Case Reports in Dermatological Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Nodular Fasciitis Complicating a Staged Surgical Excision of Dermatofibrosarcoma Protuberans Sun, 27 Nov 2016 12:43:51 +0000 http://www.hindawi.com/journals/cridm/2016/6074182/ Dermatofibrosarcoma protuberans (DFSP) is an unusual spindle cell tumor with a high rate of local recurrence with traditional excision. Fortunately, Mohs micrographic surgery yields excellent cure rates for this neoplasm due to contiguous tumor spread and meticulous tumor mapping and margin analysis. We present the unique case of a patient treated with a modified Mohs technique with an analysis of the final margin with permanent sections, who developed a spindle cell neoplasm in the margins of her second stage excision consistent with nodular fasciitis. Distinguishing residual DFSP from a benign reactive process was an essential and challenging component of this patient’s management. C. Helen Malone, Brandon Goodwin, Richard F. Wagner, Vicente Resto, and Brent Kelly Copyright © 2016 C. Helen Malone et al. All rights reserved. Evolution of Skin during Rehabilitation for Elephantiasis Using Intensive Treatment Thu, 24 Nov 2016 07:54:31 +0000 http://www.hindawi.com/journals/cridm/2016/4305910/ The objective of this study is to describe the evolution of the skin during rehabilitation for elephantiasis using intensive treatment. We report on the case of a 55-year-old patient with a seven-year history of leg edema. The patient reported that it began with repeated outbreaks of erysipelas over several years. One leg evolved with significant edema leading to an inability to ambulate and for about one month the patient said that he could not get out of bed. Moreover the patient was obese weighing 130 kilos and with a BMI of 39. Intensive treatment was performed over three weeks resulting in a significant reduction in limb volume. The treatment consisted of Mechanical Lymphatic Therapy (RAGodoy), Cervical Lymphatic Stimulation (Godoy & Godoy technique), and a custom-made inelastic stocking of a grosgrain textile. What caught the attention during therapy were the open wounds resulting from fragmentation of the plaque as the edema reduced; the plaque was about 0.5 cm thick. As the treatment evolved the plaque disappeared and the wounds healed. The limb size decreased by more than 80% in three weeks after which the patient began to be treated in an outpatient setting with ambulation using a grosgrain stocking. Henrique Jose Pereira de Godoy, Ricardo Budtinger Filho, Maria de Fatima Guerreiro Godoy, and José Maria Pereira de Godoy Copyright © 2016 Henrique Jose Pereira de Godoy et al. All rights reserved. Clinical Manifestation, Histopathology, and Imaging of Traumatic Injuries Caused by Brazilian Porcupine (Sphiggurus villosus) Quills Thu, 17 Nov 2016 11:54:39 +0000 http://www.hindawi.com/journals/cridm/2016/7851986/ Injuries to humans caused by porcupines are rare. However, they may occur due to the proximity of urban areas and the animal’s habitat in areas such as the Floresta da Tijuca in Rio de Janeiro. Outdoor sports and leisure activities in areas close to forests or in the rain forest are also relevant for incidents of this kind and a better knowledge of the local forest fauna would prevent such undesirable accidents. Porcupine quills have microscopic barbs at their tips which facilitate skin penetration, but hampering their removal. Once the spines are lodged in tissue, the microscopic backward-facing deployable barbs at the tips cause trauma if anyone tries to remove them. Local haemorrhage and an inflammatory response to the contaminated foreign body occur. Depending on the time lapse in removing the spines either septic or sterile foreign body reactions may occur. There is also the risk of migration of the spines, where fatal cases have been reported in human and veterinary medicine. Herein we report two unusual cases of accidents involving humans and the South American porcupine. The Sphiggurus villosus spines removed from scalp skin were also documented through Scanning Electron Microscopy. Lívia M. Araújo Jorge, Fred Bernardes Filho, Fabrício Lamy, Laila Klotz A. Balassiano, Loan Towersey, Roderick Hay, and Marco Andrey C. Frade Copyright © 2016 Lívia M. Araújo Jorge et al. All rights reserved. Effects of Cryolipolysis on Abdominal Adiposity Tue, 08 Nov 2016 13:48:27 +0000 http://www.hindawi.com/journals/cridm/2016/6052194/ Cryolipolysis is a noninvasive technique of localized fat reduction. Controlled cold exposure is performed in the selective destruction of fat cells. The aim of this study was to investigate the effects of cryolipolysis on adipocytes elimination through histological and sonographic analyses. This study reports the case of a 46-year-old female patient, with complaint of localized abdominal fat and in the preoperative period of abdominoplasty. The patient was submitted to a single 60-minute application of cryolipolysis, temperature of −5°C, on the hypogastrium area, 5 cm below the umbilicus. To study the effects of this treatment, ultrasound images taken before the session and 7, 15, 30, and 45 days after the therapy were analysed. After the abdominoplasty, parts of the treated and the untreated withdrawn abdominal tissues were evaluated macro- and microscopically. In ultrasound images, as well as in macroscopic and histological analyses, significant adipocytes destruction was detected, with consequent fat layer reduction and integrity of areas that were adjacent to the treated tissue. The presence of fibrosis observed during therapy and acknowledged through performed analyses encourages further studies to clarify such finding. Patricia Froes Meyer, Rodrigo Marcel Valentim da Silva, Glenda Oliveira, Maely Azevedo da Silva Tavares, Melyssa Lima Medeiros, Camila Procopio Andrada, and Luis Gonzaga de Araujo Neto Copyright © 2016 Patricia Froes Meyer et al. All rights reserved. Generational Expression of Muir-Torre Syndrome in a Canadian Family Sun, 16 Oct 2016 08:18:30 +0000 http://www.hindawi.com/journals/cridm/2016/1712527/ Muir-Torre syndrome (MTS) is a rare autosomal dominant inherited genodermatosis that is considered to be a phenotypic subtype of hereditary nonpolyposis colorectal cancer (HNPCC), commonly referred to as Lynch syndrome. We describe the clinical course of a 57-year-old female patient with MTS. She has a confirmed HMSH2 mutation. Recently she presented with two nodular lesions. Histologic examination confirmed these lesions to be sebaceous neoplasms. The patient has a history of endometrial and colorectal adenocarcinoma as well as several nonspecific sebaceous lesions throughout her life. She has a confirmed extensive family history of MTS with both male and female family members harbouring either HMLH1 or HSMH2 mutations. Affected relatives have presented at different ages throughout their lives with cutaneous neoplasms and visceral malignancies, including malignancies rarely associated with MTS. MTS presents a diagnostic challenge for clinicians. The case demonstrates that the management of MTS, a potentially underreported syndrome, requires a multiprofessional approach incorporating vigilance, screening, and expert knowledge for successful diagnosis and potentially improved prognosis for patients and their families. The case also demonstrates the varied heritability of MTS and prompts the question of how MTS is expressed in succeeding generations. Kaitlin Alexandra Vanderbeck, R. Gary Sibbald, and Nirosha Murugan Copyright © 2016 Kaitlin Alexandra Vanderbeck et al. All rights reserved. Sudden Appearance of Indurated Erythematous Plaques on a Man’s Face Thu, 15 Sep 2016 07:44:35 +0000 http://www.hindawi.com/journals/cridm/2016/5192689/ Rosacea fulminans (RF), previously known as pyoderma faciale, is a rare presentation of rosacea mostly seen in young women. RF is seen very rarely in men. We present below a case of a fifty-year-old male who presented with RF and was successfully treated with a combination of corticosteroids and isotretinoin. A. Carter, K. Viswanathan, and K. Shulman Copyright © 2016 A. Carter et al. All rights reserved. Unusual Localisation for Onychomatricoma on the 5th Toenail: A Case Report and Review of the Literature Wed, 13 Jul 2016 11:31:05 +0000 http://www.hindawi.com/journals/cridm/2016/1853495/ Onychomatricoma is a rare and benign tumour of the nail matrix but originates rarely from the ventral portion of the proximal nail fold. This tumour is characterised by fingerlike projections that invade the nail plate. This lesion, of unknown aetiology, is typically asymptomatic with slow progression. Localisation on the finger is the most frequently described. We report the case of a 68-year-old woman who has an onychomatricoma in an unusual location, the fifth toe of the left foot. Due to its clinical appearance, the tumour can be confused with and treated as onychomycosis. However, if it is resistant to an oral antifungal well behaved treatment, one must consider onychomatricoma diagnosis. A. Coutellier, I. Théate, and O. Vanhooteghem Copyright © 2016 A. Coutellier et al. All rights reserved. Mugwort-Mustard Allergy Syndrome due to Broccoli Consumption Wed, 13 Jul 2016 09:02:03 +0000 http://www.hindawi.com/journals/cridm/2016/8413767/ Pollen-food allergy syndrome (PFAS) is a relatively rare form of food allergy which develops in individuals who are sensitized to pollen. Tree pollens, especially birch pollen, frequently induce PFAS; however, the incidence of PFAS due to grass or weed pollens such as ragweed or mugwort is relatively rare. Mugwort-mustard allergy syndrome (MMAS) is an example of a PFAS in which individuals sensitized to mugwort may develop an allergy to mustard and experience severe reactions. We herein describe a case of MMAS due to broccoli consumption. Yuri Sugita, Teruhiko Makino, Megumi Mizawa, and Tadamichi Shimizu Copyright © 2016 Yuri Sugita et al. All rights reserved. Corrigendum to “Cutaneous Plasmacytosis with Perineural Involvement” Mon, 04 Jul 2016 08:21:40 +0000 http://www.hindawi.com/journals/cridm/2016/8614078/ Elizabeth A. Brezinski, Maxwell A. Fung, and Nasim Fazel Copyright © 2016 Elizabeth A. Brezinski et al. All rights reserved. A Challenging Giant Dermatofibrosarcoma Protuberans on the Face Wed, 29 Jun 2016 08:56:48 +0000 http://www.hindawi.com/journals/cridm/2016/5926307/ Dermatofibrosarcoma protuberans (DFSP) is a malignant fibrohistiocytic tumor that appears exclusively on the skin. It is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence but seldom metastasizes. It may rarely occur on the head and neck accounting for less than one percent of total head and neck malignancies. We present a man with a giant DFSP on the face. Oncological, functional, and aesthetic aspects are set forth. Gimena Castro Pérez, Cintia Arias, Paula Luna, Irene Sorín, and Luis Daniel Mazzuoccolo Copyright © 2016 Gimena Castro Pérez et al. All rights reserved. Idiopathic Sporadic Onychomadesis of Toenails Wed, 29 Jun 2016 08:27:40 +0000 http://www.hindawi.com/journals/cridm/2016/6451327/ Onychomadesis is a clinical sign of nail plate separation due to transient or permanent arrest of nail matrix activities. Onychomadesis can be considered as a severe form of Beau’s line. This condition usually occurs after trauma, causal diseases, or medications, yet it rarely occurs as an idiopathic condition. We report a case of a 38-year-old Thai female who developed recurrence onychomadesis in several toenails in the absence of predisposing factors or associated conditions. To the best of our knowledge, our patient is the first reported case of idiopathic onychomadesis limited to toenails. Poonkiat Suchonwanit and Sunatra Nitayavardhana Copyright © 2016 Poonkiat Suchonwanit and Sunatra Nitayavardhana. All rights reserved. Familial Pemphigus Vulgaris Occured in a Father and Son as the First Confirmed Cases Wed, 15 Jun 2016 10:34:37 +0000 http://www.hindawi.com/journals/cridm/2016/1653507/ Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes. Although there is some evidence pointing towards a genetic predisposition by some human leukocyte antigen (HLA) genes, familial occurrence of PV is very rare. Most of the familial PV cases so far reported have been in mother and daughter and in siblings. PV in father and son, as presented here, has not been reported in the literature before, except an unconfirmed report. The diagnosis of PV was established by histologic, cytologic studies and enzyme linked immunosorbent assay (ELISA) in Case and by ELISA and BIOCHIP indirect immunofluorescence test in Case . The son was responsive to moderate doses of methylprednisolone, with the treatment continuing with tapered doses. The father was in a subclinic condition; consequently, only close follow-up was recommended. HLA typing studies revealed identical HLA alleles of HLA-DR4 () and HLA- in both of our cases; this had been found to be associated with PV in prior studies. Familial occurrences of PV and related HLA genes indicate the importance of genetic predisposition. The first occurrence of confirmed familial PV in father and son is reported here. Ali Haydar Eskiocak, Birgul Ozkesici, and Soner Uzun Copyright © 2016 Ali Haydar Eskiocak et al. All rights reserved. Mutation in LEMD3 (Man1) Associated with Osteopoikilosis and Late-Onset Generalized Morphea: A New Buschke-Ollendorf Syndrome Variant Mon, 13 Jun 2016 09:36:20 +0000 http://www.hindawi.com/journals/cridm/2016/2483041/ Introduction. Buschke-Ollendorf syndrome (BOS) is an uncommon syndrome characterized by osteopoikilosis and other bone abnormalities, accompanied by skin lesions, most frequently connective tissue nevi. BOS is caused by mutations in the LEMD3 gene, which encodes the inner nuclear membrane protein Man1. We describe a unique case of osteopoikilosis associated with late-onset localized scleroderma and familial LEMD3 mutations. Case Report. A 72-year-old woman presented with adult-onset diffuse morphea and bullous skin lesions. Evaluation revealed multiple hyperostotic lesions (osteopoikilosis) suggestive of BOS. DNA sequencing identified a previously undescribed nonsense mutation (Trp621X) in the LEMD3 gene encoding Man1. Two additional family members were found to have osteopoikilosis and carry the same LEMD3 mutation. Conclusions and Relevance. We report a unique familial LEMD3 mutation in an individual with osteopoikilosis and late-onset morphea. We propose that this constellation represents a novel syndromic variant of BOS. Benjamin Korman, Jun Wei, Anne Laumann, Polly Ferguson, and John Varga Copyright © 2016 Benjamin Korman et al. All rights reserved. Focal Hyperhidrosis Associated with Recurrent Urinary Tract Infections Thu, 09 Jun 2016 11:24:45 +0000 http://www.hindawi.com/journals/cridm/2016/3842984/ Hyperhidrosis affects almost 3% of the population and is characterized by sweating that occurs in excess of that needed for normal thermoregulation. It can occur as a primary disease or secondary to underlying clinical conditions. Hyperhidrosis can stem from neurogenic sympathetic over activity involving normal eccrine glands. We report the interesting case of a 75-year-old male patient with a 6-month history of new onset secondary focal hyperhidrosis of buttocks, pelvis, and upper thighs. Each time his symptoms worsened he was found to have culture positive urine samples for Escherichia coli (E. coli). He underwent urological investigation and was found to have urethral strictures and cystitis. The hyperhidrosis improved each time his urinary tract infection (UTI) was treated with antibiotics and continued to remain stable with a course of prophylactic trimethoprim. We hypothesize that the patient’s urethral strictures led to inhibition in voiding which in turn increased the susceptibility to UTIs. Accumulation of urine and increased bladder pressure in turn raised sympathetic nerve discharge leading to excessive sweating. We recommend that a urine dip form part of the routine assessment of patients presenting with new onset focal hyperhidrosis of pelvis, buttocks, and upper thighs. Timely urological referral should be made for all male patients with recurrent UTI. To the authors’ knowledge, there have been no other reports of UTI-associated focal hyperhidrosis. Dina Ismail, Vidya Madhwapathi, and Evmorfia Ladoyanni Copyright © 2016 Dina Ismail et al. All rights reserved. Cutaneous Squamous Cell Carcinoma with Invasion through Ear Cartilage Mon, 16 May 2016 12:52:12 +0000 http://www.hindawi.com/journals/cridm/2016/9067428/ Cutaneous squamous cell carcinoma of the ear represents a high-risk tumor location with an increased risk of metastasis and local tissue invasion. However, it is uncommon for these cancers to invade through nearby cartilage. Cartilage invasion is facilitated by matrix metalloproteases, specifically collagenase 3. We present the unusual case of a 76-year-old man with an auricular squamous cell carcinoma that exhibited full-thickness perforation of the scapha cartilage. Permanent sections through the eroded cartilage confirmed tumor invasion extending to the posterior ear skin. Julie Boisen, C. Helen Malone, Brent Kelly, and Richard F. Wagner Jr. Copyright © 2016 Julie Boisen et al. All rights reserved. Paraneoplastic Pemphigus Associated with Follicular Dendritic Cell Tumor in the Mediastinum Mon, 11 Apr 2016 14:27:18 +0000 http://www.hindawi.com/journals/cridm/2016/6901539/ Paraneoplastic Pemphigus (PNP) is an autoimmune bullous disease characterized by severe stomatitis, polymorphous skin eruptions, and underlying neoplasms. Diagnosis of cutaneous paraneoplastic disorders requires high index of suspicion. We describe a patient with PNP associated with follicular dendritic cell (FDC) tumor in the mediastinum, a rare neoplasm originating from follicular dendritic cells. Its management requires identification of underlying malignancy and treatment of the same. Our patient showed remission of PNP upon excision of the tumor and remained disease-free for 8 years. Aparna Mullangath Prakasan, Anne Jennifer Prabhu, Kanmani Velarasan, Selvamani Backianathan, and Thomas Samuel Ram Copyright © 2016 Aparna Mullangath Prakasan et al. All rights reserved. A Case of Hereditary Leiomyomatosis and Renal Cell Carcinoma Wed, 06 Apr 2016 08:08:49 +0000 http://www.hindawi.com/journals/cridm/2016/3793986/ A 49-year-old lady presented with multiple recurring painful lesions over her thighs, arms, and back. Past medical history included a left sided nephrectomy for renal cell carcinoma and a hysterectomy for multiple uterine fibroids (leiomyomas). Histopathological examination revealed changes consistent with pilar leiomyomas. Gene mutation analysis confirmed a diagnosis of hereditary leiomyomatosis and renal cell carcinoma. Hereditary leiomyomatosis and renal cell carcinoma is an uncommon autosomal dominant condition characterised by the concurrent presentation of cutaneous and uterine leiomyomas. Renal cell carcinoma associated with this condition is more aggressive and a significant cause of mortality. Due to this association with potentially fatal renal cell carcinoma we felt that it was important to highlight this case with an update on pathophysiology and management. Sarah Mehrtens, David Veitch, Elizabeth Kulakov, and Conal M. Perrett Copyright © 2016 Sarah Mehrtens et al. All rights reserved. Confluent and Reticulated Papillomatosis of Gougerot-Carteaud on Black Skin: Two Observations Tue, 05 Apr 2016 12:47:51 +0000 http://www.hindawi.com/journals/cridm/2016/2507542/ Confluent and reticulated papillomatosis of Goujerot-Carteaud is a rare and benign skin disease characterized by flat papules taking a reticulated appearance. It is a skin disease of unknown etiology and nosology that is always discussed. This disease preferentially involves the chest and interscapular regions. It is a condition probably underdiagnosed in black skin because it generally simulates a pigmented tinea versicolor. This pathology withstands antifungal treatment but has a particular sensitivity to cyclines thus constituting a distinguishing criterion, useful for diagnosis which should be evoked in front of these reticulated confluent papules. Kouadio Celestin Ahogo, Patrice Ildevert Gbery, Vagamon Bamba, Yao Isidore Kouassi, Elidje Joseph Ecra, Kouame Alesandre Kouassi, and Ange Sylvain Allou Copyright © 2016 Kouadio Celestin Ahogo et al. All rights reserved. Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope Sun, 27 Mar 2016 08:50:28 +0000 http://www.hindawi.com/journals/cridm/2016/3121469/ Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results. Christos Bakoyiannis, Georgios Karaolanis, Nikolaos Patelis, Anastasios Maskanakis, Georgios Tsaples, Christos Klonaris, Sotirios Georgopoulos, and Theodoros Liakakos Copyright © 2016 Christos Bakoyiannis et al. All rights reserved. Acquired Localized Hypertrichosis Induced by Rivastigmine Thu, 17 Mar 2016 09:54:31 +0000 http://www.hindawi.com/journals/cridm/2016/7296572/ Hypertrichosis is the excessive hair growth in any area of the skin surface. Acquired localized hypertrichosis may be secondary to multiple causes and there is a secondary form due to several drugs, which is usually reversible with discontinuation of the causative agent. Rivastigmine is a reversible and competitive inhibitor of acetylcholinesterase and butyrylcholinesterase used for symptomatic treatment of Alzheimer dementia and Parkinson’s disease. It has an adequate safety profile and cutaneous side effects are unusual. Irritant contact dermatitis, allergic dermatitis, baboon syndrome, and cutaneous rash due to rivastigmine have been reported. We report on a Caucasian 80-year-old male with personal history of Alzheimer’s disease. The patient started therapy with oral rivastigmine one month prior to clinical presentation of localized hypertrichosis on both forearms. Norgalanthamine has been shown to promote hair growth activity via the proliferation of dermal papilla. Acetylcholinesterase inhibitors can induce hair growth. Adrian Imbernón-Moya, Sebastian Podlipnik, Fernando Burgos, Elena Vargas-Laguna, Antonio Aguilar-Martínez, Eva Fernández-Cogolludo, and Miguel Angel Gallego-Valdes Copyright © 2016 Adrian Imbernón-Moya et al. All rights reserved. A Case of Bullous Skin Disease Presenting with Odynophagia: A Diagnostic Challenge Mon, 14 Mar 2016 12:25:22 +0000 http://www.hindawi.com/journals/cridm/2016/2839104/ We report a case of Epidermolysis Bullosa Acquisita (EBA) that presented as a diagnostic challenge. A 60-year-old Qatari lady presented with odynophagia, oral ulceration, and weight loss. Multiple physicians investigated her for over 6 months with a multitude of tests and serial gastroscopies, all of which failed to reach a conclusive diagnosis. Only after referral to a dermatologist and full body examination was diagnosis finally achieved. After reviewing the literature, we provide a summary of EBA and highlight the importance of comprehensive clinical reviews in order to avoid unnecessary morbidity. G. Kravvas, D. Veitch, and C. M. Perrett Copyright © 2016 G. Kravvas et al. All rights reserved. Child Who Presented with Facial Hematohidrosis Compared with Published Cases Mon, 14 Mar 2016 09:55:18 +0000 http://www.hindawi.com/journals/cridm/2016/5095781/ Hematohidrosis is a rare condition in which an individual sweats blood from intact, unbroken skin. The aetiology of hematohidrosis is not clear, although various theories exist to explain such a phenomenon. The general consensus however in the literature relates the finding to dermal capillary blood vessels that rupture under extreme emotional or physical stress exuding blood through the skin. In this case report we disclose a case of 12-year-old girl who presented with unusual painless bleeding from her face, eye, and tear duct. The condition was investigated intensively during hospital admission for a cause, and no actual cause was speculated. The management mostly involved supportive care and medical advice. Ali Jafar and Ali Ahmad Copyright © 2016 Ali Jafar and Ali Ahmad. All rights reserved. Eleven Primary Melanomas, Colon Cancer, and Atypical Nevi in the Same Patient: A Case Report and Literature Review Sun, 28 Feb 2016 16:18:35 +0000 http://www.hindawi.com/journals/cridm/2016/3145986/ Background. As the incidence of cutaneous malignant melanoma increases in the Caucasian population, an increasing population of melanoma survivors is at risk of developing multiple primary melanomas (MPM) as well as secondary primary cancers. Objective. To present a case of a patient with atypical nevi, 11 primary melanomas over 33 years, and colon cancer and to review the literature on multiple primary melanomas, atypical nevi, and correlation of nonmelanoma cancers. Conclusion. The literature indicates that patients with MPM are not uncommon, although 11 primary melanomas are rarely described, that patients with MPM may have a better survival than patients with single primary melanoma, that atypical nevi are a risk marker of not only melanoma in general but also MPM, and that melanoma patients have a significantly increased risk of developing nonmelanoma skin and other cancers, which may be even higher for patients with MPM. Lea Juul Nielsen and Lisbet Rosenkrantz Hölmich Copyright © 2016 Lea Juul Nielsen and Lisbet Rosenkrantz Hölmich. All rights reserved. Treatment of a Refractory Skin Ulcer Using Punch Graft and Autologous Platelet-Rich Plasma Wed, 17 Feb 2016 08:48:35 +0000 http://www.hindawi.com/journals/cridm/2016/7685939/ Background. Chronic ulceration of the lower legs is a relatively common condition amongst adults: one that causes pain and social distress and results in considerable healthcare and personal costs. The technique of punch grafting offers an alternative approach to the treatment of ulcers of the lower limbs. Objective. Combining platelet-rich plasma and skin graft enhances the efficacy of treating chronic diabetic wounds by enhancing healing rate and decreasing recurrence rate. Platelet-rich plasma could, by stimulating dermal regeneration, increase the take rate after skin grafting or speed up reepithelialization. Methods and Materials. The ulcer was prepared by removing fibrin with a curette and the edges of the ulcer were freshened. The platelet-rich plasma has been infiltrated on the bottom and edges of the ulcer. The punch grafts were placed in 5 mm holes arranged. The ulcer was medicated with hydrogel and a pressure dressing was removed after 8 days. Results. After a few days the patient did not report more pain. Granulation tissue appeared quickly between implants. Most of the grafts were viable in 2-3 weeks. The grafts gradually came together to close the ulcer and were completed in four months. Mauro Carducci, Marcella Bozzetti, Marco Spezia, Giorgio Ripamonti, and Giuseppe Saglietti Copyright © 2016 Mauro Carducci et al. All rights reserved. A 27-Year-Old Severely Immunosuppressed Female with Misleading Clinical Features of Disseminated Cutaneous Sporotrichosis Mon, 04 Jan 2016 09:06:50 +0000 http://www.hindawi.com/journals/cridm/2016/9403690/ Sporotrichosis is a subacute or chronic granulomatous mycosis caused by fungus of the Sporothrix schenckii complex. It is considered to be a rare condition in most parts of the world. It mostly causes cutaneous infection but can also cause multisystemic disease. Unlike most deep cutaneous mycoses which have a primary pulmonary focus, it is usually caused by direct inoculation of the fungus into the skin causing a classical linear, lymphocutaneous nodular eruption. However, atypical presentations of the condition can occur especially in immunosuppressed individuals. We report the case of a severely immunosuppressed female who presented with disseminated cutaneous sporotrichosis which was initially diagnosed and treated as disseminated cutaneous Kaposi’s sarcoma. Atiyah Patel, Victor Mudenda, Shabir Lakhi, and Owen Ngalamika Copyright © 2016 Atiyah Patel et al. All rights reserved. Idiopathic Thrombocytopenic Purpura Misdiagnosed as Hereditary Angioedema Thu, 24 Dec 2015 12:36:17 +0000 http://www.hindawi.com/journals/cridm/2015/934247/ Hereditary angioedema is a rare, but potentially life-threatening genetic disorder that results from an autosomal dominant trait. It is characterized by acute, recurrent attacks of severe local edema, most commonly affecting the skin and mucosa. Swelling in hereditary angioedema patients does however not always have to be caused by angioedema but can relate to other concomitant disorders. In this report we are focusing on misdiagnosis in a patient with known hereditary angioedema, whose bleeding episode caused by idiopathic thrombocytopenic purpura was mistaken for an acute attack of hereditary angioedema. The case illustrates how clinicians can have difficulties in handling patients with rare diseases, especially in the emergency care setting. Michelle Fog Andersen and Anette Bygum Copyright © 2015 Michelle Fog Andersen and Anette Bygum. All rights reserved. Recurrent Thrombotic Vasculopathy in a Former Cocaine User Thu, 17 Dec 2015 11:34:02 +0000 http://www.hindawi.com/journals/cridm/2015/763613/ We report a case of a 35-year-old female who presented to the emergency room (ER) complaining of a pruritic rash involving multiple areas of the body. She had a significant history of cocaine use in the past. She had first developed a similar rash in 2013 when she was diagnosed with cocaine-induced vasculitis. Her urine toxicology had been positive for cocaine in the past until July 2013. She was incarcerated and attended a drug rehabilitation program after which she quit cocaine use, which was consistent with negative urine toxicology on subsequent admissions. Further workup did not reveal any other, autoimmune or infectious, etiology of this clinical presentation. The patient underwent biopsy of the skin lesion that was consistent with thrombotic vasculopathy likely secondary to levamisole. Preeti Jadhav, Hassan Tariq, Masooma Niazi, and Giovanni Franchin Copyright © 2015 Preeti Jadhav et al. All rights reserved. Keloidal Scleroderma: Case Report and Review Mon, 30 Nov 2015 15:37:23 +0000 http://www.hindawi.com/journals/cridm/2015/635481/ Objective. We report a rare case of keloidal scleroderma and provide an analysis of similar cases. Results. A 41 year-old woman presented with dark brown, indurated, exophytic nodules over the chest along with smaller hyperpigmented plaques scattered over the abdomen, with concomitant sclerodactyly. The clinical, laboratory, and pathological findings were consistent with a diagnosis of keloidal scleroderma. The patient was treated with methotrexate, resulting in reduced firmness of her plaques and no new lesions. A literature review of previously reported cases was performed using keywords including keloidal morphea, keloidal scleroderma, nodular morphea, and nodular scleroderma. In our review, the majority of patients were African American and female. 91% of cases had nodular lesions with distribution on the trunk. The majority of patients exhibited sclerodactyly and pulmonary involvement was reported in 28%1. The majority of patients were ANA positive (63%) and only 10% demonstrated anti-SCL-70 positivity. Conclusion. Keloidal scleroderma is a rare presentation, which can often be clinically confused with keloid and scar formation. Due to this being a rare variant, our knowledge of treatment options and efficacy is limited. Methotrexate could be considered as an initial treatment option for patients with progressive keloidal scleroderma. Sama Kassira, Tarannum Jaleel, Peter Pavlidakey, and Naveed Sami Copyright © 2015 Sama Kassira et al. All rights reserved. A Rare Case of Zosteriform Cutaneous Metastases from a Nasopharyngeal Carcinoma Mon, 30 Nov 2015 09:35:05 +0000 http://www.hindawi.com/journals/cridm/2015/415393/ From a clinical point of view, the most common presentations of cutaneous metastatic disease are papules and nodules. However, a wide morphological spectrum of lesions has been described, including erythematous patches or plaques, inflammatory erysipelas-like lesions, diffuse sclerodermiform lesions with induration of the skin, telangiectatic papulovesicles, purpuric plaques mimicking vasculitis, and alopecia areata like scalp lesions. The so-called zosteriform pattern has been described to be in few cases and to the best of our knowledge has never been described associated with a metastasis of a nasopharyngeal carcinoma. This case highlights the relevance of including cutaneous metastases in the differential diagnosis of patients with nonhealing herpes zoster-like lesions, especially in those with underlying neoplasm recently diagnosed. Andrés González García, Emiliano Grillo Fernández, Ignacio Barbolla Díaz, Asunción Ballester, Héctor Pian, and Guadalupe Fraile Copyright © 2015 Andrés González García et al. All rights reserved. An Uncommon Side Effect of Bupropion: A Case of Acute Generalized Exanthematous Pustulosis Tue, 24 Nov 2015 12:28:36 +0000 http://www.hindawi.com/journals/cridm/2015/421765/ Acute generalized exanthematous pustulosis (AGEP) is a rare inflammatory dermatosis characterized by multiple nonfollicular pustules that occur on erythematous skin. Despite its similarity to pustular psoriasis and association with fever and leukocytosis, AGEP typically heals quickly. Etiologically, drugs and viruses have been suspected in most cases. Here, we present a case of AGEP, in a woman, that developed 1 day after starting bupropion for smoking cessation, as a rare side effect of the treatment. Hasan Tak, Cengiz Koçak, Gülben Sarıcı, Nazlı Dizen Namdar, and Mehtap Kıdır Copyright © 2015 Hasan Tak et al. All rights reserved.