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A 36-year-old woman with a 1 1/2-year history of systemic lupus erythematosus was first seen in October 1984 with a six-month history of several ulcerated and scarred lesions on the lower extremities. A biopsy specimen showed a granulomatous infiltrate of deep dermis and subcutaneous tissue. Over the next three weeks, the patient developed a violaceous, warm, indurated, tender, fluctuant lesion involving most of the left buttock. A culture showed a rapidly growing atypical acid-fast bacteria, which was later identified as Mycobacterium fortuitum. The patient was treated with surgical drainage of the left hip abscess, followed by a three-week treatment with doxycycline hyclate and amikacin sulfate. She was discharged while receiving oral doxycycline and ethambutol hydrochloride.

We report a rare case of primary lymphocutaneous Nocardia brasiliensis infection occurring in an elderly diabetic man maintained on long-term therapy with prednisone. The mode of inoculation was that of a puncture wound caused by a contaminated needle that occurred one month prior to the development of the clinically apparent infection. The course of this patient's infection was protracted and required two surgical procedures and several months of antibiotic therapy. A review of 15 previously reported cases is presented as well as a discussion of appropriate medical therapy.

A patient had acute myeloblastic leukemia and extensive progressive cutaneous herpes simplex virus infection. Complete and rapid healing of skin lesions with remission of the leukemia occurred during 15 days of therapy with human leukocyte interferon and minimal doses of cytarabine hydrochloride. Pharmacokinetic studies showed that the patient had a defective antiviral interferon response, which was effectively corrected by treatment with interferon alpha. This may help to explain the dramatic response of both conditions to therapy.

Three children with severe, secondarily infected atopic dermatitis since infancy developed osteomyelitis of the distal phalanges of the hands. The insidious onset of one or more distal subungual black macules was followed by edema, erythema, and pain in the involved fingers. No child had an elevated erythrocyte sedimentation rate or fever, but all had roentgenographic or scintigraphic evidence of bony destruction. In two children, Staphylococcus aureus grew from skin surface cultures; S aureus also grew from nail bed and osseous cultures of the distal phalanges; Streptococcus viridans grew from one child's nail bed. All children had prolonged hospitalizations. In two children, laboratory evaluation of immunologic function disclosed normal findings. We postulate that intense scratching of infected skin coupled with minor trauma to the fingertips created distal subungual microabscesses that spread contiguously to the underlying bone.