Search

Introduction: Allergic drug reactions represent common clinical challenges. Selected allergic drug reactions present with blisters. Case report: A 73 year old female was prescribed levofloxacin injection and trimethoprim/sulfamethoxazole for a urinary tract infection. Subsequently, the patient developed blisters on both of her hands and feet, associated with clinical pruritus. Clinically, bullae were observed on both of her palms and soles, associated with erythema. Methods: Biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence (DIF) were performed. Results: Focal areas of the epidermis displayed diffuse, mild spongiosis. An acute inflammatory process extended into hair follicular units, with focal rupture of these structures. Focal subepidermal vesiculations were also noted in the areas of follicular unit rupture. DIF examination demonstrated faint linear deposits of anti-human fibrinogen at the basement membrane zone of the skin, as well as around several hair shafts. A similar fibrinogen deposition pattern also present around the upper dermal blood vessels. Conclusions: In our practice experience, the most common cause of blistering diseases are allergic drug reactions, in contradistinction to primary autoimmune blistering disorders. Clinical physicians, pathologists and immunodermatologists should be aware that allergic drug reactions can mimic primary autoimmune blistering disorders, both clinically and in selected immunologic aspects.

Introduction: Eosinophils are multifunctional cells that play a characteristic role in various diseases of allergic and infective etiology. Eosinophils play an important role in immunity hence eosinophilia occurs in various diseases of skin and systemic allergic disorders. Materials and Methods: One hundred patients admitted to the Dermatology ward with absolute eosinophil count (AEC) above 500 cells per cubic millimeter were included in the study. Detailed history, including, drug history, travel history, history of atopy, and insect bites, was taken. A complete hemogram, stool examination, chest x-ray, and serological test were done to rule out eosinophilia due to other causes. Results: In our study, most of the patients (40%) were between the age group of 40 and 60 years. Fifty-six percent were male patients. Most of the patients (98%) fell in the category of mild-to-moderate eosinophilia. Marked eosinophilia was seen in only 2%. Most common skin conditions were chronic urticaria (28%) followed by generalized pruritus (16%), eczema (10%), drug reaction (10%), psoriasis (7%), bullous diseases (6%), palmoplantar keratoderma (4%), and HIV (4%). Malignancy was seen in 2%. Other conditions constituted 13%. Out of all these, 12% had stool examination positive for ova and cysts. Histopathological examination was done in 22 patients, 12 of whom showed tissue eosinophilia. Conclusion: Peripheral blood eosinophilia and/or infiltration of skin by eosinophils occur in various skin diseases. Coexisting parasitic infestations may be a predominant contributing factor for eosinophilia in tropical countries.

Acrochordons are flesh-colored pedunculated lesions which occur in areas of skin folds. Although they are common in other sites of the body, herein we describe a case of acrochordon at an unusual site over the tip of glans penis which is a rarity. We report this case for its rarity, as there have been no similar reports and paucity of literature after extensive research according to our knowledge. Clinical presentation and pathological findings are presented and discussed.