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Cellulitis of the skin is most commonly a bacterial infection caused by either staphylococcal or streptococcal species. However, in immunocompromised patients, cellulitis may be a harbinger of more ominous disease. In these patients, rapid clinical diagnosis and treatment is necessary. We describe an immunosuppressed renal transplant recipient with the clinical diagnosis of cryptococcal cellulitis who was found to have a heretofore unreported dermal mucinosis of the upper chest associated with milia. We believe that cyclosporine was a significant pathogenic factor. This entity, which should be included in the clinical differential diagnosis of cryptococcal cellulitis, has a benign nature and does not require treatment.

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BACKGROUND: The technology used for artificial nails, the chemistry of cyanoacrylates and the reported reactions to these products are briefly reviewed. MATERIALS AND METHODS: We studied three patients with prominent fingernail dystrophy, nail bed hyperkeratosis, fingertip eczema, and onycholysis, two of whom also had eczematous lesions at distant sites, ostensibly from hand transfer. Patch testing was performed with a standard screening tray, dried cyanoacrylate adhesives, and, in one case, with fingernail clippings. RESULTS: All three patients were prominently patch-test positive to the polymerized 2-ethylcyanoacrylate, used as an adhesive on artificial (plastic) fingernails. One patient was also mildly formaldehyde sensitive, one was mildly reactive to two acrylate allergens, and one was extremely allergic to toluenesulfonamide formaldehyde resin. One patient had a positive patch test to her fingernail clippings 2 months after use of the adhesive was discontinued and an attempt was made to remove it. CONCLUSIONS: Reactions to cyanoacrylate adhesives used for artificial nails can cause both nail dystrophy and fingertip eczema, and may produce eczema elsewhere, probably from hand transfer. Persistence is likely due to retained polymer, which slowly degrades in the presence of water probably releasing antigens. Patch testing with the dried adhesive on an adhesive plaster seems to be reliable.

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PURPOSE: The authors document the association of peripapillary staphyloma and an atypical variant of hemimegalencephaly with the linear nevus sebaceous syndrome. BACKGROUND: Linear nevus sebaceous syndrome is an uncommon neurocutaneous disorder that has a propensity to involve the eyes. METHODS: Clinical, histopathologic, and neuroimaging findings are examined in a child with linear nevus sebaceous syndrome. RESULTS: In addition to bilateral peripapillary staphylomas, ophthalmologic abnormalities included a corneal dermoid, a complex conjunctival choristoma, macular hypoplasia, and optic nerve hypoplasia with contralateral optic atrophy. Magnetic resonance imaging disclosed a rare form of hemimegalencephaly characterized by hypoplasia of an optic radiation within the enlarged, dysgenetic cerebral hemisphere. CONCLUSION: The spectrum of oculocerebral dysgenesis in the linear nevus sebaceous syndrome can be expanded to include peripapillary staphyloma and atypical hemimegalencephaly with hypoplasia of an optic radiation.

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BACKGROUND: Squamous cell carcinoma (SCC) with histologically contiguous actinic keratosis has long been thought of as a tumor with minimal risk for metastasis. The objective of this study was to determine if contiguous actinic keratosis is present in the original tumors of metastatic cutaneous SCC and to describe the histologic features of these tumors. METHODS: The primary lesions of 22 patients with metastatic cutaneous SCC were examined using light microscopy. RESULTS: Contiguous actinic keratosis was present histologically in 44% of the original lesions of cutaneous SCC that metastasized. The average tumor thickness was 6.6 mm. Greater than 66% of the tumors were well or moderately differentiated. The skin adjacent to the tumors showed solar degeneration in almost all instances. CONCLUSIONS: The histologic presence of contiguous actinic keratosis is not a useful predictor of the metastatic behavior of cutaneous SCC. Increased tumor thickness and depth of invasion are the most consistent histopathologic features of cutaneous SCC that metastasize.

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Eruption of lymphocyte recovery (ELR) develops in the setting of leukocyte reconstitution after iatrogenic marrow aplasia and displays a superficial perivascular lymphocytic infiltrate composed of CD3+/CD4+ cells. Epidermal changes are usually minimal to absent. We report a case of an ELR mimicking mycosis fungoides with the formation of CD4+ Pautrier-like microabscesses.

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BACKGROUND: Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare malignant tumor thought to be of adnexal origin. Because of its rarity, treatment parameters have not been defined. OBJECTIVE: To examine the role and success of Mohs micrographic surgery in the treatment of LELCS versus other forms of treatment previously documented in the literature. METHODS/RESULTS: A review of the previous reported cases and their treatment outcomes was compared with the present case. Three of the 12 previously reported cases were incompletely treated with initial surgical management, with one patient subsequently dying of metastatic tumor. The present case was treated with Mohs micrographic surgery for recurrent LELCS, following initial treatment with electrodessication and curettage, and is without evidence of disease 20 months postoperatively. CONCLUSION: LELCS may be successfully treated by Mohs micrographic surgery.

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1. The in vitro effect of intense stimulation on the micromechanical stiffness of hair cell sensory hair bundles was studied at three locations on the chick basilar papilla. Threshold levels of hair bundle motion, produced by a water jet stimulus, were examined before and after exposure to a 300 Hz water jet stimulus set at 25 dB above the pre-exposure threshold level. 2. Threshold levels of motion were systematically examined in 8 unexposed control cells. The level of water jet stimulus needed to achieve the detection threshold of motion remained constant in these cells when periodically tested over a 36.5-min interval. 3. Post-exposure changes in the motion detection threshold of hair bundles were examined in 82 hair bundles, and a number of effects were identified: 2.4% of the hair bundles showed no threshold changes; 31.7% of the hair bundles had threshold shifts which indicated an increase in stiffness; 18.3% exhibited a threshold shift that indicated a decrease in hair bundle stiffness, but with no recovery; and 47.6% had thresholds that indicated a decrease in hair bundle stiffness with recovery to pre-exposure levels within 16-18 min. 4. The results suggest that chick hair bundles exhibit complex and varied responses to overstimulation which are very different from that seen in the mammal.

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