Conditions which lead to the development of an immunocompromised state make the patient more susceptible to ecthyma gangrenosum and sepsis. In case of sepsis, the bacteria reaches the skin via the bloodstream. Defective humoral or cellular immunity increases risk, as the organism is not cleared from the bloodstream as usual. The main mechanism of the organism that is causing the typical skin lesions is the invasion of the organism into the arteries and veins in the dermis and subcutaneous tissues of the skin. This perivascular invasion leads to nodular formation, ulceration, vasculitis and necrosis due to impaired blood supply. Perivascular involvement is achieved by direct entry of bacteria through the skin or hematogenous spreading in case of sepsis. Diagnosis
Diagnosis is made by clinical observation and the following tests. (1) Gram stain of the fluid from pustules or bullae, and tissue swab. (2) Blood culture
(3) Urine culture
(4) Skin biopsy
(5) Tissue culture
Magnetic resonance imaging can be done in case of ecthyma gangrenosum of plantar foot to differentiate from necrotizing fasciitis. Prevention
The main organism associated with ecthyma gangrenosum is Pseudomonas aeruginosa. However, multi-bacterial cases are reported as well. Prevention measures include practicing proper hygiene, educating the immunocompromised patients for awareness to avoid possible conditions and seek timely medical treatment. Treatments
Treatments involve antibiotics that cover for Pseudomonas aeruginosa. antipseudomonal penicillins, aminoglycosides, fluoroquinolones, third generation cephalosporins or ceftriaxone aztreonam can be given. Usually, the antibiotics are changed according to the culture and sensitivity result. In patients with very low white blood cell counts, granulocyte-macrophage colony-stimulating factor may be given.
Warthins tumor, also known as papillary cystadenoma lymphomatosum, is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers (lymph node-like stroma). It is named for pathologist Aldred Scott Warthin, who described two cases in 1929. Signs and symptoms
Warthins tumor primarily affects older individuals (age 60–70 years). There is a slight male predilection according to recent studies. The tumor is slow growing, painless, and usually appears in the tail of the parotid gland near the angle of the mandible. In 5–14% of cases, Warthins tumor is bilateral, but the two masses usually are at different times. Warthins tumor is highly unlikely to become malignant. Locations
The gland most likely affected is the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Warthins tumor is the second most common benign parotid tumor after pleomorphic adenoma, but its prevalence is steadily increasing. Cause
Its cause is unknown, but there is a strong association with cigarette smoking. Smokers are at 8 times greater risk of developing Warthins tumor than the general population. Diagnosis
The appearance of this tumor under the microscope is unique. There are cystic spaces surrounded by two uniform rows of oncocytes, which are epithelial cells with abundant, granular, eosinophilic cytoplasm. The cystic spaces have epithelium referred to as papillary infoldings that protrude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.The differential diagnosis includes sebaceous lymphadenoma and oncocytoma. Treatment
Most of these tumors are treated with surgical removal called parotidectomy.