Case Reports in Dermatological Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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. Topical Pimecrolimus as a New Optional Treatment in Cutaneous Sarcoidosis of Lichenoid Type Mon, 03 Feb 2014 08:44:55 +0000 http://www.hindawi.com/journals/cridm/2014/976851/ We report the case of cutaneous sarcoidosis of lichenoid type successfully treated with pimecrolimus. For the first time in the literature, we propose the use of this topical calcineurin inhibitor for the treatment of the cases refractory to common therapy regimens. Antonella Tammaro, Claudia Abruzzese, Alessandra Narcisi, Giorgia Cortesi, Francesca Romana Parisella, Pier Paolo Di Russo, Gabriella De Marco, and Severino Persechino Copyright © 2014 Antonella Tammaro et al. All rights reserved. Reactivation of Cutaneous Leishmaniasis after Renal Transplantation: A Case Report Thu, 16 Jan 2014 08:32:06 +0000 http://www.hindawi.com/journals/cridm/2014/251423/ A 45-year-old man with reactivation of previously existing and subsiding cutaneous leishmaniasis on his wrist and lower leg (shin) after renal transplantation was admitted to our dermatology service on March 2008. He presented to us with two huge tumoral and cauliflower-like lesions. Skin smear and histopathology of skin showed leishman bodies and confirmed the diagnosis. After renal transplantation, he received cyclosporine plus prednisolone to induce immunosuppression and reduce the probability of transplant rejection. After immunosuppressive therapy, reactivation of cutaneous leishmaniasis with the above presentation took place. The patient responded to 800 mg/day intravenous sodium stibogluconate for 3 weeks plus local cryotherapy. Systemic plus local therapy along with reducing the doses of immunosuppressive drugs led to improvement of lesions. Reactivation of leishmaniasis after immunosuppression has been rarely reported. Hossein Mortazavi, Mehrnaz Salehi, and Kambiz Kamyab Copyright © 2014 Hossein Mortazavi et al. All rights reserved. Circumscribed Morphea and Breast Asymmetry in an Adolescent Wed, 08 Jan 2014 14:03:35 +0000 http://www.hindawi.com/journals/cridm/2014/418257/ Morphea is a rare fibrosing disorder of the skin and underlying tissues. Circumscribed morphea presents with less than three discrete indurated plaques and breasts are commonly affected in women. We report the case of a 12-year-old female with a right infra-areolar, nontender, brownish patch and asymmetry of the right breast with 2 years of evolution. Skin biopsy showing thickening of the dermal collagen bundles confirmed the clinical diagnosis of morphea. After a 3-year follow-up period without progression of disease, reconstructive surgery is scheduled. Plaque morphea can involve all layers of the skin but associated breast deformity is rare. It can mimic benign and malignant breast disorders justifying the benefit for early tissue biopsy. Breast morphea generally has a good prognosis but hyperpigmentation and breast deformity in young girls have been rarely described. An early diagnosis can possibly lead to a therapeutic intervention with a different outcome, as it can be the source of severe psychological and social issues in a delicate period of development such as adolescence. António Augusto Fernandes Massa, Armando Manuel Simões Baptista, António Manuel Ferreira da Silva Abreu Couceiro, and Eduarda Macedo Osório Morais Ferreira Copyright © 2014 António Augusto Fernandes Massa et al. All rights reserved. Exophytic Parietal Skin Metastases of Renal Cell Carcinoma Thu, 26 Dec 2013 15:03:27 +0000 http://www.hindawi.com/journals/cridm/2013/196016/ The common sites for metastasis of renal cell carcinoma are lung, kidney, adrenal glands, liver, and contralateral kidney. We report an unusual case of cutaneous metastasis of renal cell carcinoma in a 68-year-old woman who was treated for renal cell carcinoma with partial right nephrectomy and multikinase angiogenesis inhibitor (sunitinib) 10 years ago. Karim Kassam, Elizabeth Tiong, Ezra Nigar, and Mahesh Kumar Copyright © 2013 Karim Kassam et al. All rights reserved. Vulvar and Perianal Condyloma Superimposed Inflammatory Linear Verrucous Epidermal Nevus: A Case Report and Review of the Literature Tue, 17 Dec 2013 08:37:22 +0000 http://www.hindawi.com/journals/cridm/2013/261574/ Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma characterized by intensely erythematous, pruritic, and inflammatory papules that occur as linear bands along the lines of Blaschko. There is a considerable clinical and histological resemblance between ILVEN and linear psoriasis, lichen striatus, linear lichen planus, and invasion of epidermal nevus by psoriasis. The pathogenesis of ILVEN is unknown. It is regarded as a genetic dyskeratotic disease reflecting genetic mosaicism. Here, a case of vulvar and perianal condyloma superimposed ILVEN is presented. Sümeyra Nergız Avcioğlu, Sündüz Özlem Altinkaya, Mert Küçük, Hasan Yüksel, Selda Demircan-Sezer, and Gonca Uçar Copyright © 2013 Sümeyra Nergiz Avcioğlu et al. All rights reserved. Acquired Vulvar Lymphangioma Circumscriptum Mon, 16 Dec 2013 14:13:17 +0000 http://www.hindawi.com/journals/cridm/2013/967890/ Lymphangioma circumscriptum (LC) is a benign dilation of lymph channels localized to the skin and subcutaneous tissues. It is generally localized in mouth mucosa, tongue, proximal regions of arms and legs, groin, axilla, and trunk. Primary vulvar involvement is very rare. Vulvar involvement occurs in various clinical settings. Here, two uncommon cases with giant lymphangioma circumscriptum mimicking genital warts will be presented: a 55-year-old female patient with extensive lymphangiectasic lesions and genital wart-like papular lesions in the vulva secondary to diffuse scrofuloderma scars and a 60-year-old female patient with verruca-like lesions secondary to chronic inflammation. Derya Uçmak, Sema Aytekin, Bilal Sula, Zeynep Meltem Akkurt, Gül Türkçü, and Elif Ağaçayak Copyright © 2013 Derya Uçmak et al. All rights reserved. Eruptive Condyloma Accuminata after Initiation of Infliximab Treatment for Folliculitis Decalvans Wed, 04 Dec 2013 14:46:01 +0000 http://www.hindawi.com/journals/cridm/2013/762035/ We report a patient with recalcitrant folliculitis decalvans who was placed on infliximab due to failure to respond to numerous immunosuppressive drugs and antibiotics. After the second infusion of infliximab the patient reported a cutaneous eruption to the bilateral groin, penis, scrotum, perineum, and perianal region consistent with genital warts. The case highlights the need to inquire about a past or current history of genital or anal warts prior to the initiation of anti-TNF therapy, particularly with infliximab. If present, consideration should be given to concurrent antiwart therapy. Douglas C. Wu and Thomas G. Salopek Copyright © 2013 Douglas C. Wu and Thomas G. Salopek. All rights reserved. Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient Thu, 28 Nov 2013 15:55:29 +0000 http://www.hindawi.com/journals/cridm/2013/793127/ Opportunistic infections following immunosuppression in solid organ transplant (SOT) patients are common complications with the skin being a common sight of infection. Nontuberculous mycobacteria (NTM) are rare but potential causes of skin infection in SOT patients. We present a case of an adult male immunosuppressed following renal transplantation who presented with an asymptomatic rash for several months. The patient’s skin eruption consisted of erythematous papules and plaques coalescing into an annular formation. After failure of the initial empiric therapy, a punch biopsy was performed that demonstrated nerve involvement suspicious for Mycobacterium leprae. However, culture of the biopsy specimen grew acid-fast bacilli that were subsequently identified as M. haemophilum. His rash improved after a prolonged course of clarithromycin and ciprofloxacin. Both organisms are potential causes of opportunistic skin infections and can be difficult to distinguish with similar predilection for skin and other biochemical and genetic similarities. Ultimately they can be distinguished with culture as M. haemophilum will grow in culture and M. leprae will not. This case was unique due to nerve involvement on biopsy which is classically seen on biopsies of leprosy. Nathanial K. Copeland, Navin S. Arora, and Tomas M. Ferguson Copyright © 2013 Nathanial K. Copeland et al. All rights reserved. Secondary Merkel Cell Carcinoma Manifested in the Parotid Wed, 27 Nov 2013 10:40:38 +0000 http://www.hindawi.com/journals/cridm/2013/960140/ Background. Merkel cell carcinoma of the head and neck is a rare and aggressive malignant tumour. Both the dermatological and surgical colleagues should be aware of this entity as lesions usually present on sun exposed areas of the skin such as the head and neck. Main Observation and Treatment. A 69-year-old male originally presented to the maxillofacial surgery department with a growing lesion on the left eyebrow. Histological analysis confirmed Merkel cell carcinoma and consequently surgical excision was carried out. A follow-up PET/CT scan 2 years later demonstrated a hotspot in the left parotid gland. Fine needle aspiration and cytology revealed Merkel cell carcinoma. A subtotal parotidectomy left side with ipsilateral selective neck dissection levels I to III was carried out. Conclusions. Potential secondary Merkel cell carcinoma in the head and neck region should be taken into account when planning short- and long-term follow up for previously diagnosed patients. This followup should involve both dermatological and surgical colleagues. M. Basati, K. Kassam, and A. Messiha Copyright © 2013 M. Basati et al. All rights reserved. Management of Extramammary Paget's Disease: A Case Report and Review of the Literature Thu, 14 Nov 2013 15:36:51 +0000 http://www.hindawi.com/journals/cridm/2013/436390/ Extramammary Paget's Disease (EMPD) is a rare condition of the skin that often involves the vulva, perianal region, scrotum, penis, and axilla. Although prognosis is generally favorable, it can be associated with neoplasms of the bladder, urethra, prostate, and rectum. This report presents a case of scrotal EMPD that failed treatment with imiquimod 5% cream and discusses benefits and complications of available treatment options. The variation of treatment success emphasizes the importance of further research. Rosa Guerra and Subhasis Misra Copyright © 2013 Rosa Guerra and Subhasis Misra. All rights reserved. Porokeratotic Eccrine Ostial and Dermal Duct Nevus Mon, 04 Nov 2013 08:35:57 +0000 http://www.hindawi.com/journals/cridm/2013/953840/ PEODDN is a rare benign cutaneous disorder that clinically resembles comedo nevus but favors the palms and soles, where pilosebaceous follicles are absent. Widespread involvement along Blaschko’s lines can also occur. It is a disorder of keratinization involving the intraepidermal eccrine duct (acrosyringium) and is characterized by eccrine hamartoma and cornoid lamellation in pathology. The patient is a 29-year-old man with an 8-year history of pruritic skin lesions on his right lateral ankle. In the pathologic examination, multiple small epidermal invagination with overlying parakeratotic cornoid lamellation, loss of granular layer, and few dyskeratotic cells at the base of epidermal invagination are revealed. After clinic-pathologic correlation, the diagnosis of porokeratotic eccrine ostial and dermal duct nevus (PEODDN) was made. Late-onset and rare clinical presentation as pruritic lesion are the characteristic features that make this patient an extraordinary presentation of PEODDN. Mona Masoumeh Naraghi, Azita Nikoo, and Azadeh Goodarzi Copyright © 2013 Mona Masoumeh Naraghi et al. All rights reserved. A Case of Almost Painless Herpes Zoster Presenting with Symptoms of Cystitis, Penile Numbness, and Acute Vestibular Failure Tue, 22 Oct 2013 14:17:59 +0000 http://www.hindawi.com/journals/cridm/2013/738579/ Herpes zoster (shingles) is an acute, painful, vesicular, and cutaneous eruption caused by varicella zoster virus, the same virus which causes chicken pox. It is due to the reactivation of the virus which remains dormant in sensory ganglions following chicken pox. It is usually confined to a single dermatome but may involve 2-3 dermatomes. Typically, it is a unilateral lesion which can affect both cranial and peripheral nerves. It is usually a self-limiting disease; however, it may cause significant morbidity especially in the elderly. It is more common in older people and individuals with immunocompromised conditions. Antiviral drugs can shorten the duration and the severity of the illness and need to be started as soon as possible after the appearance of the rash. Gabapentin and tricyclic antidepressant are effective in postherpetic neuralgia. Vaccine can reduce the risk of infection and its associated pain. Typically, it occurs once in a lifetime, but some individuals may have more than one episode. Hussain Al-Sardar Copyright © 2013 Hussain Al-Sardar. All rights reserved. Unusual Clinical Presentation of Cutaneous Angiosarcoma Masquerading as Eczema: A Case Report and Review of the Literature Mon, 07 Oct 2013 17:35:16 +0000 http://www.hindawi.com/journals/cridm/2013/906426/ An unusual case of cutaneous angiosarcoma clinically mimicking eczema is described. A 98-year-old Caucasian male presented with a 6-month history of a flesh-colored, subcutaneous nodule on his left forehead with contralateral facial erythema and scaling that had been previously diagnosed as eczema. Despite treatments with topical steroids and moisturizers, the condition did not resolve. At our clinic, excisional biopsy of the forehead lesion and scouting biopsies from the contralateral cheek were performed which revealed cutaneous angiosarcoma. The described case illustrates that dermatitis-like features should be considered as a rare clinical manifestation of cutaneous angiosarcoma. It also demonstrates that these lesions may respond well to radiotherapy as a single modality. Nhat Q. Trinh, Issra Rashed, Kelli A. Hutchens, Aileen Go, Edward Melian, and Rebecca Tung Copyright © 2013 Nhat Q. Trinh et al. All rights reserved. Ehlers-Danlos Syndrome Type VIII: A Rare Cause of Leg Ulcers in Young Patients Thu, 03 Oct 2013 18:22:17 +0000 http://www.hindawi.com/journals/cridm/2013/469505/ Ehlers-Danlos syndrome type VIII (EDS-VIII) is a very rare autosomal dominant disease characterized by early-onset periodontitis associated with features of Ehlers-Danlos syndrome. We report a 32-year-old man whose chronic leg ulcer led to the diagnosis of EDS-VIII. He had severe periodontitis with complete loss of permanent teeth and skin fragility with thin skin, atrophic scars, and brownish atrophic pretibial plaques. Leg ulcer is not a prominent feature of EDS-VIII. We suggest adding EDS-VIII to the list of rare diseases accounting for chronic leg ulcers, if this case report prompts others to report leg ulcers associated with EDS-VIII. Sophie Ronceray, Juliette Miquel, Antoine Lucas, Gérald E. Piérard, Trinh Hermanns-Lê, Anne De Paepe, and Alain Dupuy Copyright © 2013 Sophie Ronceray et al. All rights reserved. Puffy Hand Syndrome Revealed by a Severe Staphylococcal Skin Infection Wed, 02 Oct 2013 18:52:39 +0000 http://www.hindawi.com/journals/cridm/2013/376060/ Puffy hand syndrome develops after long-term intravenous drug addiction. It is characterized by a nonpitting edema, affecting the dorsal side of fingers and hands with puffy aspect. Frequency and severity of the complications of this syndrome are rarely reported. Local infectious complications such as cellulitis can be severe and can enable the diagnosis. Herein, we report the case of a 41-year-old man who went to the emergency department for abdominal pain, fever, and bullous lesions of legs and arms with edema. Bacteriologic examination of a closed bullous lesion evidenced a methicillin sensitive Staphylococcus aureus. The abdomen computed tomography excluded deep infections and peritoneal effusion. The patient was successfully treated by intravenous oxacillin and clindamycin. He had a previous history of intravenous heroin addiction. We retained the diagnosis of puffy hand syndrome revealed by a severe staphylococcal infection with toxic involvement mimicking a four limbs cellulitis. Puffy hand syndrome, apart from the chronic lymphedema treatment, has no specific medication available. Prophylactic measures against skin infections are essential. Reyhan Amode, Paul Bilan, Carole Sin, Anaïs Marchal, Michèle-Léa Sigal, and Emmanuel Mahé Copyright © 2013 Reyhan Amode et al. All rights reserved. Pruritic Vesicular Eruption on the Lower Legs in a Diabetic Female Tue, 01 Oct 2013 15:17:37 +0000 http://www.hindawi.com/journals/cridm/2013/641416/ A 50-year-old diabetic female presented with highly pruritic vesicles and excoriated lesions over the anterior aspect of both lower legs. The lesions were recurrent over the last two years. She received a lot of medications with partial response. Hb A1c was 10.8% (normal up to 7%). CBC showed microcytic, hypochromic anemia. Serum zinc, folate, IgE, TSH and T4 were all within normal ranges. Biopsy showed epidermal separation secondary to keratinocyte necrosis and minimal monocytic, perivascular infiltrate. Direct immunofluorescence was negative for intraepidermal and subepidremal deposition of immunoglobulin. The dermis was positive for mucin deposition stainable by both PAS and Alcian blue while it was negative for Congo red and APC immunoperoxidase staining for amyloid material. In conclusion, the case was diagnosed as bullosis diabeticorum by distinctive clinical and pathological features and after exclusion of other possible differentials. Pruritus was partially controlled by topical potent steroid and the case was resolved spontaneously after eight months. Hassan Riad, Hamda Al Ansari, Khaled Mansour, Haya Al Mannai, Hussein Al Sada, Samya Abu Shaikha, and Sharifa Al Dosari Copyright © 2013 Hassan Riad et al. All rights reserved.