trimethoprim--sulfamethoxazole-drug-combination and Pemphigoid--Bullous

Pemphigoid vegetans is an exceptionally rare intertriginous variant of bullous pemphigoid characterized by vegetative and purulent lesions present in the groin, axillae, thighs, hands, eyelids and perioral regions. The clinical, histopathological and immunofluorescent profile of a new case of pemphigoid vegetans in a 79-year-old man is reported. Our patient had papillomatous plaques with pustules in the bilateral inguinal folds, which clinically resembled pemphigus vegetans. Also suggesting pemphigus vegetans, an initial skin biopsy showed eosinophilic spongiosis, while a second biopsy showed histological and immunological features diagnostic of pemphigoid. Because only a few cases of pemphigoid vegetans have been reported in the literature, clinical and morphological data are scant. Most reported cases were successfully treated with topical antibiotics or steroids; therefore, appropriate diagnosis of this rare lesion will assist management.

Topics: Aged; Anti-Infective Agents; Anti-Inflammatory Agents; Chlorhexidine; Clobetasol; Fluorescent Antibody Technique; Humans; Immunosuppressive Agents; Male; Pemphigoid, Bullous; Tacrolimus; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiasis is caused by a germ belonging to the Actinomycetales order. Skin disease usually occurs as a secondary localization of a pulmonary infection in an immunocompromised patient. Purely cutaneous lesions usually occur in immunocompetent subjects.. We observed primary cutaneous nocardiasis due to N. asteroides with a cold abscess in a patient with a pemphigoid given immunodepression treatment.. Primary cutaneous nocardiasis can occur by direct contamination of a skin wound. In our patient with a pemphigoid given immunodepression treatment, the erosion of a pemphigoid bulla and general corticosteroid treatment favoured the localized infection. Cure could not be obtained until after 7 months treatment. This long course can be explained by the need to continue high-dose general corticosteroids to control the pemphigoid.

Topics: Aged; Humans; Immunocompromised Host; Leg Dermatoses; Male; Nocardia asteroides; Nocardia Infections; Pemphigoid, Bullous; Prednisone; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination