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Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous reaction to drugs. Lamotrigine is an antiepileptic agent not chemically related to the aromatic anticonvulsants that is also prescribed for mood disorder. Although adverse reaction from lamotrigine have been reported after a low initial dosage, the risk of developing TEN during lamotrigine therapy is rare when recommended guidelines for the dosing schedule are carefully followed. We present a 35-year-old woman with a mood disorder who developed TEN after about 10 days of lamotrigine (50 mg daily) monotherapy. She developed generalized maculopapular eruptions that progressed until more than 90% of her body surface area was involved, with extensive epidermal detachment. The lesions affected her conjunctival, oral, nasopharyngeal, genital, and vaginal mucosa. Lamotrigine was immediately discontinued. After receiving systemic antihistamine and corticosteroid treatment, the patient had a complete recovery.

Cercarial dermatitis (swimmer's itch) is an acute cutaneous inflammatory response caused by the penetration of cercaria of nonhuman schistosomes. It frequently presents with itchy erythematous papules, which cover the water-exposed areas within 24 hours. This paper reports a case of cercarial dermatitis in a 60-year-old man who presented with itchy erythematous papules on bilateral lower legs after walking upstream in the Mu-Gua River in Hualien. His symptoms and signs could not be relieved by treatment with topical steroids and a skin biopsy was performed. Skin pathology revealed massive eosinophil infiltration of the dermis and fragments of larvae perpendicular to the skin surface. Based on the history, clinical course and the shape, length and penetration of the larvae, which was revealed by the skin pathology, cercarial dermatitis was diagnosed. His symptoms were relieved spontaneously 3 weeks after infection. [Tzu Chi Med J 2008;20(1):63–66]

The prognosis for patients with lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is good, but multifocal lesions appear in 30-40% of patients. We report a 65-year-old woman who presented with painless, firm nodules on her right arm and face. Mine years previously, the patient presented at Tzu Chi Hospital with hoarseness and a sensation of a lump in the throat. She was first diagnosed with primary MALT lymphoma of the larynx. Subsequently, multiple painless nodules were noted on her right eyelid, right axilla, and right arm. The intervals between recurrences became shorter and skin lesions relapsed more frequently. The nodules were resected and histopathology showed small B-cells including marginal zone (centrocyte-like) cells, monocytoid cells, and small lymphocytes. Most centrocyte-like cells showed positive staining for CD20 marker in the plasma membrane—this is entirely specific for B-lymphocytes. Follicular dendritic-like cells had positive staining with stromal cell-derived factor-la (SDFla) antibody. The nuclei of the centrocyte-like cells stained positive with CXCR4, a ligand of SDFla. This may indicate that MALT lymphoma grows in a self-sustained microenvironment.

Infection with protozoan parasites of the genus Leishmania causes a variety of clinical diseases called leishmaniasis, which is transmitted to human host by the bite of a sandfly. Here, we present a Taiwanese man with cutaneous leishmaniasis after he had traveled to Sri Lanka. A 35-year-old man had a painless erythematous nodule with central ulceration on the ventral side of the right wrist. The skin lesion developed 3 weeks after he returned to Taiwan from Sri Lanka to rescue tsunami sufferers. Excisional biopsy revealed dense and diffuse infiltration of histiocytes and lymphocytes throughout the dermis, and numerous amastigotes were identified in the cytoplasm of the histiocytes. Nine months after he was first treated, his skin lesion recurred at the same location. Under the diagnosis of cutaneous leishmaniasis, he underwent a second excision and took 400 mg itraconazole per day for 4 months. No further recurrence or internal organ involvement was noted.