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Background: Lupus patients frequently exhibit specific and nonspecific skin lesions and lesions associated with skin infections. This study aimed to determine the frequency of lupus-specific and non-specific skin lesions and the incidence of skin infections. Methods: This study was conducted in the Department of Rheumatology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from 2014 to 2016. After obtaining ethical clearance from the Institutional Review Board of BSMMU, 136 consecutive patients fulfilling the ACR criteria for SLE were enrolled and followed up for at least one year. A dermatologist confirmed lupus-specific, non-specific, and skin lesions related to infections and noted them in a datasheet. Relevant investigations were performed at baseline and during subsequent follow-up visits. Results: One hundred thirty-one patients completed their follow-up period. The mean (standard deviation) follow-up period was 13.3 (2.0) months. The patients' mean (standard deviation) age was 28.8 (8.2) years. Skin lesions and skin infections were present in 71.8% and 26.7%, respectively of patients. Common lupus-specific lesions were malar rash (75.4%) and DLE (12.3%). Photosensitivity (72.6%), non-scarring alopecia (67.9%), mucosal ulcers (47.6%), Raynaud’s phenomenon (23.8%), and hyperpigmentation (23.8%) were the prevalent lupus non-specific skin lesions. The common skin infections were tinea (42.9%), herpes infection (34.3%), paronychia (20%), and scabies (17%). Conclusions: Skin lesions related to infections were common, along with lupus-specific and nonspecific lesions skin lesions. Tinea and herpes infections were more common skin infections.

Histoplasmosis is a dimorphic fungal infection caused by histoplasma capsulatum. It is the most prevalent endemic mycosis in the United States, but now it is a disease of world wide occurrence. Most infections are asymptomatic or self-limited, some individuals develop acute pulmonary infections or severe and progressive disseminated infection. Progressive disseminated histoplasmosis occurs in about one in 2000 patients with acute infection. Besides lung it may affect skin, lymph nodes, GIT, CNS, adrenals, liver and spleen. The patient of disseminated histoplasmosis usually presents with fever, anorexia, weight loss, myalgia and manifestations according to organ involved. Here we described a 45 year-male who presented to us with fever, weight loss, generalized lymphadenopathy, growths in the oral cavity and chylous ascites. The particular interest of this paper is to present a case of disseminated histoplasmosis in an immunocompetent host without pulmonary involvement, and to demonstrate the differences between this entity and other similarly presented diseases like disseminated tuberculosis, lymphoma and metastatic malignancy. Key words: histoplasmosis; disseminated histoplasmosis; histoplasma capsulatum; immunocompetent host; Bangladesh. DOI: 10.3329/bsmmuj.v3i1.5515 BSMMU J 2010; 3(1): 44-46

Abstract Background This study was focused on translation and cultural adaptation of the English Lequesne Algofunctional index (LAI) into Bengali for patients with primary knee osteoarthritis (OA) and testing reliability and validity of the Bengali version of the LAI. Methods This study was carried out in the Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh. Using the forward–backward method the English LAI was translated into Bengali including cultural adaptation. For pretesting, A sample of 40 patients with primary knee osteoarthritis were screened using the Bengali version of LAI. Following the pretest, 130 consecutive patients with symptomatic knee OA completed the interviewer administered Bengali LAI, the validated Bengali version of SF-36, Visual Analogue Scale for Pain, Distance Walked and Activities of Daily Living. For the retest 60 randomly selected patients from the cohort were administered the Bengali LAI 7 days later. An item by item analysis was performed. Internal consistency was assessed by Cronbach’s alpha, test–retest reliability by intraclass correlation coefficient (ICC) and Kappa coefficient, construct validity was measured using the Spearman rank correlation coefficient. Results It took 3.25 ± 0.71 min to complete the Bengali LAI and the mean score was 9.23 ± 4.58. For the Bengali LAI Cronbach’s alpha score was 0.88, test–retest reliability assessed by ICC was 0.97. For construct validity, excellent convergent validity was achieved (ρ = 0.93) but the divergent validity was moderate (ρ = 0.43). Conclusions The Bengali LAI showed excellent convergent validity, internal consistency and test–retest reliability, only the divergent validity was moderate. So, the Bengali LAI can be applied as a HRQoL assessment tool for primary knee OA patients.

Buschke Scleredema is a rare connective tissue disorder of unknown aetiology and characterized by thickening of the dermis. It resembles systemic sclerosis, eosinophilic fasciitis and cutaneous amyloidosis. Scleredema may be associated with a history of an antecedent febrile illness, diabetes mellitus, or blood dyscrasia. It may be classified into three clinical groups, each has a different history, course, and prognosis. Histology of skin is characterized by thickened dermis and increased spaces between large collagen bundles due to increased deposition of mucopolysaccharide in the dermis. Differential diagnosis can be made considering the typical clinical features and the histological peculiarity. No therapy is effective. In this communication we have presented a 54 year old man with scleredema successfully treated by PUVA and methotrexate. We reviewed associated diseases, clinical and histopathological characteristics, evolution and response to treatment.

This study was designed to assess cardiac abnormalities in patients with systemic lupus erythematosus (SLE) by echocardiography. It was an analytic type of cross sectional study, conducted in lupus clinic, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2008 to June 2009. Fifty lupus patients, diagnosed on the basis of ACR criteria, without cardiovascular symptoms, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. SLEDAI was applied for assessment of disease activity. Out of 50 patients 80% had abnormal echocardiographic findings. Pericardial thickening was found in 38% patients, pericardial effusion 20%, diastolic dysfunction 72%, hypokinesia of ventricular wall 8%, overall valvular abnormalities 20%, commonest being aortic regurgitation (12%), followed by mitral regurgitation (8%), and 6% had pulmonary hypertension. Males (100%) were more vulnerable to cardiac involvement than females (68.2%) and later age of disease onset (31-40 years) was associated with higher (87.5%) chance of echo abnormalities. The differences, however, were not statistically significant (p>0.05). There was significant relationship between disease duration and cardiac abnormalities (p<0.01). Active disease (80.08%) was associated with higher frequency of cardiac involvement than disease in remission (62.50%) but the result was not statistically significant (p=0.151). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic from cardiac aspect. Echocardiography is an excellent non-invasive tool for cardiac evaluation. These observations emphasize a need for further assessment of early intervention to reduce subsequent cardiac morbidity and mortality among the lupus patients.