Case Reports in Dermatology最新文献

Introduction: Eosinophilic annular erythema (EAE) is a rare disease with an unclear etiology and pathogenesis. EAE is characterized by chronic relapsing-remitting episodes, primarily presenting as annular erythematous patches and plaques. Whether it is a distinct entity or a subtype of eosinophilic cellulitis (Wells syndrome) remains controversial.

Case presentation: To our knowledge, there have been no prior reported cases of EAE triggered by bee stings. We describe a 58-year-old male patient with EAE who presented with recurrent erythematous eruptions on both calves for 6 months, experienced a flare-up 2 weeks before consultation. Notably, his symptoms initially appeared following a bee sting. The patient also reported a history of childhood asthma. Physical examination revealed infiltrated annular plaques on both calves and the left groin, with centrally hyperpigmented areas. Laboratory tests showed normal peripheral blood eosinophil counts, while histopathology demonstrated dense perivascular eosinophilic infiltrates in the superficial dermis with flame figures. The patient was treated with corticosteroids and immunosuppressants, leading to significant improvement after 2 weeks. Follow-up over 3 months showed no recurrence.

Conclusion: Despite significant pathological overlap with Wells syndrome, the clinical features in this case supported a diagnosis of EAE. The bee sting is postulated as a potential trigger for the recurrent type 2 immune response. This case suggests that bee stings may represent a previously underrecognized trigger for EAE and highlights the diagnostic challenges in distinguishing it from related disorders.

Introduction: Hydroquinone is topical depigmenting agent that is frequently used to treat hyperpigmentation disorders. Prolonged contact exposure can lead to asymptomatic, reversible orange discoloration of the nail plate.

Case presentation: A 52-year-old woman of Hispanic ethnicity presented to our dermatology clinic for follow-up of melasma, 2 months after initiating hydroquinone therapy. She also was taking isoniazid and rifampin therapies for reactivated tuberculosis. On physical examination, she had sharply demarcated, non-blanching, orange-brown areas of discoloration affecting the distal fingernails. Nail clipping histopathology and serologic testing for vitamin deficiencies, complete cell blood count, and liver and renal functioning were unremarkable. After ruling out alternative etiologies and considering causes such as antituberculosis treatment, a diagnosis of orange nail discoloration secondary to topical hydroquinone use was rendered.

Conclusion: The differential diagnosis for orange chromonychia is broad and requires a thorough workup to rule out autoimmune diseases, organ failure (cardiac, hepatic, renal), and vitamin or mineral deficiencies. It is important to consider comorbidities, medications, and contact and exogenous exposures into consideration. Awareness and patient education of this rare side effect may prevent unnecessary distress and, in some cases, avoid unnecessary testing.

Introduction: Livedoid vasculopathy (LV) is a rare chronic recurrent occlusive disease characterized by painful ulcers and atrophic porcelain-white scars. Owing to the lack of strict treatment guidelines, the commonly used traditional treatment methods are not effective in some patients. Therefore, there is an urgent need to develop new therapies for LV.

Case presentations: Here we report 4 cases of LV that were successfully treated with the Janus kinase (JAK) inhibitors. The present study revealed a significant improvement in clinical activity and pain relief in patients with LV after the administration of abrocitinib (3 patients) or upadacitinib (1 patient). The median composite clinical score derived from erythema, ulceration, and physician-assessed pain fell from 7.25 ± 0.25 at baseline to 4.50 ± 0.50 at 4 weeks, 2.50 ± 0.50 at 8 weeks, and 1.00 ± 0.707 at 12 weeks. The remission time ranged from 5 to 8 weeks, with a mean remission time of 6.75 ± 1.258 weeks. Two patients experienced disease recurrence after the discontinuation of JAK inhibitor therapy. The average relapse time was 13.00 ± 7.071 months after drug withdrawal. The mean follow-up period was 6.00 ± 1.414 months. During the long follow-up period, only 1 patient showed a slight increase in the total cholesterol level, and no other adverse reactions were observed. Our study included 1 pediatric patient treated with upadacitinib. No adverse reactions occurred in this pediatric patient.

Conclusion: We believe that JAK inhibitors could be a promising therapeutic option for LV.

Introduction: The evaluation of pigmented lesions remains a daily diagnostic challenge. Dermoscopy enhances accuracy, but seborrheic keratoses (SKs), though benign, may mimic melanoma due to melanocytic-like features. In patients with multiple SK, detecting a malignant lesion can be difficult, especially when it shares clinical or dermoscopic characteristics with SK.

Case presentation: A 47-year-old man presented with multiple pigmented lesions on the face, scalp, and trunk. Most lesions were typical SK. However, one scalp lesion appeared clinically distinct with heterogeneous pigmentation. Dermoscopy revealed SK features combined with melanocytic criteria: a central bluish pigmentation and irregular globules and dots. This "ugly duckling" lesion was excised and diagnosed as melanoma in situ, with no SK component histologically.

Conclusion: SK is a common benign tumor that can mimic melanoma, complicating diagnosis. The originality of this case lies in applying the ugly duckling sign -typically used to assess nevi - to multiple SK lesions. This comparative approach enabled the identification of a single atypical lesion, ultimately diagnosed as melanoma in situ. In patients with numerous SK, extending the use of this method beyond nevi may help detect malignant lesions that would otherwise remain unnoticed.

Introduction: Chronic cutaneous lupus erythematosus (CCLE) is a subtype of lupus erythematosus that primarily affects sun-exposed areas, resulting in atrophic scarring and dyspigmentation. While its classic presentation involves erythematous, scaly plaques with follicular plugging, rare clinical variants have been described. Among these, acneiform or comedonal CCLE can closely mimic acne vulgaris, leading to delayed diagnosis and inappropriate management.

Case presentation: A 49-year-old woman presented with multiple facial scars after more than 20 years of unsuccessful acne treatments. Physical examination revealed deep atrophic scars and pseudocomedones on the cheeks and chin, along with erythematous, scaly plaques on the ear, and an alopecic patch on the scalp. A skin biopsy showed a picture of CCLE. A diagnosis of CCLE presenting as acne scar was concluded. The patient responded well to hydroxychloroquine followed by successful surgical scar revision.

Conclusion: Acneiform CCLE is a rare and often misdiagnosed variant. Dermatologists should consider it in patients with treatment-resistant "acne," particularly when lesions are scarring or involve sun-exposed sites, as early diagnosis and appropriate therapy can prevent irreversible disfigurement.

Introduction: Dermatofibromas are benign skin tumors that are typically diagnosed clinically without the need for biopsy. While they are not commonly associated with PET imaging findings, they have been occasionally reported to exhibit FDG uptake in radiology literature. However, this remains significantly underrecognized by many dermatologists.

Case presentation: We describe a 42-year-old woman with a history of HER2-positive breast cancer who underwent PET-CT for surveillance. Multifocal FDG-avid nodules were noted and initially interpreted as possible cutaneous metastases. Dermatologic evaluation revealed longstanding, stable papules consistent with dermatofibromas. Biopsy was deferred due to classic features and diagnostic certainty.

Conclusion: Dermatofibromas can appear hypermetabolic on PET imaging due to histiocytic and inflammatory cell activity. Awareness of this pitfall is important for dermatologists involved in the care of oncology patients, as recognition may prevent unnecessary biopsies, oncologic escalation, and patient anxiety.

Introduction: Brooke-Spiegler syndrome is a rare hereditary skin disorder characterized by the development of multiple adnexal tumors, such as trichoepitheliomas and cylindromas, with a higher prevalence in females.

Case presentation: We report a rare case involving two male siblings who developed facial lesions consistent with this condition. Both patients presented with tumors on the nasal ala, which were successfully treated with carbon dioxide (CO₂) laser therapy. Genetic testing confirmed the diagnosis of Brooke-Spiegler syndrome, consistent with autosomal dominant inheritance.

Conclusion: This case underscores the importance of family history and genetic evaluation in the diagnosis and management of this syndrome. Repeated CO₂ laser therapy may provide effective long-term cosmetic control of facial lesions.

Introduction: Acute generalized pustular bacterid (AGPB) is a rare dermatological condition characterized by the abrupt onset of a generalized pustular eruption, often occurring secondary to an upper respiratory tract streptococcal infection. Histopathological findings typically reveal epidermal pustules and/or leukocytoclastic vasculitis. Notably, antibiotic therapy has been shown to be effective in managing this condition. We present a rare case of AGPB elicited by tinea pedis. This report seeks to improve clinicians' competence in the accurate identification of this condition.

Case presentation: A 72-year-old Chinese male patient was admitted to the hospital with AGPB that developed following treatment for tinea pedis. The diagnosis was supported by clinical manifestations and a pathological biopsy. After 1 week of combination therapy with intravenous cefuroxime sodium and topical triamcinolone acetonide and econazole nitrate cream, the skin lesions showed significant improvement. The patient was discharged upon achieving stable condition.

Conclusion: This case highlights that for patients presenting with acute generalized pustular eruptions accompanied by tinea pedis, AGPB should be included in the differential diagnosis. Early recognition and targeted treatment can lead to a favorable prognosis.

Introduction: Nicolau syndrome (NS) is a rare complication following intramuscular (IM), intra-articular, or subcutaneous injections, marked by severe localized pain, skin discoloration, and tissue necrosis. Treatments focus on halting causative agents, pain control, and preventing secondary infections. Here we describe a case of NS due to the use of penicillin G benzathine for syphilis.

Case presentation: A 39-year-old male presented with a painful rash on his left buttock 3 min after IM injection of penicillin G benzathine for the treatment of syphilis. The patient, with a history of type 2 diabetes, experienced significant complications including rhabdomyolysis and liver dysfunction. After the treatment of corticosteroids, anticoagulation, fluid resuscitation, and alkalinizing the urine, the patient recovered well.

Conclusion: NS may result from accidental arterial injection (causing vascular occlusion) or hypersensitivity reactions to medications. We reported the clinical course of a case of NS and highlight the need for proper injection technique, early intervention, and multidisciplinary care to manage NS and its complications.

Introduction: Pustular vasculitis is a rare skin disease with only a few reported cases worldwide, especially when the lesions occur on the lower limbs. This report presents a rare case of pustular vasculitis on both lower limbs, and good therapeutic effects were achieved after our treatment.

Case presentation: We report a case of an 86-year-old female who presented with annular erythema, purpura, and pustules on both lower limbs. Skin biopsies showed neutrophilic infiltration and leukocytoclastic vasculitis changes. She had a history of chronic diarrhea for the past 2 years. An X-ray of both hands revealed osteoarthritis of multiple interphalangeal joints. After treatment with systemic methylprednisolone, minocycline, and tripterygium glycosides for anti-inflammation, the lesions were significantly relieved.

Conclusion: We report this case because of its rarity and remind physicians to keep in mind the possibility of pustular vasculitis while dealing with lesions of extensive annular hemorrhagic spots with pustules, along with diarrhea and arthritis.