Case Reports in Dermatology最新文献

Introduction: In this manuscript, we present a case of pemphigus vulgaris (PV) with unusual and rarely found clinical features and course. Primary pustular lesions forming annular arrangement made the current case challenging in terms of diagnostics. This case broadens the clinical spectrum of PV; therefore, we believe it is important from educative and medical point of view.

Case report: The study examined a patient with pemphigus lesions resembling dyshidrotic eczema initially located on the soles and on the scalp during the subsequent relapses. The final diagnosis of PV was based on histopathology, direct and indirect immunofluorescence (DIF, IIF), ELISA, and mycology. Histopathological examination showed the presence of suprabasal acantholysis and acantholytic cells. DIF and IIF revealed IgG in the epidermal intercellular spaces of the epidermis. Circulating IgG antibodies reacted with Dsg3 in ELISA. Mycology was negative. Though mild clinical features, the patient experienced two relapses and required higher doses of prednisone to achieve a remission.

Conclusion: PV may mimic dyshidrotic eczema. This is a rare case, in which non-obvious clinical picture made the diagnosis delayed. Numerous diagnostic procedures were required for the final PV diagnosis.

Introduction: Mammary Paget disease (MPD) and extramammary Paget disease (EMPD) are distinct conditions typically differentiated by anatomical location: MPD occurs on the breast and is indicative of underlying breast carcinoma, while EMPD arises in apocrine gland-rich areas like the genitals or axilla. MPD is almost always associated with underlying breast cancer, whereas EMPD may occur with or without malignancy. Both present as erythematous, scaly lesions with histopathologic features of Paget cells, necessitating clinicopathologic correlation for diagnosis.

Case presentation: We present a diagnostically challenging case of an erythematous, scaly plaque in the axilla of a 56-year-old female with a history of invasive ductal carcinoma and bilateral mastectomy. Initial findings, including positivity for CK7, CEA, and HER2, suggested EMPD. However, given the proximity to the previously afflicted breast, a wide local excision was performed and revealed tumor cells within mammary epithelium and glands, leading to a final diagnosis of MPD (in situ breast carcinoma involving the skin). The lesion's location in the axillary tail, overlapping with her prior breast cancer site, raised concerns for residual disease. Imaging showed no metastatic disease or pathologic mutations. Clear margins were achieved, and adjuvant radiation was deferred due to her history, limited disease extent, and potential toxicity.

Conclusion: This case highlights the diagnostic challenges of MPD in atypical locations and underscores the importance of clinicopathologic correlation, particularly in patients with a history of breast cancer. It also emphasizes the need for individualized treatment strategies and long-term surveillance, even after mastectomy, to detect and manage rare recurrences. Clinicians must maintain vigilance for atypical presentations of recurrent or residual disease, as breast cancer can manifest unexpectedly years after definitive treatment.

Introduction: Mucormycosis is a rare and life-threatening fungal infection caused by Mucorales, primarily affecting immunocompromised individuals such as those with diabetes or organ transplants. While it typically involves the sinuses, lungs, or central nervous system, cutaneous mucormycosis following minor trauma, including spider bites, is extremely uncommon.

Case presentation: We report the case of a 44-year-old Palestinian man with uncontrolled diabetes mellitus and a history of renal transplant on immunosuppressive therapy who developed progressive pain, swelling, and erythema of the right forearm after a spider bite. Despite empirical antibiotic therapy, the lesion worsened, with necrosis and bullae formation. Biopsy confirmed mucormycosis, and cultures also revealed methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated with systemic antifungal therapy (amphotericin B deoxycholate) and targeted antibiotics, alongside repeated surgical debridement and vacuum-assisted closure wound care. His condition improved significantly, and he is currently awaiting skin grafting with no residual infection.

Conclusion: This case highlights an atypical presentation of cutaneous mucormycosis following a spider bite in an immunocompromised patient. Early recognition, prompt initiation of antifungal therapy, and aggressive surgical intervention are crucial for favorable outcomes in such rare and complex infections.

Introduction: Gastrointestinal involvement in Henoch-Schönlein Purpura (immunoglobulin A [IgA] vasculitis) is common but can mimic other conditions, including inflammatory bowel disease, leading to diagnostic challenges.

Case presentation: We report a 19-year-old male who presented with a palpable purpuric rash and abdominal pain without significant renal involvement. Imaging with abdominal computed tomography and MR enteroclysis, as well as histopathology, revealed features of terminal ileitis and duodenitis, initially suggestive of inflammatory bowel disease. However, skin biopsy with immunofluorescence confirmed the diagnosis of IgA vasculitis. The patient demonstrated a rapid and dramatic clinical improvement following initiation of systemic glucocorticoid therapy.

Conclusion: This case illustrates a rare diagnostic pitfall where IgA vasculitis can mimic inflammatory bowel disease. Recognition of this overlap is essential to avoid misdiagnosis, and timely initiation of glucocorticoids can lead to excellent therapeutic outcomes.

Introduction: We present a case of lymphoepithelioma-like carcinoma of the skin (LELCS) of the chest identified in an elderly white male. We discuss the management and various treatment options for this rare type of cutaneous malignancy and highlight treatment uncertainty for this uncommon skin cancer, and the need to balance best patient outcomes with minimal treatment morbidity.

Case presentation: Our patient presented with a waxing and waning erythematous rash on his chest for 2 years. After a shave biopsy revealed lymphoepithelioma-like carcinoma, the patient underwent wide local excision and 6 weeks of radiation therapy due to the identification of adverse pathologic features.

Conclusion: Overall, this case shows the diverse range of LELCS presentations and available treatment options and highlights areas of clinical treatment uncertainty and areas for future therapeutic development.

Introduction: Speckled, confetti, or guttate pigmentary disorders include conditions with overlapping features and diagnostic challenges. These disorders present considerable clinical overlap with frequent diagnostic difficulties due to variable phenotypic expression.

Case presentation: A 9-year-old Saudi female presented with a 1-year history of asymptomatic skin lesions involving the face, forearms, hands, legs, and feet. The lesions appeared spontaneously and remained unchanged since onset. Examination revealed 1-3 mm, well-defined, multiple, speckled hypopigmented-to-depigmented macules with bilateral symmetrical distribution. Wood's lamp examination revealed no pigment accentuation. Dermoscopic examination showed well-defined, marginated hypopigmented macules with feathery margins. Microscopic examination, including special DOPA staining, revealed normal melanin pigmentation in the basal keratinocyte layer and normal to focal slightly reduced numbers of basal melanocytes, along with a focal sparse superficial perivascular mononuclear inflammatory cell infiltrate. Based on clinicopathological correlation, a diagnosis of acral speckled guttate hypomelanosis was made. The patient responded well to 1% pimecrolimus cream twice daily.

Conclusion: This case represents a novel presentation of acquired speckled acrofacial hypomelanosis with unique findings, including facial involvement and absence of hyperpigmentation. The patient's excellent response to pimecrolimus cream suggests this may be an effective treatment option for this rare condition.

Introduction: Bowen's disease (BD) and seborrheic keratosis (SK) share certain common pathogenic factors, yet their relationship remains controversial. The central debate revolves around whether SK can undergo malignant transformation into BD or whether their coexistence merely represents a "collision tumor" phenomenon. This article aimed to explore the relationship, diagnosis, and treatment of BD and SK through a clinical case of generalized BD accompanied by generalized SK, supplemented with a review of relevant literature.

Case presentation: A 70-year-old male presented with a 14-year history of widespread "red patches" across his body. Dermoscopic examination of the red plaques revealed a red background with uniformly distributed glomerular vessels and scattered yellow-white scales. The brown plaques exhibited a homogeneous brown pattern with yellowish-white scales, occasionally accompanied by light red homogeneous structures and dotted or linear vessels. Histopathological analysis showed irregular epidermal hyperplasia, hyperkeratosis, parakeratosis, and acanthosis. The epidermal cells displayed disordered arrangement, significant atypia, and visible mitotic figures, while the basal cell layer remained intact. Inflammatory cell infiltration was observed in the dermis. The patient was diagnosed with generalized BD accompanied by generalized SK. Treatment included cryotherapy, oral acitretin capsules, and topical isotretinoin cream. The patient responded favorably to the treatment and continues to be monitored in follow-up.

Conclusion: Clinicians should maintain a high index of suspicion when evaluating irritated or inflamed SK lesions, as they may mask underlying Bowen's-like changes. Early recognition and appropriate management are essential to ensure optimal patient outcomes.

Introduction: Immunoglobulin A (IgA) vasculitis is a small vessel leukocytoclastic vasculitis marked by IgA-dominant immune complex deposition, typically affecting the skin, joints, gastrointestinal tract, and kidneys. While common triggers include infections and medications, alcohol is a rarely reported precipitant. Its role remains unclear but may involve mucosal immune dysregulation, impaired IgA clearance, and increased immune complex formation.

Case presentations: We report 2 adult patients with biopsy-proven IgA vasculitis presenting with recurrent lower extremity purpura. Both experienced disease flares closely following alcohol consumption and showed limited response to colchicine. Systemic involvement was absent, and laboratory evaluations were largely unremarkable. Notably, symptom resolution or marked improvement occurred with alcohol avoidance.

Conclusion: These cases support a potential link between alcohol consumption and recurrent IgA vasculitis flares. Recognizing alcohol as a possible trigger may improve disease control and highlights the importance of thorough exposure histories in dermatologic assessment.

Introduction: Pityriasis versicolor is a common epidermal mycotic infection, well known in its classic hypo- or hyperpigmented macular form. However, its atrophic variant, first described in 1971, remains rare and poorly documented. The underlying cause of this variant has yet to be determined.

Case presentation: We report 3 cases of patients treated with topical steroids for inflammatory skin diseases (atopic dermatitis, cutaneous scleroderma, and mycosis fungoides) who developed erythematous and squamous atrophic lesions on their back during follow-up. Complete resolution of both patches and atrophy was observed following the discontinuation of topical steroids and the onset of topical and systemic antifungal therapy.

Conclusion: Atrophic pityriasis versicolor is a disease which deserves to be highlighted to prevent misdiagnosis with other severe dermatological conditions also presenting with skin atrophy, as to avoid lesions worsening due to inappropriate treatment.

Introduction: Raynaud's phenomenon (RP) can be classified as either primary or secondary and is traditionally characterized by triphasic color changes, including white/ischemia (blanching), blue/cyanosis, and red/hyperemia. Secondary RP, resulting from the use of handheld vibrating tools, is also referred to as vibration white finger. Blanching typically occurs in the fingertips; however, there are no documented cases of severe bilateral cyanosis associated with hand-arm vibration syndrome (HAVS).

Case presentation: A 69-year-old male with a 40-year history of using vibrating tools such as chainsaws, picks, and vibrators presented with symptoms of coldness, burning, and numbness. Photographs of the RP were taken during the winter after the patient had been outdoors without adequate warm clothing or gloves. The images depict blanching and cyanosis in all five fingers of both the hands. In this case, nailfold capillaroscopy did not reveal any structural changes such as reduced capillary density, capillary enlargement, or neovascularization but showed minor bleeding. At the 2-year follow-up, finger skin temperature, assessed using cold-water immersion testing, showed no improvement.

Conclusion: This was a rare case of extensive blanching followed by cyanosis. Clinicians should consider a history of vibrating tool use when evaluating patients with blue fingers. This case enhances our understanding of RP and HAVS and offers insights into occupational health practices for individuals using hand-arm vibratory tools.