trimethoprim--sulfamethoxazole-drug-combination and Skin-Ulcer

Topics: Aged; Anti-Bacterial Agents; Drug Eruptions; Hand Dermatoses; Humans; Male; Recurrence; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are causes of rare but life-threatening emergencies characterized by desquamation of the skin and mucosa. As SJS most commonly presents with skin rash followed by mucosal involvement, we present a case of vulvovaginal lesions as the initial presentation with progression to SJS after re-exposure to the culprit drug. CASE REPORT A 27-year-old female with acute cystitis was given trimethoprim-sulfamethoxazole. After 2 days, she reported vaginal pain. Three days later, she was hospitalized with vulvovaginal ulcerations and restarted on trimethoprim-sulfamethoxazole, leading to worsening vaginal lesions with rapid desquamation of conjunctival and oropharyngeal involvement. Biopsies of arm lesions revealed SJS. CONCLUSIONS It is important to recognize SJS as a rare but life-threatening cause of vulvovaginal ulceration, as early diagnosis is vital for successful treatment.

Topics: Adult; Anti-Infective Agents, Urinary; Female; Humans; Pain; Skin Ulcer; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Vulvar Diseases

Topics: Actinomyces; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Male; Mycetoma; Penicillin G Benzathine; Rifampin; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Breast Neoplasms; Collagen; Female; Humans; Mastectomy; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Skin Ulcer; Skin, Artificial; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Healing

In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.

Topics: Acute Kidney Injury; Adult; Azithromycin; Biopsy; Fatal Outcome; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Immunosuppressive Agents; Leucovorin; Male; Methotrexate; Mucositis; Necrosis; Pancytopenia; Plasma; Psoriasis; Recombinant Proteins; Self Medication; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

Primary cutaneous actinomycosis is very uncommon. We report a patient with cutaneous actinomycosis with multiple lesions without any detectable extra-cutaneous lesions. In our patient the actinomycosis was the presenting manifestation of HIV infection.

Topics: Actinomyces; Actinomycosis; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Combined Modality Therapy; Debridement; HIV Seropositivity; Humans; Male; Skin Diseases, Bacterial; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

We describe the case of a 14-year-old girl with Down syndrome and a large cutaneous plaque localized to the right neck and shoulder that had enlarged over five years after a minor traumatic injury. The plaque was characterized by numerous inflammatory nodules and fistulae that secreted purulent discharge. Nocardia grains were identified and Nocardia brasiliensis was identified by culture. Histopathology examination showed a chronic inflammatory infiltrate with granuloma development. The treatment scheme was with Diaminodiphenylsulfone 50/mg/d and Trimethoprim-Sulfamethoxazole 800/160 mg BID. Therapy was continued over 1(1/2) years, with a tapering dose. After 2(1/2) years of continuous treatment, clinical and microbiological healing was achieved.

Topics: Adolescent; Dapsone; Diagnostic Errors; Down Syndrome; Edible Grain; Female; Granuloma; Humans; Mycetoma; Neck; Nocardia; Nocardia Infections; Plant Shoots; Shoulder Injuries; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Cutaneous; Wound Infection

In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.

Topics: Aged; Aged, 80 and over; Bacteriological Techniques; Chronic Disease; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Foot Ulcer; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Oxacillin; Penicillin Resistance; Pressure Ulcer; Radiodermatitis; Skin Diseases, Bacterial; Skin Ulcer; Staphylococcal Skin Infections; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Vancomycin Resistance; Varicose Ulcer; Wound Infection

Topics: Adult; Aged; Anti-Infective Agents; Balanitis; Humans; Male; Middle Aged; Penile Diseases; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

Absent for several decades, the chancroid reappeared in Algeria in 1988. In the unique department of Dermatology and Venereology of the University Hospital of the country of Tlemcen (more than 700,000 inhabitants), we wanted to know the state of this STD seven years after the report of the first cases. The file of the consulting patients were examined. We looked for the principal characteristics of this STD: age, sex, incubation period, place infection contact, type of relation, clinical presentation, evolution without and with treatment, other associated STD (syphilis, HIV). From August 1988 (1st case) to December 1995, 144 cases of chancroid were collected = 1988: 6, 1989: 5, 1990: 7, 1991: 18, 1992: 11, 1993: 33, 1994: 48, 1995: 16. The presentation is quite stereotyped; it concerns males only, singles in must cases, having had sexual relations with prostitutes. The incubation period is short (less than 10 days), the characteristic ulceration presents, very often, some adenopathies. The treatment by cotrimoxazole is efficient. They are no concomitant syphilis or HIV infection. The chancroid is the first cause of genital ulceration in the world. Since 1991, it is the principal STD in our department. It spreads within a male population, young singles associated with prostitutes. It is well installed in Algeria, and its role, although minor, in the transmission of the HIV infection, should not be neglected.

Topics: Adolescent; Adult; Age Factors; Algeria; Anti-Infective Agents; Chancroid; Genital Diseases, Male; HIV Infections; Humans; Lymph Nodes; Male; Marital Status; Middle Aged; Penile Diseases; Retrospective Studies; Scrotum; Sex Factors; Sex Work; Sexual Partners; Sexually Transmitted Diseases, Bacterial; Skin Ulcer; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination

In the course of a study to determine the nature and type of secondary bacterial infection in dracunculiasis. The most common organisms cultured from lesions were Escherichia coli, Enterobacter and Staphylococcus aureus. E. coli and Enterobacter which were found to carry high morbidity were sensitive to Gentamycin, Claforan and Septrin.

Topics: Cefotaxime; Dracunculiasis; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Skin Diseases, Infectious; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A case of Hemophilus ducreyi infection clinically resembling granuloma inguinale is reported. Culture of the causative organism permitted a definitive diagnosis to be made. Combined treatment with tetracycline and sulphamethizole/trimethoprim rapidly cleared the infection.

Topics: Adult; Chancroid; Diagnosis, Differential; Drug Combinations; Drug Therapy, Combination; Granuloma Inguinale; Humans; Male; Skin Ulcer; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination