Case Reports in Dermatological Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Diffuse Cutaneous Mucinosis in Dermatomyositis: A Case Report and Review of the Literature Tue, 18 Nov 2014 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2014/938414/ We present the case of a patient with dermatomyositis and diffuse cutaneous mucinosis and give an up-to-date detailed review of all the published cases in the English literature describing the demographics, clinical picture, pathology management, and outcomes of this unique group of patients. Alexandra Caitlin Perel-Winkler and Chris T. Derk Copyright © 2014 Alexandra Caitlin Perel-Winkler and Chris T. Derk. All rights reserved. Cutaneous Metastasis of Medullary Carcinoma Thyroid Masquerading as Subcutaneous Nodules Anterior Chest and Mandibular Region Tue, 11 Nov 2014 13:34:25 +0000 http://www.hindawi.com/journals/cridm/2014/805205/ Cutaneous metastasis of underlying primary malignancies can present to dermatologist with chief complaints of cutaneous lesions. The underlying malignancy is generally diagnosed much later after a complete assessment of the concerned case. Medullary carcinoma thyroid (MCT) is a relatively uncommon primary neoplasia of the thyroid. Very few cases presenting as cutaneous metastases of MCT have been reported in the literature. Most of the cases which have been reported are of the papillary and the follicular types. We here report a case of a patient who presented in the dermatology clinic with the primary complaint of multiple subcutaneous nodules in anterior chest wall and left side of body of mandible. By systematic application of clinical and diagnostic skills these nodules were diagnosed as cutaneous metastasis of MCT bringing to the forefront a history of previously operated thyroid neoplasm. So clinically, the investigation of a flesh coloured subcutaneous nodule, presenting with a short duration, particularly in scalp, jaw, or anterior chest wall should include possibility of metastastic deposits. A dermatologist should keep a possibility of an internal organ malignancy in patients while investigating a case of flesh coloured subcutaneous nodules, presenting with short duration. A systematic application of clinical and diagnostic skills will eventually lead to such a diagnosis even when not suspected clinically at its primary presentation. A prompt and an emphatic diagnosis and treatment will have its bearing on the eventual outcome in all these patients. Rahul Mannan, Jasmine Kaur, Jasleen Kaur, Sanjay Piplani, Harjot Kaur, and Harleen Kaur Copyright © 2014 Rahul Mannan et al. All rights reserved. Hypertrichotic Giant Nevus Spilus Tardivus and Neurofibroma of the Tongue in Sporadic von Recklinghausen’s Disease Tue, 11 Nov 2014 11:46:22 +0000 http://www.hindawi.com/journals/cridm/2014/141075/ Solitary neurofibromas are rare, benign tumours of nonodontogenic origin. The presentation of a solitary neurofibroma on the tongue is an uncommon occurrence and we present such a case here which was discovered in concomitance with multiple neurofibromatosis type 1 (von Recklinghausen’s disease). Such a rare presentation seen in this case is a diagnostic challenge and often clinched only with the aid of histopathological and immunohistochemical examination. This work also discusses the various differential diagnoses that can be considered in similar cases. The presence of a hypertrichotic “giant” nevus spilus tardivus (Becker’s nevus) is also a rare finding in this particular case. We present such a case which will be of interest to the budding dental practitioner. The lesion was excised and the patient followed up without any evidence of malignant transformation. Prabhath Ramakrishnan, Vijay Sylvester, Prathima Sreenivasan, Janisha Vengalath, and Smruthi Valambath Copyright © 2014 Prabhath Ramakrishnan et al. All rights reserved. Expansion of Natural Killer Cells in Peripheral Blood in a Japanese Elderly with Human T-Cell Lymphotropic Virus Type 1-Related Skin Lesions Sun, 09 Nov 2014 12:20:11 +0000 http://www.hindawi.com/journals/cridm/2014/937513/ Natural killer (NK) cells were proposed to play an important role in the pathogenesis of human T-cell lymphotropic virus type 1- (HTLV-1-) associated neurologic disease. Our patient was a 77-year-old Japanese man, who had been treated for infective dermatitis associated with HTLV-1 for nearly 10 years. When referred to us, he had facial eczema/edema as well as extensive dermatitis at the neck/upper chest and nuchal area/upper back regions. Dermal lesions had CD3+CD4+ cells, but no NK cells. Flow cytometry of his peripheral blood showed a phenotype of CD2+ (97%), CD3+ (17%), CD4+ (12%), CD7+ (94%), CD8+ (6%), CD11c+ (70%), CD16+ (82%), CD19+ (0%), CD20+ (0%), CD56+ (67%), HLA-DR+ (68%), and NKp46+ (36%). Absolute numbers of CD56+NK cells in the peripheral blood were in a range of 986/μL–1,270/μL. The expanded NK cells in the peripheral blood are considered to be reactive, to maintain the confinement of the HTLV-1-positive CD4+ cells in the skin, and to prevent the progression of the disease. Shinsaku Imashuku, Naoko Kudo, Kagekatsu Kubo, and Kouichi Ohshima Copyright © 2014 Shinsaku Imashuku et al. All rights reserved. A Life Threatening Rash, an Unexpected Cause Sun, 09 Nov 2014 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2014/146251/ We describe a 74-year-old man with purpura fulminans and altered sensorium following an acute febrile illness. Intensive sepsis management was to no avail, until institution of doxycycline therapy following confirmation of scrub typhus. Empirical doxycycline needs to be considered in endemic areas for patients presenting with purpura fulminans. Dhiraj Jain, Stalin Viswanathan, and Chandramohan Ramasamy Copyright © 2014 Dhiraj Jain et al. All rights reserved. A Gigantic Anogenital Lesion: Buschke-Lowenstein Tumor Thu, 06 Nov 2014 08:46:31 +0000 http://www.hindawi.com/journals/cridm/2014/650714/ Buschke-Lowenstein tumor is a relatively rare sexually transmitted disease. It is a neoplasm of the anogenital region which has benign appearance on histopathology but is locally destructive. It carries a high recurrence rate and a significant potential for malignant transformation. Human papilloma virus has been implicated as an etiologic agent for this tumor. Since this disease is rare and no controlled studies exist, radical excision of this anogenital lesion is generally recommended as the first line therapy and close vigilance and followup are essential. We have discussed an overview of etiopathogenesis, clinical presentation, diagnosis, and management of this uncommonly encountered disease. Rikinder Sandhu, Zaw Min, and Nitin Bhanot Copyright © 2014 Rikinder Sandhu et al. All rights reserved. Majocchi’s Granuloma after Topical Corticosteroids Therapy Thu, 23 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2014/507176/ Majocchi’s granuloma (MG) is an unusual but not rare dermatophyte infection of dermal and subcutaneous tissues. Dermatophytes usually result in the infections of hair, epidermis, and nail, and are rarely involved in deep cutaneous and subcutaneous tissues. Now it is considered that MG includes two forms: one is a small perifollicular papular form and the other is a deep subcutaneous nodular form; the front one mainly occurs in healthy individuals and the latter one usually presents in immunocompromised hosts. The clinical manifestations of MG are many and varied, except the common presentations of erythema, papule and nodules, and Kaposi sarcoma-like and molluscum-like lesions have been reported in literatures (Kim et al. (2011), Bord et al. (2007), and Lillis et al. (2010)). This characteristic induces the difficulty of diagnosis, and thus it is so important and necessary to make direct microscopical and histological examinations. We describe a case of MG over the face in a patient who had been treated with topical corticosteroids over a long time. Fu-qiu Li, Sha Lv, and Jian-xin Xia Copyright © 2014 Fu-qiu Li et al. All rights reserved. Granulomatous Cheilitis: Successful Treatment of Two Recalcitrant Cases with Combination Drug Therapy Wed, 15 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2014/509262/ Granulomatous cheilitis is a rare, idiopathic, inflammatory disorder which usually affects young adults. It is characterized by persistent, diffuse, nontender, soft-to-firm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up. Ambika Gupta and Harneet Singh Copyright © 2014 Ambika Gupta and Harneet Singh. All rights reserved. Crusted Demodicosis in an Immunocompetent Pediatric Patient Sun, 12 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2014/458046/ Demodicosis refers to the infestation by Demodex spp., a saprophytic mite of the pilosebaceous unit. Demodex proliferation can result in a number of cutaneous disorders including pustular folliculitis, pityriasis folliculorum, papulopustular, and granulomatous rosacea, among others. We report the case of a 7-year-old female presenting with pruritic grayish crusted lesions over her nose and cheeks, along with facial erythema, papules, and pustules. The father referred chronic use of topical steroids. A potassium hydroxide mount of a pustule scraping revealed several D. folliculorum mites. Oral ivermectin (200 μg/kg, single dose) plus topical permethrin 5% lotion applied for 3 consecutive nights were administered. Oral ivermectin was repeated every week and oral erythromycin plus topical metronidazole cream was added. The facial lesions greatly improved within the following 3 months. While infestation of the pilosebaceous unit by Demodex folliculorum mites is common, only few individuals present symptoms. Demodicosis can present as pruritic papules, pustules, plaques, and granulomatous facial lesions. To our knowledge, this is the first reported case of facial crusted demodicosis in an immunocompetent child. The development of symptoms in this patient could be secondary to local immunosuppression caused by the chronic use of topical steroids. Guillermo Antonio Guerrero-González, Maira Elizabeth Herz-Ruelas, Minerva Gómez-Flores, and Jorge Ocampo-Candiani Copyright © 2014 Guillermo Antonio Guerrero-González et al. All rights reserved. Iatrogenic Anetoderma of Prematurity: A Case Report and Review of the Literature Wed, 08 Oct 2014 08:43:13 +0000 http://www.hindawi.com/journals/cridm/2014/781493/ Anetoderma is a skin disorder characterized by focal loss of elastic tissue in the mid dermis, resulting in localized areas of macular depressions or pouchlike herniations of skin. An iatrogenic form of anetoderma has been rarely described in extremely premature infants and has been related to the placement of monitoring devices on the patient skin. Because of the increasing survival of extremely premature infants, it is easy to foresee that the prevalence of anetoderma of prematurity will increase in the next future. Although it is a benign lesion, it persists over time and can lead to significant aesthetic damage with need for surgical correction. Sometimes the diagnosis can be difficult, especially when the atrophic lesions become evident after discharge. Here, we report on a premature infant born at 24 weeks of gestation, who developed multiple anetodermic patches of skin on the trunk at the sites where electrocardiographic electrodes were previously applied. The knowledge of the disease can encourage a more careful management of the skin of extremely premature babies and aid the physicians to diagnose the disease when anetoderma patches are first encountered later in childhood. Laura Maffeis, Lorenza Pugni, Carlo Pietrasanta, Andrea Ronchi, Monica Fumagalli, Carlo Gelmetti, and Fabio Mosca Copyright © 2014 Laura Maffeis et al. All rights reserved. Relapsing Polychondritis Tue, 30 Sep 2014 11:49:53 +0000 http://www.hindawi.com/journals/cridm/2014/791951/ Relapsing polychondritis (RP) is a rare systemic disease characterized by recurrent, widespread chondritis of the auricular, nasal, and tracheal cartilages. Additional clinical features include audiovestibular dysfunction, ocular inflammation, vasculitis, myocarditis, and nonerosive arthritis. Although the cause remains unknown, the etiology is suspected to be autoimmune. We describe a case of a 31-year-old woman with a four-month history of bilateral auricular and nasal chondritis. Infectious and neoplastic diseases were excluded by imaging and laboratory examinations. RP was diagnosed based on three McAdam’s criteria. The patient was medicated with oral prednisolone and methotrexate with positive clinical response. In this case clinical history and detailed physical examination were fundamental in concluding the correct diagnosis and administrating the appropriate medication. Beata Sosada, Katarzyna Loza, and Ewelina Bialo-Wojcicka Copyright © 2014 Beata Sosada et al. All rights reserved. Pemphigus Vulgaris Presented with Cheilitis Thu, 25 Sep 2014 13:05:58 +0000 http://www.hindawi.com/journals/cridm/2014/147197/ Background. Pemphigus vulgaris is an autoimmune blistering disease affecting the mucous membrane and skin. In 50 to 70% of cases, the initial manifestations of pemphigus vulgaris are oral lesions which may be followed by skin lesions. But it is unusual for the disease to present with initial and solitary persistent lower lip lesions without progression to any other location. Main Observations. We report a 41-year-old woman with dry crusted lesions only on the lower lip, clinically resembling actinic cheilitis and erosive lichen planus, but histopathological evaluation showed unexpected results of suprabasal acantholysis and cleft compatible with pemphigus vulgaris. We treated her with intralesional triamcinolone 10 mg/mL for 2 sessions and 2 g cellcept daily. Patient showed excellent response and lesions resolved completely within 2 months. In one-year follow-up, there was no evidence of relapse or any additional lesion on the other sites. Conclusion. Cheilitis may be the initial and sole manifestation of pemphigus vulgaris. Localized and solitary lesions of pemphigus vulgaris can be treated and controlled without systemic corticosteroids. Zaheer Abbas, Zahra Safaie Naraghi, and Elham Behrangi Copyright © 2014 Zaheer Abbas et al. All rights reserved. A Case of Onychomycosis Caused by Rhodotorula glutinis Thu, 25 Sep 2014 06:50:18 +0000 http://www.hindawi.com/journals/cridm/2014/563261/ Rhodotorula spp. have emerged as opportunistic pathogens, particularly in immunocompromised patients. The current study reports a case of onychomycosis caused by Rhodotorula glutinis in a 74-year-old immunocompetent female. The causative agent was identified as R. glutinis based on the pinkish-orange color; mucoid-appearing yeast colonies on Sabouraud Dextrose Agar at 25°C; morphological evaluation in the Corn Meal-Tween 80 agar; observed oval/round budding yeast at 25°C for 72 hours; no observed pseudohyphae; positive urease activity at 25°C for 4 days; and assimilation features detected by API ID 32C kit and automated Vitek Yeast Biochemical Card 2 system. Antifungal susceptibility test results were as follows: amphotericin B (MIC = 0.5 µg/mL), fluconazole (MIC = 128 µg/mL), itraconazole (MIC = 0.125 µg/mL), voriconazole (MIC = 1 µg/mL), posaconazole (MIC = 0.5 µg/mL), anidulafungin (MIC = 0.5 µg/mL), and caspofungin (MIC = 16 µg/mL). Antifungal therapy was initiated with oral itraconazole at a dose of 400 mg/day; seven-day pulse therapy was planned at intervals of three weeks. Clinical recovery was observed in the clinical evaluation of the patient before the start of the third cure. Although R. glutinis has rarely been reported as the causative agent of onychomycosis, it should be considered. Hatice Uludag Altun, Tuba Meral, Emel Turk Aribas, Canan Gorpelioglu, and Nilgun Karabicak Copyright © 2014 Hatice Uludag Altun et al. All rights reserved. Dermatofibroma Arising within a Black Tattoo Tue, 23 Sep 2014 06:57:56 +0000 http://www.hindawi.com/journals/cridm/2014/745304/ Many complications have been reported over tattoos, some of which are tumours, such as dermatofibromas. It is important to establish a differential diagnosis because they can resemble other malignant lesions as dermatofibrosarcoma protuberans. We report the development of a dermatofibroma in a 21-year-old man with a tattoo painted two years ago. Alejandro Lobato-Berezo, Micaela Churruca-Grijelmo, Marcela Martínez-Pérez, Adrián Imbernón-Moya, María Elena Vargas-Laguna, Eva Fernández-Cogolludo, Antonio Aguilar-Martínez, and Miguel Ángel Gallego-Valdés Copyright © 2014 Alejandro Lobato-Berezo et al. All rights reserved. Acute Methotrexate Toxicity: A Fatal Condition in Two Cases of Psoriasis Mon, 08 Sep 2014 09:48:52 +0000 http://www.hindawi.com/journals/cridm/2014/946716/ We describe two fatal cases of low dose methotrexate (MTX) toxicity in patients with psoriasis, emphasizing the factors that exacerbate MTX toxicity. The first patient was a 50-year-old male of psoriasis on intermittent treatment with MTX. After a treatment-free period of six months, he had self-medication of MTX along with analgesic for joint pain for one week which followed ulceration of the lesions, bone marrow suppression, and eventually death. The second patient was a 37-year-old male of psoriasis, who has taken MTX one week earlier without prior investigations. He had painful ulcerated skin lesions and bone marrow suppression. On investigations, he showed high creatinine level and atrophied, nonfunctioning right kidney on ultrasonography. In spite of dialysis, he succumbed to death. MTX is safe and effective if monitored properly, but inadvertent use may lead to even death also. Prior workup and proper counseling regarding the drug interactions as well as self-medication should be enforced. Pankti Jariwala, Vinay Kumar, Khyati Kothari, Sejal Thakkar, and Dipak Dayabhai Umrigar Copyright © 2014 Pankti Jariwala et al. All rights reserved. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty Wed, 03 Sep 2014 12:36:04 +0000 http://www.hindawi.com/journals/cridm/2014/768624/ Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time. Maira Elizabeth Herz-Ruelas, Minerva Gómez-Flores, Joaquín Moxica-del Angel, Ivett Miranda-Maldonado, Ilse Marilú Gutiérrez-Villarreal, Guillermo Antonio Guerrero-González, and Adriana Orelia Villarreal-Rodríguez Copyright © 2014 Maira Elizabeth Herz-Ruelas et al. All rights reserved. Seborrheic Pemphigoid Mon, 18 Aug 2014 06:29:38 +0000 http://www.hindawi.com/journals/cridm/2014/768217/ Seborrheic pemphigoid (SP), first described in 1969 by Schnyder, is a peculiar variant of BP which clinically resembles pemphigus erythematosus, since it is characterized by ruptured bullae and erosions covered with crusts involving the seborrheic areas. To the best of our knowledge, from the first description only four other cases of SP have been reported, of which two are in the English literature. We report an additional case of SP in a 56-year-old man with cervical spondylogenic myelopathy with very impaired mobility. Enzo Errichetti, Giuseppe Stinco, Enrico Pegolo, Nicola di Meo, Giusto Trevisan, and Pasquale Patrone Copyright © 2014 Enzo Errichetti et al. All rights reserved. Miliary Osteoma Cutis: A Case Report Sun, 10 Aug 2014 13:27:34 +0000 http://www.hindawi.com/journals/cridm/2014/347829/ The authors present a rare case of osteoma cutis miliaris and briefly update the current knowledge about its clinic, pathogenesis, and therapeutic options. Felipe Aguinaga, Beatriz Trope, Juan Piñeiro-Maceira, and Marcia Ramos-e-Silva Copyright © 2014 Felipe Aguinaga et al. All rights reserved. Postural Hypotension Associated with Nonelastic Pantyhose during Lymphedema Treatment Sun, 06 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2014/536126/ The case of a 72-year-old female patient with elephantiasis is reported. The patient was submitted to two surgeries to remove the edema. After surgery, the leg again evolved to elephantiasis and eventually she was referred to the Clinica Godoy for clinical treatment. Intensive treatment was carried out (6 to 8 hours per day) and the patient lost more than 70% of the limb volume within one week. After this loss, the volume was maintained using grosgrain compression pantyhose for 24 hours per day. During the return appointment, the patient suffered from systemic hypotension (a drop of more than 30 mmHg within three minutes) while she was standing after removing the stocking. A further investigation showed that the symptoms only appeared when the stocking was worn for 24 hours. Thus, the patient was advised to use the stocking only during the day thereby avoiding the symptoms of hypotension. Jose Maria Pereira de Godoy, Daniel Zucchi Libanore, and Maria de Fatima Guerreiro Godoy Copyright © 2014 Jose Maria Pereira de Godoy et al. All rights reserved. Familial Kaposi’s Sarcoma: A Report of Five Cases from Greece Sun, 29 Jun 2014 11:00:25 +0000 http://www.hindawi.com/journals/cridm/2014/671631/ Introduction. Familial cases of Kaposi’s sarcoma have rarely been reported. Kaposi’s sarcoma is not uncommon in Greece; its incidence is estimated at 0.20 per 100.000 habitants, showing an increased predominance in the Peloponnese, in Southern Greece. Case Report. We describe five cases of familial clustering of KS originating from Greece. Discussion. The pathogenesis of familial Kaposi’s sarcoma is still far from being completely understood. Genetic, environmental, and infectious factors have been incriminated. Kalliopi Armyra, Anargyros Kouris, Arsinoi Xanthinaki, Alexandros Stratigos, and Irene Potouridou Copyright © 2014 Kalliopi Armyra et al. All rights reserved. Facial and Periorbital Cellulitis due to Skin Peeling with Jet Stream by an Unauthorized Person Wed, 16 Apr 2014 13:42:09 +0000 http://www.hindawi.com/journals/cridm/2014/529153/ Technologies and devices for cosmetic procedures are developing with each passing day. However, increased and unauthorized use of such emerging technologies may also lead to increases in unexpected results and complications as well. Here, we report a case of facial cellulitis after a “beauty parlor” session of skin cleaning with jet stream peeling device in 19-year old female patient for the first time. Complications due to improper and unauthorized use of jet stream peeling devices may also cause doubts about the safety and impair the reputation of the technology as well. In order to avoid irreversible complications, local authorities should follow the technology and update the regulations where the dermatologists should take an active role. Asli Feride Kaptanoglu, Didem Mullaaziz, and Kaya Suer Copyright © 2014 Asli Feride Kaptanoglu et al. All rights reserved. Xanthoma Disseminatum with Tumor-Like Lesion on Face Thu, 10 Apr 2014 06:46:08 +0000 http://www.hindawi.com/journals/cridm/2014/621798/ Xanthoma disseminatum (XD) is a rare benign mucocutaneous xanthomatosis that is classified as a benign non-Langerhans cell histiocytosis. We report a 62-year-old man who presented with widespread yellow-brown papulonodular and tumoral lesions on face, flexors, and trunk. Histopathological features of the cutaneous lesions were typical of XD. Habib Ansarin, Hoda Berenji Ardestani, Seyed Mehdi Tabaie, and Nasrin Shayanfar Copyright © 2014 Habib Ansarin et al. All rights reserved. Subcutaneous Histiocytoid Sweet Syndrome Associated with Crohn Disease in an Adolescent Wed, 26 Mar 2014 09:16:27 +0000 http://www.hindawi.com/journals/cridm/2014/954254/ We report a case of subcutaneous histiocytoid Sweet syndrome in an adolescent with Crohn disease. A 14-year-old boy with a 1-year history of ileocolonic and perianal Crohn disease, treated with infliximab and azathioprine, was admitted to the Pediatrics Department with malaise, abdominal pain, bloody diarrhea, and fever (39°C) from 15 days ago. Two days later, he developed cutaneous lesions consisting of tender, erythematous, and violaceous papules and nodules scattered over his legs, soles, and upper extremities. Laboratory studies revealed neutrophilia, microcytic anemia, and elevation of both erythrocyte sedimentation rate and C-reactive protein rate. A skin biopsy specimen showed deep dermal and predominantly septal inflammatory infiltrate in the subcutaneous tissue composed of polymorphonuclears, eosinophils, and mononuclear cells of histiocytic appearance. These histiocytoid cells stained positive for myeloperoxidase. Subcutaneous Sweet syndrome is a rare subtype of acute neutrophilic dermatosis, in which the infiltrate is exclusively or predominantly located in the subcutaneous tissue, causing lobular or septal panniculitis. It is often described in patients with an underlying haematological disorder or caused by drugs, but very rare in patients with inflammatory bowel disease, especially in childhood or adolescence. To our knowledge, this is the first case of subcutaneous histiocytoid type in a paediatric patient. Rosa María Fernández-Torres, Susana Castro, Ana Moreno, Roberto Álvarez, and Eduardo Fonseca Copyright © 2014 Rosa María Fernández-Torres et al. All rights reserved. Methylprednisolone Therapy in Acute Hemorrhagic Edema of Infancy Wed, 05 Mar 2014 13:29:48 +0000 http://www.hindawi.com/journals/cridm/2014/853038/ We present a case of an 18-month-old boy who showed severe clinical signs indicative of acute hemorrhagic edema of infancy (AHEI) with painful purpuric skin affection primarily of the face and marked edema of the ears. The histological findings were diagnostic for leukocytoclastic vasculitis and thus met the histological criteria for AHEI. Indicative of infection as causative agent for the condition were symptoms of gastroenteritis. High-dose intravenous corticosteroids led to a fast resolution of symptoms and normalization of laboratory parameters. AHEI is usually not described as being very responsive to corticosteroids. The case presented here indicates that severe cases of AHEI can be treated with high-dose intravenous corticosteroids resulting in significant relief and shortening of the symptoms. Clinical followup showed no underlying malignancy or other severe chronic systemic diseases thus confirming earlier reports that AHEI is not associated with such conditions. The differential diagnoses with AHEI are discussed. Jeyanthini Risikesan, Uffe Koppelhus, Torben Steiniche, Mette Deleuran, and Troels Herlin Copyright © 2014 Jeyanthini Risikesan et al. All rights reserved. Squamous Cell Carcinoma Developing in a Cutaneous Lichen Planus Lesion: A Rare Case Tue, 04 Mar 2014 08:39:01 +0000 http://www.hindawi.com/journals/cridm/2014/205638/ Lichen planus is a benign disorder characterized by an itchy, noninfectious skin rash. Though lichen planus is a common papulosquamous disorder affecting about 1-2% of the population, neoplastic transformation of cutaneous lichen planus lesions occurs very rarely and should be borne in mind while treating nonhealing longstanding lesions of lichen planus. Studies suggest an estimated 0.3–3% risk of malignancy in patients with oral lichen planus, however, cutaneous lichen planus does not carry an increased risk of malignant degeneration. We present a case of a 36-year-old male with a 10-year-long history of hypertrophic lichen planus who presented with a nonhealing ulcer in the left popliteal fossa. The patient underwent wide local excision with superficial skin grafting. Postoperative histopathological examination revealed verrucous squamous cell carcinoma complicating lichen planus. In view of underlying structure involvement, adjuvant radiation therapy was given. This case is being reported to emphasize the infrequent possibility of development of malignancy in cutaneous lichen planus, especially if it presents as a longstanding, nonhealing, itchy lesion with patchy areas of depigmentation in the lower limbs. Saptarshi Ghosh, Sivasankar Kotne, P. B. Ananda Rao, S. P. V. Turlapati, and Dillip Kumar Soren Copyright © 2014 Saptarshi Ghosh et al. All rights reserved. Bilateral Paget’s Disease of the Breast—Case Report of Long-Time Misdiagnosed Tumors with Underlying Ductal Carcinomas and Review of the Literature Mon, 03 Mar 2014 11:57:17 +0000 http://www.hindawi.com/journals/cridm/2014/152836/ Paget’s disease of the breast is often misdiagnosed. We report on a 72-year old patient with a history of 2.5 years without any malignant findings, followed by the identification of a bilateral Paget’s disease with bilateral breast cancers. This case underlines how important histological examinations even in unusual clinical pictures are. Dietrich Barth Copyright © 2014 Dietrich Barth. All rights reserved. Granuloma Caused by Carbon Deposition in the Dermis Thu, 20 Feb 2014 07:57:37 +0000 http://www.hindawi.com/journals/cridm/2014/686489/ Pencil core granuloma is characterized by a delayed foreign-body reaction against retained fragments of pencil lead. Previous case reports presented pencil core granuloma resembling malignant melanoma, haemangioma, or soft tissue sarcoma. We present a case of pencil core granuloma arising from the palm 25 years after the initial injury. The patient presented a bluish nodule that had been present over 25 years before. The nodule initially measured 5 mm in diameter. However, five years before presentation, it suddenly enlarged to the size of 30 mm during six months. Computed tomography (CT) of the lesion revealed a linear radiopaque structure of 8 mm long with a mass on its distal end. Surgical resection revealed a bluish muddy mass and pencil lead. Histological examination revealed degenerative tissue with calcification surrounded by massive amounts of black granular material in the middle and lower dermis. Rintaro Shibuya, Yuichiro Endo, Akihiro Fujisawa, Miki Tanioka, and Yoshiki Miyachi Copyright © 2014 Rintaro Shibuya et al. All rights reserved. Drug Reaction with Eosinophilia and Systemic Symptoms: DRESS following Initiation of Oxcarbazepine with Elevated Human Herpesvirus-6 Titer Wed, 12 Feb 2014 14:26:18 +0000 http://www.hindawi.com/journals/cridm/2014/853281/ Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal severe cutaneous reaction, which has a delayed onset after the initiation of an inciting medication. After recognition and withdrawal of the causative agent, along with aggressive management, a majority of patients will have complete recovery over several months. We present a rare case of DRESS secondary to oxcarbazepine with an elevated human herpesvirus-6 titer. Seth L. Cornell, Daniel DiBlasi, and Navin S. Arora Copyright © 2014 Seth L. Cornell et al. All rights reserved. Cutaneous Plasmacytosis with Perineural Involvement Thu, 06 Feb 2014 16:10:34 +0000 http://www.hindawi.com/journals/cridm/2014/840845/ Importance. Cutaneous and systemic plasmacytosis are rare conditions of unknown etiology with characteristic red-brown skin lesions and a mature polyclonal plasma cell infiltrate within the dermis. Perineural plasma cell infiltrates may be a histologic clue to the diagnosis of cutaneous plasmacytosis. Observations. Our patient had a five-year history of persistent reddish-brown plaques on the neck and trunk without systemic symptoms. Histologic examination showed dermal perivascular and perineural plasma cells with excess lambda light chain expression. Due to decreased quality of life caused by his skin lesions, he was placed on a chemotherapeutic regimen with bortezomib. Conclusions and Relevance. The patient was diagnosed with cutaneous plasmacytosis based on classic histopathology results with a recently characterized pattern of perineural involvement. Bortezomib therapy was initiated to manage his skin eruption, which has not been previously described as a treatment for this chronic condition. Elizabeth A. Brezinski, Maxwell A. Fung, and Nasim Fazel Copyright © 2014 Elizabeth A. Brezinski et al. All rights reserved. Dyschromatosis Symmetrica Hereditaria of Late Onset? Tue, 04 Feb 2014 14:05:50 +0000 http://www.hindawi.com/journals/cridm/2014/639537/ Dyschromatosis symmetrica hereditaria (DSH), also known as reticulated acropigmentation of Dohi, is an autosomal dominant disease with high penetrance, characterized by hypo- and hyperpigmented macules of varying sizes on the dorsal of the extremities with reticulated pattern. This paper presents a female patient with typical dermatological lesions, but only diagnosed in adulthood. It is necessary to perform differential diagnosis with other pigmentary disorders. This entity is not very common in South America, and the vast majority of cases were described in Japanese population. Since it is a benign disease, it is important to be aware of this diagnosis in order to establish the correct conduct for these patients. Caroline Balvedi Gaiewski, Sergio Zuneda Serafini, Betina Werner, and Janyana M. D. Deonizio Copyright © 2014 Caroline Balvedi Gaiewski et al. All rights reserved.