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Cutaneous larva migrans is considered to be a self-limited parasitic infection of about 2 to 8 weeks' duration, though it has been reported to persist for as long as 55 weeks. In this case, a healthy 47-year-old white man had multiple serpiginous lesions typical of cutaneous larva migrans for 18 months. A biopsy taken 2 months before presentation showed a parasite consistent with Ancylostoma species deep in a hair follicle. The patient initially responded to topical thiabendazole, but relapse occurred when therapy was discontinued. Oral thiabendazole cured the problem after 22 months of infestation. Cutaneous larva migrans may sometimes be long-standing, here almost 2 years, even in a healthy patient. Organisms may reside deep in the hair follicles. Topical thiabendazole may not penetrate to this depth, necessitating oral thiabendazole therapy.

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BACKGROUND: Dermatologists may evaluate patients with African trypanosomiasis. The currently available dermatologic literature does not review the cutaneous manifestations of African trypanosomiasis. OBSERVATION: We describe an American man who acquired African trypanosomiasis while hunting in Tanzania, and we review and classify the cutaneous findings of this disease. This article reports the results of the first biopsy of a trypanid and depicts trypanosomes on the first touch preparation done from a trypanid biopsy specimen. Rare color photographs of trypanids are shown. CONCLUSIONS: Recognition of the unique cutaneous manifestations of African trypanosomiasis may allow dermatologists to make a rapid diagnosis that is essential for timely treatment and survival. Classifying the disease with primary chancriform, secondary hemolymphatic, and tertiary central nervous system stages should improve the understanding of the complex natural history of African trypanosomiasis.

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Chronic superficial dermatophyte infection may predispose the immunocompromised patient to invasive or disseminated involvement. We report a case of deep dermatophyte infection in a patient treated with long-term corticosteroid therapy for lung disease. The patient responded well to oral griseofulvin. Previously reported cases are reviewed along with recent investigative findings in the pathogenesis of chronic dermatophyte infections. Recommendations are made for diagnosis and therapy.

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The classification of palmoplantar lesions resembling music box spines is confusing, and nearly all attempts at treatment have been futile. We present the case of a 62-year-old white man with symptomatic music box spine lesions on his palms and fingers composed of parakeratotic columns over a hypogranular epidermis. Lesions and symptoms disappeared after a short course of 6 percent salicylic acid gel applied under occlusion. We suggest a classification scheme for this and similar-appearing conditions under the title spiny keratoderma, based on their histologic pattern (parakeratotic or hyperkeratotic) and anatomical location (palmoplantar, diffuse, or associated with epidermal appendages).

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Clinical and histologic characteristics of tularemia are reviewed in this report of a 65-year-old man who presented with fever, cutaneous ulceration, and regional lymphadenopathy. Examination of a biopsy specimen failed to demonstrate the granulomatous inflammation one would expect according to the current dermatologic literature. We review the diagnostic implications of this finding.

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The case of a 59-year-old woman with a history of an organoid nevus of the scalp is reported. Histologic examination revealed multiple secondary tumors including a tumor of the follicular infundibulum, an apocrine nevus, a syringocystadenoma papilliferum, an apocrine adenoma, and a piloleiomyoma occurring in the absence of sebaceous glands. The types of secondary tumors which may develop within organoid nevi are reviewed. The terminology and pathogenesis of this hamartoma are discussed.

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A case of porokeratosis punctata palmaris et plantaris (punctate porokeratosis) in a 60-year-old man of Korean ancestry is reported. The patient presented with a 15-year history of numerous asymptomatic pits measuring 1 to 3 mm in diameter and having keratotic plugs irregularly distributed on the plantar aspects of both feet and on the palmar aspects of both hands, including the flexor portions of the digits. Histologic examination revealed distinct epidermal depressions containing cornoid lamellae. Six previous case reports of this unusual dermatosis are reviewed and compared to our case.

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A keratoacanthoma is a benign epithelial growth most often found in sun-exposed skin of the elderly. Two main groups of multiple keratoacanthomas have been described: the Ferguson-Smith type and the Grzybowski type. A patient with multiple keratoacanthomas of the Ferguson Smith type is described and the treatment with intralesional 5-fluorouracil is explained. Intralesional therapy with 5-fluorouracil is a safe treatment and may be the treatment of choice for multiple keratoacanthomas and solitary lesions which are difficult to remove surgically.

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A 46-year-old woman with cryptococcal meningoencephalitis also had Mycobacterium intracellulare isolated from her cerebrospinal fluid. She was treated with amphotericin B,5-fluorocytosine, and antituberculous agents (isoniazid and rifampin). She gradually improved and was well, except for residual neurologic damage, three years after discharge from the hospital. No evidence of significant underlying disease has been found.

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