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ACUTE GUTTATE PSORIASIS AFTER STREPTOCOCCAL SCARLET FEVER

To the Editor: We were impressed by the close similarities between the case reported by Farolan et a! {1992;9; 264-267) under the title of lipoid proteinosis (LP) and the case we reported in the same issue with infantile systemic hyalinosis (ISH) (1992;9:255-258). Indeed, we believe that the two case reports almost certainly accidentally relate to the same patient. In our view, it is difficult to justify a diagnosis of LP in the case reported by Farloan et al, whereas the clinical features described are very suggestive of ISH. The absence of laryngeal involvement, lack of eyelid margin lesions, and presence of profound gingivai hyperplasia and generalized joint stiffness are as indicative of ISH as they are incompatible with LP. As we previously showed, children with ISH do not all die during infancy (1). The light and electron microscopic features described by Farolan et al are also consistent with a diagnosis of ISH. Although there is no evidence in their Figure 4 of the banding pattern we described in ISH or of any evidence of phagocytosis of the amorphous material (1), these findings are not always readily demonstrated. We believe that these two case reports relate to a single patient, and that the clinical and pathologic findings indicate a diagnosis of ISH, of the type in which there are some overlap features with juvenile hyaline fibromatosis.