Atlas of Clinical Dermatopathology - Infectious and Parasitic Dermatoses
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Table of Contents

Foreword xi

Acknowledgments xiii

1 Bacterial Infections 1

1.1 Staphylococcal and Streptococcal Infections 2

1.1.1 Impetigo Contagiosa 2

1.1.2 Ostiofolliculitis (Bockardt) 4

1.1.3 Pseudomonas (Gram‐Negative) Folliculitis (Whirlpool/Hot Tub Dermatitis) 5

1.1.4 Perianal Streptococcal Dermatitis 6

1.1.5 Differential Diagnosis: Acne Papulopustulosa 7

1.1.6 Differential Diagnosis: Pseudofolliculitis Barbae 8

1.1.7 Ecthyma Gangrenosum 8

1.1.8 Abscess 10

1.1.9 Furuncle 11

1.1.10 Carbuncle 12

1.1.11 Erysipelas (Cellulitis) 13

1.1.12 Phlegmon 15

1.1.13 Necrotizing Fasciitis (Streptococcal Gangrene)° 17

1.1.14 Hidradenitis Suppurativa (Acne Inversa) 17

1.2 Other Bacterial Infections: Corynebacteria 18

1.2.1 Erythrasma 18

1.2.2 Pitted Keratolysis (Keratoma Sulcatum) 19

1.2.3 Trichobacteriosis (Trichomycosis) Palmellina 20

1.2.4 Erysipeloid 21

1.2.5 Anthrax 22

1.2.6 Nocardiosis 23

1.2.7 Rhinoscleroma 24

1.3 Rochalimaea/Bartonellae 25

1.3.1 Bacillary Angiomatosis and Cat Scratch Disease 25

1.3.2 Verruga Peruana 27

1.3.3 Differential Diagnosis: Pyogenic Granuloma (Lobular Capillary Hemangioma; Botryomycosis) 28

1.4 Mycobacterial Infections 29

1.4.1 Tuberculosis Cutis 29

1.4.1.1 Primary Tuberculosis of the Skin 30

1.4.1.2 BCG Vaccination Granuloma 30

1.4.1.3 Differential Diagnosis: Lupus Miliaris Disseminatus Faciei (LMDF) 31

1.4.1.4 Lupus Vulgaris (LV) 32

1.4.1.5 Variant: Tuberculosis (Lupus) Cutis Verrucosa 34

1.4.1.6 Variant: Tuberculosis Cutis Colliquativa (Scrofuloderma) 35

1.4.1.7 Lichen Scrofulosorum (Tuberculosis Cutis Lichenoides) 36

1.4.1.8 Papulonecrotic Tuberculid 37

1.4.1.9 Erythema Induratum Bazin 38

1.4.2 Atypical Mycobacteriosis: Fish Tank (Swimming Pool) Granuloma 39

1.4.3 Leprosy (Hansen Disease) 40

1.4.3.1 Tuberculoid Leprosy 41

1.4.3.2 Borderline Leprosy 42

1.4.3.3 Lepromatous Leprosy 43

1.4.3.4 Variant: Histoid Lepromatous 45

1.4.3.5 Variant: Erythema Nodosum Leprosum 46

1.4.4 Buruli Ulcer 47

1.5 Actinomycosis 48

1.6 Borrelia Infections (Lyme Disease) 49

1.6.1 Variant: Erythema (Chronicum) Migrans (ECM) (Stage I) 50

1.6.2 Variant: Lymphadenosis Cutis Benigna (Pseudolymphoma, Lymphocytoma Cutis) (Stage I) 52

1.6.3 Variant: Morphea/Scleroderma‐Like Lesions (Stage II) 55

1.6.4 Variant: Acrodermatitis Chronica Atrophicans (Stage III) 56

1.6.5 Variant: Juxta‐Articular Fibrous Nodules in Acrodermatitis Chronica Atrophicans (Stage III) 58

1.6.6 Differential Diagnosis: Actinic Reticuloid° 59

1.7 Venereal Diseases 59

1.7.1 Gonorrhea 59

1.7.2 Syphilis, Chancre 60

1.7.2.1 Stage I 60

1.7.2.2 Stage II 61

1.7.2.3 Stage III° 62

1.7.3 Ulcus Molle (Chancroid) 63

1.7.4 Granuloma Inguinale (Donovanosis; Granuloma Venereum) 63

1.7.5 Lymphogranuloma Inguinale (Lymphogranuloma Venereum; Duran-Nicolas–Favre Disease) 64

1.8 Rickettsial Infections 65

1.9 Dermatoses Associated with Bacterial Infections 66

1.9.1 Staphylococcal Scalded Skin Syndrome (SSSS) 66

1.9.2 Differential Diagnosis: Toxic Epidermal Necrolysis (TEN) 67

1.10 Dermatoses Mimicking Bacterial Infections 68

1.10.1 Pyoderma Gangrenosum 68

1.10.2 Infantile Acropustulosis 70

1.10.3 Acute Generalized Exanthematous Pustulosis (AGEP) 71

1.10.4 Psoriasis Pustulosa 72

1.10.5 Localized Neutrophilic Eccrine Hidradenitis Associated with Mitoxantrone Treatment 73

1.10.6 Erosive Pustular Dermatitis (Pustular Ulcerative Dermatosis) of the Scalp 74

2 Fungal Infections 77

2.1 Superficial Cutaneous Fungal Infections 78

2.1.1 Variants: Tinea Corporis; Tinea Faciei 79

2.1.2 Variants: Tinea Barbae; Tinea Capitis (Trichophytia) 80

2.1.3 Granuloma Trichophyticum (Majocchi’s Granuloma) 82

2.1.4 Candidiasis (Moniliasis) 83

2.1.5 Candida Tropicalis and Candida Lipolytica 85

2.1.6 Pityriasis (Tinea) Versicolor 86

2.1.7 Variant: Malassezia (Pityrosporum) Folliculitis 87

2.1.8 Differential Diagnosis: Seborrheic Dermatitis 88

2.1.9 Tinea Nigra 89

2.1.10 Piedra (Trichomycosis Nodosa Alba and Nigra)° 90

2.2 Subcutaneous Mycoses 90

2.2.1 Sporotrichosis 90

2.2.2 Mycetoma (Madura Foot) 91

2.2.3 Chromo(blasto)mycosis (Dermatitis Verrucosa) 92

2.3 Systemic Mycoses (Deep Fungal Infections) 93

2.3.1 Cryptococcosis (Torulosis, European Blastomycosis) 94

2.3.2 North American Blastomycosis (Blastomycosis, Chicago Disease) 96

2.3.3 Lobomycosis (Lobo Disease, Keloidal Blastomycosis, Blastomycoid Granuloma) 98

2.3.4 Histoplasmosis 99

2.3.5 Coccidioidomycosis (Desert or Valley Fever, San Joaquin Fever) 100

2.3.6 Paracoccidioidomycosis (South American Blastomycosis) 101

2.3.7 Emmonsiosis 102

2.4 Opportunistic Fungal Infections 103

2.4.1 Aspergillosis (Alternaria) 103

2.4.2 Zygomycosis (Mucormycosis; Phycomycosis) 104

2.4.3 Hyalohyphomycosis 105

2.4.4 Phaeohyphomycosis 106

2.4.5 Protothecosis, Cutaneous 107

3 Viral Infections 109

3.1 Herpes Viruses 110

3.1.1 Herpes Simplex (HSV‐1, HSV‐2) 110

3.1.2 Varizella/Zoster Virus (VZV/HHV-3) 111

3.1.2.1 Varicella (Chickenpox) 112

3.1.2.2 Herpes Zoster (Shingles) 113

3.1.2.3 Special Feature: Necrotizing (Herpes) Zoster Folliculitis 115

3.1.2.4 Special Feature: Zoster‐Associated Vasculitis 116

3.1.2.5 Postherpetic Cutaneous Reactions° 117

3.1.3 Burkitt Lymphoma; Epstein‐Barr Virus (HHV-4; EBV) 117

3.1.4 Hairy Leukoplakia (HHV-4; Epstein‐Barr Virus; EBV) 118

3.1.5 Cytomegalovirus (CMV; HHV-5) 119

3.1.6 Exanthema Subitum (HHV-6) (Roseola Infantum, 6th Disease) 120

3.1.7 Pityriasis Rosea (HHV-7) 121

3.1.8 AIDS‐Kaposi Sarcoma (HHV-8) 122

3.1.9 Multicentric Castleman’s Disease (HHV-8) 127

3.2 Human Papilloma Virus (HPV) 128

3.2.1 Verruca Vulgaris 129

3.2.2 Variant: Verrucae Planae 132

3.2.3 Variant: Condylomata Acuminata 133

3.2.4 Differential Diagnosis: Acrokeratosis Verruciformis (Hopf) 134

3.2.5 Bowenoid Papulosis 135

3.2.6 Epidermodysplasia Verruciformis (Lewandowsky–Lutz); Verrucosis Generalisata 136

3.3 Viral Exanthema 137

3.3.1 Measles 138

3.4 Parvovirus Infections and Coxsackievirus Infections 139

3.4.1 Erythema Infectiosum; (Slapped Cheek Disease; Fifth Disease) 139

3.4.2 Papular Purpuric Glovesand‐Socks Syndrome 140

3.4.3 Hand‐Foot‐and‐Mouth Disease (Coxsackie Virus) 141

3.5 Polyoma Virus Infections 142

3.5.1 Trichodysplasia Spinulosa 142

3.5.2 Merkel Cell Carcinoma (Primary Neuroendocrine Carcinoma of the Skin; Trabecular Carcinoma of Toker) 144

3.6 Poxviruses 146

3.6.1 Orthopox Virus Infections 146

3.6.1.1 Cowpox (Catpox) 147

3.6.1.2 Vaccinia Inoculata 148

3.6.1.3 Smallpox (Variola Vera) 148

3.6.2 Parapox Virus Infections 149

3.6.2.1 Ecthyma Contagiosum (Orf) 149

3.6.2.2 Variant: Milker’s Nodule 150

3.6.2.3 Molluscum Contagiosum 151

3.7 Other Skin Diseases with Suspected Viral Association 152

3.7.1 Asymmetric Periflexural Exanthema of Childhood 152

3.7.2 Eruptive Pseudoangiomatosis 153

3.7.3 Gianotti–Crosti Syndrome 154

3.7.4 Pityriasis Lichenoides 155

4 Parasitoses 159

4.1 Protozoan Diseases 160

4.1.1 Leishmaniasis 160

4.1.2 Variant: Leishmaniasis Mexicana 162

4.1.3 Amebiasis: Entamoeba Histolytica 163

4.1.4 Rhinosporidiosis 164

4.2 Arthropod: Arachnids 165

4.2.1 Mites 165

4.2.1.1 Demodex Folliculorum 166

4.2.1.2 Scabies 167

4.2.1.3 Variant: Scabies Crustosa 168

4.2.1.4 Trombidiosis (Harvest Mites; Chigger Itch) 169

4.2.2 Spiders° 169

4.2.3 Ticks° 170

4.2.4 Insects 170

4.2.5 Tungiasis (Sand Flea) 171

5 Helminthic Infections (Parasitic Worms) 173

5.1 Larva Migrans (Plumber’s Itch; Creeping Eruption) 174

5.2 Filariasis 175

5.3 Onchocerciasis (River Blindness) 176

5.4 Cysticercosis 177

5.5 Sparganosis 177

5.6 Schistosomiasis (Bilharziasis) 178

5.7 Cercarial Dermatitis (Swimmer’s Itch) 179

5.8 Annelida (Ringed Worms; Segmented Worms)° 180

5.9 Hirudinea (Leeches) 180

6 Sepsis 181

6.1 Septic Vasculitis 182

6.2 Bacterial Sepsis 185

6.2.1 Gonococcal Sepsis 185

6.3 Fungal Sepsis 186

6.3.1 Variant: Penicillium Marinum Sepsis 186

6.3.2 Variant: Candida Sepsis 187

6.3.3 Variant: Aspergillus Sepsis 187

Index 189

About the Author

Günter Burg, MD, is Professor of Dermatology and Chairman Emeritus, University of Zurich, Zurich, Switzerland.

Heinz Kutzner, MD, is Professor of Dermatology, Institute of Dermatopathology, Friedrichshafen, Germany.

Werner Kempf, MD, is Professor of Dermatology, Department of Dermatology, University of Zurich, Zurich, Switzerland, and Founder and Co-Director of the dermatopathology laboratory Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.

Josef Feit, MD, is Associate Professor of Pathology, University of Ostrava, Ostrava, Czech Republic.

Omar Sangueza, MD, is Professor of Pathology and Dermatology, Director of Dermatopathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.

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