SAGE Open Medical Case Reports最新文献

The proteasome inhibitor bortezomib is widely used in the treatment of multiple myeloma. While peripheral neuropathy and gastrointestinal effects are well-documented adverse reactions to bortezomib administration, cutaneous side effects in patients with multiple myeloma are less commonly reported. We present a patient with IgG kappa multiple myeloma who developed a spider-like and digitate eruption at the site of subcutaneous bortezomib injection. This report expands the spectrum of bortezomib-associated dermatologic toxicity and emphasizes the importance of clinician awareness for prompt diagnosis and management.

Pyoderma gangrenosum is a rare neutrophilic dermatosis often associated with systemic inflammatory or malignant conditions. We report a case of recurrent pyoderma gangrenosum injection site reactions following subcutaneous Maveropepimut-S (previously known as DPX-Survivac), an anti-cancer vaccine, in a 31-year-old woman undergoing immunotherapy for stage 3C ovarian cancer. The diagnosis was confirmed histologically and clinically after repeated ulcerative lesions developed at injection sites. The lesions showed a rapid response to corticosteroid therapy. This case highlights the importance of recognizing pyoderma gangrenosum as a potential cutaneous adverse event in immunotherapy treatments and suggests that timely dermatologic evaluation may help avoid delays in diagnosis and treatment.

Dual biologic therapy is not often used in psoriasis and psoriatic arthritis due to cost and safety concerns, with limited literature supporting its use. We present a case of a 31-year-old man with severe plaque psoriasis and erosive psoriatic arthritis, refractory to multiple therapies. While guselkumab improved skin symptoms, joint inflammation persisted. Given the patient's reluctance to discontinue guselkumab and his poor response to prior therapies, bimekizumab was added. This combination led to near-complete skin clearance and significant joint improvement within 3 months, with sustained benefits and no adverse effects at 17 months. This case illustrates how targeting multiple points in the interleukin-23/interleukin-17 pathway can improve outcomes in patients unresponsive to monotherapy. Dual biologic therapy may be a viable option for select patients with complex disease, though further research is needed to evaluate its long-term safety and efficacy.

Leiomyosarcoma (LMS) of the skin is a rare malignant neoplasm that can have varied clinical presentations, even mimicking benign lesions, making diagnosis challenging. We describe a 74-year-old male with a history of subcutaneous LMS of the left leg treated successfully with surgery, chemotherapy, and radiation over 10 years prior, who presented with an incidental papule on the lower back resembling an accessory nipple. Biopsy revealed a spindle cell tumour with diffuse smooth muscle actin and desmin positivity and a high Ki-67 index, consistent with a non-metastatic subcutaneous LMS. Wide local excision confirmed dermal and subcutaneous involvement with negative margins. This case is notable for the occurrence of two distinct primary LMS lesions more than a decade apart, underscoring the importance of long-term surveillance in high-risk patients. Given the potential for recurrence or metastasis, careful histopathologic evaluation and ongoing monitoring remain critical in the management of LMS.

Plasmablastic lymphoma is a rare and aggressive variant of diffuse large B-cell lymphoma characterized by heterogeneous clinical presentations and poor outcomes. This study presents a comprehensive review integrated with three cases demonstrating diverse clinical manifestations and treatment outcomes. We conducted a detailed analysis of three plasmablastic lymphoma cases diagnosed and treated at our institution between 2022 and 2023, incorporating clinical presentations, diagnostic findings, treatment approaches, and outcomes. These cases were analyzed in the context of current literature and treatment guidelines. The cases included an HIV-positive male with perianal plasmablastic lymphoma, an HIV-negative female with gastric plasmablastic lymphoma arising from marginal zone lymphoma, and an HIV-negative female with retroperitoneal plasmablastic lymphoma. Two patients achieved complete remission with bortezomib plus dose-adjusted-etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin therapy, while one experienced treatment failure and death. Epstein-Barr virus positivity was observed in two cases. Treatment-related complications included peripheral neuropathy and organ failure. The cases demonstrated variable outcomes independent of HIV status but correlating with age and performance status. Our series highlights the diverse presentation patterns of plasmablastic lymphoma and validates known prognostic factors while demonstrating the efficacy of contemporary treatment approaches. The outcomes underscore the importance of individualized therapy and careful patient selection for intensive treatment regimens.

Malignant tumours within the nipple-areola complex (NAC) should be considered when a non-healing, bleeding, or painful unilateral lesion persists. We report the unusual case of an 81-year-old male with prior melanoma and non-melanoma skin cancers who presented for a 1- to 2-year history of a painful lesion on the left nipple. On examination, there was a pink, crusted, tender, indurated papule within the left nipple without underlying breast masses or axillary lymphadenopathy. Histopathology revealed nodular basal cell carcinoma (BCC). The patient also had suspicious pulmonary nodules, which demonstrated metastatic melanoma. Unexpectedly, the BCC rapidly grew. It was ultimately treated with Mohs micrographic surgery. This case highlights the importance of maintaining a high index of suspicion for malignant tumours in atypical areas like the NAC, especially unexpected tumours such as BCC. Within the NAC, tumours may display more aggressive features, be misdiagnosed or undiagnosed until later stages, or inadequately treated.

Sebaceoma is a benign sebaceous neoplasm with rare potential for malignant transformation. We report a case of recurrent sebaceoma in a 70-year-old male with Muir-Torre syndrome, successfully treated with Mohs micrographic surgery. Despite its benign histology, the lesion demonstrated rapid growth and incomplete initial excision. Mohs micrographic surgery provided complete margin control with tissue preservation. This case highlights the value of Mohs micrographic surgery in managing select benign sebaceous neoplasms exhibiting concerning clinical behavior or diagnostic uncertainty, supporting its inclusion in treatment considerations for high-risk patients.

Epithelioid hemangioendothelioma is a rare vascular neoplasm with clinical behavior that varies from indolent to aggressive. While the clinical presentation of epithelioid hemangioendothelioma may be variable, the diagnosis of epithelioid hemangioendothelioma is based on histologic and immunohistochemistry features. We describe a case of epithelioid hemangioendothelioma presenting as a groin nodule in a 76-year-old man. He was admitted to hospital with progressive hemoptysis, accompanied by a growing, ulcerated right groin nodule. Excisional biopsy confirmed a diagnosis of epithelioid hemangioendothelioma. The patient opted for palliation and died 1 month after hospital admission. Our case highlights an atypical presentation of epithelioid hemangioendothelioma characterized by hemoptysis and a solitary groin nodule, underscoring the importance of timely diagnosis and management.

We report an uncommon case of transient Bell's palsy-like facial paralysis following local anesthesia during Mohs micrographic surgery of the left conchal bowl. The temporary complication resolved spontaneously without intervention and is suspected to have resulted from anesthetic diffusion to the facial nerve via the tragal region. This case highlights the importance of understanding facial nerve anatomy during procedures in the auricular area and the need to counsel patients regarding rare but benign complications of local anesthesia.

Leprosy, or Hansen's disease, is a chronic granulomatous infection caused by Mycobacterium leprae, with a broad spectrum of clinical and histopathological manifestations. Histological examination plays a pivotal role in accurately diagnosing its various subtypes. Elastophagocytosis (phagocytosis of elastic fibers by giant cells) is typically associated with annular elastolytic giant cell granuloma and other granulomatous conditions but has rarely been reported in leprosy. We report the case of an 85-year-old male who presented with a solitary, slowly enlarging annular plaque on the trunk. The lesion was asymptomatic and exhibited mild sensory loss without peripheral nerve involvement. Histopathological analysis of the skin biopsy showed granulomatous inflammation with Langhans-type giant cells and a striking feature of elastophagocytosis. Fite-Faraco staining confirmed the presence of acid-fast bacilli, establishing the diagnosis of borderline tuberculoid leprosy. The patient was treated with multibacillary multidrug therapy and demonstrated complete lesion resolution.