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Branislav Lekić, Mirjana Gajić-Veljić and Miloš Nikolić

Abstract

Wells syndrome (WS) is a rare inflammatory skin disease of unknown etiology. Possible triggers for WS include insect bites/stings, infections, medications, malignancies, and vaccination. Most cases have been reported in adults, but WS may also occur in children.

We report a case of idiopathic WS in a 12-year-old boy, who presented with pruritic papulonodular and granuloma annulare-like lesions on his legs. The patient had an excellent response to topical and systemic corticosteroids.

WS may present as plaque, granuloma annulare-like, urticaria-like, papulovesicular, bullous, papulonodular, or fixed drug eruption-like lesions. Erythematous annular lesions are most common in adults, while plaques are mostly found in children. The histopathologic features are dynamic, starting with dermal edema and infiltration of eosinophils, then flame figures develop, and finishing with the appearance of histiocytes and giant cells.

Our patient represents a rare pediatric case with granuloma annulare-like WS syndrome.

Open access

Branislav Lekić, Mirjana Gajić-Veljić, Svetlana Popadić and Miloš Nikolić

Abstract

IgA pemphigus (IGAP) is a rare autoimmune bullous disease characterized by IgA deposits on keratinocyte cell surfaces. The IGAP is classified into: 1) subcorneal pustular dermatosis (SPD) type, and 2) intraepidermal neutrophilic (IEN) IgA dermatosis type. So far, only 9 children with IGAP have been described in the literature, of whom only 3 with SPD type. We report a 3-year-old boy with SPD type of IGAP. Clinically, he presented with pruritic vesicles, pustules and erosions on the face, trunk, groin area, and extremities. Histopathology showed subcorneal pustules containing a few acantholytic cells. Direct immunofluorescence (DIF) test of Tzanck smear showed intercellular IgA deposits on the surface of the groups of epidermal cells. Oral dapsone and prednisone induced remission after two weeks; the treatment was discontinued 11 months later, and complete remission was achieved during 19 months without any treatment. Direct immunofluorescence of Tzanck smear is a simple, sensitive, rapid and non-aggressive test, very suitable for the diagnosis of IGAP in children.

Open access

Branislav Lekić, Mirjana Gajić-Veljić, Dušan Škiljević, Svetlana Popadić and Ljiljana Medenica

Abstract

Apocrine adenocarcinoma is a rare form of sweat gland malignancy mostly affecting adults without evident prevalence for sex or race. Clinically, it presents as a single or a multi-nodular mass or plaque in the axillary or anogenital region, with no additional symptoms. This neoplasm is locally invasive, grows slowly and has an ability to metastasize to visceral organs, regional lymph nodes and bones. We report a case of infiltrating apocrine adenocarcinoma on the scrotum and pubic area with extramammary pagetoid spread into the groin. The immunohistological staining patterns suggested that both extramammary Paget’s disease and apocrine adenocarcinoma derived from the apocrine gland, because the tumor cells were positive for cytokeratin (CK) 7 and gross cystic disease fluid protein-15 (GCDFP-15), but negative for CK20 and prostate-specific antigen (PSA). The results of this case study will facilitate the understanding of this malignant tumor.

Open access

Jovan Lalošević, Branislav Lekić, Mirjana Gajić-Veljić, Dušan Škiljević, Katarina Đukić and Ljiljana Medenica

Abstract

Verrucous carcinoma (VC) is a rare variant of a well-differentiated squamous cell carcinoma (SCC) with a low grade of malignancy. Epithelioma cuniculatum (EC) is a subtype of VC, usually found on the sole of the foot.

Two patients, a 55-year-old female, and a 77-year-old male, with VC were treated at the Clinic of Dermatology and Venereology, Clinical Center of Serbia, from 2002 to 2011. Both patients presented with a tumor on the foot. Incisional biopsies showed a well differentiated squamous cell carcinoma. Foot x-rays showed bone involvement in one case. One patient underwent surgical amputation of the lower extremity, while the other had a partial amputation of the affected foot.

In the initial stage of the disease, it is difficult to distinguish pseudoepitheliomatous hyperplasia from verrucous carcinoma. The superficial biopsy of EC lesion may mislead to a histopathological diagnosis of warts or condylomas. Multiple deep biopsies are necessary for accurate and timely diagnosis of verrucous carcinoma.

Open access

Jelena Perić, Branislav Lekić, Vesna Reljić, Lana Ćirković and Dušan Škiljević

Abstract

Cutaneous larva migrans (CLM) is a parasitic skin disease caused by the accidental percutaneous penetration and subsequent intraepidermal migration of larvae of various nematode parasites of the hookworm family. The hookworms responsible for CLM are spread worldwide, but the infection occurs mostly in tropical and subtropical climates. Nowadays, because of ever increasing foreign travel, the disease is no longer confined to these areas. Moreover, a significant increase of autochthonous cases in southern Europe has been observed in recent years. We report two new patients from Serbia who acquired CLM, none of them having traveled abroad. As the recommendations for the treatment of CLM are not uniform, two different treatment modalities were applied in these patients, both with an excellent response.

Open access

Branislav Lekić, Danijela Milčić, Mirjana Popadić, Dušan Škiljević and Mirjana Milinković Srećković

Abstract

Cutaneous polyarteritis nodosa (CPAN) is a variant of polyarteritis nodosa that is limited primarily to the skin. It is a chronic recurrent disorder characterized by the presence of nodular lesions with or without ulceration on the distal third of the lower limbs. Nodular vasculitis and thrombophlebitis can be clinically or pathologically mistaken for CPAN. We present a case of a 51-year-old woman with painful nodules on the lower limbs. Some of the nodules were ulcerated. Histopathological examination of a nodule on deep incisional biopsy revealed fibrinoid necrosis of a medium-sized artery in the subcutis along with perivascular mixed infiltrate. The patient did not have any symptoms or signs of internal organ involvement. The possible etiological factor has not been detected. The patient was treated with oral prednisone 0.5 mg/kg/day and dapson 150 mg/day. Over the one-year follow-up the lesions showed regression, with one minimal relapse which resolved after the short course of oral prednisone.