SummaryBackground Leishmaniasis is a newly emerging infection in Thailand. Most of the previous human cases have presented with the clinical features of visceral leishmaniasis and were mainly found in southern Thailand. Here we report the first two patients from northern Thailand presenting with disseminated cutaneous leishmaniasis. Objectives To determine the nature of the infection of leishmaniasis and to identify the species of parasite responsible. Methods Clinical investigations included the taking of biopsy samples and histology. Parasitological diagnosis was performed by establishment of Leishmania promastigote cultures, and identification was performed by DNA sequencing of four independent gene loci (ribosomal RNA internal transcribed spacer 1; large subunit of RNA polymerase II; heat shock protein 70; RPL23a intergenic sequence). Results Both patients were infected with HIV, and had multiple cutaneous lesions and accompanying visceral leishmaniasis. They had similar cutaneous manifestations characterized by chronic generalized fibrotic lesions, which were more prominent on traumatic areas. In both patients the parasite was identified as Leishmania martiniquensis. This is a recently described species that is distinct and only distantly related to the classical agents of cutaneous leishmaniasis in Asia (Leishmania major and Leishmania tropica) or of visceral leishmaniasis (Leishmania donovani and Leishmania infantum). Each patient responded well to therapy with intravenous amphotericin B followed by oral itraconazole. Conclusions Leishmania martiniquensis is a cause of cutaneous leishmaniasis in Thailand.

Carcinoma ex-pleomorphic adenoma is exceedingly rare in sites other than the major salivary glands and the oral cavity. We present the first two histopathologically documented examples to occur in the nasal cavity.From the Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.

The findings suggest that appropriately expressed p53 protein may play a role in tumorigenesis of oral NHLs. In addition, EBV may be involved with the pathogenesis of oral NHLs particularly in patients with HIV infection.

Fusarium spp. are recognized as the second most frequently filamentous fungi causing opportunistic infections and particularly important due to the increasing number of immunocompromised patients. F. keratoplasticum (a member of F. solani species complex) is one of the Fusarium species commonly associated with human infection, and therefore, studies on the virulence of this fungus are needed. This study aimed to confirm the presence of melanin in F. keratoplasticum from a patient with systemic fusariosis. Immunofluorescence labeling with anti-melanin monoclonal antibody (MAb) was used to examine an expression of melanin in F. keratoplasticum in vitro and during infection. Electron spin resonance identified the particles extracted from F. keratoplasticum as stable free radical consistent with melanin. Lesional skin from the sites with fusariosis contained hyphal structures that could be labeled by melanin-binding MAb, while digestion of the tissue yielded dark particles that were reactive. These findings suggest that F. keratoplasticum hyphae and chlamydospores can produce melanin in vitro and that hyphae can synthesize pigment in vivo. Given the potential role of melanin in virulence of other fungi, this pigment in F. keratoplasticum may play a role in the pathogenesis of fusariosis.

A 20-year-old well nourished woman was found dead suddenly and unexpectedly in her bedroom. According to her medical history, Graves' disease was diagnosed in August 2000 and the symptoms of thyrotoxicosis were poorly controlled. Autopsy and histology revealed diffuse enlargement of the thyroid gland (125 g, diffuse hyperplastic goiter), pulmonary edema, cardiomegaly (440 g) without coronary artery occlusion or stenosis. The cardiac muscles showed interstitial fibrosis with hypertrophy of the myocardial fibers. The circumstances and scene of death as well as the detailed postmortem analysis indicated that thyroid crisis from Graves' disease was the cause of death.