Thursday, March 20, 2008

Disseminated cutaneous leishmaniasis secondary to lymphedema: Two cases

Disseminated cutaneous leishmaniasis secondary to lymphoedema: Two cases
Ann Dermatol Venereol. 2008 Feb

Meziou TJ, Chaabène H, Masmoudi A, Boudaya S, Cheikhrouhou H, Bouassida S, Turki H.
Service de dermatologie, EPS Hédi Chaker, Sfax 3029, Tunisie.

BACKGROUND: Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema.

PATIENTS AND METHODS: Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis.

DISCUSSION: Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (>10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.


Lymphedema Seminar Boca Raton Florida

Lymphedema Seminar Boca Raton Florida

For our friends in south Florida:

Living Well with Lymphedema

10 a.m. to 1 p.m. April 12

Ruth Rales Jewish Family Service will host the event at the Jerusalem Room of the Jewish Community Center 9801 Donna Klein Blvd. Boca Raton, FL.

Seminar will feature
Dr. Harvey Mayrovitz, professor, and Susan Lanham, a physical therapist at Boca Raton Community Hospital.

Call (561) 852-3330 to register.

For more information, visit Ruth Rales Jewish Family Service Center

Friday, March 14, 2008

One-sided limb lymphedema in a liver transplant recipient receiving sirolimus

One-sided limb lymphedema in a liver transplant recipient receiving sirolimus
Acta Gastroenterol Belg. 2007 Oct-Dec
van Onna M, Geerts A, Van Vlierberghe H, Berrevoet F, de Hemptinne B, Troisi R, Colle I.
Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium.

Sirolimus (SRL) is associated with many side effects including hypercholesterolemia, anaemia, impaired wound healing and abnormal liver function tests. Limb lymphedema has only been reported several times in renal transplant recipients. We present a case of lower limb lymphedema that occurred in a 59-year-old liver transplant recipient after being on a SRL regimen for seven months. Extensive diagnostic investigations could not reveal signs of infection, venous obstruction or malignancy. After discontinuation of SRL, the lymphedema gradually resolved during the next three months. The pathologic mechanism behind this phenomenon is unknown, but antiangiogenetic and antiproliferative properties of SRL have been hold responsible. Further studies are necessary to explain this rare side effect.

PMID: 18330092 [PubMed - in process]

For further information, please see:

Lymphedema From Sirolimus Treatment

Saturday, March 08, 2008

The management of genital lymphedema.

The management of genital lymphedema.

BJU Int.

2008 Mar 4

Garaffa G, Christopher N, Ralph DJ.
St Peter’s Department of Andrology, and The Institute of Urology, London, UK.


To report our experience and management of genital lymphoedema, as this condition can be extremely debilitating and difficult to manage.


The clinical records of 90 patients with genital lymphoedema who presented between 1998 and 2007 were retrospectively reviewed. The surgical management of 34 patients consisted of the excision of the affected skin and of the subcutaneous layers. This involved scrotal excision in 15 patients with primary closure. Skin grafts were required in seven patients for penile shaft cover. The results for cosmesis, recovery of sexual function, patient's satisfaction and complications are discussed.


In all, 56 patients were successfully managed conservatively by treating the underlying condition, antibiotic administration, compression and elevation of the genitalia. The remaining 34 patients required surgical management with an overall excellent cosmetic result and a significant improvement in sexual function.


When surgery is necessary for genital lymphoedema, the new techniques described provide excellent cosmetic and functional results.


For additional Information:

Female Genital Lymphedema

Male Genital Lymphedema

Saturday, March 01, 2008

Learning from a lymphedema clinic: an algorithm for the management of localized swelling.

Learning from a lymphedema clinic: an algorithm for the management of localized swelling.

Plast Reconstr Surg. 2008 Feb

Garfein ES, Borud LJ, Warren AG, Slavin SA.
Boston, Mass. From the Harvard Plastic Surgery Program, Harvard Medical School, and the Division of Plastic Surgery, Beth Israel Deaconess Medical Center.

BACKGROUND: Lymphedema is a chronic disease causing significant morbidity for affected patients. It can be difficult to diagnose, and patients are often frustrated by multiple referrals and inadequate therapies. Centralized, comprehensive care for the patient presenting with lymphedema or other causes of localized swelling allows for appropriate evaluation and provides improved management and treatment.

METHODS: A 4-year review of the first 100 patients seen at the Beth Israel Deaconess Medical Center Lymphedema Clinic was performed. On the basis of the clinical experience from these patients, an algorithm for diagnosing and managing patients with localized swelling was developed.

RESULTS: The mean age of the patients was 50 years, and 81 percent of the patients were women. On average, patients had experienced their symptoms for 11.6 years (range, 3 months to 60 years). Lymphoscintigraphy was performed on 43 patients, 81 percent of whom showed lymphatic obstruction or dysfunction. In total, 75 percent of patients were diagnosed with lymphedema based on clinical presentation or additional testing. Fourteen of these patients underwent subsequent excisional procedures, whereas the rest were managed conservatively with compression garments.

CONCLUSIONS: Patients presenting with swollen extremities can frequently be diagnosed through history and physical examination alone, but many patients require more extensive diagnostic workup. An algorithm for the management of these patients can facilitate evaluation and treatment.

Plastic and Reconstructive Surgery