A case of green nail syndrome with onychomycosis

( Joongoon Kim ),( Moonhyung You ),( Yeonwoong Kim ),( Byeongsu Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Green nail syndrome is characterized by greenish discoloration of the nail. It is caused by Pseudomonas aeruginosa which is an aerobic gram-negative rod found in moist environment. Trauma of the nail and exposure to water are common predisposing factors of green nail syndrome. A 66-year-old woman developed an asymptomatic greenish discoloration of the nail plate of the right great finger nail over a period of 20 days. Dermatologic examination showed onycholysis and many hyphae were seen in KOH examination. Pseudomonas aeruginosa was identified by bacterial culture and susceptible to ciprofloxacin. We prescribed oral ciprofloxacin, oral terbinafine and topical hexamedine. Three weeks later, the nail discoloration was improved significantly. Detailed medical history should be obtained because green nail syndrome often can be developed following trauma, periungal infection and inflammatory skin disease. In case of the green nail syndrome with onychomycosis, identifying causative organism is necessary to choose appropriate treatment.

A case of adult onset rhabdomyomatous mesenchymal hamartoma

( Joongoon Kim ),( Moonhyung You ),( Yeonwoong Kim ),( Byeongsu Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Rhabdomyomatous mesenchymal hamartoma is an uncommon benign lesion, which is usually congenital, polypoid. This lesion is primarily located on the head and neck. This hamartoma typically presents as a nodule or skin tag, but has also been described as a solitary indurated plaque or depressed plaque. The critical histopathologic finding is the existence of individualized fascicles of striated muscle affecting the dermis and subcutaneous fat tissue. A 39-year-old male presented with a single walnut sized normal skin colored soft elevated plaque on the chin for about 2 years. We performed punch biopsy, and histopathologic exam showed skeletal muscles and adipose tissues in the dermis. Because of cosmetic morbidity due to large size of hamartoma, he didn’t want surgical treatment. We report a rare case of adult onset rhabdomyomatous mesenchymal hamartoma. Although our patient and other reported cases had no clinically observable abnormalities, we recommend systemic evaluation in the patient with rhabdomyomatous mesenchymal hamartoma because etiology of this disease can be associated with aberrancy in the embryonic migration.

A case of tumid lupus erythematous following Kikuchi`s disease

( Joongoon Kim ),( Moonhyung You ),( Yeonwoong Kim ),( Byeongsu Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Tumid lupus erythematosus is a rare subtype of chronic cutaneous lupus erythematosus. Clinical lesions are characterized by raised erythematous plaques on sun-exposed areas such as the face, chest, arms and shoulders. Kikuchi’s disease is commonly associated with systemic lupus erythematosus, but rarely associated with tumid lupus erythematosus. A 36-year-old female patient presented with multiple erythematous plaques on both cheeks and back. She was diagnosed as Kikuchi’s disease by lymph node biopsy 3 month ago. ANA was negative, and histopathologic examination showed little vacuolar alteration, periadnexal, perivascular lymphocytic infiltration at dermo-epidermal junction. Mucin deposition in the reticular dermis was identified by alcian blue stain, so we diagnosed as tumid lupus erythematosus. After treatment with oral hydrochloroquine 100mg daily, the skin lesion was improved significantly. Herein, when skin lesion developed in patient with Kikuchi’s disease, we recommend skin biopsy to identify whether the skin lesion is from Kikuchi’s disease or other associated diseases.

A case of keratoacanthoma successfully treated with intralesional methotrexate

( Joongoon Kim ),( Moonhyung You ),( Yeonwoong Kim ),( Byeongsu Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Solitary keratoacanthoma is a rather common, rapidly growing neoplasm appearing mainly on sun-exposed areas of the skin in elderly, light-complexioned person. The majority of these lesions occur on the face, forearms, and hands. It is thought that intralesional methotrexate is effective as nonsurgical treatment of keratoacanthoma. A 85-year-old female presented with history of a rapidly growing 1.5cm-sized mass on the right submandible for 2 months. Histopathologic examination showed eosinophilic and glassy cell within shell and resulted in diagnosis of keratoacanthoma. We performed methotrexate injection with 0.1cc (50mg/2cc) each, four times in a row, with an interval of 3 weeks between inspections. After 6 weeks of treatment, the skin lesion had almost completely resolved. We report a case of keratoacanthoma which was successfully treated by intralesional methotrexate. Intralesional methotrexate can promote rapid improvement so in patient with cosmetic concern, we recommend intralesional methotrexate as nonsurgical treatment of keratoacanthoma.

A case of folliculotropic mycosis fungoides

( Joongoon Kim ),( Moonhyung You ),( Yeonwoong Kim ),( Byeongsu Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma, and it rarely exhibits predilection for hair follicle and eccrine gland infiltration. Folliculotropic mycosis fungoides is a distinct variant of mycosis fungoides. It is characterized by tropism of the lymphocytic infiltrate for hair follicle and other adnexal structure. Two cases of folliculotropic mycosis fungoides have been reported in Korean dermatologic literature. A 68-year-old male presented with a single recurring nodule on the left chin for 3 years. Histopathologic examination showed folliculotropism of atypical lymphocytes and immunohistochemical stain showed positivity for CD3, negativity for CD20 and elevated CD4: CD8 ratio (6:1). These findings correspond to folliculotropic mycosis fungoides’s histopathologic finding. We report an interesting case of folliculotropic mycosis mimicking acne or folliculitis-like lesion and recommend biopsy when skin lesion is persistant despite long term therapy.

Subcutaneous wood stick found by Leclercia adecarboxylata infection

( Joongoon Kim ),( Moonhyung You ),( Yeonwoong Kim ),( Byeongsu Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Leclercia adecarboxylata is gram-negative, motile, facultative anaerobic bacillus of the En-terobacteriaceae family. It has been rarely isolated from clinical specimens. A 15-year-old boy presented with two nodules on the left lower leg. He said that the first nodule emerged presumably following an injury about 2 years ago, and the second one emerged about 6 months ago. A week before visiting hospital, he felt pain on both nodules. We performed incision & drainage, bacterial culture on the first nodule, and skin biopsy on the second one. During incision & biopsy, we found an approximately 4cm-long wood stick. Histopathologic examination showed foreign body granuloma and Leclercia adecarboxylata was isolated from the bacterial culture. We report an interesting case of the skin lesion following wood stick injury, which was asymptomatic during last 2 years and later diagnosed as Leclercia adecarboxylata infection.

Necrobiotic xanthogranuloma coexists with diffuse normolipidemic plane xanthoma and multiple myeloma

( Hyeri Kim ),( Moonhyung You ),( Joongoon Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Necrobiotic xanthogranuloma (NXG), is a rare multisystem disease that manifests as cutaneous inflammatory lesions, and is commonly associated with lymphoproliferative disease. Diffuse normolipidemic plane xanthoma (NX), is also a rare, acquired disease that is often associated with systemic diseases such as lymphoproliferative disease. Both these diseases have been reported to be associated with monoclonal immunoglobulins (MIg). However, there are few cases in which these diseases co-exist. A 78-year-old woman, who had a known case of NX on the neck and axillary area, presented with an asymptomatic erythematous plaque on her left supraclavicular area for 6 months. Histopathological examination showed lymphoid aggregates, necrobiotic areas, and granulomatous inflammation in the dermis. Numerous foreign-body and Touton type giant cells were noticed. Serum protein immunoelectrophoresis showed an IgG kappa type monoclonal gammopathy. Lipid profile of serum was normal. Bone marrow examination showed plasma cell myeloma. Based on these histologic and laboratory results, we diagnosed this lesion as NXG coexisting with NX and multiple myeloma. She was started on treatment with bortezomib and melphalan for multiple myeloma, and high-dose systemic corticosteroid and triamcinolone intralesional injection for the skin lesion. After 3 months of treatment, the NXG skin lesion and MIg improved.

Causative species of sporotrichosis in Korea

( Hyeri Kim ),( Moonhyung You ),( Joongoon Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Sporotrichosis is a chronic cutaneous fungal infection caused by Sporothrix (S.) schenckii complex. Sporotrichosis was common deep mycosis in Korea. All strains were reported as S. schenckii. There was no molecular studies until 2016. In northeast China and Japan, S. globosa was main species of Sporothrix, and S. schenckii sensu stricto was very rare. Objectives: We want to know accurate species of Korean strains reported as S. schenckii. Methods: We searched the Korean strains of Sporothrix spp. at fungus collection centers or private collections and reviewed literatures of molecular studies for Korean strains. We found 6 strains of S. schenckii and 3 strains of S. globosa. Ribosomal DNA ITS sequences were compared with those of the species of Sporothrix schenckii complex. Results: Ribosomal ITS sequences of 9 strains were 100 % identical with S. globosa. There was no S. schenckii sensu stricto. We found one study about molecular analysis of Korean S. schenckii . It was published in 2004 by Ishizaki et al. All of 8 strains of Korean S. schenckii were mitochondrial subtype group 2, that was S. globosa. So all 17 strains of Korean S. schenckii complex were S. globosa. Conclusion: S. globosa was the causative species in tested Korean sporotrichosis.

Sporotrichosis caused by direct infection of Sporothrix globosa in family

( Hyeri Kim ),( Moonhyung You ),( Joongoon Kim ),( Donghoon Shin ),( Jongsoo Choi ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Sporotrichosis is one of the most common subcutaneous mycosis caused by Sporothrix(S.) schenckii complex. S.schenckii complex comprises at least six closely related dimorphic fungi including S.brasiliensis, S.globosa, S.mexicana, S.albicans, S.luriei, and S.schenckii sensu stricticto. Spirotrichosis usually occur through skin injury from contaminated plant debris or scratches from felines carrying the disease. Human-to-human transmission of the sporotrichosis is very rare in the world. A 3-year-old boy presented with a single indurated ulcer and crust on the left inner thigh. The lesion appeared a year ago, and gradually grew up in size. His father was diagnosed as sporotrichosis caused by S.globosa 2 years ago. He and his father used different room at bed time, and denied raising any animals or plants. Histopathologic examination of the lesion revealed granulomatous infiltration containing lymphocytes, histiocytes, and giant cells. GMS and PAS histochemical staining showed positive for many spherical yeast cells. The fungal culture on Sabouraud dextrose agar showed dark brown to black, moist and wrinkle colonies. The sequences of ribosomal DNA internal transcribed spacer region of clinical sample was 100% similarity with S. globosa. We diagnosed the lesion as sporotrichosis and treated with itraconazol. We report a rare case of sporotrichosis caused by direct infection of S.globosa.

손가락 말단 피부로 전이된 간세포암 1예

김혜리 ( Hyeri Kim ),유문형 ( Moonhyung You ),김준군 ( Joongoon Kim ),신동훈 ( Donghoon Shin ),최종수 ( Jongsoo Choi ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.6