SAGE Open Medical Case Reports最新文献

Erosive pustular dermatosis is a rare and chronic inflammatory condition of the scalp which can be mistaken for cutaneous malignancy, precancerous lesions, dermatitis or pyoderma gangrenosum. The recurrent and resistant characteristics of erosive pustular dermatosis of the scalp pose a challenge to successful management and remission of the condition. The purpose of this case report is to provide management options and treatment recommendations for refractory cases of erosive pustular dermatosis of the scalp. We report a case of erosive pustular dermatosis of the scalp that proved resistant to treatment, with various therapeutic modalities explored to address the persistent condition. In our patient, multiple treatment modalities included topical and oral corticosteroids, topical and oral antibiotics, topical vitamin D analogue, topical calcineurin inhibitor and oral isotretinoin. Based on our findings, refractory disease progression of erosive pustular dermatosis of the scalp may be more responsive to combination therapy rather than monotherapy.

Clear cell renal cell carcinoma is the predominant subtype of kidney cancer. With distant metastasis, the overall survival rate for patients with renal cell carcinoma decreases significantly compared to localized disease. However, pembrolizumab plus axitinib combination is safe and improves long-term survival. Herein, we report a case of a pathological complete response from systemic pembrolizumab plus axitinib therapy in a 57-year-old male with locally advanced renal cell carcinoma with extensive kidney, inferior vena cava, and hepatic invasion, as well as metastatic disease to the retroperitoneal lymph nodes and lung. After 2-years of systemic treatment, there was absent radiographic evidence of renal cell carcinoma in the lung. The patient underwent right radical nephrectomy, adrenalectomy, partial hepatectomy, and inferior vena cava ligation. Pathology indicated no evidence of tumor consistent with a pathological complete response. This case highlights the possibility of a pathological complete response with pembrolizumab plus axitinib in metastatic renal cell carcinoma and potential disparate findings between radiological response and pathological response.

Remimazolam, a short-acting benzodiazepine approved for use in general anesthesia in Japan in 2020, has cardiovascular stability superior to conventional anesthetics. Anesthesia management using remimazolam of a patient with impaired cardiac function and several complications is reported. A man in his 50s with hypertension, diabetes mellitus, and chronic kidney disease (G 5) on dialysis came to our hospital with a chief complaint of exertional dyspnea and chest tightness, and a close examination showed stenoses of three coronary arteries. The patient was managed under anesthesia using remimazolam as a sedative because anesthetics could easily induce circulatory failure. Cardiopulmonary bypass was initiated without causing any circulatory failure, and coronary artery bypass grafting and aortic valve replacement were performed. The patient was successfully weaned with a small dose of catecholamine. Remimazolam was selected for this patient because of its minimal effect on cardiac rhythm, and the anesthesia was safely administered.

Childhood linear immunoglobulin A bullous dermatosis is a well-recognized autoimmune blistering dermatosis that can be idiopathic, drug-induced, secondary to autoimmune diseases, malignancies, infections, or gastrointestinal diseases including inflammatory bowel disease. However, it has not been previously associated with a history of organ transplantation. Here, we report two cases of childhood linear immunoglobulin A bullous dermatosis in young infants following multivisceral organ transplant, including one with a particularly recalcitrant course. We propose potential mechanisms contributing to the development of linear immunoglobulin A bullous dermatosis and challenges in the management of these patients in light of their complex medical histories and immunosuppression.

Glycogenic acanthosis (GA) is a benign, asymptomatic condition commonly found in the lower third of the esophagus. This case report presents a unique occurrence of GA on the lips of a 55-year-old male smoker, who exhibited asymptomatic white lesions on his upper and lower lips for many years. Physical examination revealed multiple white papules on the wet-dry vermilion border of the lips. Biopsies confirmed the diagnosis of GA, showing acanthosis, hyperkeratosis, and glycogenesis without dysplasia. The rarity of GA on the lips underscores the need to consider it in the differential diagnosis of white papules on the lips. This report is the first to document GA's histopathological features on the lips, highlighting its potential occurrence in atypical sites.

Dermatomyositis (DM) is an autoimmune idiopathic inflammatory myopathy with characteristic dermatologic manifestations. Myositis-specific autoantibodies (MSAs) delineate DM subtypes and their prognoses. Uncommonly, patients present with distinct clinical features of DM, including photosensitive dermatitis, heliotrope rash, Gottron's papules, and nailfold changes; however, their autoimmune serology is negative for expected MSAs. Herein, we describe two unconventional cases of seronegative, amyopathic MDA5-DM and offer potential explanations, including fluctuating antibody levels, non-MSA pathophysiology, and limitations in current immunoassays.

This case report discusses two clinical encounters of a 62-year-old Hispanic woman initially hospitalized with suspected Stevens-Johnson syndrome, later correctly diagnosed with bullous fixed drug eruption during an outpatient visit for a similar eruption. The first encounter involved an extensive evaluation and an 11-day hospital stay, while the second was managed successfully as an outpatient with oral prednisone. This report highlights the importance of differentiating bullous fixed drug eruption from Stevens-Johnson syndrome/toxic epidermal necrolysis and emphasizes the need for a collaborative approach between Primary Care Providers and Dermatology to ensure optimal patient care.

We report a 56-year-old male who developed cutaneous lichen planus (LP) following Vaxzevria (Oxford-AstraZeneca) COVID-19 vaccination. Multiple topical and systemic therapies were tried with limited success; however, partial improvement was observed with narrow-band UVB (NB-UVB) phototherapy. This report adds to the growing evidence of new-onset LP following COVID-19 vaccination and underscores the need for careful reporting, monitoring, and management of vaccine-related adverse effects.

Cutaneous metastases from colorectal cancer are an uncommon but critical finding, typically signaling advanced disease with poor prognosis. This case report describes a 64-year-old woman with a limited past medical history who presented to our outpatient dermatology practice with rapidly spreading erythematous, indurated, and nearly verruciform plaques in the groin, vaginal, and perineal region. Biopsy confirmed metastatic adenocarcinoma of colonic origin, and diagnostic imaging, and colonoscopy revealed stage IV colorectal cancer involving extensive cutaneous, lymphatic, and visceral metastases. Unfortunately, the patient had not received routine colorectal cancer screening, despite a positive family history. Due to extensive disease, palliative radiation was not an option, and systemic chemotherapy was initiated. This case emphasizes the need for awareness of cutaneous metastases as a potential initial presentation of undiagnosed malignancies, the importance of routine colorectal cancer screening, and timely biopsy of suspicious skin lesions for early diagnosis and management.

We present a case of an 82-year-old woman who developed sustained heart failure with left ventricular dyssynchrony after the modified Bentall procedure. Persistent circulatory instability and complete atrioventricular block suggested coronary artery stenosis. Multidetector computed tomography revealed stenosis of the grafted portion of the coronary artery. The patient was successfully treated by coronary artery bypass grafting with simultaneous epicardial cardiac resynchronization therapy system implantation.