The mushroom avium

The Mycobacterium mushroom (synonym mushroom granuloma) is a chronic disease with a primary lesion of the skin, related to hematogenial (see).
The etiology is unknown; currently, mushroom avium include in the group of retikuleze skin. Occurs in age from 30 to 65 years and only very rarely in the young, males more often than females.
In the course of the disease there are three periods, each of which can last several years. The first period - precociously is characterized by scattered across the skin-lesions resembling seborrheic dermatitis, or eczema, psoriasis or plaque parapsoriasis. Rashes are always accompanied by intense itching. The second period - infiltrative characterized by the formation infiltrated plaques that appear on the background predications changes or healthy before the skin. Plaques have different size and often reach large sizes, color them congestive-red, surface lichenification (enhanced skin pattern), sometimes there peeling. Boundaries plaque sharply highlighted and often rise as a cushion. Patients complain of intense itching. Individual plaques can be reverse development (regression), not at the same time new. Some patients say hair loss, nail dystrophy, as well as swollen lymph nodes (frequently thigh, groin and armpit). The third period - the tumor is characterized by the occurrence in the thickness of the skin nodules, which quickly grow and become like formation of the size from 2-3 up to 10 cm and more in diameter. Towering above the skin, they sometimes narrowed at base and sit as if in the leg. Some like formation have lobed shape. Often there is pitting the individual nodes. Nodes arise as to the affected and unaffected skin. After a few months they can spontaneously (spontaneously) to regress, but at the same time there are new sites; overall health of patients begins to deteriorate markedly, symptoms destruction of internal organs, and the patient dies. In some cases, the tumor stage of mycosis fungoides may occur without previous stages.
A special kind of mycosis fungoides is erythrodermic form. It is characterized by the appearance of red spots, which, increasing and merging, quickly lead to universal defeat. The skin is bright red, often with a brown tint color ("the red man"), infiltrated, tense, often slightly scaly. Only in some areas it retains a normal appearance. Hair fall out, patients experience severe itching, lymph nodes are enlarged. After a few months, develops cachexia (see), and patients die.
Forecast for life is poor, but with regular maintenance therapy, patients may live for many years.
Treatment. In period and early infiltrative often a good effect (long-term remission) gives arsenic designated inwards (TableRow solution of 1 - 3 drops 3 times a day) or subcutaneous (1% solution of sodium arsenate from 0.2 to 1 ml, 30 injections)and steroids (triamcinolone, dexamethasone) in high doses, with gradual dose reduction to support. In late inflammatory and tumor periods shown treatment cytostatic agents (embihin, Copan, dipin, fospassin and others) in conjunction with local radiotherapy. The dosage and duration of treatment with hormones and cytotoxic drugs depend on the stage of the disease, General condition of the patient and individual tolerance of drugs. Treatment in specialized hospitals.
Prevention of exacerbations: early detection and treatment of disease dispensary observation of patients, repeated courses of treatment.

The mushroom avium [mycosis fungoides; synonym: mushroom granuloma (pyogenic granuloma fungoides), fibroma fungoides] - chronic common disease type inflammatory granulomas with predominant localization in the skin. Aliber (J. L.'alibert) and bazen (A. Bazin) first described the most frequent typical form of mycosis fungoides. Vidal (E. Vidal) and Brock (L. A. Brocq) described mycosis fungoides and tumeurs d emblee. Gallop (N. Haliopeau) and Besnier (I.e. Besnier) allocated erythrodermic form of mycosis fungoides.
Etiology of mycosis fungoides is not clear. Some attribute it to diseases of the reticuloendothelial system, the other - to limpoblastnom. Possible transition in the convent, some dermatoses primarily plaque parapsoriasis.
The typical form. Localized rash on the skin, rarely on the mucous membranes (mainly of the oral cavity). Defeats of other organs and systems are less distinctive and not always found in the patient's life. Characteristic common skin itch. There are three stages of development of mycosis fungoides: I - the so-called predications eritem; II - infiltrative, lichenification, patchy rash; III - tumor formation. Strict sequence of specified clinical staging is not mandatory.
In the first stage, lasting from a few months to a few years, there are many diverse in the clinic and histomorphology skin lesions (by type seborrheic dermatitis, prurigo, eczema, dermatitis herpetiformis of during, red flat denying, parapsoriasis). Histomorphological changes in this period the most part are not typical of mycosis fungoides.
Skin lesions in stage II the most characteristic. The size of lesions up to the size of the palm and more; merging, they capture large areas of skin; border-their clear - oval, round, sometimes scalloped. There is serpegginate, sometimes with surface ulcerated lesions; pinkish rash, often deep red, sometimes brown, often there is melkopuzyrchatoy peeling. Lesions regressive in some places, can appear on old or new. Marked dystrophic changes in the nails, hair, secondary surface adenopathy. Often in connection with malaise, and sleeplessness celebrated bad General condition.
The diagnosis should be confirmed by histological examination, which at this stage are frequently found typical changes: the epidermis is thickened and has long appendages, in malpighian layer it is possible to detect small clusters of cells and histiocytes abscesses Patrie. Infiltrate in a derma has considerable cell polymorphism and consists of cells, fat cells, polynuclear leukocytes, reticular cells and eosinophils, there kariorexis. Can meet and large, the so-called fungal, often incorrectly contoured cells with a single, less often multiple intensively Krassimira nuclei with figures of mitosis and pigment inclusions. In the dermis can be detected and monomorphic infiltrates.
Stage III of mycosis fungoides begins with development knotty formations. The overall health of patients deteriorates; symptoms of damage of organs and systems. Sometimes significantly increase peripheral lymph nodes. In the blood may be a leukocytosis with eosinophilia, polynucleated, limfotsitoz, monocytosis. In some cases there are changes in blood, mainly type lymphoid leukemia. At showdown in the lungs, stomach, spleen, liver, kidney, heart, bone marrow can be found above typical histomorphological changes.
III stage usually lasts several years. Less common are the galloping of the form ending in death after a few months of onset. Histologically in this stage is very significant typical cell infiltrates in various, including those deep layers of the skin and subcutaneous adipose tissue. Typical polymorphic infiltrates consists of Mature and immature reticular cells, lymphocytes, neutrophils, eosinophils, plasma and fat cells. A number of fungal cells can be significantly; infiltration marked advanced vessels with proliferating endothelium; skin appendages atrophy. Changes in the epidermis can be similar to the changes in the II stage of mycosis fungoides; sometimes there is a considerable atrophy, disappear epithelial processes and smooth, wavy line separates from the epidermis dermis.
When mycosis fungoides a tumeurs d emblee often without any prior changes on the skin suddenly in different places appear gradually increasing nodes in size from a pea to orange; they first pale red, and then intensively red with violet hues. Histological examination revealed typical of mycosis fungoides picture. Differential diagnostics is carried out with Hodgkin's disease, skin reticular sarcomas, and leukemias, primary reticulatae skin and retikulosarkoma.

the mushroom avium
Fig. 1-3. Forms of mycosis fungoides: Fig. 1 - erythrodermic; Fig. 2 - erythrodermic and "tumor"; Fig. 3 - "opujolevidnami".

Erythrodermic Form (printing. Fig. 1) of mycosis fungoides is uncommon. It can start without predications rash. In some cases defeat gradually spread in the skin, in others the disease immediately takes widespread. Infected skin usually red; the intensity of redness sometimes very significant ("the red man"). It is often observed increased peripheral naniniwala simpaticas nodes. In connection with strong itching, taut skin and because of this strained movements greatly disturbed the overall health of patients, join destruction of internal organs, secondary infection, increases cachexia, and the patient dies. Describes the form most often occurs without tumor formations.
Histological pattern in apparent cases of eritrodermii typical of mycosis fungoides (erythrodermic and tumor forms of mycosis fungoides, printing. Fig. 2; opujolevidnami form - printing. Fig. 3).
Forecast heavy. Patients mushroom avium should be under medical supervision.
Treatment. Prescribed drugs arsenic; in infiltrative and especially tumor stage good symptomatic effects of radiotherapy and rays Bucky tray. Corticosteroids (prednisone, triamcinolone, dexamethasone) used initially in high doses with the transition to long-term maintenance therapy with small doses of these drugs.
Good symptomatic effect in some patients was observed in the treatment of ethylenimine (fospassin, dipin); some patients during treatment with drugs from the group of hloretilaminam (Doan and others), as well as aurantia. Useful for complex treatment with low doses of ethylenimine and corticosteroids; very important the correct mode, nutrition, rest, lack of physical and nerve injuries.