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  • Author: Radoš D. Zečević x
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Kristina Kostić, Lidija Kandolf Sekulović and Radoš D. Zečević

Abstract

Bullous pemphigoid is an autoimmune blistering disease that predominantly affects elderly persons and rarely children. We present a 12-year-old girl with sudden appearance of tense blisters on an erythematous base on the trunk, neck, hands and legs with intense pruritus. Standard laboratory test results were within the normal range except for blood eosinophilia of 12% of the total white cell count. Skin biopsy specimens showed evolving subepidermal blisters with perivascular lymphohistiocytic, eosinophil and neutrophil infiltrations in the papillary dermis. Direct immunofluorescence of perilesional skin showed linear, continuous deposits of IgG and C3 along the dermoepidermal junction. Indirect immunofluorescence showed circulating anti-basement membrane zone IgG autoantibodies at a titer of 1:80. We started treatment with systemic corticosteroids, methylprednisolone 0,5 mg/kg per day and 500 mg erythromycin 4 times a day during 10 days. After 3 days 50 mg dapsone (DDS, 4,4-diaminodiphenylsulphone) per day was added. After a few days, there were no new changes on the skin and pruritus disappeared completely.

Open access

Miroslav Ž. Dinić, Lidija Kandolf-Sekulović and Radoš D. Zečević

Abstract

One hundred years of dermatovenereology of the Serbian Army was celebrated on November 7, 2009, in the amphitheatre of the Military Medical Academy (MMA). The oldest document in possession of the Serbian Armed Forces Medical Services is dated on St. George’s Day, May 6th, 1869 and represents a “Daily report of military hospitals”. This document clearly shows the number of patients, and what they suffered from. Moreover, this document shows, among other things, how many patients were suffering from “venereal diseases, red wind, mechanical injuries, base wounds, ulcers, lichen and mange“. Until 1909, the Department of Dermatovenereology did not exist as an independent. Today, the Clinic has 2 divisions (a total of 36 beds), as well as the Laboratory for immunodermatology, Surgical unit, General Dermatology Outpatient Clinic, Allergology Section, Phototherapy Section, Dermoscopy and Melanoma Outpatient Clinic. The Clinic is the leader in the treatment of psoriasis, autoimmune skin diseases (pemphigus, pemphigoid), severe forms of atopic dermatitis, erythroderma, skin lymphomas and cutaneous manifestations of connective tissue diseases (lupus, dermatomyositis, sclerodermia), and a dermatologic oncology section is being developed, where systemic therapy of melanoma and follow-up of these patients will be done. Regarding the vision of the future, the main task of the Clinic is to ensure continuous improvement in the field of dermatology in Serbia. The plan is to develop the area of photodiagnostics and phototherapy, which are insufficient in the region. Also, further development of dermatological surgery is planned. Further development of Allergology Service is mandatory, as well as establishment of Pediatric Dermatology, Phlebology and Trichology Outpatient Clinic. Continued scientific research is essential for the development of an academic institution and a prerequisite for continuous diagnostic and therapeutic progress, and a permanent pursuit.

Open access

Željko P. Mijušković, Lidija Kandolf Sekulović and Radoš D. Zečević

Abstract

Molluscum contagiosum is a very common, benign, often self-limiting skin disease caused by Molluscum contagiosum virus, member of the poxvirus family. Genital ulcers in HIV positive women are usually acute or subacute, mostly idiopathic or aphtous. Sixty percent of cases are caused by herpes simplex virus syphilis or chancroid. We present a 31-yearold woman with a 2.5 month history of vulval ulceration and a several month history of molluscum contagiosum in the pubic region, neck and face. After she was admitted to our department, the patient underwent physical examination using enzyme-linked immunosorbent assay, and an immunoblot test for HIV 1/2. Both tests were positive. Thereafter, the patient was referred to an infectologist who recommended application of 5% imiquimod cream 3 times per week for molluscum contagiosum and acyclovir 3x400 mg/day. Considering that there are more accepted indications for HIV testing, we agree with other authors that all adults with molluscum contagiosum or chronic genital ulceration should be tested for HIV serology.

Open access

Miroslav Ž. Dinić, Lidija Kandolf-Sekulovi, Tomislav Mladenović and Radoš D. Zečević

Abstract

Primary cutaneous T-cell lymphomas (CTCLs) are Non-Hodgkin lymphomas where skin may be the only involved organ for a long time. The erythrodermic form of CTCL, including Sezary syndrome, with increased IgE concentration, eosinophilia and intense pruritus, may suggest atopic dermatitis, in the lack of evidence for diagnosis of T-cell lymphoproliferative disorder. After vigorous research, two patients with erythroderma, increased IgE and eosinophilia, were not diagnosed with CTCL. Adult atopic dermatitis was diagnosed, based on clinical examination and histopathologic analysis of the skin sample. Therapy with oral cyclosporin A (CsA) and systemic corticosteroids were initiated, but the improvement was minimal and short-lived. Disease progression was noted in both patients, after a month of cyclosporine therapy: malaise, subfebrile and febrile temperatures, and development of generalized skin nodules were evident. In the first patient (aged 30) repeated examinations confirmed presence of Sezary cells in peripheral blood samples, dominant T-cell clone in the skin, peripheral blood and bone marrow, whereas the last repeated histopathologic analysis revealed T-lymphoproliferative skin disorder. In the second patient, (aged 44) primary cutaneous CD30+ T-cell lymphoma was diagnosed, based on histopathologic analysis of the newly appearing skin nodule. Differential diagnosis of erythroderma is always difficult, since clinical, histopathologic and immunophenotypic findings are frequently insufficient to differentiate between inflammatory and lymphomatous erythroderma. Treatment with cyclosporin A always demands carefull evaluation of the course of the disorder.

Open access

Željko P. Mijušković, Lidija Kandolf-Sekulović, Danica Tiodorović, Miloš Nikolić, Marina Jovanović, Dušan Škiljević, Zorica Gajinov and Radoš D. Zečević