Rice grains - cysticercosis

Lesions on plain radiographs (X-rays) or computed tomography (CT) scans resembling rice grains may be seen in cysticercosis. Commonly, cysticercosis results from consumption of food (including fruits and vegetables) or water contaminated with Taenia solium (pig tapeworm) eggs.

These eggs reach the small intestine, ‘hatch’, and the resulting embryos (oncospheres) enter the intestinal wall and spread via the blood stream to, for example, the brain, muscles and eyes. The embryos then develop into larvae (cysticerci) which over time die and become calcified because of the body’s immune response to them. The dead larvae, particularly in muscle, resemble rice grains on X-rays or CT scan.

Reference:

Ortega CD et al. Helminthic Diseases in the Abdomen: An Epidemiologic and Radiologic Overview. Radiographics, 2010 30(1):253-67. Go to reference

Cysticercosis

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Peau d’orange – orange peel - pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE) is a relatively rare disease in which there is progressive mineralization and fragmentation of elastic fibers.
Bruch’s membrane a thin layer in the eye contains elastic fibers whose mineralization and fragmentation results in the back part of the eye, visible using special equipment, becoming mottled thereby resembling an orange peel – peau d’orange.
PXE is usually inherited in an autosomal recessive manner meaning that each parent has a single genetic mutation but remains largely unaffected by disease; when two such parents – each carrying a single mutation - have children, on average one in four of their children will have two genetic mutations resulting in full disease manifestation.
The skin, blood vessels and heart contain elastic fibers and are consequently also affected in PXE. On the skin one may see a plucked chicken skin appearance.
Reference:
Chassaing N, Martin L, Calvas P, Le Bert M, Hovnanian A: Pseudoxanthoma elasticum: a clinical, pathophysiological and genetic update including 11 novel ABCC6 mutations. J Med Genet, 2005 42(12):881–892. Go to reference

Autosomal recessive inheritance

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Peau d’orange – orange peel – nephrogenic systemic fibrosis

Nephrogenic systemic fibrosis (NSF) is an uncommon disorder that occurs in kidney failure (hence nephrogenic) and involves multiple organs (systemic) that abnormally have tissue that is more fibrous (fibrosis). Because of this fibrosis, the skin of the limbs may look like an orange peel – peau d’orange.
Use of gadolinium (a metal) containing agents that are injected intravenously to enhance the appearance of magnetic resonance images (MRIs) have been associated with nephrogenic systemic fibrosis.
Reference:
Piera-Velázquez S, Sandorfi N, Jiménez SA: Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy: clinical aspects. Skinmed, 2007 6(1):24-7. Go to reference

MRI brain

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Cauliflower warts

There are several types of human papilloma viruses (HPVs), some of which are transmitted by sexual contact. Certain types of HPVs, for example type 6 and 11 cause genital warts (condyloma acuminata), which may look like cauliflowers - cauliflower warts.
Vaccination with an HPV vaccine around the time of adolescence before the onset of sexual activity may prevent genital warts.

Warts caused by HPVs other than type 6 and 11 can be spread by methods such as skin to skin contact and these warts can affect other regions of the body besides the genital and anal areas.
Reference:

Wen YC, Wu HH, Chen KK: Pan-urethral Wart Treated with 5-Fluorouracil Intraurethral Instillation. J Chin Med Assoc, 2006 69(8):391-392. Go to reference

Genital warts in a male and female

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Prune belly syndrome

Due to anterior abdominal wall muscle deficiency, the overlying skin covering the abdomen becomes wrinkled resembling a prune’s skin – prune belly syndrome.

Prune belly syndrome, also known by various designations such as Fröhlich syndrome, Obrinsky syndrome, Eagle-Barrett syndrome, triad syndrome is characterised by deficiency of the anterior abdominal wall muscles and urogenital abnormalities such as urinary tract obstruction and undescended testes.

Obstruction of the urinary tract results in urine backflow, urinary bladder overfilling, enlarged ureters, kidney distension with urine and the accumulation of urine in the abdominal cavity resulting in anterior abdominal wall muscle degeneration.

Prune belly syndrome is a rare syndrome with a poor outcome from birth; it is more common in males than females.

Reference:

Metwalley KO, Farghalley HS, Abd-Elsayed AA: Prune belly syndrome in an Egyptian infant with Down syndrome: A case report. J Med Case Reports, 2008 2:322. Go to reference

Prune belly syndrome

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Peau d’orange – orange peel – breast cancer

When lymphatic obstruction occurs in breast cancer, lymph accumulates. An effect of this process is breast skin dimpling at sites of sweat ducts giving the skin the appearance of an orange peel – peau d’orange (French for orange skin).
Overall, breast cancer is the most common cancer amongst women worldwide.

Breast self examination (BSE) does not reduce the chances of dying from breast cancer compared to no breast self examination, rather counter intuitively BSE can be harmful by causing fear, anxiety, depression and so on concerning finding or having a breast lump. Also those who practice BSE have more invasive procedures like breast biopsies which may be injurious.

Reference:

Russell RCG, Williams NS and Bulstrode CJK (eds.), 2004, Bailey and Love’s Short Practice of Surgery, 24th edition, Arnold, London, pages 837-838. Go to reference

Breast cancer

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Caseous (cheesy) necrosis

White soft tissue resulting from cell death (necrosis) resembles cheese in appearance. This caseous (cheesy) necrosis is a feature of tissue destruction by tuberculosis (TB); however other illness can also cause caseous necrosis.

TB is mainly caused by the non-motile bacterium Mycobacterium tuberculosis which grows inside cells particularly in regions with high oxygen content such as the lungs. Spread of TB is by inhaling minute droplets resulting from coughing by an individual with active TB.

TB is more common in areas with overcrowding, under nutrition, low income, HIV and so on; essentially among the poor. Poverty predisposes to TB and TB worsens poverty – a vicious cycle

A third of the world’s population is estimated to be infected with TB (latent); however the vast majority of infected people do not develop active TB for largely unknown reasons.

Reference:

Ahmad S: Pathogenesis, Immunology, and Diagnosis of Latent Mycobacterium tuberculosis Infection. Clin Dev Immunol, 2011; 2011: 814943. Go to reference

Cheese

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Peach fuzz in anorexia nervosa

Commonly affecting more females than males, anorexia nervosa also known simply as anorexia is a serious eating disorder. Sufferers - who tend to be young women - maintain unhealthy low body weights by various strategies such as eating sparingly, exercising vigorously, inducing vomiting and so on. Anorexia nervosa is classified as a form of mental illness.

Manifestations of anorexia nervosa include, for example: because of under nutrition the hair of the back, abdomen and forearms becomes soft and thin resembling lanugo a type of fetal hair - this appearance of hair is likened to peach fuzz.

Reference:

Strumia R: Skin signs in anorexia nervosa. Dermatoendocrinol. 2009, 1(5):268-70. Go to reference

Lanugo

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Café au lait spots – coffee with milk spots

Café au lait (French for coffee with milk) spots are flat dark skin lesions with a color resembling that of coffee mixed with milk. These spots can be found in various conditions, for example, neurofibromatosis a disorder due to an abnormality on the seventeenth chromosome(s) that leads to a tendency of developing tumors, which may be benign or malignant.

Reference:

Baek et al: Recurrent Massive Subcutaneous Hemorrhage in Neurofibromatosis Type 1: A Case Report. J Korean Med Sci, 2007 22(4):728–730. Go to reference

Café au lait spot in neurofibromatosis

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