JEADV clinical practice最新文献

Primary cutaneous gamma-delta T-cell lymphoma has been described as an aggressive entity with a poor prognosis. However, gamma-delta T-cell receptor expression has been described in various types of skin lymphoproliferations. Paediatric cases of LyP are increasingly recognized, but paediatric LyP with a gamma-delta phenotype have been rarely described. We report three paediatric patients with indolent gamma-delta lymphoproliferation, with a relapsing-remitting course evoking LyP. These three cases emphasize that TCR gamma-delta expression in a lymphoproliferation is not a synonym of gamma-delta lymphoma. Indeed, these cases raise the question of a paediatric variant of CD30-negative lymphomatoid papulosis with histological features of atypical gamma-delta-positive T-cell lymphoproliferation and underline the necessity of cautious clinico-histological correlation when facing a gamma-delta lymphoproliferation to avoid overtreatment.

A 38-year-old female presented with a 4-week history of painful livedoid violaceous plaques with retiform purpura and central necrosis on both anterior thighs (Figure 1A,B). The lesions acutely developed following intramuscular gentamicin injections into the vastus lateralis muscles. Light microscopy studies of a skin biopsy demonstrated intravascular thrombi and necrosis in the dermis and in the subcutis. NMR imaging studies confirmed subcutaneous tissue involvement. Nicolau syndrome (NS) was diagnosed. Initial management included intravenous heparin, oral prednisolone (1 mg/kg/day), analgesics, and topical antiseptic wound care. However, after 2 weeks of minimal improvement, surgical debridement was performed. The resultant defects were reconstructed using a biodegradable polyurethane dermal matrix (NovoSorb BTM). Complete wound healing was achieved by using a human placental allograft (NuShield) 3 months later.

NS, also called embolia cutis medicamentosa, is a rare severe iatrogenic complication following usually intramuscular injection of various drugs, including most frequently nonsteroidal anti-inflammatory agents and antibiotics [1]. Our case with bilateral involvement was striking. To reduce the occurrence risk of NS, healthcare workers should be both restrictive in prescribing injections and familiar with the correct injection techniques including proper needle length, injection sites and the Z-track method [2, 3]. Potential risk factors, including adiposity, female gender and diabetes, should be considered [2, 4].

K.K., L.G. and R.B. drafted the manuscript, while L.B. critically revised it. All authors reviewed and approved the final manuscript and gave consent for publication.

The patient in this manuscript has given written informed consent for the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.

The authors declare no conflicts of interest.

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

The Sunlight Sanctuary Sporting Smile Sign (SSSSS) is the absence of enlarged pores in the nasolabial sulcus contrasting with the presence of enlarged pores in the adjacent skin of the cheek. This is an original observation not previously described Figure 1.

In competitive athletes pursuing sun-facing endurance sports, orbicularis oculi and zygomaticus major narrow the eyes whilst levator labii superioris et alaeque nasi elevates the upper lip. The medial cheek metamorphoses from a flat vertical surface into a three-dimensional anterior projection. The superior part of the projection receives almost perpendicular sunshine, whereas the nasolabial sulcus itself is in shade. The sun spared pores of the sulcus do not become enlarged. This constitutes the Sunlight Sanctuary Sporting Smile Sign Figure 2.

The repeatedly sun-exposed cheek suffers solar dermopenia; the shaded sulcus does not. As the superficial dermal support around the irradiated pilosebaceous orifices atrophies, the pores widen; in the shaded areas of the nasolabial sulcus the dermis is spared such atrophy.

In “Silver Blaze,” the critical clue was that the dog did not bark in the night [1].

Because the dog did not bark in the night, Sherlock Holmes deduced that the intruder was known to the dog, i.e. it was the absence of the bark in the night that was the clue that revealed the identity of the culprit. Similarly, it is the absence of enlarged pores in the nasolabial sulci that is the clue that comprises the Sunlight Sanctuary Sporting Smile Sign.

C. A. Hopper: drafting, literature review, manuscript writing and review. C. M. E. Rowland Payne: conceptualisation, manuscript review and final approval of submitted version.

All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical approval is not applicable for this study.

The authors declare no conflicts of interest.

The data that support the findings of this study are available from the corresponding author upon reasonable request.