Blastomycosis-like pyoderma in a man with AIDS
Identifieur interne : 000385 ( Istex/Corpus ); précédent : 000384; suivant : 000386Blastomycosis-like pyoderma in a man with AIDS
Auteurs : Jeffrey J. Crowley ; Youn H. KimSource :
- Journal of the American Academy of Dermatology [ 0190-9622 ] ; 1997.
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DOI: 10.1016/S0190-9622(97)70257-3
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Kim, MD, Stanford University, Department of Dermatology, 900 Blake Wilbur Dr. W0064, Palo Alto, CA 94304</note><note>J Am Acad Dermatol 1997;36:633-4</note><note>0190-9622/97/$5.00 + 0 16/54/78476</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Blastomycosis-like pyoderma in a man with AIDS</title><author xml:id="author-0000"><persName><forename type="first">Jeffrey J.</forename><surname>Crowley</surname></persName><roleName type="degree">MD</roleName><affiliation>Palo Alto, California</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Youn H.</forename><surname>Kim</surname></persName><roleName type="degree">MD</roleName><affiliation>Palo Alto, California</affiliation></author><idno type="istex">089029EC058DF4E9075CF7105CB38F2F6EEED09D</idno><idno type="DOI">10.1016/S0190-9622(97)70257-3</idno><idno type="PII">S0190-9622(97)70257-3</idno></analytic><monogr><title level="j">Journal of the American Academy of Dermatology</title><title level="j" type="abbrev">YMJD</title><idno type="pISSN">0190-9622</idno><idno type="PII">S0190-9622(05)X7232-2</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">36</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="633">633</biblScope><biblScope unit="page" to="664">664</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage></profileDesc><revisionDesc><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/089029EC058DF4E9075CF7105CB38F2F6EEED09D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMJD</jid><aid>78476</aid><ce:pii>S0190-9622(97)70257-3</ce:pii><ce:doi>10.1016/S0190-9622(97)70257-3</ce:doi><ce:copyright type="other" year="1997">American Academy of Dermatology, Inc</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>From the University Department of Dermatology, Stanford University School of Medecine.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para>Reprint requests: Youn H. Kim, MD, Stanford University, Department of Dermatology, 900 Blake Wilbur Dr. W0064, Palo Alto, CA 94304</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para>J Am Acad Dermatol 1997;36:633-4</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★★</ce:label><ce:note-para>0190-9622/97/$5.00 + 0 <ce:bold>16/54/78476</ce:bold></ce:note-para></ce:article-footnote><ce:title>Blastomycosis-like pyoderma in a man with AIDS</ce:title><ce:author-group><ce:author><ce:given-name>Jeffrey J.</ce:given-name><ce:surname>Crowley</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Youn H.</ce:given-name><ce:surname>Kim</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:affiliation><ce:textfn>Palo Alto, California</ce:textfn></ce:affiliation></ce:author-group></head><body><ce:sections><ce:para>Blastomycosis-like pyoderma is rare and usually occurs only in patients who are locally or systemically immunocompromised. It most likely represents an unusual exaggerated tissue reaction to prolonged primary or secondary bacterial infection. <ce:cross-ref refid="bib1"><ce:sup>1</ce:sup></ce:cross-ref> The lesions consist of erythematous indurated plaques that may be verrucous. Histologic examination shows pseudoepithelial hyperplasia with abscesses. Culture reveals one or more pathogenic bacteria, including streptococci, staphylococci, and gram-negative species. We describe blastomycosis-like pyoderma in a man with AIDS and Kaposi's sarcoma.</ce:para><ce:section><ce:section-title>CASE REPORT</ce:section-title><ce:para>A 40-year-old black man had a 7-year history of Kaposi's sarcoma localized to the left lower extremity. The patient's only other manifestation of AIDS was cryptococcal meningitis for which he underwent treatment 2 years before.</ce:para><ce:para>Eight months ago the patient noted drainage and increased swelling of his left lower extremity. He was treated for presumed cellulitis with several courses of oral dicloxacillin, with little improvement. Ten days before admission the patient noticed increased leg pain and scrotal swelling. Culture from the left leg grew 4+ <ce:italic>Pseudomonas aeruginosa</ce:italic> and 4+ <ce:italic>Escherichia coli</ce:italic> . He was treated with oral ciprofloxacin, and dicloxacillin was continued. Other medications were fluconazole, trimethoprim/sulfamethoxazole, acyclovir, and D4T.</ce:para><ce:para>The left lower extremity and scrotum were diffusely edematous. There was a 5 × 4 cm well-defined erythematous plaque on the scrotum (<ce:cross-ref refid="fig1">Fig. 1</ce:cross-ref>) as well as several 2 to 4 cm plaques on the lower abdomen.
<ce:display><ce:figure id="fig1"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para>Erythematous plaque on scrotum with distinct borders and adherent crust.</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display>The lesions were partially covered with a fibrinous crust and drained a straw-colored fluid. The remainder of the left lower extremity showed indurated violaceous macules and plaques of Kaposi's sarcoma extending to the left lower abdomen.</ce:para><ce:para>Biopsy specimens from the scrotal and abdominal plaques showed marked pseudoepitheliomatous hyperplasia and focal ulceration. The dermis showed a moderate mixed inflammatory infiltrate of neutrophils and histiocytes, and the epidermis showed superficial abscesses. Gram's stain revealed numerous bacterial organisms within the epidermal keratin but not within the lower epidermis or dermis. Periodic acid–Schiff and other special stains were negative. Culture of both tissue specimens revealed 3+ <ce:italic>E. coli</ce:italic> and 3+ <ce:italic>Prevotella bivia</ce:italic> (an anaerobe formerly classified as <ce:italic>Bacteroides bivius</ce:italic> ). Fungal, viral, and mycobacterial cultures were negative.</ce:para><ce:para>The patient was treated with intravenous antibiotics. Daily whirlpool treatment was given and subsequent curettage of the lesions was performed. The patient was much improved after 7 days, and bacterial cultures were negative for pathogenic bacteria. After 6 weeks, the lower extremity became less edematous and the pyoderma had nearly cleared.</ce:para></ce:section><ce:section><ce:section-title>DISCUSSION</ce:section-title><ce:para>Criteria for the diagnosis of blastomycosis-like pyoderma have been proposed by Su, Duncan, and Perry. <ce:cross-ref refid="bib1"><ce:sup>1</ce:sup></ce:cross-ref> These include (1) large verrucous plaques with multiple pustules and an elevated border; (2) pseudoepitheliomatous hyperplasia with abscesses histologically; (3) the growth of at least one pathogenic bacteria from the culture of a tissue biopsy specimen; (4) negative culture for deep fungi, atypical mycobacteria, and <ce:italic>Mycobacterium tuberculosis</ce:italic> ; (5) negative fungal serology tests; and (6) normal bromide and iodide levels in the blood.</ce:para><ce:para>Our patient had clinical and histologic findings consistent with blastomycosis-like pyoderma. Bacterial cultures revealed infection with <ce:italic>Pseudomonas, E. coli,</ce:italic> and <ce:italic>Prevotella</ce:italic> . Fungal, viral, and mycobacterial cultures showed no growth. Serum halogen levels were not obtained, but there was no history of halogen ingestion. Additionally, no recent fungal serology studies had been performed on this patient. However, the patient was taking fluconazole as prophylaxis for cryptococcal meningitis, and all fungal stains and cultures from the lesions were negative for fungus. Therefore we believe this case meets the criteria for diagnosis of blastomycosis-like pyoderma.</ce:para><ce:para>Gram-negative bacteria ( <ce:italic>Pseudomonas, E. coli, Proteus</ce:italic> sp.), gram-positive bacteria (e.g., <ce:italic>Staphylococcus aureus</ce:italic> , β-hemolytic streptococci), and anaerobes have been implicated in blastomycosis-like pyoderma. <ce:cross-ref refid="bib1"><ce:sup>1</ce:sup></ce:cross-ref> In this patient multiple species of bacteria were isolated. It is possible that staphylococci were initially involved but were eliminated by antistaphylococcal antibiotics. The organisms first isolated <ce:italic>(Pseudomonas, E. coli)</ce:italic> were sensitive to ciprofloxacin. After treatment with oral ciprofloxacin, <ce:italic>Pseudomonas</ce:italic> was no longer present, and cultures grew <ce:italic>E. coli</ce:italic> resistant to ciprofloxacin and an anaerobe. Thus antibiotic treatment without wound care and debridement was not adequate in this patient and may have led to infection with more resistant bacteria.</ce:para><ce:para>Most patients with blastomycosis-like pyoderma have a low resistance to bacterial infection. Previous case reports have cited several potential sources of systemic compromise including alcoholism, chronic granulocytic leukemia, long-term prednisone use, and radiation therapy. <ce:cross-refs refid="bib1 bib2 bib3 bib4"><ce:sup>1-4</ce:sup></ce:cross-refs> Blastomycosis-like pyoderma most likely represents an unusual, exaggerated, vegetating reaction to a primary or secondary bacterial infection. <ce:cross-ref refid="bib5"><ce:sup>5</ce:sup></ce:cross-ref>Our patient was systemically im munocompromised (AIDS with CD4 count < 20), and the involved tissue was locally compromised by Kaposi's sarcoma, chronic lymphedema, and previous radiation therapy. A search of English-language literature has revealed no other reports of blastomycosis-like pyoderma in a patient with AIDS.</ce:para></ce:section></ce:sections></body><tail><ce:bibliography><ce:section-title>References</ce:section-title><ce:bibliography-sec><ce:bib-reference id="bib1"><ce:label>1</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>D</ce:given-name><ce:surname>Su</ce:surname></sb:author><sb:author><ce:given-name>SC</ce:given-name><ce:surname>Duncan</ce:surname></sb:author><sb:author><ce:given-name>HO.</ce:given-name><ce:surname>Perry</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Blastomycosis-like pyoderma</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Arch Dermatol</sb:maintitle></sb:title><sb:volume-nr>115</sb:volume-nr></sb:series><sb:date>1979</sb:date></sb:issue><sb:pages><sb:first-page>170</sb:first-page><sb:last-page>173</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib2"><ce:label>2</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>KJ</ce:given-name><ce:surname>Trygg</ce:surname></sb:author><sb:author><ce:given-name>KC.</ce:given-name><ce:surname>Madison</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Blastomycosis-like pyoderma caused by <ce:italic>Pseudomonas aeruginosa:</ce:italic> report of a case responsive to ciprofloxacin</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Acad 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therapy</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Dermatol Surg Oncol</sb:maintitle></sb:title><sb:volume-nr>12</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>271</sb:first-page><sb:last-page>273</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference></ce:bibliography-sec></ce:bibliography></tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Blastomycosis-like pyoderma in a man with AIDS</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Blastomycosis-like pyoderma in a man with AIDS</title></titleInfo><name type="personal"><namePart type="given">Jeffrey J.</namePart><namePart type="family">Crowley</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Palo Alto, California</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Youn H.</namePart><namePart type="family">Kim</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Palo Alto, California</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><note>From the University Department of Dermatology, Stanford University School of Medecine.</note><note>Reprint requests: Youn H. Kim, MD, Stanford University, Department of Dermatology, 900 Blake Wilbur Dr. W0064, Palo Alto, CA 94304</note><note>J Am Acad Dermatol 1997;36:633-4</note><note>0190-9622/97/$5.00 + 0 16/54/78476</note><relatedItem type="host"><titleInfo><title>Journal of the American Academy of Dermatology</title></titleInfo><titleInfo type="abbreviated"><title>YMJD</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199704</dateIssued></originInfo><identifier type="ISSN">0190-9622</identifier><identifier type="PII">S0190-9622(05)X7232-2</identifier><part><date>199704</date><detail type="volume"><number>36</number><caption>vol.</caption></detail><detail type="issue"><number>4</number><caption>no.</caption></detail><extent unit="issue pages"><start>513</start><end>658</end></extent><extent unit="pages"><start>633</start><end>664</end></extent></part></relatedItem><identifier type="istex">089029EC058DF4E9075CF7105CB38F2F6EEED09D</identifier><identifier type="DOI">10.1016/S0190-9622(97)70257-3</identifier><identifier type="PII">S0190-9622(97)70257-3</identifier><accessCondition type="use and reproduction" contentType="copyright">©1997 American Academy of Dermatology, Inc</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>American Academy of Dermatology, Inc, ©1997</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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