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1. Bone Mineral Density Test in Patients of Pemphigus Vulgaris on Long Term Oral Steroid Therapy 2. Dexamethasone-Cyclophosphami

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1. Bone Mineral Density Test in Patients of Pemphigus Vulgaris on Long Term Oral Steroid Therapy 2. Dexamethasone-Cyclophosphami Abstracts Silver Jubilee Conference, December 9 -12, 2004. 1. Bone mineral density test in patients of 2. Dexamethasone-cyclophosphamide pemphigus vulgaris on long term oral pulse therapy (DCP) in pemphigus steroid therapy vulgaris Zahida Rani, Abdul Hameed, Atif Hasnain Zakin Ahmed, Mohammad Kausar Kazmi Consultant Dermatologist, Forest College, Department of Dermatology, King Edward Peshawar. Medical College/ Mayo Hospital, Lahore. This is a study of 22 cases of pemphigus Introduction Glucocorticoids are indispensable vulgaris and pemphigus foliaceus with for controlling pemphigus vulgaris. They are dexamethasone and cyclophosphamide pulse also the most common cause of drug induced therapy. Most of the cases were in complete osteoporosis. Approximately one out of five remission by the end of 8th pulse. There was patients treated for one year with 7.5-10 mg of no side effect of either steroids or daily prednisolone will develop skeletal cyclophosphamide. Even those who were fractures. Patients at increased risk are over 50 cushi ngoid also recovered from Cushing years of age, postmenopausal or have restricted syndrome. So we recommend steroids/ mobility. Alternate day therapy does not cyclophosphamide pulse as best option for the minimize the risk of osteoporosis. treatment of pemphigus. Aims and objectives To determine the 3. Clinico-pathological spectrum of frequency of osteoporosis in patients with mycosis fungoides pemphigus vulgaris on long term steroid the rapy. Faria Asad, Sabrina Suhail Pal, Shahzad Shafqat Materials and methods The study was Department of Dermatology, King Edward conducted at the Department of Dermatology, Medical College/ Mayo Hospital, Lahore. Mayo Hospital, Lahore. Fifty consecutive patients of both sexes and any age, diagnosed Cutaneous lymphomas represent a with pemphigus vulgaris who had been taking heterogeneous group of T, NK and B-cell oral steroids for more than six months, were neoplasms, with mycosis fungoides being the enrolled. Bone mineral density (BMD) test in most common subtype. Mycosis fungoides all patients was done. BMD test of twenty five presents with a variety of clinical patterns and controls belonging to the same age group was stages. It frequently poses a diagnostic also done carried out. challenge both for the clinician and the pathologist especially in the early stages of the Results Results will be presented and discussed disease. at the conference. Objective The objective of the study was to Key words Pemphigus vulgaris, glucocorticoids, correlate histopathological features with the bone mineral density, osteoporosis clinica l presentation. Patients and methods This study was performed in the Department of Dermatology, 66 Abstracts Silver Jubilee Conference, December 9 -12, 2004. Mayo Hospital, Lahore from June, 2001 to nodules 3 (9%), noduloulcerative 2 (6%), August, 2004. Patients whose biopsy ichthyosiform 2 (6%) poikiloderma 2 (6%), specimens were diagnostic or consistent with follicular 1 (3%), morphoea – like 1 (3%), and mycosis fungoides by means of a scoring purpuric 1 (3%). The histological features system were enrolled in the study. The scoring included lymphocytic infiltrate in the dermis, system included presence or absence of epidermotropism, epidermal lymphocytes Pautrier’s microabscesses, extent of exocytosis, larger than dermal lymphocytes, lymphocytes dermal infiltrate and dermal fibrosis. The with cerebriform nuclei, Pautrier’s micro scores were then compared with the clinical abscesses, haloed lymphocytes, and interface stage of the disease. dermatitis. The records of the marker studies (n=12) showed predominantly T helper cell Results Twenty two patients in which the immunophenotype (CD4+) in 11 (92%) cases dermatopathological features were consistent and cytotoxic immunophenotype (CD8+) in 1 with or diagnostic of mycosis fungoides were (8%) patient. In a clinically non-specific studied. The mean age at the time of diagnosis dermatosis, a high index of suspicion and a was 45 years, with a range of 21 to 74 years. regular follow up may eventually lead to the Forty five per cent patients (n=10) were diagnosis of CTCL. clinically in erythrodermic phase, 27.27% (n=6) were in plaque stage, 13.63% (n=3) Key words Mycosis fungoides, clinical presented with patches and 9.09% (n=2) had presentations, histopathological features. poikiloderma. Only in one patient (4.5%) nodules were present. The histopathological 5. Diagnostic efficacy of histopathology in patterns were evaluated and showed that the cutaneous leishmaniasis in absence of LT scores interpreted by the dermatopathologist bodies did not correlate with the clinical severity. Conclusion Histopathological assessment in Syed Afaq, Attiya Tareen, Ikramullah Khan, Riaz mycosis fungoides showed a weak association A. Sheikh, Anwarul Haq with the clinical stage of the disease. Pakistan Institute of Medical Sciences, Islamabad 4. Clinicopathological spectrum of my cosis fungoides–type cutaneous T-cell Objective To determine the diagnostic efficacy lymphoma of histopathology in cutaneous leishmaniasis (CL) in absence of LT bodies. Zafar Iqbal Shaikh, Simeen Ber Rahman Military Hospital, Rawalpindi Background Leishmaniasis is an epidemic problem in various parts of Pakistan and is Mycosis Fungoides (MF) is the commonest already endemic in certain areas particularly in type of cutaneous T-Cell lymphoma (CTCL). northern areas like Kohat, Bannu, Peshawar, A retrospective analysis of 33 patients and various parts of Baluchistan, Murree, diagnosed as MF at Military Hospital, Chakwal and Mianwali in Punjab, Kashmir and Rawalpindi between years 2000 and 2004 was even in peripheries and suburbs of Islamabad. undertaken. The data collected included age, Presence of LT bodies is considered a sex, time span between onset of manifestations diagnostic clue for leishmaniasis. In their and the definite diagnosis of MF, clinical absence, diagnosis becomes difficult. We presentations, stage of the disease ranged from attempted to determine the most likely 24 to 68 years (mean age, 52 years), with 24 histopathological patterns, which can help in males and 9 females (male to female ratio, the diagnosis of leishmaniasis in the absence of 2.6:1). The time duration between onset and LT bodies. the diagnosis of MF ranged from 2 months to 3 years (mean, 8 months) and number of Setting Department of Dermatology and biopsies performed for diagnosis were 1 to 5 Pathology, Pakistan Institute of Medical (mean , 1.5). 60% of the cases were diagnosed Sciences, Islamabad, Pakistan at first biopsy. The clinical presentations included hypopigmented patches 7 (21.3%), Study Design Retrospective descriptive study erythematous papules and plaques 6 (18.2%), erythroderma 5 (15.2%), psoriasiform 3 (9%), 67 Abstracts Silver Jubilee Conference, December 9 -12, 2004. Material and methods All the suspected cases and with positive smear (LD bodies) were of CL presenting to outpatient Department of selected. 12 patients received oral miltefosine Dermatology from August, 2002 to August, 100 mg/day for 28 days along while 12 2004 were subjected to skin biopsy for patients received injectable pentavalent histopathology. All the slides were stained with antimony 20 mg/kg/day for 28 days. hae matoxylin and eosin and were studied by a Pretreatment complete general physical and board of dermatologists and pathologists. Only systemic examination was performed with those cases that turned out to be negative for laboratory investigations (CBC, LFTs, serum LT bodies but were clinically strongly urea creatinine and lipid profile). These suspected to be cases of cutaneous investigations were repeated again after 2 leishmaniasis with supporting circumstantial weeks and at the end of treatment to note any evidence and responding to parenteral injection deviation from the normal limits. Until now 4 meglumine antimoniate were included in the patients have completed therapy. study. Circumstantial evidence implied presence of CL in same community, history of Results All patients completed the study fly bite or positive history of visit to endemic without any serious complication. Nausea and areas. mild headache lasted 1 – 2 days in 1 patient receiving miltefosine. Lesions improved Results Various histopathological patterns were significantly and only scarring and found, out of which the most common pattern postinflammatory pigmentation was left. was diffuse chronic inflammatory infiltrate Among patients on pentavalent antimony, at with prominent plasma cell infiltrate. Second least 40% of cases showed myalgias and pattern was non-specific inflammatory anorexia while 60% showed increase in liver infiltrate in which plasma cell infiltrate was enzymes while 10% developed ECG changes less prominent. Third pattern was and Injection abscess at the site and a further granulomatous reaction with presence of 5% showed no response to the treatment. plasma cells. Necrosis and fibrosis were also noted in some cases. Conclusion The assessment of the efficacy of any therapeutic agent in a self-healing disease Conclusion We concluded that in the absence of such as cutaneous leishmaniasis is very LT bodies diffuse chronic lymphocytic infiltrate difficult. However, miltefosine appears to be a with predominance of plasma cells was most safe and effective alternative to currently used often found. therapies. It may also be helpful in regions where parasites are resistant to current agents. 6. Cutaneous leishmaniasis – trial of an oral drug Key words Cutaneous leishmaniasis, drug trial,
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