats:p