Case Reports in Dermatological Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Pulmonary Tuberculosis and Lepromatous Leprosy Coinfection Sun, 04 Oct 2015 12:30:56 +0000 Simultaneous occurrence of leprosy and pulmonary tuberculosis is reported infrequently in the modern era. We report a case of pulmonary tuberculosis diagnosed in patient being treated with glucocorticoids for complications of leprosy (type II reaction). Physicians should recognize that the leprosy patients treated with glucocorticoid may develop tuberculosis. F. A. Sendrasoa, I. M. Ranaivo, O. Raharolahy, M. Andrianarison, L. S. Ramarozatovo, and F. Rapelanoro Rabenja Copyright © 2015 F. A. Sendrasoa et al. All rights reserved. Omalizumab for Urticarial Vasculitis: Case Report and Review of the Literature Tue, 08 Sep 2015 11:52:46 +0000 Urticarial vasculitis is characterised by inflamed itching or burning red patches or wheals that resemble urticaria but persist for greater than 24 hours. It is often idiopathic but is sometimes associated with collagen-vascular disease, particularly systemic lupus erythematosus. Treatment options include oral antihistamines, oral corticosteroids, dapsone, colchicine or hydroxychloroquine. We describe a male patient with urticarial vasculitis who was treated with omalizumab (anti-IgE) with convincing results and provide a review of previous reports of patients with urticarial vasculitis treated with omalizumab. Misbah Nasheela Ghazanfar and Simon Francis Thomsen Copyright © 2015 Misbah Nasheela Ghazanfar and Simon Francis Thomsen. All rights reserved. Reconstruction of a Large Anterior Ear Defect after Mohs Micrographic Surgery with a Cartilage Graft and Postauricular Revolving Door Flap Thu, 03 Sep 2015 11:25:24 +0000 A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm2 of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection. Stephanie Nemir, Lindsey Hunter-Ellul, Vlad Codrea, and Richard Wagner Copyright © 2015 Stephanie Nemir et al. All rights reserved. Buschke-Löwenstein Tumour: Successful Treatment with Minimally Invasive Techniques Mon, 31 Aug 2015 08:30:06 +0000 We report a case of an 80-year-old female who presented with a four-year history of a growing mass in the perianal area with pain and bleeding during defaecation. Clinical examination revealed a locally destructive, cauliflower-like, verrucous mass measuring 10 12 cm in diameter. Histologic findings revealed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis, features that are consistent with Buschke-Löwenstein tumour. Polymerase-chain-reaction assay for human papillomavirus (HPV) showed an infection with HPV type 11. Full-thickness excision of involved skin was undertaken by cryotherapy and electrocautery over five months. The entire wound was left open to heal by secondary intention. After 3 years of follow-up, the patient has not experienced a recurrence, with excellent functional results, but the cosmetic results were satisfactory. These minimally invasive techniques can be safer and more cost-effective than surgery and the General Practitioner can play a key role in diagnosis. Estefânia Correia and António Santos Copyright © 2015 Estefânia Correia and António Santos. All rights reserved. Methotrexate Treatment in Children with Febrile Ulceronecrotic Mucha-Habermann Disease: Case Report and Literature Review Thu, 27 Aug 2015 13:23:35 +0000 Febrile Ulceronecrotic Mucha-Habermann disease is a rare and potentially fatal variant of pityriasis lichenoides et varioliformis acuta and is characterized by high fever, constitutional symptoms, and acute oncet of ulceronecrotic lesions. We present an 11-year-old male with Febrile Ulceronecrotic Mucha-Habermann disease who was cured with methotrexate and review the use of methotrexate for this disorder in the pediatric age group with the relevant literature. Isil Bulur, Hilal Kaya Erdoğan, Zeynep Nurhan Saracoglu, and Deniz Arık Copyright © 2015 Isil Bulur et al. All rights reserved. Case of Rapid Progression of Hemiatrophy on the Face: A New Clinical Entity? Tue, 25 Aug 2015 10:59:01 +0000 A lot of diseases, including lupus profundus, morphea, lipodystrophy, and Parry-Romberg syndrome, may manifest progressive hemifacial atrophy. These diseases usually progress slowly and rapid progression of atrophy is extremely rare. We report a case of elderly-onset rapid progression of hemifacial atrophy only in three weeks. Our case did not meet variable differential diagnoses. We discuss the clinical character of the patient against the past of literature and suppose it may be a new clinical entity. Hisashi Nomura, Shohei Egami, Tomoaki Yokoyama, and Makoto Sugiura Copyright © 2015 Hisashi Nomura et al. All rights reserved. Lymphatic Malformation, Retinoblastoma, or Facial Cleft: Atypical Presentations of PHACE Syndrome Sun, 28 Jun 2015 11:39:52 +0000 PHACE syndrome is a neurocutaneous disorder characterized by large cervicofacial infantile hemangiomas and associated anomalies: posterior fossa brain malformation, hemangioma, arterial cerebrovascular anomalies, coarctation of the aorta and cardiac defects, and eye/endocrine abnormalities of the brain. When ventral developmental defects (sternal clefting or supraumbilical raphe) are present the condition is termed PHACE. In this report, we describe three PHACE cases that presented unique features (affecting one of the organ systems described for this syndrome) that have not been described previously. In the first case, a definitive PHACE association, the patient presented with an ipsilateral mesenteric lymphatic malformation, at the age of 14 years. In the second case, an anomaly of the posterior segment of the eye, not mentioned before in PHACE literature, a retinoblastoma, has been described. Specific chemotherapy avoided enucleation. And, in the third case, the child presented with an unusual midline frontal bone cleft, corresponding to Tessier 14 cleft. Two patients’ hemangiomas responded well to propranolol therapy. The first one was followed and treated in the pre-propranolol era and had a moderate response to corticoids and interferon. María Fernández-Ibieta and Juan Carlos López-Gutiérrez Copyright © 2015 María Fernández-Ibieta and Juan Carlos López-Gutiérrez. All rights reserved. Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease Mon, 15 Jun 2015 07:07:42 +0000 Fox-Fordyce Disease (FFD) is a rare, chronic, pruritic, inflammatory disorder of apocrine glands. It is characterized by dome-shaped, firm, discrete, skin-colored, and monomorphic perifollicular papules. The most common sites of involvement are axillae and anogenital and periareolar regions which are rich in apocrine sweat glands. Treatment is difficult. Topical, intralesional steroids, topical tretinoin, adapalene, clindamycin, benzoyl peroxide, oral contraceptives, isotretinoin, phototherapy, electrocauterisation, excision-liposuction and curettage, and fractional carbon dioxide laser are among the treatment options. In the literature, there are articles reporting beneficial effects of pimecrolimus in FFD. Nevertheless, there have not been any reports about the use of tacrolimus in FFD. We report two patients diagnosed with FFD by clinical and histopathologic examination and discussed therapeutic effects of topical tacrolimus on FFD in the light of literature. Hilal Kaya Erdoğan, Işıl Bulur, and Zeliha Kaya Copyright © 2015 Hilal Kaya Erdoğan et al. All rights reserved. Subcutaneous Emphysema Induced by Cryotherapy: A Complication due to Previous Punctures Wed, 10 Jun 2015 12:51:39 +0000 Cryosurgery is a common therapeutic modality used in dermatology; therefore we must be aware of its possible adverse effects. We report a case of a patient with subcutaneous emphysema which occurred following the application of cryotherapy after multiple punctures of local anesthetic and intralesional steroids in a chest keloid scar. Despite the fact that this condition was gradually resolved after expectant observation, we warn about this complication when sprayed cryotherapy is preceded by multiple punctures on cutaneous lesions above bony surfaces. In similar settings, cryotherapy must be first administered or a cotton-tip applicator should be used. Jared Martínez-Coronado, Bertha Torres-Álvarez, and Juan Pablo Castanedo-Cázares Copyright © 2015 Jared Martínez-Coronado et al. All rights reserved. Staphylococcal Scalded Skin Syndrome in Neonate Mon, 08 Jun 2015 08:12:13 +0000 We described a case of Staphylococcal Scalded Skin Syndrome in infant age of 21 days by discussing clinical and management issues. This newborn presented large erythematous, eroded, and oozing areas covered by epidermal skin flap. The average surface of cutaneous unsticking on admission was 31.35% of body surface area corresponding to lesions of superficial second-degree burns. An important biological inflammatory syndrome including positive C-reactive protein was found. Under treatment, erythroderma decreased within 7 to 10 days and the newborn was completely healed after 3 weeks of followup, with the disappearance of the inflammatory syndrome and total body surface restored. This clinical case report showed that SSSS remains a major dermatological problem in neonates. Therefore, its diagnosis should be made without doubt and its care should start earlier in a neonate emergency unit in order to have good prognosis. And the rigorous “search and destroy” policy based on screening of staff and patients and isolation of identified patients advocated in the United Kingdom should be applied in neonate units in Côte d’Ivoire. K. Kouakou, M. E. Dainguy, and K. Kassi Copyright © 2015 K. Kouakou et al. All rights reserved. Paget Disease of the Vulva: Diagnosis by Immunohistochemistry Tue, 28 Apr 2015 08:11:56 +0000 The objective of this paper is to report a case of extramammary Paget disease of the vulva, to describe its diagnosis, surgical treatment, and outcome, and to discuss the general characteristics of this pathology. This is a rare neoplasm, found principally in areas in which apocrine and eccrine glands are numerous. This case report is relevant to the literature since the differential diagnosis of extramammary Paget disease is difficult to be done only with the macroscopic appearance of the lesion and even with the microscopic characteristics, requiring further studies, immunohistochemistry, as to differentiate pathologies. The present report describes the case of a 63-year-old patient at the Santa Casa de Misericórdia Hospital in Vitória, Espírito Santo, Brazil, who presented with a hardened, ulcerated, and purplish lesion with hyperchromic and hypochromic spots, measuring 4 cm in diameter, located on the lower third of right labium majus, close to the vaginal fourchette. A right hemivulvectomy was performed, leaving wide margins all around. The patient progressed satisfactorily following surgery. Although extramammary Paget disease is rare, its incidence increases as a function of the patient’s age. Patients should be followed up closely because of the risk of persistence and/or recurrence of the disease. Andressa Gonçalves Amorim, Brunelle Batista Fraga Mendes, Rodrigo Neves Ferreira, and Antônio Chambô Filho Copyright © 2015 Andressa Gonçalves Amorim et al. All rights reserved. Two Basal Cell Carcinomas of the Axillae: A Metastasis or an Independent Development? Sun, 15 Mar 2015 11:28:46 +0000 Cutaneous basal cell carcinoma (BCC) is a common malignancy amongst the elderly. BCC rarely metastasises, and fewer than 300 cases of metastatic BCC have been reported in the literature. Here, we report a case of sequentially developed BCCs located adjacent to each other. We discuss that these BCCs were considered to have developed independently rather than due to metastasis, after referencing previous studies on metastatic BCC. Yuichiro Endo and Yoshiki Miyachi Copyright © 2015 Yuichiro Endo and Yoshiki Miyachi. All rights reserved. Perianal Median Raphe Cyst: A Rare Lesion with Unusual Histology and Localization Sun, 22 Feb 2015 07:37:15 +0000 Median raphe cysts present anywhere between the external urethral meatus and the anus. The cysts can occur at parameatus, glans penis, penile shaft, scrotum, or perineum. Perianal region is an extremely rare location for these lesions. Here we present a 50-year-old male patient who presented with a cystic, fluctuant lesion, located at 12 o’clock in perianal region. Microscopic examination revealed a cystic lesion with keratinized and nonkeratinized stratified squamous epithelium, pseudostratified ciliated epithelium, and scattered goblet cells. The final diagnosis of the lesion was median raphe cyst. Ciliated cells and perianal localization in median raphe cysts are extremely rare characteristics. Betül Ünal, Cumhur İbrahim Başsorgun, Meryem İlkay Eren Karanis, and Gülsüm Özlem Elpek Copyright © 2015 Betül Ünal et al. All rights reserved. Etanercept-Induced Pityriasis Lichenoides Chronica in a Patient with Rheumatoid Arthritis Wed, 18 Feb 2015 11:56:54 +0000 We present a 74-year-old female patient who developed a pityriasis lichenoides chronica (PLC) during etanercept therapy. This association is not described in the literature and might be considered in the spectrum of cutaneous adverse reactions of etanercept. Andrés F. Echeverri, Andrés Vidal, Carlos A. Cañas, Andrés Agualimpia, Gabriel J. Tobón, and Fabio Bonilla-Abadía Copyright © 2015 Andrés F. Echeverri et al. All rights reserved. A Case of Recalcitrant Plantar Warts Associated with Statin Use Wed, 18 Feb 2015 09:47:06 +0000 Background. Plantar warts are a common presenting skin complaint caused by the human papillomavirus. 1st line therapies include cryotherapy and topical salicylic acid. Where there is resistance to these treatments, consideration is made for 2nd line therapies, including intralesional bleomycin, imiquimod, 5-fluorouracil, and photodynamic therapy. We present a case of bilateral persistent plantar warts, resistant to treatment with repeated cryotherapy and topical salicylic acid over a 6-year period. Following a patient initiated decision to discontinue their statin medication, we observed rapid clearance of plantar warts without change to standard therapy or their environment. This case correlates with emerging literature demonstrating a link between statin medication and proliferation of HPV through increased levels of FOXP3+ regulatory T cells. Aaron G. Wernham and Shireen S. Velangi Copyright © 2015 Aaron G. Wernham and Shireen S. Velangi. All rights reserved. Mixed Cutaneous Infection Caused by Mycobacterium szulgai and Mycobacterium intermedium in a Healthy Adult Female: A Rare Case Report Wed, 18 Feb 2015 09:18:14 +0000 Nontuberculous mycobacteria (NTMs) are ubiquitous and are being increasingly reported as human opportunistic infection. Cutaneous infection caused by mixed NTM is extremely rare. We encountered the case of a 46-year-old female, who presented with multiple discharging sinuses over the lower anterior abdominal wall (over a previous appendectomy scar) for the past 2 years. Microscopy and culture of the pus discharge were done to isolate and identify the etiological agent. Finally, GenoType Mycobacterium CM/AS assay proved it to be a mixed infection caused by Mycobacterium szulgai and M. intermedium. The patient was advised a combination of rifampicin 600 mg once daily, ethambutol 600 mg once daily, and clarithromycin 500 mg twice daily to be taken along with periodic follow-up based upon clinical response as well as microbiological response. We emphasize that infections by NTM must be considered in the etiology of nonhealing wounds or sinuses, especially at postsurgical sites. Amresh Kumar Singh, Rungmei S. K. Marak, Anand Kumar Maurya, Manaswini Das, Vijaya Lakshmi Nag, and Tapan N. Dhole Copyright © 2015 Amresh Kumar Singh et al. All rights reserved. Unilateral Oral Mucous Membrane Pemphigoid: Refractory Atypical Presentation Successfully Treated with Intravenous Immunoglobulins Sun, 15 Feb 2015 06:48:51 +0000 A 57-year-old male presented with a 6-month history of blisters and painful erosions on the right buccal mucosa. No skin or other mucosal involvement was seen. The findings of histopathological and direct immunofluorescence examinations were sufficient for the diagnosis of oral mucous membrane pemphigoid in the context of adequate clinical correlation. No response was seen after topical therapies and oral corticosteroids or dapsone. Intravenous immunoglobulin was started and repeated every three weeks. Complete remission was achieved after three cycles and no recurrence was seen after two years of follow-up. The authors report a rare unilateral presentation of oral mucous membrane pemphigoid on the right buccal and hard palate mucosa, without additional involvement during a period of five years. Local trauma or autoimmune factors are possible etiologic factors for this rare disorder, here with unique presentation. André Laureano and Jorge Cardoso Copyright © 2015 André Laureano and Jorge Cardoso. All rights reserved. Harmful Effects of Synthetic Surface-Active Detergents against Atopic Dermatitis Thu, 15 Jan 2015 06:21:03 +0000 We report herein two cases of intractable atopic dermatitis successfully treated by simply avoiding the contact with surface-active detergents in the daily life and living. The detergents were closely related to the exacerbation and remission of the disease. Steroid ointment was no longer used. We discuss that the removal of horny layer lipids by surface-active detergents accelerates the transepidermal water loss and disturbs the barrier function of the epidermis and thus is intimately involved in the pathogenesis of atopic dermatitis. Hajime Deguchi, Riho Aoyama, Hideaki Takahashi, Yoshinari Isobe, and Yutaka Tsutsumi Copyright © 2015 Hajime Deguchi et al. All rights reserved. Acquired Brachial Cutaneous Dyschromatosis in a 60-Year-Old Male: A Case Report and Review of the Literature Wed, 31 Dec 2014 08:43:29 +0000 Acquired brachial cutaneous dyschromatosis is an acquired pigmentary disorder that has been described in only 20 patients but likely affects many more. This case of a man with acquired brachial cutaneous dyschromatosis is unique as most reports are in women. We report the case of a 60-year-old male who presents with an asymptomatic eruption characterized by hyperpigmented and telangiectatic macules coalescing into patches on the bilateral extensor aspects of the forearms which is consistent clinically and histopathologically with acquired brachial cutaneous dyschromatosis. Given its presence in patients with clinical evidence of chronic sun exposure and its histopathological finding of solar elastosis, acquired brachial cutaneous dyschromatosis is likely a disorder caused by cumulative UV damage. However, a possible association between angiotensin-converting enzyme inhibitors and acquired brachial cutaneous dyschromatosis exists. Further investigation is needed to elucidate both the pathogenesis of the disorder and forms of effective management. Treatment of the disorder should begin with current established treatments for disorders of dyspigmentation. Nadia Abidi, Kristen Foering, and Joya Sahu Copyright © 2014 Nadia Abidi et al. All rights reserved. Angioedema due to Systemic Isotretinoin Therapy Tue, 23 Dec 2014 00:10:07 +0000 Angioedema is the swelling of the mucosal membranes as a variant of urticaria induced by hereditary C1 esterase inhibitor enzyme deficiency, certain foods, or drugs. Herein, we report the case of a 23-year-old woman, with mild-moderate acne presenting with widespread facial angioedema on the 2nd day of systemic isotretinoin treatment. The patient had taken no drugs other than isotretinoin in the preceding days and had no known food allergy. Her angioedema was resolved after the isotretinoin was discontinued. We want to draw the attention of dermatologists to this rare adverse allergic effect of isotretinoin which is frequently used in the treatment of acne vulgaris. Pelin Üstüner Copyright © 2014 Pelin Üstüner. All rights reserved. Paraneoplastic Dermatomyositis with Carcinoma Cervix: A Rare Clinical Association Thu, 18 Dec 2014 00:10:34 +0000 Dermatomyositis is an uncommon inflammatory myopathy associated with cutaneous manifestations. It may also occur as paraneoplastic syndrome associated with various malignancies, most common of which being lung, breast, stomach, rectum, kidney, or testicular cancer. A postmenopausal woman presented to us with generalized itching along with skin rash and proximal muscle weakness of 2 years’ duration. Examination revealed heliotrope rash and mechanic hands and muscle power 2/5 in proximal muscle groups of both upper and lower limbs. A clinical diagnosis of dermatomyositis was made which was supported by raised lactate dehydrogenase levels and skin biopsy findings. Past history was significant for vaginal discharge and bleeding per vagina. Further work-up revealed carcinoma cervix and she was referred to oncology department for further management. Temporal relationship and improvement of muscle weakness with treatment of underlying neoplasm supported its paraneoplastic nature. So, final diagnosis of keratinizing squamous cell carcinoma of cervix with paraneoplastic dermatomyositis was made. A nationwide cohort study of 1,012 patients with dermatomyositis in Taiwan revealed only 3 patients with cervical cancer. So this case is being reported for its rare association with carcinoma cervix and to highlight the need of detailed evaluation for underlying malignancies in patients with dermatomyositis. Sumir Kumar, B. B. Mahajan, Sandeep Kaur, and Amarbir Singh Copyright © 2014 Sumir Kumar et al. All rights reserved. A Case of Apparent Contact Dermatitis Caused by Toxocara Infection Tue, 16 Dec 2014 12:58:06 +0000 Infection from Toxocara species may give rise to a large array of clinical symptoms, including apparent manifestations of allergy such as asthma, urticaria/angioedema, and dermatitis. We report a case, thus far not described, of contact dermatitis attributed to nickel allergy but caused by Toxocara infection. The patient was a 53-year-old woman presenting from 10 years a dermatitis affecting head, neck, and thorax. Patch tests initially performed gave a positive result to nickel, but avoidance of contact with nickel did not result in recovery. The patient referred to our Allergy Service in 2010 because of dermatitis to feet. Patch testing confirmed the positive result for nickel, but expanding the investigation a positive result for IgG antibodies to Toxocara was detected by Western blotting and ELISA. Treatment with mebendazole achieved immediate efficacy on feet dermatitis. Then, two courses of treatment with albendazole resulted in complete regression of dermatitis accompanied by development of negative ELISA and Western blotting for Toxocara antibodies. This report adds another misleading presentation of Toxocara infection as apparent contact dermatitis caused by nickel and suggests bearing in mind, in cases of contact dermatitis not responding to avoidance of the responsible hapten and to medical treatment, the possible causative role of Toxocara. Rosanna Qualizza, Eleni Makrì, Laura Losappio, and Cristoforo Incorvaia Copyright © 2014 Rosanna Qualizza et al. All rights reserved. Successful Treatment of Disseminated Subcutaneous Panniculitis-Like T-Cell Lymphoma with Single Agent Oral Cyclosporine as a First Line Therapy Sun, 23 Nov 2014 08:11:47 +0000 Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare cutaneous neoplasm of mature cytotoxic T-cells. Currently there are no standardized therapies for SPTL; however good responses have been seen with chemotherapy regimens generally employed for B-cell lymphomas. Cyclosporine, an immunosuppressant, has shown good responses in relapsed/refractory SPTL; however its use in first line setting is not well established. We, herein, describe a 22-year-old girl with disseminated SPTL who attained complete clinical remission with single agent oral cyclosporine used as a first line therapy. Nida Iqbal and Vinod Raina Copyright © 2014 Nida Iqbal and Vinod Raina. All rights reserved. Vascular Malformation and Common Keratinocytic Nevus of the Soft Type: Phacomatosis Pigmentovascularis Revisited Sun, 23 Nov 2014 00:00:00 +0000 Phacomatosis pigmentovascularis is a rare syndrome characterized by the coexistence of a pigmented nevus and a cutaneous vascular malformation. We report a 5-year-old boy with all the typical findings of phacomatosis pigmentovascularis type Ia. Although its existence according to the traditional classification has been questioned, this case represents a very rare association of a capillary vascular malformation and a common keratinocytic nevus of the soft type. André Laureano, Rodrigo Carvalho, Cristina Amaro, Isabel Freitas, and Jorge Cardoso Copyright © 2014 André Laureano et al. All rights reserved. Diffuse Cutaneous Mucinosis in Dermatomyositis: A Case Report and Review of the Literature Tue, 18 Nov 2014 00:00:00 +0000 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 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 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 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 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 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.