P2309Clinical-epidemiologic profile of patients hospitalized for erysipelas ina Brazilian tertiary care hospital

Camila Silveira, MD, Faculdade de Medicina de Ribeir~ao Preto, Universidade deS~ao Paulo, S~ao Paulo, Brazil; Marco Andrey Frade, PhD, Faculdade de Medicina deRibeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo, Brazil; Mariana Coelho,Faculdade de Medicina de Ribeir~ao Preto, Universidade de S~ao Paulo, S~ao Paulo,Brazil; Vagner Silveira Jr, Faculdade de Medicina de Ribeir~ao Preto, Universidadede S~ao Paulo, S~ao Paulo, Brazil

Erysipelas is defined as an infection of dermis and superficial subcutaneous tissue,predominantly caused by Streptococcus spp. It is clinically characterized by localsigns of inflammation and fever. The diagnosis is basically clinical and the standardtreatment is penicillin. This study was a retrospective review of the hospitalizationsfor erysipelas in S~ao Paulo University Hospital, Ribeir~ao Preto, between 2001 and2005. The patients were selected by the hospital registry and their medical recordswere reviewed in order to record their clinicaleepidemiologic characteristics. Datawere analyzed by the software EpiInfo version 3.3.2. There were 428 hospitaliza-tions of 378 patients analyzed, of which 53% were men and 47% women. Age variedbetween 1 and 97 years (average, 57.35 yrs). It had predominance of the white etnia(89.5%), followed for medium brown (5.8%) and black (4.7%), most of the patientshad their residence in Ribeir~ao Preto. More than half (55.3%) of the patients werehospitalized in the internal medicine department, and the emergency room was themain way of access to the hospital. The average time of hospitalization was of 10.1days, with mode of 1 day and 8% of the patients had more than one hospitalization.The most commonly associated diseases were hypertension (41.4%), diabetesmellitus (25.5%), and heart disease (23.6%), and 12.3% had no other disease. Morethan one quarter (25.5%) of the patients had bullous lesions and 47.4% had an ulcer.The cultures were done in 40.8% of the cases and 39.9% of those were positive.Great variation of species was found, including 21% of Streptococcus spp. and 24%of Staphylococcus aureus. The antibiotic’s resistance rate was 40.2%. The most usedtreatments were first generations cephalosporin and penicillin. The mortality ratewas 0.5%. It was concluded that erysipelas was most prevalent in white males, withaverage age of 57.35 years. The hospitalization’s average time was 10 days, andhypertension and diabetes mellitus were the main disease associated. The legs werethe main site of infection and the portal of entry was unknown in most of the cases.Bullous were found in 25.5% of the patients and ulcer in 47.4%. Cultures were donein 40.8% of the hospitalizations, and 39.9% of those were positive, showing multiplesagents. The most used treatment in and after hospitalization was first generation’scephalosporin. The study’s great limitation was the inadequate filing of medicalrecords.

MARCH 2

cial support: None identified.

Commer

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P231121st-century department, 19th-century diseases

Mark Griffiths, MD, Department of Dermatology, Solihull Hospital, Solihull, WestMidlands, United Kingdom; Adrian Heagerty, MD, MBBS, Department ofDermatology, Solihull Hospital, Solihull, West Midlands, United Kingdom; BavaniArun, MBBCh, Department of Dermatology, Solihull Hospital, Solihull, WestMidlands, United Kingdom; Irshad Zaki, MBBS, Department of Dermatology,Solihull Hospital, Solihull, West Midlands, United Kingdom; Stephen Orpin,MBBCh, Department of Dermatology, Solihull Hospital, Solihull, West Midlands,United Kingdom

At a time when medicine, including dermatology, is moving ever faster towards the‘‘magic bullet’’ with biologic therapies, immune modulators, and the prospect ofgene therapy, we were recently surprised by three patients who presented to our21st-century department with disorders more reminiscent of the 19th.

Case 1: A 37-year-old Anglo Asian woman gave a 1-year history of five hypopig-mented patches over her arms, face, back, and left buttock. These had reducedsensation to pin prick, and a biopsy revealed well circumscribed confluentgranulomatous foci consisting of both epithelioid histiocytes and inflammatorycells in the dermis. ZiehleNeelsen staining for acid-fast bacilli was positive. Thehistology was consistent with borderline tuberculoid leprosy and she was started onthe National Hansen Disease Program regimen of rifampicin 600 mg and dapsone100 mg daily.

Case 2: A 41-year-old female presented with a widespread nonpruritic papulareruption of 2 weeks’ duration. She was otherwise well apart from a recent onset ofintermittent headache. Her medical history was remarkable for excess alcoholconsumption. She settled with a new partner 8 weeks earlier. A clinical examinationrevealed widespread coppery red papules with fine scale. The palms and soles wereinvolved. There were no ulcers or oral involvement. Treponemal serology waspositive and a diagnosis of secondary syphilis was established. There was norecollection of a primary chancre. She was referred to the genitourinary physiciansfor definitive management and contract tracing.

Case 3: At routine follow-up following a wide excision for superficial spreadingmalignant melanoma, a 28-year-old female pointed out five firm lumps on the rightside of her neck that had been present since shortly after her primary excision.Computed tomographic scan confirmed that they were enlarged lymph nodes andalso showed lymphadenopathy in the mediastinum and calcification in the apex ofthe left lung. Lymph node biopsy revealed caseating granulomas and numerous acid-fast bacilli that proved to be Mycobacterium tuberculosis. She was started onrifampicin, isoniazid, and pyrazinamide. It is easy to think that the infectious diseasesthat formed the bulk of the physician’s workload before the advent of antibiotics arethings of the past. Our recent experience suggests otherwise. The 21st-centurydermatologist, it appears, is still on the front line in the fight against these oldenemies.

cial support: None identified.

Commer

P2312A case of syphilitic keratoderma in concurrence with syphilitic uveitis

Deborah Lee, MD, Department of Dermatology, Busan Paik Hospital, College ofMedicine, Inje University, Busan, South Korea; Ho Suk Sung, MD, PhD,Department of Dermatology, Busan Paik Hospital, College of Medicine, InjeUniversity, Busan, South Korea; Ju-Hyun Kang, MD, Department of Dermatology,Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea;Sang-Hyun Kim, MD, Department of Dermatology, Busan Paik Hospital, Collegeof Medicine, Inje University, Busan, South Korea; Seon-Wook Hwang, MD,Department of Dermatology, Busan Paik Hospital, College of Medicine, InjeUniversity, Busan, South Korea

A 69-year-old female presented with steroid-resistant hyperkeratotic patches on thepalms and soles with uveitis for 4 months. Because steroid-resistant uveitis must beevaluated for syphilis, viral infections, and autoimmune diseases, we checkedseveral laboratory tests and found serologic test for VDRL reactive (titer, 1:128).After treatment with penicillin G 4 million units intravenously every 4 hours for2 weeks, her skin lesions and visual disturbance were completely resolved. Therefore,she was diagnosed as having syphilitic keratoderma and uveitis. Syphilitic kerato-derma is a rare type of cutaneous manifestation of secondary syphilis, characterizedby symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, thecases of syphilitic keratoderma and uveitis have not been appeared in the dermato-logic literatures. Here, we report a rare case of syphilitic keratoderma in concurrencewith syphilitic uveitis and suggest that an evaluation for syphilis may be requiredwhen the skin lesions and ocular disturbances are resistant to long-term steroidtherapy.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB109